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Background Briefing


Sunday 11 November 2007

Glam reaper


It's been twenty years.

Some things have changed, some have not.

Jane Shields: This is Background Briefing on ABC Radio National; I'm Jane Shields.

The Glam Reaper:

HIV remains with us.

Use condoms to protect yourself,

Your partners, and our community!

Jane Shields: What you're hearing is the sound of a campaign to once again remind people to have safe sex. HIV has not gone away; the Glam Reaper brings a warning.

The Glam Reaper:

It's been twenty years,

Some things have changed, some have not!

Jane Shields: It's a contemporary revamp of the iconic Grim Reaper campaign which terrified us out of unprotected sex 20 years ago. This time around the Reaper is a glamorous, camp, drag queen, described as the younger sister to her withered and tired twin, Grim.

Glam Reaper has her own MySpace page, hot friends such as Party Boy, Mr Leather, and Twinky, plus over 700 online friends have already signed up.

There's a personal message from Glam, reminding her friends that they can have great sex and safe sex by using condoms.

Use condoms to protect yourself,

Your partners and our community!

Jane Shields: It's been twenty years since the Grim Reaper and ten years since doctors discovered successful treatments for HIV and AIDS. These treatments transformed HIV infection from a death sentence into an illness some people can live with for decades.

That survival comes at a price: the drugs are highly toxic and have serious side effects, including an increased risk of heart and kidney disease, and new evidence shows that people with HIV are three times more likely to develop a whole range of cancers.

But still there's an increase in new HIV infections, and the reason is, at least partly, that these treatments have lulled a generation into a false sense of security and sexual wellbeing.

The biggest jumps in infection have been in Victoria, Queensland, and Western Australia, and it's not only in the gay community. Rates among heterosexuals have risen, and in Queensland two children were infected through their mothers.

To treat a person with HIV costs around $20,000 a year just for the medicine, and treatment may go on for 20 or 30 years. On top of that, regular pathology tests are needed and they can cost up to several hundred dollars. Then there's specialist GP costs, time lost off work, and hospital costs when people become very ill.


Hello, it's Jane from ABC to see Don Baxter.

Jane Shields: The office of the Australian Federation of AIDS organisations is above a busy street in Sydney's inner west.

Head of the Federation, Don Baxter.

Don Baxter: Even if you become infected you're probably going to live 30 years, 30 or 40 years. What you're actually doing if you become infected is costing the taxpayers at least half a million dollars over that number of years. We have about a thousand a year, that's half a billion dollars we're adding to the PBS drug costs each year.

Jane Shields: But Don Baxter says there is now less fear of HIV and old habits are returning.

Don Baxter: What's the incentive to stay HIV negative? Because as the drugs get better and treatments get better, condoms don't actually add to sex. I know we tried to sell them initially in the early days as being hot or something, but they actually detract from the sexual experience. And so for older gay men I'm concerned that it comes to be a question of what would it matter now if I become infected? By the time I actually start to get sick I'll be 70 or 80 and the prospect for gay men in particular living that long is not that enticing.

Jane Shields: AIDS organisations have been trying to find ways to tackle this new attitude to HIV infection.

Don Baxter: And that's a real challenge I think for us to tap into what is the rationale for this. And ultimately it really comes in fact back to being a good citizen, a good gay citizen, because the main effect we would be having if we became positive, is on the taxpayers, because we'd be loading up the costs of the PBS.

Jane Shields: Are you concerned that there might be a backlash to these figures that are showing increased rates of HIV infection from the broader community, who may rightly ask why on earth are the rates going up when the understanding could be that they should in fact be stabilised or going down?

Don Baxter: I think that's a risk, and in fact in this year when it got mixed up with the two cases, the Michael Neill case and the Stewart McDonald case of allegedly knowingly infecting people, I think it did jar, particularly in Ministers' offices and senior levels of health, about 'Well is Australia's program actually continuing to work'?

Jane Shields: Don Baxter says that while it's been proven that if properly resourced campaigns do work, he thinks it's time to move beyond the traditional gay subcultures, and into the mainstream media.

Don Baxter: Which is why we AFAO, are advocating strongly to Minister Abbott that we needed to move back into that electronic media coverage, not blanket coverage like we see in all the drugs campaigns, all that sort of stuff, but we think you can do clever, witty, not sexual ads, which speak with gay men; in a sense gives the imprimatur for, or registers with them that they need to continue doing safe sex, and that society cares that they do.

Jane Shields: Sydney's Oxford Street was for many years the traditional capital of gay life, not just in that city but for Australia, a focal point for gay-friendly bars and bathhouses, shops and socialising.

