AIDS revisited

PUBLIC SYMPOSIUM

Every eight seconds: AIDS revisited
National Library of Australia, Canberra, 29-30 November 2000

Speakers' CVs, abstracts and papers

Opening
by Michael Moore MLA

Michael Moore's qualifications include a BA (Flinders University), DipEd (Adelaide University) and Master degree in Population Health (Australian National University). He has been an Independent member of the ACT Legislative Assembly since 1989. In April 1998, he made political history when, after re-election as an Independent member in the Assembly, he was appointed Minister for Health and Community Care in a Liberal Government. He has maintained his Independent status and runs his Private Member's programme parallel to his portfolio responsibilities. Mr Moore believes that a political philosophy should be based much more on an individual's right to be free from domination rather than an individual right to non-interference. The legislative changes he has made over the last 11 years are based on the desire to build a healthier society and minimise harm to the community whilst allowing the individual to make informed choices. Mr Moore has chaired a number of select and standing committees. These committees have investigated the various issues affecting individuals and their ability to make informed choices about their health and well being. These have often been the committees which were far from politically palatable – like the Select Committee on HIV, Illegal Drugs and Prostitution, and the Select Committee on Drugs – but extremely important for building a healthy society.

Introduction
by Professor Malcolm Gillies

Since 1998 Malcolm Gillies has been President of the Australian Academy of the Humanities and also President of the National Academies Forum. A musician and linguist by training, he has authored numerous books in the field of early twentieth-century music history and analysis. He is currently Executive Dean responsible for humanities, social science and business faculties at Adelaide University.

Abstract

The National Academies Forum is a coordinating body of Australia's four learned academies. Its symposia investigate issues of public interest from the intellectual perspectives represented by the Academies. This Symposium will consider HIV/AIDS from the medical and social viewpoints; it will also consider important aspects of the disease from personal, human and moral dimensions. The tragedy of HIV/AIDS has been recently reinforced by media exposure of the extent of the problem in southern Africa and of the emerging crisis in Papua New Guinea. This introductory paper looks at ways in which Australians have responded to issues of HIV/AIDS since the early 1980s and how national strategy might best be directed in the twenty-first century.

Consensus or complacency: 'Post AIDS' but pre what?
by Chris Puplick

Chris Puplick is the Chair of the Australian National Council on AIDS, Hepatitis C and Related Diseases and has been involved in various aspects of HIV/AIDS policy work since 1985. He is also the Chair of the AIDS Trust of Australia. He migrated from the UK in 1962 and completed his education at Manly Boys' High School and the University of Sydney, where he gained an MA in politics and history. He served as a Senator for NSW from 1978 to 1981 and from 1984 to 1990. Between 1987 and 1990 he held several portfolios in the Shadow Cabinet, including Environment. In 1994 he became President of the Anti-Discrimination Board of NSW and also concurrently holds office as the Privacy Commissioner. He has five published books and approximately 100 journal or other publications to his credit.

Abstract

It is important to understand that Australia's success in fighting AIDS and in developing effective public policy responses to its challenges owe a great deal to good luck and not just good management. A combination of particular people and peculiar circumstances led to our responses being of a nature and quality which were not observed in most similar developed countries where partisan politics featured prominently in the early days of AIDS policy debate. Since those early days the political climate in Australia has changed significantly and the partnership which keeps AIDS policy on track is finely balanced. Anything which looks like a 'failure' of policy – for example, increases in rates of new infections – challenges these delicately balanced forces and must be taken very seriously.

HIV and AIDS: A geographical overview
by Robin Gorna

Robin Gorna, MA (Hons) Oxon, is Executive Director of the Australian Federation of AIDS Organisations (AFAO), and Chair of ANCHARD's HIV/AIDS Committee. She is the Co-Chair of the 6th International Congress on AIDS in Asia and the Pacific (to be held in Melbourne in 2001). She joined the UK's leading HIV/AIDS community organisation, the Terrence Higgins Trust, in 1986, and subsequently occupied a range of leadership roles in the UK and Europe in HIV health promotion, education, care and support. Ms Gorna was a founding Director of the European AIDS Treatment Group and worked at the European Commission coordinating AIDS & Drugs NGO activities. She sits on the Scientific Advisory Committee of the National Centre in HIV Epidemiology and Clinical Research and on the Program Executive Committee of the Australian Vaccine Consortium. She is the author of Vamps, Virgins and Victims: How can Women Fight AIDS? (Cassell, UK, 1996).

