24 May: An update has been added at the bottom of the post – the Public Health Association of Australia has raised concerns about the cuts to Healthy Communities.

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It seems that some high-need areas are being targeted for cuts by the new Queensland Government. The prison advocacy group Sisters Inside has been in the news over its concerns about the future of services to women inside Townsville Women’s Correctional Centre (TWCC) – most of whom are Indigenous.

As the tweet below suggests, there are also concerns about plans to cut funding for Healthy Communities, or QAHC, an organisation that promotes the health and well-being of lesbian, gay, bisexual and transgender Queenslanders (although the Qld branch of the AMA reportedly supports the funding cut).

In the article below, Daniel Reeders, a senior project worker in multicultural HIV, sexual health and viral hepatitis prevention in Melbourne – and blogger, warns that the “shortsighted” move will have devastating consequences for public health.

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This cut is about politics, not public health

Daniel Reeders writes:

The LNP decision to de-fund the Queensland Association for Healthy Communities (QAHC) is deeply short-sighted.

Health Minister Lawrence Springborg says the QAHC shift to advocacy around health for LGBT communities shows the agency has “lost its way”, and he wants to fund a single-issue AIDS council doing HIV prevention alone.

His statement also says that infection rates show the agency failing in its mission.  Both claims betray an embarrassing ignorance about HIV prevention.

Three decades ago Australia and America made different choices on how to configure their HIV epidemic responses.  America made it a public health issue; Australia made it a community health issue.

Now, cities like San Francisco are reporting 25% HIV prevalence among gay men (Schwarcz et al, 2007).  In Queensland, prevalence is around 8.8% (Lee et al, 2011). Tell us again, Minister Springborg, how that constitutes failure?

The other claim deserves closer interrogation.  It seems reasonable enough, if you’re funding someone to do HIV prevention, to want them to focus on that.  How does advocacy around LGBT health issues, like preventing of bullying in schools, youth suicide, domestic violence, help in preventing HIV infections?

It comes down to two things: the role of belonging to a community in health, and safe sex culture in sustaining prevention behaviours.

Healthy communities

Since the advent of effective treatments over 17 years ago, we are no longer living in an AIDS crisis, in the developed world at least.

Prevention approaches predicated on fear/crisis just aren’t credible any more.  Some people will predictably feel outraged by that statement, but I’d urge them to can it.  It doesn’t signal any lack of commitment to prevention: it just means finding new themes to make our work relevant and effective.

Those themes are social justice, including marriage equality; a much broader focus on health, including drugs and alcohol, domestic violence, and mental health; and a more inclusive sense of community with lesbians, bisexuals, trans- and intersex folk.

With the full support of Queensland Health, QAHC took these themes and issues on, creating many more reasons for people to get involved with their organisation and activities.

It’s a classic multi-issue coalition approach, and it’s highly effective, as AdShel found out when it removed posters from the QAHC Rip ‘n’ Roll campaign.  (Little wonder they made the LNP government nervous – as it plans to wind back Anna Bligh’s civil union laws.)  It is also textbook health promotion.

A volunteer who gets involved because of their concern about youth suicide still benefits from activities promoting safe sex, as well as the inclusive social spaces the organisation creates.  Such spaces are vital, because social connectedness is directly beneficial to health.

For twenty-eight years, QAHC has been a hub connecting individuals into friendship networks and those networks into a community.  Healthy social networks include a mix of bonding (similar) and bridging (different) ties, which respectively afford intimacy and exposure to novel perspectives and information (Sarason et al, 1997).

People who are isolated lack opportunities for social learning about safe sex and relationships, as well as ‘bridges into care’ when problems arise and they need supportive referrals for professional assistance.

The outcome of defunding QAHC will be more people living for longer with gaps in their knowledge and patterns of sexual risk-taking leading to HIV infection.

Safe sex culture 

Springborg has announced plans to create a committee of experts to oversee HIV prevention in Queensland.  But what does ‘an expert’ look like to a Minister of Health?

It is very unlikely to be someone who has direct personal knowledge of gay men’s sexual cultures in all their diversity and ingenuity.  It is far more likely to be someone with a medical degree and a PhD in epidemiology.

I have nothing against Doctor Doctors — indeed, I envy their energy — but in matters of HIV prevention strategy they consistently make two errors: they overestimate the influential power of information and underestimate that of safe sex culture.

This far into the epidemic, it’s news to precisely nobody that condoms protect against infection.  The marginal utility of condom reinforcement campaigns declines rapidly into negative value: research shows audience members losing faith in campaigns that repeat what they already know.