From Hyde Park in the city's CBD, it runs through the suburbs of Paddington and Woollahra, to Bondi Junction in the city's east.

But over the last few years, gay culture has been changing and Oxford Street has changed with it. It's not such a big gay scene any more. There are many clubs for young people of all orientations and the drugs, alcohol and violence is rife.

Man: This whole street's changed, not for the better, particularly at weekends, it attracts all the anti-gay people. That's why you see a lot of fights, stabbings, which is a great pity.

Jane Shields: It got so bad that earlier this month, Lord Mayor of Sydney, Clover Moore, announced that there will be a shopfront operating on weekends, where people can report incidents of violence, 'a gay-safe space'.

The former editor of The Sydney Star Observer , Marcus O'Donnell, says his experience of Oxford Street was as a wonderful, liberating place when he was a young man.

Marcus O'Donnell: I can remember when I went to my first Mardi Gras, what a tremendous sensation it was to be suddenly in a room of 10,000 other gay people. It was just an overwhelming sensation because suddenly you could be totally open and totally free with all these other gay men. Now, you know, a lot of gay men and lesbians will grow up these days and they'll meet their partners at work, they'll even meet their partners at school. So that sense of having to be part of a specific sub-culture I don't think is anywhere nearly as strong as it was then.

Jane Shields: Marcus is now in his 40s, and lectures in journalism at the University of Wollongong. He says the nature of gay media, gay festivals like Mardi Gras, and gay organisations, have changed dramatically since those early days.

Marcus O'Donnell: ACON is no longer just an AIDS organisation, it's a general gay and lesbian health organisation. Mardi Gras is not just a march and a dance party, it's a broader arts festival. The Sydney Star Observer is no longer just a commercial and political magazine, it's a lifestyle magazine or newspaper, so those three institutions have changed as the gay community has changed.

Jane Shields: But when men of Marcus' age were younger there was very little known about HIV or AIDS and there was a great deal of confusion and fear.

The second Australian case of AIDS was announced in this 1983 ABC Radio Report.

Presenter: Another case of the Acquired Immune Deficiency Syndrome, AIDS, has been diagnosed in Sydney. The patient is a 29-year-old New Zealand man who had travelled widely, including in the United States. The man, who is a homosexual, agreed to an interview with PM today and our reporter Anna Menzoni went to see him.

Anna Menzoni: When I accepted this assignment I didn't know quite what to expect. Because of everything I'd read about AIDS, I was more than a little apprehensive, and when I arrived at the hospital, scrubbed with disinfectant, being careful not to touch anything, donned my gloves and long white gown, my anxiety had not lessened. Ironically however, the doctors assured me that I was more likely to pass on an infection to the patient than vice versa. He seemed terribly pale ...

Jane Shields: Since that time, Australian doctors and researchers have been working with others around the world, on the HIV virus. There's new understanding, and increasingly better treatments.

Across Australia there are around 16,000 people who are HIV positive. But in the last ten years, for example, Queensland has had a 63% increase in HIV diagnosis, affecting heterosexuals and homosexuals, as well as children infected by their mothers.

There is no cure, but the virus can be held at bay for decades, in some cases.

The National Centre for HIV Epidemiology and Research is in Darlinghurst, in Sydney.

One of the directors at the centre is Professor Andrew Grulich, and he says that HIV is still a very serious disease.

Andrew Grulich: It's certainly not a trivial infection and I think the pendulum in people's thinking has probably swung too far. It's absolutely not the case that HIV is what it was a decade or so ago when in the suburbs where gay men predominantly live in Australia, you would see people walking the street who were clearly dying, on a very regular basis. You just don't see that any more. But I think people have gone too far thinking the other way, that it's just a minor inconvenience. It's much more than a minor inconvenience.

Jane Shields: At the moment, if you were diagnosed with HIV, what's really the next step in terms of a medical sense?

Andrew Grulich: There's still quite a medical question over whether you need to treat HIV during the first few years of HIV infection. And that's a key research question that people are trying to answer now. But most people do not treat HIV for the first couple of years after HIV infection, and wait till the gradual immune dysfunction progresses a little. And the reason for that is really that even the currently available drugs are somewhat toxic, and so the idea is to spare the toxic side effects to the person until they really require treatment.

Jane Shields: In the short term, these drugs can cause many side effects, including persistent diarrhoea, and a condition called Lipodystrophy, which is a redistribution of body fat that can cause sunken eye sockets, a pot belly, a condition known as 'buffalo hump' as fat deposits on the back, and the wasting of limbs.