Abstract

The HIV/AIDS epidemic in Australia is increasingly unique in global terms. The Australian domestic response is still justifiably regarded as exceptionally effective. We have reduced the numbers of new infections among gay men to very low levels and we have continued to prevent epidemics among injecting drug users and sex workers. The Australian situation is a stark contrast to that of other nations in our region. The Asia-Pacific Region is the site for a number of exploding epidemics that need swift action now. It is urgent that Australian expertise in areas like needle exchange, community development and vaccine trials be made available to our neighbours in the region. This is a humanitarian issue and a security issue. With increasing rates of mobility and migration throughout the region, and the rise in HIV and AIDS in nations like PNG, it is also a domestic public health concern. Australia's domestic response to HIV/AIDS deserves to be regarded as the best in the world. It is now the time for us to make sure that our international commitment, especially in the Asia-Pacific, is regarded equally highly.

The origin of AIDS: Can science afford to ignore it?
by Julian Cribb

Julian Cribb is one of Australia's leading science communicators. A newspaper journalist since 1969 he has received 32 awards for journalism, mainly in the scientific, medical and agricultural fields. He was editor of several newspapers, and science editor for the national daily The Australian. He was foundation president of the Australian Science Communicators, and is a member of numerous national and international scientific advisory bodies. His present position is director of science awareness for a leading scientific research organisation. His published work includes more than 7000 media articles and various non-fiction works including The White Death (1996), the first book exploring the origins of AIDS.

Abstract

There is a crisis of public faith in science and scientists. Recent research shows concern over scientific ethics, transparency and who benefits from R&D, exemplified in the GMO debate. Scientific discussion of one hypothesis, that AIDS may have started in an early polio vaccine, has been systematically suppressed for more than twelve years. Julian Cribb calls for an independent international multidisciplinary inquiry into the origin of AIDS, arguing it is essential to human health, to preventing new pandemics, and to safeguard public trust in science.

HIV/AIDS in Africa
by Nona Bennett

Nona Bennett (MA, ANU) is Director of the Africa and Middle East Section of the Australian Agency for International Development (AusAID), the Federal Government's overseas development agency. She joined AusAID from the Department of Foreign Affairs and Trade's South and Southeast Asia Branch. She has devoted her public service career to international social development issues, including education policy in the international area of the Department of Education and gender and development policy in AusAID. She has recently returned from a mission to southern and east Africa that included a study of Australia's $10 million dollar program of assistance for prevention of HIV/AIDS and support for those affected by it.

Abstract

If you are an Australian, you can expect to live around 78 years, but if you are a Zambian, your life expectancy is now 37. In 1991, it was 49. Since the International HIV/AIDS Conference in Durban, South Africa, in July 2000, statistics such as these have conveyed to the world some measure of the catastrophic impact of the epidemic.

The loss of life and the effect on individuals and families is devastating. So too is the loss of development gains of the past decade. Families and communities are over-burdened; employers are losing workers in their prime; economies are faltering; the demand on the public health sector to care for sick and dying far outstrips the resources available. These factors, compounded with extreme poverty, have created highly vulnerable groups – women, youth, orphaned children – for whom neither the public sector nor community are able to care.

The international community, including Australia, considers the epidemic the paramount threat to Africa's development. Australia is working with African governments and community groups to care for those affected by it and to strengthen the responses of government, employers, researchers and communities. Australian-government-funded activities – largely through Australian NGOs – are combining technical strategies (condom promotion, reduction of STDs and behaviour change) with broader responses, including community prevention and care, outreach to highly vulnerable groups, support for national level research and capacity building.

Focus on Asia and the Pacific: Major issues
by Dr Chris Lyttleton

Dr Chris Lyttleton lectures in anthropology at Macquarie University. He has conducted extensive research in Southeast Asia, with a particular focus on the ongoing social impact of HIV/AIDS in the region. He recently published the book Endangered Relations: Negotiating Sex and AIDS in Thailand. He has been employed as an adviser on a number of HIV/AIDS programs in Thailand, Laos and Burma. Most recently he has been working with community-based opium reduction programs in north Laos.

Abstract

AIDS continues to wreak tremendous social and human damage in Asia. In some countries, such as India, Burma and Cambodia, descriptions of ‘out-of-control’ epidemics are common. In others, such as Vietnam, Laos and Malaysia, more measured terms are used and observers are hopeful that prevention policies are proving to some extent effective. Thailand, long regarded as the epicentre of AIDS in this region, is usually held up as a model of a country that has tamed the havoc that AIDS embodies through progressive policies and committed social support. Unfortunately, the reality is not so clear-cut. Dr Lyttleton will outline ways in which the presence of HIV/AIDS continues to pose complicated dilemmas for prevention and care programs in the SE Asian region, particularly in Thailand where, after years of decline, rates of infection in some sectors are again beginning to rise.

