Queensland’s LGBT community was rocked this week when the Qld Minister for Health announced that he would discontinue HIV funding to the Queensland Association for Healthy Communities (QAHC) because of a large increase in the rate of HIV. A new expert Ministerial Advisory Committee will be established to decide the best way forward for HIV prevention in Queensland. Was this a dangerous decision or the shake up that we needed? QNews went directly to QAHC Executive Director Paul Martin and the Health Minister Lawrence Springborg to get their respective positions on the matter. Here is what they had to say.

PAUL MARTIN QAHC EXECUTIVE DIRECTOR

What do you believe has led the Health Minister to de-fund the HIV prevention money QAHC receives annually? QAHC has not been granted a meeting with the Minister, so we only know as much as has been made public in statements and correspondence from his office to us. The reasons stated are the increase in HIV infections over the past decade and that QAHC is no longer just an HIV organisation and is too ‘political’. QAHC has been successfully delivering on our contract with Queensland Health and has had no questions raised with us about the quality, quantity, focus or management of the services we deliver.  Our work is in keeping with both the Queensland HIV, Hepatitis C and STIs strategy and the national HIV strategy.  We have served both Liberal-National and Labor governments for over 20 years.

Do you believe this decision was politically motivated or motivated by a concern over rising rates of HIV? If HIV rates were the only concern, why was our LGBT training project and LGBT alcohol, tobacco and others drugs project funding removed?  If increasing HIV rates are the concern, why has QAHC been the only government or non-government service affected? QAHC has been concerned about the rises in HIV for some time.

Has QAHC become too political? The overwhelming focus of our work is providing frontline services to LGBT people and working in partnership with mainstream services to increase their capacity to respond to the needs of LGBT people. Following the World Health Organisation’s ‘Ottawa Charter for Health Promotion’ we do promote healthy public policy.  This means raising policy or legal issues that help or hinder the health of LGBT people.  This has included supporting civil partnerships.  Advocacy on healthy public policy is specifically written in to our contract with Queensland Health, but is only a very small amount of the work that we do.

There has been a barrage of figures released over the past week. Many of these figures are contradictory. What does QAHC believe are the real HIV figures in Queensland, and the rate of annual growth as we know it? According to the latest published Queensland HIV report for 2010, in 2001 the rate of HIV diagnoses per 100,000 population was 2.7.  In 2010 this had increased to 4.7 (not a doubling to 5.4 as has been claimed).  People can look at the report for themselves on page 28 via the Queensland Health website. This increase is largely in line with the pattern of HIV in other states and territories and other western cities, with a lag-time of several years as Queensland ‘catches up’ with NSW and Victoria in particular. What we all agree on is that HIV rates have increased and more needs to be done in Queensland to reverse this trend.

As QAHC is both the most prominent and the highest funded body by the Queensland Government to prevent HIV, what responsibility does QAHC accept for the rise in HIV figures? The Queensland government spends more money on its network of 16 sexual health clinics than it does on the service agreement with us.  QAHC receives 13% of the HIV, Hepatitis C and STI funding that goes to non-government organisations. QAHC plays an important role in ensuring that gay men are aware of HIV, have the knowledge and skills to protect themselves and others and have access to quality services.  However it is not appropriate for us to be solely responsible for HIV rates in Queensland and we are not responsible for the behaviour or decisions that individual gay men make about their sex lives. We are only funded to work with one population group (gay/msm). There are many factors that influence HIV rates that are beyond the control of Healthy Communities e.g. the lack of compulsory sex & relationships education in schools, lack of general community HIV awareness, lack of timely and convenient access to testing services and stigma & discrimination about HIV and LGBT people.

Is it true that Queensland has one of the lowest HIV testing rates here in Australia, and if so, what do you believe the indications of the real HIV figures? No.  71% of gay men in Queensland (who aren’t HIV positive) tested for HIV in the past 12 months.  This has been stable for the past 5 years.  This compares to 72% of men in Sydney and 70% of men in Melbourne (note Qld data covers regional centres as well as Brisbane).  Source: Gay Community Periodic Surveys, National Centre for HIV Social Research.

What programs will QAHC no longer be able to deliver with the cuts to HIV funding? HIV, Hepatitis C & STI Prevention Services for Gay, Bisexual and other Men who have Sex with Men will cease: This will include cutting both group and one on one HIV/safe sex support, condom & lube distribution, sexual health phone support, HIV printed resources, safe sex social media, peer education and community outreach. It would also cut our research into current trends in local sexual health, our presence in LGBT media, and the access to hidden LGBT subcultures. It will mean less social support and a decreased awareness of gay men’s sexual health needs for doctors, nurses and other health professionals

LGBT Training & Development project will cease for GPs, mainstream health & community services and individuals including targeted groups, as well as ending the inclusion of LGBT training in undergraduate health and community services courses

