The real life challenge of HIV organisations covers much more than just crafting and delivering a simple safe sex message. But how should we define a successful HIV/AIDS prevention organisation? Should a simple count of new infections be a fair enough measure? Should our HIV/AIDS organisations just inform at-risk groups, or should they be more pro-active? Shouldn’t they at least mention gay people, as the Queensland government Sexual Health webpage above fails to do?
The Queensland government sacked the Queensland Association for Healthy Communities (the former state AIDS Council), citing a doubling of HIV infections as the main reason. The government claimed the increase (the reality of which is disputed) was evidence that QAHC wasn’t doing its job. But there may be many more reasons why HIV infection rates rise besides the quality of AIDS organisations prevention campaigns.
Health promoters are making a rod for their own backs in defining their performance by HIV infection rates. Geoff Honnor from ACON suggests caution, as claiming success for falling HIV infections may fix a health promoter’s fate when rates climb.
“We all need to be careful when cases are stable or reducing in claiming credit. Our role is not fixing our fate to our indicators. Have we done our job, educating men in order to make informed decisions by the degree of contact? We need to measure engagement (to at risk groups)” Mr Honnor explains.
Paul Martin from QAHC agrees.
“By looking at only one metric, being HIV infections, the total performance of all involved needs to be considered. Movement of HIV infection rates is an indicator of the joint efforts of multiple players. It is not realistic to judge the performance of just one of those players on whether HIV goes up or down.”
AIDS organisations have to teach prevention to people at risk of contracting HIV, and then if prevention fails, help people to live with the reality of their HIV+ status. Prevention means discussions with a range of groups, from teenagers through to sexually adventurous men and those that use drugs to heighten sexual experience, each of which must be tailored for the target group.
Then there are those who are already infected. Most HIV+ people live a full life. Some even report a feeling of liberation about living with HIV. On the other hand, others report feelings like a minority within a minority, leading to social withdrawal and sexual disfunction. And we are not done yet. Health promoters must also address sero-adaptive people, serodiscordant relationships (one positive and one negative) and sero-sorting (where men look for other men based on their HIV status).
This gets down to the nitty gritty of health messaging. Different messages and different approaches are needed for all these different groups. And the best people to deliver these messages, the people most likely to be heard, are the expert organisations within the LGBTIQ community.
This is why the Queensland example seems so confounding. By ripping the guts out of a community group, and insisting the replacement Ministerial Advisory Committee doesn’t lobby, the Queensland government seem to be turning its back on the World Health Organisation.
Their first effort following the de-funding of QAHC was cutsie television ads resurrecting the Grim Reaper, thirty years later . The “We Shouldn’t be Making this Advert” campaign is almost the reverse of what WHO recommends. Words like “shouldn’t” promote judgement and a sense of right or wrong. To quote the young guns, “FFS, WTF does this ad do to help meet the real challenges of health promotion?” Despite its high production value it relies on an outdated, waffly message, blowing millions in money that could be spent talking to a real audience. It sounds like mum wagging her finger and saying “you shouldn’t…” And AIDS bodies cannot be our mother.
Matt Dixon from the Victorian Aids Council suggests health promotion is a shared responsibility. Drawing on the The WHO’s Ottawa Charter for Health Promotion, he says it is “101, absolutely accepted wisdom that you meet people where they are, in their world.” This includes clinicians, academics and the at-risk target group, in this case – men that have sex with men. The Ottawa Charter says:
“Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation in and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support.”
So it looks as if, by withdrawing funding from community initiatives and bringing HIV prevention and education under direct ministerial control, Queensland is going against the grain and ignoring best practice.
Dixon explains that “even when you might have an infection rate going up it does not mean that you are failing. Without (the community’s efforts), infection rates may be higher.” Failing to get the message to at-risk groups could leave a health promoter flatfooted because they don’t have the street smarts.
Geoff Honnor also notes that the 24/7 media cycle may get in the way of a message if it is picked up in the mainstream press. “The news cycle – at a federal and state level has eroded the latitude of peer based language and talking in terms that are cultural for the group. It is a different environment than at the beginning of the epidemic.”
In plain English, if you use the everyday language of men who have sex with men in your health promotion material, it may shock mainstream Australia, so don’t be surprised if it’s written up in the tabloids as a misuse of government money.
As most of HIV health promoters depend on government money, how can they justify their funding when they are only one link in the chain, albeit a strong one. Perhaps that insight best comes from the man who lost the most in Queensland’s reversal, Paul Martin.
“There were some weakness in comparing QAHC to other AIDS councils who do service delivery, and we were left with delivering only health promotion. With a health minister that does not value health promotion, that has made us vulnerable. Helping sick or in need people people is an easier message to sell” says Martin.
Any business dependent on a single customer, with 80% of revenue coming from one source, is vulnerable should that source dry up. They are also at the behest of the client – in this case, the state government. HIV and gay men’s health is not pretty and is not likely attract corporate sponsors. Mr Honnor is not sure a local retailer would be prepared to brand the next bareback awareness ad or drug awareness program This means there will always be dependence on governments.
This places immense pressure on the shoulders of the HIV/AIDS organisations to make the relationship work . They may not be our mother, but they certainly want gay men to make informed choices based on the best information available. Even if the risks are high. Even if the risks are low. Should they be held accountable if people weigh up the choices and still take the risks? Well that depends. If their job is merely to preach – then by all means strip their funding. If their job is to accurately inform and ensure risks are taken in full knowledge, well, perhaps that is a little harsh.
The Queensland government claimed that QAHC wasn’t working: HIV rates, it was said, were climbing. That is disputed. We must now wait to find out if the government’s go-it-alone finger-wagging is any more or less effective in reducing the rate of new infections.
NOTE: The Stirrer and the journalist have put questions to the Queensland Heath Minister on various occasions since they announced the changes to de-fund QAHC. Mr Springborg’s media representative has promised to reply to questions on two occasions, but then has failed to do so.
Missed Part 1? BARE REALITY FACING HIV ORGANISATIONS
Coming up in the Part 3: Drug Use in GLBTI Community….
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