Key issues for Australia: Panel discussion
with Mike Kennedy

Mike Kennedy has been the Executive Director of the Victorian AIDS Council/Gay Men's Health Centre since July 1999. He was General Manager of the AIDS Action Council of the ACT from June 1997 to July 1999. Prior to that, Mike worked in the Commonwealth and Queensland public sectors in a range of finance and human resource management positions. Mike has held numerous voluntary positions in the HIV/AIDS sector since 1987: Board member and President of the Queensland AIDS Council; ordinary Executive member, Secretary and Vice-President of the Australian Federation of AIDS Organisations; member of the Ministerial Advisory Committee on HIV/AIDS in Queensland, the ACT and Victoria; member of the Attorney-General's Sex Industry Advisory Committee in the ACT; member of the Ministerial Advisory Committee on Gay and Lesbian Health in Victoria; and member of the Attorney-General's Advisory Committee on Gay, Lesbian, Bisexual and Transgender Issues in Victoria.

Abstract

Australia has had a comprehensive national approach to responding to HIV/AIDS since the first National HIV/AIDS Strategy in 1989. We are now in the second year of our fourth National HIV/AIDS Strategy. We have well developed networks of people living with HIV/AIDS, researchers, clinicians, government officials, and community based organisations which, most of the time, work together very effectively. To guide our way forwards, we have a substantial body of high quality evaluation of the work we have done. Yet the language used in the HIV/AIDS sector to describe our work in a changing epidemic refers consistently to the complexity of the issues that confront us and the responses that are required to meet the challenges.

The speakers in this session will briefly outline a few of the key issues which confront PLWHA organisations and AIDS Councils in responding to the epidemic and this will lead into a broader discussion of the Australian response.

Discussion on AIDS: Private morals and public policy
with the Most Reverend George Pell, Catholic Archbishop of Melbourne, and Ian Rankin

Dr George Pell, DD STL MEd DPhil (Oxon) FACE, is the Catholic Archbishop of Melbourne. He was ordained a priest for the Diocese of Ballarat in St Peter's Basilica, Rome in 1966. He was Director of the Aquinas Campus of the Institute of Catholic Education from 1974-84 and Principal of ICE from 1981-84. From 1991-95 Dr Pell was the Foundation Pro-Chancellor of the Australian Catholic University. He was made an Auxiliary Bishop for the Archdiocese of Melbourne in 1987. From 1988-97 he was Chairman of the Church's agency for overseas development and relief, and a member of the Bishops' Committee for Justice, Development and Peace. Since 1990 he has been a member of the Vatican Congregation for the Doctrine of the Faith. Dr Pell's most recent publications include Issues of Faith and Morals (1996), and Catholism and the Architecture of Freedom (1999).

Ian Rankin is an ex-president of the National Association of People Living With HIV/AIDS (NAPWA). He is a current member and ex-president of the local AIDS Action Council of the ACT. He has been a member of the Australian National Council on AIDS and Related Diseases Research Advisory Committee and the ACT Sexual Health and Blood Borne Diseases Advisory Committee. A public servant for ten years in the employment policy area, Ian has been diagnosed with HIV infection for over 14 years. He is currently undertaking undergraduate studies at the Australian National University in political science and sociology.

Abstract

Archbishop Pell and Ian Rankin will present their views on a number of topics:

how HIV/AIDS challenges moral frameworks
the degree to which private behaviours (for example, injecting drug use and prostitution) require public action to maintain public health
what children/young adults should be told about behaviour that has an AIDS transmission risk
whether 'saying no' can work
the extent and appropriateness of church influence on public policy.

This will be followed by questions from the audience and wider discussion.

Circumcision and prevention
by Professor Roger Short

Professor Roger Short, ScD FAA FRS, is Wexler Professorial Fellow in the Department of Obstetrics and Gynaecology at the University of Melbourne. In 1989 he spent a year working with the late Dr Jonathan Mann in the Global Programme on AIDS of the World Health Organisation in Geneva, and until recently was Chairman of the Board of Directors of Family Health International in North Carolina, USA, the world's largest NGO with a major involvement in AIDS prevention programs in developing countries. He has pioneered innovative adolescent safe sex education programs in Australia and, at the invitation of the Chinese Government, has extended them to a number of universities in Beijing and Shanghai, where they have been very successful. He recently co-authored, with Malcolm Potts, a book on the evolution of human sexuality entitled Ever Since Adam and Eve (Cambridge University Press, 1999). It has received excellent reviews around the world, has already been reprinted, and is being translated into Chinese, Spanish, Portuguese and Italian.