As well as this, the drugs can dramatically increase cholesterol levels which in turn increases the chance of heart disease. And there's also increased chances of diabetes and kidney problems.

The treatments developed over the years have been aimed at weakening the virus and blocking its ability to multiply and destroy the immune system. It was thought that from time to time HIV positive people could take breaks from these strong drugs, but that is no longer the case.

Andrew Grulich: Recent evidence suggests that once you've started therapy, having breaks in the therapy is quite dangerous, and you can get AIDS-related illnesses in those breaks. So really, once a person commits to HIV therapy, they're making a lifelong commitment.

Jane Shields: The doctor in combination with the patient, would decide when it was time for treatment; would the patient start feeling some effects of the HIV infection that might signal that?

Andrew Grulich: Really just rather subtle effects. They may notice some differences in their skin, they may notice some differences in their energy levels. But it's really the levels of their immune cells, the levels of those CD-4 cells, that triggers the doctor's decision to discuss treatment with the patient. And it's because when they decline beyond that certain point, then the patient starts to be at risk of opportunistic infections and malignancies.

Jane Shields: It's at this point that a person is at risk of developing what are called AIDS-related illnesses, like pneumonia, which is life threatening for people with severely weakened immune systems.

Until recently, researchers knew that three types of cancer were far more prevalent in a person infected with HIV, Kaposi's sarcoma, non-Hodgkin lymphoma, and cervical cancer.

Andrew Grulich: The new thing that's been noted recently though is that people with HIV also seem to be at increased risk of conditions which were traditionally not regarded as AIDS-related, things like heart disease and things like a range of cancers that have been described as occurring at increased rates.

Jane Shields: This new research has shown that people with HIV are three times more likely to develop cancers, such as lung and mouth cancer, and twenty times more likely to get anal cancer. And, Andrew Grulich says, there are other new problems emerging: the long-term effects of living with HIV are now being seen among older men.

Andrew Grulich: We really are entering into a stage of the interaction of the normal effects of ageing with the effects of HIV. And if you're talking about increases in the rates of heart disease or two- or three-fold, in older populations, in people older than 50 to 60, those sorts of increases are pretty dramatic and will lead to substantial declines in life expectancy of those people. So you know, it's no longer a disease which kills in ten years, but it's still very likely that it is a disease associated with pretty significant reductions in life expectancy.

Jane Shields: Is there a chance that the virus could become immune to the drugs we currently have?

Andrew Grulich: In a small proportion of cases, that's already happening. We have viruses that are resistant to multiple antiretroviral medications, but it is very much a minority at present, and it has to be said that the news in this field is quite good, in that we are discovering new classes of drugs, which target different parts of the viral life cycle. So we are at a relatively optimistic time in the development of anti-HIV therapies.

Jane Shields: And what about vaccines? Are they a long way off yet, do you think?

Andrew Grulich: We're certainly not in an optimistic phase of vaccine development, with recent results of the global step vaccine trial, which included sites in Australia which showed that that vaccine was completely ineffective. That vaccine has very good laboratory-based evidence that it provokes immunity against HIV so the thinking currently is, 'Well if that didn't work, what could possibly work?'

Jane Shields: So there is neither a cure, nor a permanent treatment in the picture. While researchers continue to work on the devastation this virus is causing around the world, the most productive thing anyone can do is to prevent it spreading. Andrew Grulich says that means condoms.

Andrew Grulich: Men, heterosexual or homosexual, have never wanted to use condoms for sex, and getting them to use condoms regularly has proven very, very difficult. Nevertheless, it's still the case in Australia that gay men do use condoms most of the time, and that shouldn't be lost sight of. But to get back. To drive this epidemic into the ground, to make it disappear, we would need to get condom use up to where it was in the mid-1990s, and I really can't imagine that we're going to be able to do that.

Jane Shields: To get men to continue to use condoms they need to be worried enough about what can happen if they don't.

In Sydney's Oxford Street, this man was surprised to hear that New South Wales was the only place in Australia where the rate of HIV infections had not gone up.

Do you know many people who are HIV positive?

Man: Yes, lots of people. But it's hard to say; it's a wonder it hasn't gone up here, because I think things have reverted back. The whole thing is the younger people haven't lived through the HIV thing, so if they'd only seen the walking dead in the street, then there'd be a big difference. But now I think they just think sex is back to how it used to be, just do it. And that's the sad thing, I think.

Jane Shields: Do you know the average age of new HIV infections is around 38?

Man: Is it? Well that surprises me. Well then, they're idiots, they deserve to have it. I mean as hideous as that sounds, that's just - they're idiots. If someone gets it at 38, they know better, so no, no, no, no, they're obviously not being safe.

