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Globally we are at a crossroads, with significant progress made towards the virtual elimination of new HIV transmissions in Australia by 2020. Success is characterised by collaboration and strong partnerships between community-based organisations, research, policy and (some) affected communities. Combination prevention strategies have been enhanced through peer-education and harm reduction programs, condom usage, PrEP, PEP and TasP. Also, there has been a focus on increasing the quality of life for PLHIV.
In Australia, the sector is well positioned to achieve the UNAIDS global targets of 90-90-90.
But is this enough?
There are persistent issues for people of culturally and linguistically diverse communities. Late diagnoses are an ongoing issue, in particular with Aboriginal and Torres Strait Island communities, as well as South East Asian populations. For Aboriginal and Torres Strait Islander people, the rate of HIV is more than double that for non-Indigenous Australians, exacerbated by a completely unique set of transmission drivers. Criminalisation is still impacting negatively on sex-workers and their access to services. Data on key populations, such transgender and culturally and linguistically diverse populations is incomplete. Stigma and discrimination, barriers to health literacy, shame and machismo are having a continued impact on progress.
From a moral and human rights perspective it is imperative that on one is left behind!
Over the period of the epidemic we have amassed a great deal of evidence and a good blueprint of what works well to enable the sector to move forward, but action needs to be taken now to:
- Enable equitable access to new HIV testing technologies and harm reduction strategies
- Reduce barriers to accessing treatment and care
- Increase health literacy among the sector workforce and throughout communites
- Enhance the meaningful opportunities to involve affected communities
- Improve the framing and reach of health promotion efforts
- Advance shared care models and dedicated services for key populations
- improve date and surveillance, research and evaluation strategies
- Continue to invest in partnerships
What is our response?
Are grass-roots efforts like we saw in the 80s and 90s needed or even achievable? We need to assess what things are different now and ask what support is needed by affected communities today to give them a voice. As well, we need to better understand what role other key stakeholders (policy-makers, funders, practitioners and researchers) collectively play - we need better funding models and more visibility of the issues.
How do we coordinate our efforts for efficiencies and synergy ti ensure no one is left behind?