Abstract

An increasing number of national, cross-sectional and longitudinal studies in Africa and Asia are showing a 2- to 8-fold protective effect of male circumcision against HIV infection. Our studies have demonstrated that circumcision apparently has no effect on the epithelium of the glans penis, which is always keratinized, thus protecting it from HIV infection. This is in contrast to the inner surface of the foreskin, which is weakly keratinized, but well supplied with Langerhans (Dendritic) cells which contain HIV receptors. These cells are likely to be the primary point of viral entry into the penis of uncircumcised men. Adolescent male circumcision should be seriously considered as an additional means of preventing HIV infection in all countries with a high prevalence of infection. The definition of safe sex should include a warning about exposure of the foreskin to infected semen or vaginal secretions, even if penetrative intercourse has not occurred. In the future, we may be able to develop a range of topically active receptor blockers that could prevent HIV binding to the Langerhans cells in the foreskin and the vaginal epithelium. Reference: Szabo, R. & Short, R.V. (2000). British Medical Journal 320, 1592-1594.

Can we overcome viral resistance to anti-AIDS therapies?
by Dr Jenny Martin

Dr Jenny Martin is a principal investigator at the Institute for Molecular Bioscience at the University of Queensland. Jenny obtained her undergraduate Pharmacy degree at the Victorian College of Pharmacy in Melbourne. She subsequently undertook research degrees in drug design and protein structure at the Victorian College of Pharmacy (MPharm) and the University of Oxford (DPhil). In 1993, as a Queen Elizabeth II Fellow, Jenny established her own laboratory at the University of Queensland where she undertook structural studies on HIV-1 protease. Jenny was recently awarded an Australian Research Council Senior Research Fellowship to investigate protein crystallography and its applications in drug design. She continues to study the HIV-1 protease enzyme and its inhibitors, and has several research papers in this area.

Abstract

There are now a dozen or so drugs approved for use in treating HIV infection. These currently available drugs target primarily the enzymes reverse transcriptase and the aspartyl protease from the HIV virus. One of the major problems with these drug treatments is that, over time, the virus becomes resistant to the effects of the therapy. Why is this? How might we overcome viral resistance to current drug regimens? Will it be possible to design drugs that can outmanoeuvre the virus?

How close is a vaccine?
by Professor Ian Ramshaw

Professor Ian Ramshaw is a researcher at the John Curtin School of Medical Research, Australian National University. He has developed new approaches for HIV vaccines including prime-boost immunisation, which has recently resulted in the award of a $27 million grant from the US National Institutes of Health.

Abstract

The need for an AIDS vaccine is imperative. The statistics of HIV infection are horrendous: more than 16 million people have died of AIDS, more than 34 million people are living with AIDS, mostly in the developing world, and nearly all will die of AIDS within the next two decades. Although other measures have slowed the progress of HIV only an AIDS vaccine can end the HIV/AIDS pandemic. Although after 15 years and more than 30 vaccines having been tested in humans, only one vaccine is currently in Phase III trials and scientifically unlikely to be successful.

The failure to find an AIDS vaccine has been both political and scientific. Currently the world spends $US 20 billion on HIV/AIDS but only $US 300 million on AIDS vaccine research and development – less than 2%. Much of this is from national research agencies for basic research. Industry has not had the incentives to invest heavily in product development and has had virtually negative incentives to invest in creating products for developing countries. Furthermore, it is now likely that an AIDS vaccine will be intricate and multi-component in which ownership of associated intellectual property will be complex, making it difficult for individual organisations to invest. National governments, including Australia, need to take a more active role in AIDS vaccine development, particularly in the area of providing funds for clinical trials.

At the scientific level, most conventional approaches have failed. Protein based vaccines have so far failed to induce the correct form of immunity associated with protection and attenuated vaccines have proved too dangerous. New recombinant DNA approaches are more encouraging and in some cases have protected monkeys against infection. One approach being used by an Australian vaccine consortium funded ($27 million) by the United States National Institutes of Health is to use two different recombinant DNA vaccines consecutively. This has produced unprecedented levels of immunity against HIV and could protect against infection. Trials of the vaccine will commence in Sydney within 2 years. However, the possibility exists that no vaccine will completely protect against infection and will only prevent the development of full-blown AIDS. A useful vaccine is unlikely to occur within the next 5 years so a long-term commitment is required for such programs.

Presentation of the Hope Rose
Professor Malcolm Gillies and Kerrie Hadfield

Hope Rose Kerrie Hadfield presents the Hope Rose to Professor Malcolm Gillies, President of the National Academies Forum, at the Symposium on Every eight seconds: AIDS revisited.