Jane Shields: It is mostly older men who are getting infected with HIV now.

Background Briefing spoke to another man in Oxford Street, a Frenchman who's recently settled in Australia, and he says things have changed in the gay community everywhere.

Man: I think that anywhere in the world, I think that we're getting used to it, and I have the feeling that we don't talk about it enough anymore. And especially for the young generation, because my nephews for example, nephews and nieces are in the age of having their first sexual relations; they haven't been informed as much as my other friends who are, like, five years older, or something like this. So yes, I think that's quite a big concern.

Jane Shields: This man's 45, and says he's noticing his generation becoming blasé about the risks of HIV infection.

Man: We have been living with HIV now for the last 20 years, and maybe we're just like fed up of it, and we just think, 'Oh, you know, never mind, if we get infected today', to speak very frankly with you, 'if we get infected today, we'll always find something to be cured; it's not as lethal as it used to be', which is not true, because we still have friends who are dying about it. So yes, maybe we're a bit less cautious about it and a bit fed up to have heard of it so much.

Jane Shields: Are you worried about HIV?

Man: Yes, I'm worried about HIV, yes.

Jane Shields: And what sort of precautions do you take to try and minimise your chances?

Man: The simplest one, condom during sex relations.

Jane Shields: Do you think that message is a little bit lost these days?

Man: I think so. I think it is lost. I think for the reason I'm telling you, I think that we have been making sex for the last 15 years with condoms, and a lot of our friends who are HIV positive, and they still live normally for the last 15 years. Well I'm not talking about the medications or anything like this, which is quite heavy, but generally, they keep on living normally, and which I think people who are HIV negative today are less cautious because we just think 'Well, why not try without condoms for once in our 20 years of sex life?'

Jane Shields: In Queensland, Paul Martin is head of the Queensland Healthy Communities Association, and he says the risky behaviour of older men cannot be explained by youthful ignorance or bravado.

Paul Martin: We're not talking young people just exploring their sexuality, or just out of school, we're talking about men who were around in the early '80s, perhaps as teenagers, who perhaps have lived through the experience of HIV, and friends dying. So, it's not an ignorant group of men who are becoming infected, it's an older age group, and that age group is getting older.

Jane Shields: Paul himself is HIV positive.

Paul Martin: I guess in some ways I'm relatively fortunate if you can say that, in that I became HIV positive after having worked in the HIV sector for some years, which some people will potentially find strange, but that meant I had a level of awareness, and it also meant that I became infected when there were a much wider range of treatments available. So I've been on treatments I guess for about 3 or 4 years now. For me, I take 2 pills when I go to bed, and that's it.

Jane Shields: The latest medication has, as yet, no side effects for Paul.

Paul Martin: But my experience is certainly not the experience of all people with HIV, particularly those who have been HIV for much longer, who are on more difficult treatment regimes, who have built up resistance to the treatments, experience episodic periods of illness.

Jane Shields: Well Paul, you hinted at it yourself, that some people might be surprised that someone like yourself who was actually working in the field and so potentially had the greatest knowledge of all, did become infected. How did that happen?

Paul Martin: Well if I can be slightly glib about it, the old-fashioned way, through unprotected sex. But knowledge is not the answer, is not just the only thing that needs to be there. Humans make mistakes; sex is complicated, it's messy, it's irrational, it's driven by emotions and desires and urges and feelings and often we don't necessarily make the most rational decisions when we're in the middle of sex. Sometimes things can go wrong, and the condom can break, it can come off, you could think that the other person was also negative, and they're not. So it's not just about knowledge. People know that skin cancer happens because of the sun, yet we still go out in the sun; people know that speeding kills, yet we still speed; people know that smoking cigarettes causes cancer; we've got 25% of people who still smoke cigarettes. So just being knowledgeable about something isn't enough.

Jane Shields: Paul Martin says that there are new patterns emerging in how these older men, who do understand the consequences, are trying to manage their chances of infection.

Paul Martin: They're making a bunch of risk calculations, or risk reduction calculations, to try and have sex that is safe enough for them. Unfortunately, these calculations are going wrong for men more often than they have in the past. So a person who's negative, for example, might think, 'Well I can have sex with someone else who's negative, and if we're both negative, neither of us can get HIV'. So that's true, that makes sense. But how you tell that the other person is negative is where the problem comes in. So some men are thinking 'Well he looks healthy, he can't possibly be HIV, he's fit and strong', or 'He's from the country, and there's no HIV in the country, so it's all right for us not to use condoms. Or maybe I'll be the insertive partner and that's less risky.' So it's those risk calculations that people are getting wrong, and so what that tells us is that men are aware, men do have knowledge, men are trying to be safe, but the calculations, the decisions that they're making in an attempt to be safe, are actually false decisions or false assumptions, which is leading to HIV infections.