And yet the majority of gay men continue to use condoms most of the time, and even when they don’t, the patterning of their risk-taking evinces a continued commitment to avoiding HIV infection.  Isn’t that bizarre?

And yet it isn’t: it shows how early messages were translated into everyday practices of care of the self and others, frequently non-verbal, practiced and passed on in casual encounters and long-term relationships, between friends and lovers, fuck buddies and partners — in what the Australian cultural theorist Michael Hurley has called “cultures of care” (Hurley, 2003).

Tell us again, Minister Springborg, how your experts will understand that better than QAHC?

Readers only need eyes to see the conservative political reasons underpinning the LNP decision to de-fund Healthy Communities.

From a prevention strategy viewpoint, even their alibi is laughable.  The move is nothing less than an attack on the LGBT community and for the simple reason of its strength.  The LNP government must reverse course or Queensland will reap the consequences.

• If you share the concerns expressed here, please consider adding your voice to this petition organised by friends of QAHC.

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References

Hurley, Michael. (2003) <em>Then &amp; Now: Gay Men &amp; HIV</em>. Melbourne: Australian Research Centre in Sex, Health and Society.

Lee, E., Holt, M., Mao, L., Prestage, G., Zablotska, I., Spratling, T., Norton, G., Watts, P., &amp; de Wit, J. (2011). Gay Community Periodic Survey: Queensland 2011. Sydney: National Centre in HIV Social Research, The University of New South Wales.

Sarason, B, I Sarason, and R Gurung. “Close Personal Relationships and Health Outcomes: A Key to the Role of Social Support.” (1997) In <em>Handbook of Personal Relationships: Theory, Research and Intervention</em>. 2nd ed. Chichester: Wiley.

Schwarcz, Sandra, Susan Scheer, Willi McFarland, Mitchell Katz, Linda Valleroy, Sanny Chen, and Joseph Catania. (2007) “Prevalence of HIV Infection and Predictors of High-Transmission Sexual Risk Behaviors Among Men Who Have Sex With Men.” <em>American Journal of Public Health</em> 97, no. 6 (June 2007): 1067–1075.

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• Daniel Reeder’s previous article on the Grim Reaper campaign

 

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Update, 24 May: Statement from Public Health Association of Australia

The Public Health Association of Australia (PHAA) has written to the QLD Government to express its concern over the decision to de-fund a key HIV prevention organisation.  The Queensland Association of Healthy Communities (Healthy Communities) plays a central role in efforts to prevent the spread of HIV among at-risk populations.

“PHAA is concerned about funding cuts to the Healthy Communities organisation, given the importance of a carefully targeted approach to prevent the spread of HIV.  Successful population health approaches take into account the broader community but also specifically target groups that are in the highest risk categories.  Healthy Communities focuses on one of the most vulnerable groups – lesbian, gay, bisexual, and transgender (LGBT) populations,” said Michael Moore, Chief Executive Officer (CEO) of the PHAA.

PHAA’s Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Policy states:

Transmission of HIV can be avoided through changes in individual behaviour in the context of being in a supportive environment. Comprehensive health promotion programs and genuine participation of affected communities are integral to an effective and sustainable strategy.

“Funding provided to Healthy Communities supports an awareness training project and also a drug and alcohol project which we understand are both under threat.  9% of gay men in Queensland are HIV positive compared to about 0 .1% in the general community.  This requires a specific effort to direct prevention to where most infections can be found, rather than taking a broad brush approach for general community,” explained Mr Moore.

“The PHAA is keen to promote an appropriate preventive approach to target vulnerable groups.  We are keen to be involved with the Government’s announced Ministerial Advisory Committee on HIV and are happy to play a role in the review of HIV prevention strategies in QLD.  There is no need to reinvent the wheel.  The current approach to tackling HIV in Australia – as set out as the primary goal of the Sixth National HIV Strategy 2010-2013 – is to ‘reduce the transmission of, and morbidity and mortality caused by, HIV and to minimise the personal and social impact of HIV’.  The strategy sets out priority areas for action.  The very first of these is to ‘target HIV prevention targeting priority communities and populations’,” said Mr Moore.

PHAA has requested that the QLD Government:

1.      Review the QLD HIV strategies in the light of the Sixth National HIV Strategy 2010-2013;

2.      Consider involvement of the PHAA and the broader HIV sector in the establishment of the new Ministerial Advisory Committee and Prevention Review;

3.      Maintain funding of Healthy Communities until such time as a further decision has been made as to any better alternatives; and

4.      If no better alternatives are found – expand the remit of Healthy Communities to ensure they have a broader role.