Remarks by Professor Malcolm Gillies

Towards the end of the Second World War, at a time of immense human loss, the precious prize of peace was held up and projected in the birth of the Peace Rose, now probably the most famous rose in the world.

We, here today, together, are very much engaged against the world-savaging war of HIV/AIDS. Just last month, at the International Rose Festival in Adelaide, the South Australian Premier, John Olsen, launched the world's first 'cause' rose for HIV/AIDS. It carries the wonderful name of Hope – our hope for a vaccine in this new millennium. Eventually, in stature, it could become a sister to the Peace Rose. Its production was commissioned by the Melbourne charity, the Australian AIDS Fund Incorporated, which came into being as a response to the appalling discrimination meted out against New South Wales pre-schooler, Eve van Grafhorst, the first Australian child to be HIV-infected via a blood transfusion. Her story, and that of the Australian AIDS Fund, are on the website www.aids.org.au.

On this eve of World AIDS Day, I have been invited especially to share Hope with all of you – the Australian-produced Hope Rose. Our guest with those first precious blooms is Kerrie Hadfield from Queanbeyan. Kerrie was herself suffering from a life-threatening medical condition when, as a 10-year-old in the then Prince of Wales Children's Hospital (now the Sydney Children's Hospital), she met Eve van Grafhorst, another young AIDS hero of that time, Troy Lovegrove, and other HIV-infected children in Ward C5, the AIDS ward. These meetings left an indelible mark on Kerrie's life and inspired her support for HIV-positive people.

We are pleased that Kerrie is here to present the Hope Rose on behalf of the Australian AIDS Fund.

Presentation of Hope Rose by Kerrie Hadfield

I am very honoured and also very proud to share your company today and to bring you this very special rose, which I hope can find a home here in the grounds of the National Library of Australia.

What a joy it is to be open and hopeful, compared to those early days of the mid-eighties, when ignorance and fear of people with HIV was more prevalent than the disease itself. During my many hospital stays, we staged regular water fights on the wards. The plastic syringes, drop bags and tubes made great bombs and water pistols for our battles. I still remember that day in 1987, when we were suddenly banned from touching these things, and watched as the nurses put them into huge yellow plastic bags which were later burnt. In many places in Australia today, these fears are still not far from the surface, and even some doctors are not fully educated on the virus.

At the moment, the Hope Rose is still very much an infant. We are hoping that there will be enough cut blooms to show up in World AIDS Day celebrations in Sydney, Melbourne and Adelaide, but it will be out in strength next year – as a fund-raiser for all HIV-positive people – not just in Australia, but throughout the world.

I stand before you today with the spirits of my beautiful HIV friends by my side. Troy, Adam, Skye, Blake and Eve are not here to share with you their love and inspiration that they were to my life, but their message is like that of this rose which carries hope within its beautiful petals – the hope that this world will see an end to AIDS. Please keep it with you always.

Legal and ethical considerations
by Julie Hamblin

Julie Hamblin is a partner of Ebsworth & Ebsworth, solicitors, in Sydney. She heads up the firm's health law practice, which includes policy and advisory work for Government and the health sector, medical negligence litigation and advice on all legal issues affecting health care providers. Since 1992, she has worked as a consultant to the United Nations Development Programme on legal and ethical issues associated with the HIV epidemic in developing countries. This has included field work in more than fifteen countries in Africa, Asia and Eastern Europe. From 1997 – 1999, she served on the Australian National Council on AIDS and Related Diseases (ANCARD) and is currently a member of the ANCAHRD Legal Working Party. She has also served on the board of the Central Sydney Area Health Service, the National Pituitary Hormones Advisory Committee and the State Advisory Committee of the NSW Cervical Screening Programme. She is a former Vice President of the Australian Bioethics Association. She is co-author of The Australian HIV/AIDS Legal Guide, and has written and lectured widely on legal and ethical issues in health.

How can spatial information systems assist in the fight against AIDS?
by Professor Graeme Hugo

Graeme Hugo is Professor of Geography at the University of Adelaide and Director of the National Key Centre for the Social Applications of Geographical Information Systems. The Centre is currently examining the feasibility of using spatial information systems to assist in combatting AIDS in Southeast Asia, and Professor Hugo is also engaged in a study of the relationship between migration and AIDS in Indonesia. He has served on a number of committees and commissions of the International Union for the Scientific Study of Population and the International Geographical Union, and he has written extensively on population issues in Australia and in Southeast Asia. His books include Australia's Changing Population, The Demographic Dimension in Indonesian Development (with Jones, Hull and Hull), Worlds in Motion (with Massey, Arango, Kouaouci, Pellegrino and Taylor) and Internal Migration in Australia 1991 to 1996 (with Bell).