Glam Reaper: It's been twenty years.

Some things have changed.

Some have not.

HIV remains with us.

Use condoms to protect yourself, your partners, and our community.

Jane Shields: That's the Glam Reaper that we heard about earlier, the latest safe sex campaign to be launched soon by the New South Wales AIDS Council. There's already been controversy in the local gay press, with some people complaining that by glamorising the Reaper, the campaign does not take HIV infection seriously enough.

ON the Glam Reaper's MySpace, the message is: Don't take risks and think you can just take medication; don't get it in the first place.

Glam Reaper: Use condoms to protect yourself.

Jane Shields: Western Australia is in the midst of an economic boom, and there's been dramatic increases in the State's population and disposable income, and an increase in HIV infections.

From the Western Australian AIDS Council, Trish Langdon.

Trish Langdon: One of the really interesting features of our epidemic is the number of heterosexual men and women who acquire their HIV overseas, and they get diagnosed in W.A. And we have a sense that some of this is related to the resource boom in W.A., where people have very high incomes, they travel if they're in fly-in, fly-out situations up north, they use this higher income for recreation as well as going overseas for work purposes, and they're going into the high prevalence region, which is South East Asia and Pacific.

Jane Shields: Most of these cases of HIV were contracted by heterosexual men visiting Thailand on business trips. Indonesia is another popular destination. Trish Langdon says many men have partners in countries like Thailand, and naively believe these partners are monogamous.

Jane Shields: I think they don't quite understand that for some women, and I'm not talking about women who would see themselves necessarily as sex workers, I think these are women who understand that Westerners may be able to provide some additional financial support. And they hitch up with them, and they continue to believe that those women are, if you like, being faithful to them. And the other part about sexual cultures I think that Australian men may not necessarily get is that late at night in a bar, there's a really attractive girl who strikes up a conversation, and I don't think that men necessarily understand that that's part and parcel of the culture, and that may in fact be a risky activity unless they use protection.

Jane Shields: This new pattern of HIV infection poses a particular problem for the Western Australian AIDS Council. Whether married or single, when these men come back to Western Australia, they are part of a broader society in many different ways. They are not as easily targeted with campaigns as the gay population has been. Trish Langdon says the big employers, such as the mining companies, can help to tackle the issue.

Trish Langdon: My dream would be that the big resource companies, that send workers overseas, would actually as a part of their duty of care for their employees, would provide really good information. So not just on where they're going to stay and how they're going to get around in the country that they're going to, but actually some good information about sexual cultures, whilst they're there.

Jane Shields: Across Australia, including in Western Australia, HIV is still overwhelmingly within the gay community. But Trish Langdon says everyone needs to be aware of the risks.

Trish Langdon: I can assure people that it is something that people need to be aware of, particularly with the level of global travel that is happening at the moment, and to a degree has happened in the past. But it's really the level of money that's around, and the ease of travel, people just pop on a plane and they get to an overseas destination very easily, and that's a change in the way that Australians live.

Jane Shields: The Asia and Pacific regions are also experiencing epidemics of HIV and AIDS . La Trobe University sociologist, Gary Dowsett.

Gary Dowsett: Papua-New Guinea is going through dramatic changes in understanding its epidemic, as is Indonesia right now. Now these places are places where Australians spend a lot of time, and so our epidemic is not quarantined by Customs, you can't keep it out with a sniffer dog when you come off the plane. We have to recognise that our epidemics are going to integrate in particular sorts of ways, as yet unpredictable, in some circumstances, and ought to be thinking five years ahead now, about training young people and educating Australians of all ages about potential risks so that people can make informed decisions about their sexual behaviour, their drug-taking behaviour, when they're travelling, when they're on business, when they're a tourist, when they're backpacking, when they're overseas, when they're meeting people at conferences, when other people are coming to Australia from countries which have got a higher prevalence of HIV. That's where we should be focusing if we are serious about not just our epidemic maintaining under our control, but also helping control the epidemics in our region for a collective effect. Because we're too integrated in the world now, to neglect that and think we can just be kind of fortress Australia.

Jane Shields: And everywhere, says Gary Dowsett, people of all genders and sexual orientation are vulnerable to HIV.

