The Australian - HealthHealth Travel Motoring HIV policies flawed as officials miss bare
reality
Natasha Robinson
April 21, 2007

FOR the gay lobby, coffee with a Victorian health official must be planned with the utmost
discretion.
"We've got to meet somewhere where no one will see us," says one public servant - terrified of
being perceived as captive to the community sector - to a lobbyist new on the scene and keen to
network.

In the nation's gay capital, Sydney, it is a different story.

Former community sector workers rule the roost in the NSW Health Department's HIV policy wing.

Not only do they make up the majority of the six bureaucrats who work in the department's HIV
and Sexually Transmitted Infections Unit, but Sydney's powerful gay community players have a
direct line to the most senior officials leading HIV policy direction - public servants who are
also responsible for distributing millions of dollars in funding that outstrips the Victorian
Government's HIV prevention funding four-fold.

The different approaches are significant at a time when HIV infection rates are rising - 41 per
cent nationally in the past five years - and more men are not wearing condoms.

Complicating the handling of HIV is the emergence of anti-retroviral drugs, meaning the disease
is no longer an instant death sentence, and in extreme cases it is even a badge of honour.

In two states, officials stand accused of putting privacy and the welfare of individuals
alleged to have knowingly spread HIV ahead of public health.

As the case of one accused individual, Michael Neal, unfolded in court in Victoria, eventually
claiming the scalp of the state's chief health officer, it emerged that government lawyers
attempted to curtail police investigations into men alleged to have spread the fatal virus.

In the wake of the Neal case, the federal Government's chief adviser on HIV, Michael
Wooldridge, branded the Victorian Government's "balance of rights and responsibilities" as
flawed.

The former chairman of the federal Government's now-defunct Australian National Council on
AIDS, Chris Puplick, blames bureaucratic failure in the DHS for the Neal debacle.

"Privacy has been used as an excuse by incompetent bureaucracies," Mr Puplick said. "The
current (Victorian) Government and the current minister just seem to have lost the plot
entirely."

Fear of stigma has swept through the sensitive channels of the gay community sector following
the Neal case.

But some believe an excessive focus on anti-discrimination messages in HIV policy, driven by
the gay community, is behind the health departments' obsession with privacy.

A South Australian doctor pilloried in the mid-1980s for suggesting that health bodies needed
the power to quarantine those who refused to practise safe sex says the HIV health policy is
stillinfluenced by the pervasive fear of homophobia that existed in the 1980s.

"The sensitivities of that time have resulted in a fairly lenient attitude to people who are
spreading a deadly disease," Adelaide GP Peter Joseph tells The Weekend Australian.

"Now the disease is better understood, and the hysteria andthe fear of victimisation havegone."

One of the nation's leading HIV medicos, the Albion Street Centre's Julian Gold, says
policy-makers face an uphill battle if they continue to focus on individual protection.

"The single most important issue is we have to move from the concept of people protecting
themselves to the concept of people with HIV being responsible to protect other people,"
Professor Gold says.

Mr Neal's case has brought American subcultural phenomenons such as "barebacking" and
"bugchasing" to grim reality in a Melbourne courtroom.

Mr Neal was committed to stand trial last month on 106 charges, including intentionally
spreading a deadly disease, attempting to intentionally cause serious injury, rape and
possession of child pornography. He is due to stand trial in the Victorian County Court in June
next year.

The eroticisation of "barebacking" - deliberate condom-free sex - has caused controversy within
the gay community in the US but has prompted a counter-backlash from its proponents, who see
condom-free sex as their right.

"Bugchasing" - the desire to contract HIV, which, one academic told The Weekend Australian, was
dismissed within the gay community as a "western Californian cultural invention" - was first
covered in the mainstream in a Rolling Stone magazine article published in the US in 2003.

Though gay community advocates weren't aware that the subculture had arrived here, a steady
stream of witnesses in the Neal case told the court they were familiar with terms such as
"gift-giving" and "breeding" (passing on HIV).

In the gay mecca of San Francisco, a controversial HIV prevention strategy called serosorting
(choosing a partner with the same HIV status) is now official health policy. Some, such as the
National Centre in HIV Social Research's Kane Race, describe barebacking, which largely took
place between two men of the same HIV status, as its "predecessor".

In Victoria, the damaged reputation of Health Minister Bronwyn Pike rests on her ability to
recover and drive forward a coherent HIV prevention strategy for the state. Victorian AIDS
Council executive director Mike Kennedy is not hopeful. "We are not hearing anything that
sounds like urgency," he says.

Health officials are attempting to market to a gay man that does not exist, Mr Kennedy says,
adding public health messages have more in common with drink driving campaigns than the reality
of modern sexual encounters.

"Saying to people: you must wear a condom every time you have sex ... it's a bit like saying to
people: don't masturbate or you will go blind," Mr Kennedy says. "Our whole credibility with
the audience that we work with is we tell them the truth."

Additional reporting: Jeremy Roberts