Abstract

Spatial Information Systems apply rapidly developing computer-based technologies and methodologies to the collection, storage, analysis, retrieval, modelling and visualization of spatially referenced information. They have considerable potential for assisting in monitoring the spread of HIV/AIDS and hence are useful in planning where preventative strategies can be introduced to maximize their effects. Some examples of the use of SIS in this way are drawn from Asia and Africa. Some of the barriers which currently prevent the wider use of SIS for these purposes are discussed.

The Lucky Country? Australian Adolescents and HIV/AIDS
by Professor Doreen Rosenthal

Professor Doreen Rosenthal, BA(Hons) PhD, is Associate Dean (Research) in the Faculty of Health Sciences at La Trobe University and Professorial Fellow in the Department of Psychology at The University of Melbourne. She was the Foundation Director of the Australian Centre for Research in Sex, Health and Society at La Trobe University and Director of two National Priority Programs in the National Centre for HIV Social Research. Professor Rosenthal has carried out research on adolescent risk-taking and HIV/AIDS for the past ten years and is an international expert on adolescent sexuality. She is a Fellow of the Academy of Social Sciences in Australia and on the Council of the International Society for Research in Adolescence. She was Deputy Chair of the Australian National Council on AIDS and Related Diseases (1995-99) and Chair of its Education Sub-committee; and was a member of the Victorian Ministerial Advisory Committee on AIDS and Deputy Chair of its Education Sub-Committee.

Abstract

Unlike their peers in many other countries affected by HIV/AIDS, few Australian adolescents have been infected with HIV. Nevertheless, it is clear from research that young people engage in a wide variety of risk practices, including sexual intercourse without using condoms, that are likely to be unsafe. In some marginalised groups, such as young people who are experiencing homelessness or who are attracted to peers of the same sex, risky practices are a relatively common occurrence. Australia's prevention education programs have achieved considerable success in promoting safe sex and safe injecting practices. These programs must be reinforced and expanded so that our young people remain alert to the means of avoiding infection with HIV and other blood-borne viruses and act accordingly.

Biomedical strategies for responding to the HIV epidemic
by Dr John Kaldor

Professor John Kaldor, PhD, is Deputy Director of the National Centre in HIV Epidemiology and Clinical Research, and Head of the Epidemiology Unit. In this capacity he has been responsible for coordinating national surveillance for HIV/AIDS since 1989, and for a range of epidemiological research programs in blood borne viruses and sexually transmissible diseases. Prior to this appointment, Professor Kaldor worked as a researcher at the International Agency for Research on Cancer, Lyon, France, and continues to maintain an active role in cancer epidemiology. Professor Kaldor has been President of the Australasian Epidemiological Association for the past four years, and a member of the Governing Council of the International AIDS Society for the past five years. He is an author on over 240 published scientific papers.

Abstract

HIV infection is an infectious disease like no other we have seen. Transmitted via sexual or blood contact, or from parents to newborns, it has the capacity to kill most people who become infected, but only after a long period of dormancy.

When this infection revealed itself in the early 1980s, we discovered that we were not well prepared. After nearly twenty years of experience, we have learnt much about prevention and treatment, but the number of people newly infected continues to grow in much of the world.

Biomedical science had little to offer at the start of the HIV epidemic, but its role has steadily increased, in partnership with the political, social and behavioural initiatives that have been at the centre of most national responses to the HIV epidemic.

Initially the role of the biomedical sciences was to provide an understanding of HIV transmission and disease progression, and the characteristics that affected the likelihood that these events would occur in individuals. This knowledge provided the basis for prevention programs, as well as counselling people with HIV infection.

More recently, there have been major advances in the effectiveness of therapy. For many of those in a position to have access to the range of expensive new pharmaceutical agents, disease progress has been halted or at least greatly slowed. The durability of this benefit remains uncertain however, and the vast majority of people with HIV infection in the world cannot even gain access to minimal analgesic or palliative treatment. As this situation will not change in the foreseeable future, there is an urgent need for a vaccine. Multiple scientific, technical and ethical challenges lie in the path of vaccine development, but must be faced if HIV is ever to be seriously countered.