Gary Dowsett: We must never allow ourselves to be fooled into thinking that HIV and AIDS is a gay-only phenomenon. We do have rates of heterosexual transmission in this country, even though young heterosexual people are not seriously at risk for HIV infection compared with gay men in their 20s and 30s. Levels of sexually transmissible infections are increasing among young heterosexual people, and particularly late school-age people. So that indicates if you like, in a kind of indirect way, the possibilities of risky sexual behaviour, which could produce a burst of epidemic elsewhere.

Jane Shields: Gary Dowsett is a Deputy Director of the Australian Research Centre in Sex, Health and Society in Melbourne.

David Marr: Welcome to Mardi Gras, and to the biggest crowd Mardi Gras' ever brought on to the street of Sydney ...

Jane Shields: Back in 1996 when David Marr was commentator at the Mardi Gras in Sydney, it was already recognised that women too could become positive.

Woman: Positive Women and Friends.

David Marr: There are about 500 women in Australia who are HIV positive, and for most of them, HIV was transmitted through heterosexual sex. Half of them have children and families, and HIV positive women are particularly isolated.

Woman: One of the biggest problems that they have to confront is people's belief that HIV is just a gay disease, and there aren't any women with it.

Jane Shields: Around this time, 36-year-old Melbourne woman Deanna was living in England, when she contracted HIV from her boyfriend, who didn't know that he was HIV positive.

Today Deanna is back in Australia, and spoke to Background Briefing while she was on holidays in central New South Wales.

Deanna: Within two years I had my first AIDS defining illness, so in 1996 I was given six months to live, which is pretty terrifying for a 26-year-old to hear. Well I guess more terrifying for a 24-year-old to actually hear that they've only got less than 5 years to live and they're carrying the HIV virus. Fortunately for myself in 1996, HIV medication became available and I took that, and my body regained health and energy and life again.

Jane Shields: Deanna was told she'd never be able to have children, but she now has two. Neither of her children have HIV. She competes at elite level in adventure sports, and visits High Schools to raise awareness of HIV.

Deanna: Part of my job as a speaker is to educate the kids about HIV but also put a face of normality to it as well. I mean I'm the girl next door, well, mother next door now; got a couple of kids, normal family, fit, healthy, you know, no-one can tell by looking at me no-one can tell, and that just blows them away most of the time.

Jane Shields: The students are astonished by the understanding that HIV infection can happen to ordinary, heterosexual people like Deanna.

Deanna: We talk about HIV and what sort of people they think have HIV, and it always come back to gay man, drug user, or prostitute, time and time again. So that is a message that has been painted in Australia, and it's not helping them make choices regarding their own health, their own sexual health, because they think they are, well, they're not a gay man, they're not a prostitute, they're not a drug user, so they don't have to worry about HIV. Education needs to be at the general population, because HIV doesn't discriminate between anything.

Jane Shields: Deanna tries to put the risks of HIV infection into a context that the teenagers can relate to

Deanna: And you know, one of the first things I say is Who here thinks HIV is something that they'll have to think about in their future? And this is a group of maybe 60 kids; one or two people put their hands up. So then I go on to discuss how HIV is passed on from body to body, and I talk about being over 40-million people infected worldwide, and 'Put your hand up, who wants to travel?' And they all put their hands up. Then I say, 'Now knowing what you know, who thinks that HIV may be something I need to think about?' And we have about two-thirds, nearly all of the class, then putting their hands up.

Jane Shields: In Melbourne, 34-year-old Martin found out a year ago he is HIV positive.

Martin: I actually became very sick, very ill, very quickly after I was infected, and I became very, very ill, and that lasted for about two weeks, so I got to the point where I was in bed for two weeks almost straight, high fevers, incredible body pain, dehydrated. I lost about 10 kilos in 2 weeks, and it was the sort of thing where, 'OK, I need to go and see a doctor and find out what's going on', had the tests, they came back a few days later, and with the news.

Jane Shields: Do you know how you became infected?

Martin: Yes. Do I really want to answer this question? I was going through a really rough patch in my life, and I was going out and drinking excessive amounts of alcohol, and ending up in places where men have sex with men. And I lost control, and I don't really know what had happened at the time, so I didn't realise that I'd put myself at risk. I found out two weeks later that I had, and now I'm paying the price for it.

Jane Shields: After his initial bout of sickness, he and his doctor decided that he shouldn't go on to the drugs yet. He's well without them, although he gets tired very easily, and frequently has severe flus, which he'd never had before.

As a young gay man, he had an active sex life, but did from time to time resort to what's known as 'the morning-after pill', a medication that can counteract a viral infection if taken shortly after exposure to risk.

