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Monday, 1 December 2008
Page: 12059


Mrs HULL (7:30 PM) —In speaking to this motion, I congratulate the member for putting this forward on World AIDS Day. I will be quoting extensively from a document from the National Association of People with AIDS. It says:

  • A decade of treatment optimism and declines in HIV/AIDS mortality and morbidity have changed the expectations of many PLWHA about their lives and future. Many people with HIV/AIDS now expect that they should be able to live as close as possible to a normal life—with longer term goals and expectations replacing short-term ones based around survival.

There are going to be enormous pressures placed on clinical services. The document says:

  • HIV clinical management and ARV prescribing have evolved to encompass a mix of specialist and generalist services, with hospital based physicians, sexual health physicians and general practitioners involved to varying degrees.
  • Currently there are 19 ARV drugs available in five different classes.

That would be 19 in 2005, so there are probably more now. It goes on:

The new drug pipeline contains 15 new drugs which look promising. There are a host of others in very early development. Within another 5 years there may be some 30 ARV drugs available in six different classes.

  • It is a major challenge for physicians and GPs working in HIV/AIDS to keep up to date with new drugs and new scientific knowledge and incorporate this into management of their patients. This applies even to the most experienced HIV clinicians.

…            …            …

  • Keeping up to date with developments in HIV treatment and care is a considerable task. Time involved in reading journals, attending scientific conferences, training courses sponsored by ASHM, pharmaceutical industry educational events, also impacts on general practice remuneration for training, even when certain sponsorships are provided. For practices with small HIV caseloads, the motivation and/or opportunity to acquire and put all this information into practical use is obviously very limited.

This applies specifically and particularly in rural and regional areas, where the spread of HIV-AIDS has taken place with very few practitioners to deal with it. The document goes on:

There are difficulties in recruiting new GPs to become ARV prescribers, even among high HIV caseload practices.

So what chance do we have in many of our rural and regional areas? The paper continues:

  • In the current complex environment, management of HIV disease and ARV treatment requires not only substantial knowledge, but also an active PLWHA—

that is, people living with HIV-AIDS—

caseload. It is not in the best interests of PLWHA to have complex decisions about their HIV care and treatment made in low HIV caseload medical facilities, be they general practices, sexual health clinics or hospitals.

It is so important that formal linkages be established between rural and regional practitioners to form pathways to our accredited practitioners. The paper goes on:

Training and accreditation requirements for current ARV prescribers should be upgraded, in light of complexity.

As part of upgrading training requirements, maybe consideration should be given to introducing a minimum HIV caseload level for ARV prescribing accreditation and then clear pathways set so that other, smaller caseload GPs and practitioners have a clear pathway to get them to the latest in treatments and the most important services and support networks available.

These issues have been raised by NAPWA for many years and there is an enormous paper on this. I think it is time that, in the review stage of the current domestic strategy that I believe will report back in January, we determine pathways forward to ensure that models of care for HIV-AIDS sufferers are included in a new strategy to reflect the new and emerging drugs, treatments and issues involved with HIV-AIDS sufferers living longer and more productive lives, thus causing in many new areas that need to be identified and addressed. I thank NAPWA for their dedication to all of those people who are living with HIV-AIDS and commend their work to the minister.