Complacency or complexity: Managing gay sex
by Professor Susan Kippax

Professor Susan Kippax, PhD (University of Sydney), is Director of the National Centre in HIV Social Research (NCHSR). As a social psychologist, she has been engaged in research in the fields of sexuality, social aspects of the clinic, and harm minimisation and disease prevention since 1985. She has published widely and has an international reputation, particularly in regard to her research on gay men's sexual practice. Professor Kippax was plenary speaker at the IXth Annual Meeting of the Canadian Association for HIV Research, Montreal (2000), the Social Aspects of AIDS Conference, London (1999) and the 3rd AIDS Impact International Conference (1997), and an invited speaker at conferences in Japan, the United States, France and Canada. She was a member of the UNAIDS Joint Dialogue on HIV/AIDS: Policy Dilemmas Facing Governments (1999). She is a foundation editor of the international journal Culture, Health and Sexuality, and sits on the editorial boards of four international journals: AIDS Care, Venereology, Sexualities, and Feminist Theory.

Abstract

There is understandable concern about the upturn in unprotected anal intercourse among gay men. This upturn has been documented in a number of studies of gay men living on the east coast of Australia (Sydney, Melbourne and Brisbane). Recent research has turned to uncovering the reasons for this upturn. The findings of the research indicate a number of plausible hypotheses – some of which have been confirmed. These include: post-crisis climate; optimism about new treatments; and the development of complex risk reduction strategies among a number of gay men. There is little evidence for the widely held view that gay men have become complacent.

AIDS and the arts
by Dr David Pear

Dr David Pear is Director and CEO of International House, Brisbane, a college of the University of Queensland, and one of 13 International Houses worldwide. Responsible for 248 students, from undergraduate through to post-doctoral (of which over 160 are from overseas – representing 35 different nationalities and ethnicities), he is particularly concerned with HIV education among adolescent or immediately post-adolescent students, the majority of whom are now in the era of not having personally known somebody with HIV/AIDS. He holds a PhD in Education, has published numerous articles in history and music journals, and has co-edited a book on the Australian composer and sado-masochist, Percy Grainger.

Abstract

The arts, whether visual, literary or performing, have tremendous potential to bring home the issues faced by those affected by, or living with, HIV/AIDS. Illness and art, however, have always had a stormy relationship. The impoverished painter in his attic bemoaning the loss of his consumptive lover may well be an emotive subject for an opera, but does such work help to articulate the joys, tragedy and suffering experienced by such individuals, or does it distract us from the reality of the situation? This paper presents a profile of the arts in Western Society – and literature in particular – over the last eighteen years and seeks to demonstrate how it has been simultaneously both therapy and challenge, to the reader and writer alike.

Documenting AIDS: The response from cultural institutions
by Margy Burn

Margy Burn is Assistant Director-General, Australian Collections and Reader Services at the National Library of Australia. In her work as an Australiana specialist at the National Library and, before that, the State Library of New South Wales, she has been responsible for collections which document HIV/AIDS in Australia. These include a large-scale National Library Oral History project called 'The Australian Response to AIDS', and State Library of NSW archival collections from AIDS organisations and the personal papers of people living with AIDS, as well as poster collections and the work of artists and photographers documenting HIV/AIDS.

Public attitudes towards AIDS in Australia in the 1990s: Continuity and change
by Dr Mariah Evans and Dr Jonathan Kelley

Dr Mariah Evans, PhD (Uuniversity of Chicago), is Senior Research Fellow at the University of Melbourne's Melbourne Institute of Applied Social and Economic Research. She has published widely on work, gender, and health-related attitudes and behaviours in refereed journals both in Australia and internationally. Her book with Jonathan Kelley, Economy and Society, Volume 1: Education, Work, and Welfare in Australia, is forthcoming from Federation Press in March 2001.

Dr Jonathan Kelley, PhD (University of California, Berkeley), is Director of the International Social Science Survey (ISSS), Professorial Associate at the University of Melbourne's Melbourne Institute of Applied Social and Economic Research, and Head of the International Survey Project at the Australian National University's Research School of Social Sciences. He has published widely in refereed journals, both in Australia and internationally, on public opinion, popular culture, religion, and inequality.

Abstract

International Social Science Survey/Australia data show that among the Australian citizenry at large in the early 1990s, very few people had any AIDS victims among their acquaintance, but that quite a lot felt at least slightly at risk. The degree of sympathy felt for AIDS victims varied greatly according to the transmission route, as is even more true of blame. Many people who blamed AIDS victims nonetheless felt sympathy for them. Ideal financial responsibility for health care for AIDS acquired by most transmission routes was seen as shared between the government and the person with AIDS, with the heavier share being shouldered by the person. How has this context changed during the 1990s? Is contact with AIDS victims more widespread? Has that increased sympathy? These questions and issues of social differences in attitudes towards persons with AIDS form the focus of this paper.