Martin: I'd done that twice in the past because I knew that there was a risk involved. This particular time, I didn't think there was the risk involved, I knew that I'd been out, I knew that I'd had a big night; I didn't think that I'd done anything wrong, and it was the one time when I did.

Jane Shields: Now Victoria is one of the States that's shown one of the biggest increases in rates of HIV infection. Do you have a sense of why that might be?

Martin: I think there are a lot more people out there who think that having unprotected sex is still safe. I chat to people online; I chat to people in the streets, at clubs and pubs and places like that, and I find that there are a significant number who want to have sex that is unprotected.

Jane Shields: Martin says that as well as the usual campaigns of posters and information in gay venues, he thinks more targeted campaigns are needed, particularly on the Internet where some people are seeking out risky sex.

Martin: There is a percentage of people out there will only want to have unprotected sex. Now in that situation, like I will declare that I am HIV positive, and I've done that numerous times in the past, and to a mixed reaction, like some of these people are negative, some of them are positive, and the reaction is sometimes quite disturbing, meaning that like there are people out there who are negative, who are still willing to take a risk. And young people as well. Like I recently had discussions with a 19-year-old who was quite happy to continue with the risk, and it's like 'Well why would you want to do that?'

Jane Shields: Did he say why he was prepared to take that risk?

Martin: Because it feels better. That's a bit too candid, really isn't it. A good response for you though.

Jane Shields: Well it certainly reinforces the difficulty of HIV prevention in the 21st century if there is a perception there that that risk is worth taking.

Martin: Look and I think there are too many people out there that are still willing to take the risk, and too many people out there who, dare I say it? are HIV positive, that are willing to put people at risk.

Jane Shields: In Sydney, Head of the New South Wales AIDS Council is Stevie Clayton.

Stevie Clayton: HIV Prevention work is just getting harder and harder. And when people in the gay and lesbian community were surrounded by people who were getting sick and dying, there was that natural fear factor that discouraged sex and encouraged safe sex if there was going to be sex at all. And when that went away it became a harder challenge to convince people that it's a good thing to stay negative.

Jane Shields: One of the ways AIDS organisations are trying to get their message across is to appeal to people's altruism, the notion that they have a responsibility to care about what they are inflicting on others. The new drugs are perceived to be a cure-all and HIV is not seen as bad enough to stop a sexually free life.

Stevie Clayton: You're left with very few reasons to give people for wanting to be negative, other than the fact that there are still numbers of countries in the world who won't let you travel there, so you have a fair amount of restriction, and there are few businesses or industries that are allowed to discriminate against you any more in Australia, so it's probably not going to impact greatly on your ability to get a job. But even the best estimate now in the new research out of Europe is that if you're 25 and diagnosed today, you'll probably live to around 66. There's still going to be episodic illness, there's still going to be some impact on your lifestyle. But maybe not sufficient enough to encourage people to try and stay negative.

Jane Shields: Hi, I'm from ABC Radio National. I'm doing a documentary about the recent reports of increased HIV infection rates in Victoria and Queensland. Would you be increased in commenting at all?

Man: I've only had a couple of friends I've known who've had the HIV virus. I actually thought that the rate might have been higher here in New South Wales rather than Queensland and Victoria. And there are still a few of the careless people out there that don't wear protection. And the Ice, a lot of it is the drugs, yes, the Ice or the G:, I thought would lead to the higher rate than that.

Jane Shields: And do you notice that drug use amongst the particular age group, or is it right across the age groups?

Man: In the gay community, it's more across the whole of the age group, I find are the drug-takers, yeah.

Jane Shields: Would you be surprised to hear that the age of new infections, the average age is 38?

Man: Oh, so it's actually in the older community, oh, OK, no that's quite a surprise, yeah.

Jane Shields: And do you think - do you still have that thing in your mind that you must always use a condom, or are there times - ?

Man: Yes definitely. Even more so in the gay community, because they're bigger sluts than everybody else...

Jane Shields: And would that be your experience too?

Man: Yes, yes, yes, if it's not on, it's not on.

Jane Shields: And do you think that's still coming through in the younger generations?

Man: No, I think they're complacent about it. Yeah, that's all.

Man: They've got the attitude, 'It can't happen to me'.

Man: Yes, more so in the younger -

Man: And it can happen to you, you know.

Man: I don't know why in the younger community you'd think they'd be more conscious of it, but they're just more blasé about it, they don't care, it's like where you'll find the older community, they've been around a bit more longer and they would be more conscious about things like that, where the younger community are just out to party and have a good time, and sort of worry about the consequences at the end of the week sort of thing. So it's not a good way to look at it, but -

Jane Shields: Thanks very much for your time.

