This cut is about politics, not public health
This cut is about politics, not public health
HIV Australia | Vol. 10 No. 1 | June 2012
Writing in response to QAHC defunding, DANIEL REEDERS discusses the role of community in effective HIV health promotion.
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.1 In Queensland, prevalence is around 8.8%.2 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.3
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”.4
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.
References
1 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.” American Journal of Public Health 97, no. 6 (June 2007): 1067–1075.
2 Lee, E., Holt, M., Mao, L., Prestage, G., Zablotska, I., Spratling, T., Norton, G., Watts, P., & de Wit, J. (2011). Gay Community Periodic Survey: Queensland 2011. Sydney: National Centre in HIV Social Research, The University of New South Wales.
3 Sarason, B, I Sarason, and R Gurung. “Close Personal Relationships and Health Outcomes: A Key to the Role of Social Support.” (1997) In Handbook of Personal Relationships: Theory, Research and Intervention. 2nd ed. Chichester: Wiley.
4 Hurley, Michael. (2003) Then & Now: Gay Men & HIV. Melbourne: Australian Research Centre in Sex, Health and Society.
This article was originally published by Croaky – the Crikey health blog. Reproduced with permission.