Panel: Living with HIV/AIDS
with Neville Fazulla, Sonja Ristov and John Robinson

Neville Fazulla is an Indigenous Australian with experience in the retail and hospitality industries. He worked for the Commonwealth Department of Social Security in policy development and client service delivery, including the publication of an Indigenous Australian Training and Development Manual. He has had vast and varied experience working with the Indigenous and gay communities, and has held a number of positions including Statewide Sexual Health Co-ordinator, Aboriginal Health Council of SA, 1993-95; Co-convenor of the AFAO Indigenous Australian Gay and Transgender Peoples Steering Committee, 1994-98; ACSA Indigenous Gay Men's Project Officer, 1995-96; Member of the ANCAHRD Indigenous Australians Steering Committee, 1995-98; President of ACSA, 1996-97; Member of the Gay Education Strategies Steering Committee, 1996-98; QuAC Indigenous Australian Gay and Sistergirl Project Officer, 1997-98; Co-ordinator of People Living with HIV/AIDS South Australia, 1999; and Ordinary Member of the AFAO Executive, 1997-2000. He is currently the NAPWA Executive Indigenous Spokesperson.

Sonja Ristov is the elected chairperson of Positive Women Victoria, and has been an active member of the group for the greater part of the last decade. She was also an early member of People Living With HIV/AIDS Victoria, a founding member of the Prostitutes Collective of Victoria, and a project worker for the the group VIVAIDS (Victoria IV drug users and AIDS). She tested positive in 1989 and came out publicly as an HIV positive woman in 1990. From 1993 to 1996 she lived in Sydney and was involved in education campaigns run by ACON and Positive Women (NSW). She has served on several State and Federal Government committees looking at HIV/AIDS strategic planning.

John Robinson is currently the Vice President of People Living with HIV/AIDS (NSW) Inc. and one of the two NSW representatives to the National Association of People Living with HIV/AIDS. He represents PLWH/A (NSW) on the South East Sydney Area Health Service's HIV/AIDS & Sexual Health Advisory Committee and the Dental Services for PLWH/A Committee, convened by NSW Health. John was responsible for the PLWH/A (NSW) publication, International travel and HIV, Advice for the HIV positive traveller. Formerly employed as a policy officer in the NSW public sector, he has worked in both the education and health portfolios. Diagnosed with HIV in 1986, John is currently on combination therapy.

Critique of Australia's National HIV/AIDS Strategy
with Bill Whittaker and Professor John Mathews

Bill Whittaker AM is National President of the Australian Federation of AIDS Organisations (AFAO). He has been involved in the Australian response to HIV/AIDS since the early 1980s. This includes service as Executive Director of the AIDS Council of NSW, executive membership of the Australian National Council on HIV/AIDS, membership of ANCA's HIV Clinical Trials and Treatments Advisory Committee and membership of the NSW Ministerial Advisory Committee on HIV/AIDS. He was involved in the formulation of the 1st and 2nd Australian National HIV/AIDS Strategy.

Professor John Mathews graduated in science and medicine from the University of Melbourne. From 1972-75 he worked on cancer in nickel workers and the side effects of vasectomy at Oxford. From 1975-85 he was an NHMRC Research Fellow, and later Principal Research Fellow, in the Department of Medicine at the Royal Melbourne Hospital, helping to establish the Australian Twin Registry and the discipline of genetic epidemiology in Australia. He advise government on radiation matters and served as Senior Scientific Adviser to the Agent Orange Royal Commission. In 1984 he was appointed Foundation Director of the Menzies School of Health Research in Darwin, which he developed as a centre of excellence in Aboriginal and tropical health, and in 1999 he was appointed Head of the National Centre for Disease Control in the Commonwealth Department of Health and Aged Care. He has served on many NHMRC Committees and has published over 200 scientific papers. He was appointed as a Member in the Order of Australia in 1994.

Canberra Gay and Lesbian Qwire

The Canberra Gay and Lesbian Qwire was formed in 1993. The Qwire's repertoire varies widely from traditional folk songs to contemporary popular works, from classical a cappella to humorous songs and parodies. Increasingly, the Qwire performs works written or arranged by its own members.

The Qwire is a very visible part of the lesbian and gay communities in the national capital. It regularly performs at AIDS benefits, major music events such as the National Folk Festival and Opera by George, and concerts with its sister choirs in Sydney, Wollongong and Melbourne. The Qwire is led by its musical director, Leanne Clark, and assistant musical director, Stephen Lawton.

GPO Box 119 | Canberra ACT 2601 | AUSTRALIA | Ph: 02 6249 1788 | Fax: 02 6247 4335