Man: No, no, that's OK.

Jane Shields: It's not surprising to hear that young people might be taking risks. When you're young, growing old isn't a priority, perhaps that is, until something happens that brings the realities home.

Growing up in the northern suburbs of Sydney, 22-year-old Ash now goes to university and w orks in media marketing. We went to meet him in a pub in Surry Hills.

As a young man, living in Sydney, what's your perception of HIV?

Ash: To be honest, I don't really think about it, I only think about it in relation to a close friend of mine who is actually HIV positive, who also happens to be a young man, so it's through him I've learnt I guess what the complexities of HIV are, things like that. But the interesting thing is, I've never thought it as something that would affect my life. It's like terrorism: I know it's out there, it's a kind of pertinent issue that we deal with, but it's not something I deal with on a day-to-day basis. But in saying that, as a habit I've always practised safe sex, and that doesn't make me complacent about my habits, I guess.

Jane Shields: Ash has one gay male friend who regularly has unprotected sex with men he knows are HIV positive. This friend tells Ash the risk is worth it, because he can always take the morning-after pill.

Ash: He's done that about 4 or 5 times, and he has sex deliberately unprotected, and he's an intelligent, highly informed articulate guy about one year older than me. I don't know, it's hard to get into his brain as to why he does that; he knows what the risks are, yes.

Jane Shields: It's been suggested that young people might identify HIV as being associated with the older population. Have you found that amongst your friends?

Ash: Yes. I've found that with me, and amongst my friends definitely. I mean when I'm out, when I'm cruising, or if I'm trying to pick up or whatever, if I see someone who's my age, I would never pick them to have HIV. It's something which is very kind of old school gay, like you know, built guys, shaved heads, maybe in their mid-30s, early 40s, maybe associated with a particular subculture within the gay community, the S&M culture, or the leather scene or something like that, it's what you associate HIV with. Because you assume those people are the ones taking the risks, whereas I'm normal; the friendship I have with this person who is actually HIV positive, broke those stereotypes, but they still exist, because I still don't see him as an HIV positive person, which is weird, yes.

Jane Shields: Is that because outwardly there's no physical sign?

Ash: No, there isn't, which is probably why people are becoming complacent, because if you have drugs that can make you life till you're 50, and there's no physical signs initially of HIV and really it's very hard to differentiate diseases associated with the later stages of HIV with other ailments that you may have, that it's not as kind of full-on, in-your-face. But then again, I mean people smoke, and people die from smoking; people do so many things that increase your risk of dying, and HIV is one of them. Maybe there's your answer. I think a lot of people look at it as another added health concern out there amongst many.

Jane Shields: It's been 20 years since the Grim Reaper was launched, a safe sex campaign that very successfully frightened people about the realities of HIV and AIDS.

Grim Reaper: At first, only gays and IV drug users were being killed by AIDS. But now we know every one of us could be devastated by it ...

Jane Shields: The Reaper was a decomposing, hooded image of death, with a scythe, and it launched speeding bowling balls, representing the fast-moving and unpredictable AIDS epidemic. They knocked down men, women and children of all ages.

Grim Reaper: But if not stopped, it could kill more Australians than World War II. But AIDS can be stopped, and you can help stop it. If you have sex, have just one safe partner, or always use condoms. Always.

Jane Shields: Many people researching and working on HIV and sexual health issues across the country are now thinking about new ways to deal with HIV.

But one thing that will never change is that sexuality is a critical part of being human, and sexual behaviour is often powerful, irrational and unpredictable.

From La Trobe University, sociologist Gary Dowsett says any new strategies on HIV and sexual heath must keep pace with the changes to society.

Gary Dowsett: This is a much more sexually complex world than it was 25 years ago. Twenty-five years ago we barely had VCR, videos, no-one had the Internet, CD-ROMS were just coming into fashion to play your music on. No-one had email, and it's an entirely different world now, sexually and technologically, as to how people even understand their sexuality, so we should be expecting that the sexual behaviours and sexual cultures people inhabit underneath this epidemic are not the same ones as we saw 25 years ago, and those old-fashioned behavioural public health responses aren't going to work.

Glam Reaper: Some things have changed.

Some have not.

HIV remains with us. Use condoms to protect yourself, your partners, and our community.

Jane Shields: Background Briefing's Co-ordinating producer is Linda McGinness. Technical operator, Russell Stapleton. Research, Anna Whitfeld. Executive Producer is Kirsten Garrett. And I'm Jane Shields