LGBT Alcohol, Tobacco & Other Drugs Project will cease: This will include cutting social marketing campaigns, online support, community awareness events and relationships with outside services which can all help minimise and prevent harmful outcomes

What funding does QAHC continue to receive and what programs will this funding allow you to continue? QAHC continues to receive funding to deliver HIV, Hepatitis C and STI prevention among Aboriginal & Torres Strait Islanders, through our ‘2 Sprits’ program, counselling & group-work for people affecting by the natural disasters of 2011, piloting a volunteer led home visiting service for LGBT seniors and an information resource for LGBT people from a multicultural background who are newly arrived in Queensland.  The work of our mainly volunteer led Health Action Groups (lesbian, ageing, multicultural, trans, history) will also continue. Over the next few months, the QAHC Board  will restructure the organisation and look for other sources of income. The organisation will be much smaller and more reliant on volunteers to provide frontline services to the LGBT communities of Queensland.

Before the funding cuts, what were QAHC's visions as a way to move forward on HIV prevention here in Queensland and with what time frame? Healthy Communities continuously changes and adapts our HIV prevention activities in light of research, evaluation, and consultation with communities, discussion with similar services in Australia and overseas and with the agreement of Queensland Health. Recent developments have included a focus on ‘sexually adventurous men’ (who make up 15% of gay men but contribute 35% of infections), support for ‘risk reduction strategies’ for times when condoms aren’t used, creating a better understanding of the lived experience of people with HIV in 2012, better use of social media to reach more men and engage in discussion, trialling new HIV testing technologies, ‘Food for Thought’ sexual health discussion groups with peers and taking basic condom reinforcement messages beyond the “gay ghetto” (e.g. Rip & Roll campaign on billboards and bus shelters).

QAHC wrote to the Minister with 29 recommendations for revitalising the HIV response in Queensland.

What about the other work QAHC does in the community for preventative health measures, (EG Drugs, alcohol and smoking) When were these projects funded until and has QAHC applied for a continuance of these projects? Minister Springborg has also decided to withdraw funding for our LGBT training project which provides LGBT awareness training to health and community services. Our LGBT health promotion work to help people stop, reduce or better manage their alcohol, tobacco and other drug use has also been withdrawn. Healthy Communities will be seeking funding from other sources to continue this important work and hopes that Queensland Health will fund targeted peer education and health promotion work in the LGBT community in the future.

What would be an ideal outcome for you in relation to HIV in Queensland? A cure and/or vaccine for HIV.  But until that happens, a proper independent expert review of HIV prevention strategies in Queensland, with results made public.  To be followed by a properly funded, multi-faceted HIV prevention action plan, delivered in partnership with affected communities and peer organisations.  Healthy Communities’ funding should be maintained until after the review is completed, with any future decisions based on the findings of the expert review. We hope that the new Government will increase spending on HIV prevention (latest figures available 2007-08 show that Queensland spent less on HIV, Hepatitis C and STI control than any other state or territory in Australia).  In our view, we have got the ‘medicine’ right, but the ‘dosing’ is not enough to be more effective.

LAWRENCE SPRINGBORG QLD MINISTER FOR HEALTH 

QN: What led you to the decision that QAHC’s funding needed to be moved into a different area? LS: Simply because the money is not giving us results, we’re not getting value for money and the core role that they are funded for is failing. The simple reality is we are giving them over  two million a year and they are the main HIV/AIDS awareness prevention body in our community, yet in the last ten years we have seen a doubling of the diagnoses rates for HIV in Queensland. The rates are probably much higher than what we have detected and to me that’s the greatest indication of failure.

Did QAHC have any forewarning that this would happen? Well they didn’t have any forewarning from me. I made the decision and the decision was around results. The decision was around my concern for the fact that I was disturbed that this organisation which was the principle body funded to bring awareness to HIV prevention was failing. It followed on from concerns I raised seven or eight years ago when the whole funding arrangement changed for the Queensland AIDS Council and a deliberate decision that was made for the AIDS Council to take on a larger broader agenda that we would see this (rising rates of HIV) happen. So I’ve been really concerned about this for almost a decade.

Could it have been done in a different way? Well you can always do things in different ways, there’s more than one way to skin a cat. I’m not convinced it would’ve given us any different results. I mean we’ve got an organisation that made a deliberate decision in recent years to go in other directions than their agenda. We need to actually find a different way of doing it and to take control, to refocus and prioritise core values and make people aware that we have this problem in the community. Once we refocus, then we can look at other ways at going back to a non-government organisation but I want a very very strict criteria.

Should QAHC be surprised that they had their funding cut? No, I shouldn’t think so because you are funding them to do a job and they are not doing their job and HIV diagnosis rates have doubled in the last 10 years and they’ve been the organisation that has been in charge of addressing that increase. Why would they be surprised? If we were giving millions of dollars to an organisation to raise awareness and prevention around smoking rates, and they doubled in ten years, then they wouldn’t be surprised if we cut their funding.  

There have been a lot of different figures about HIV and claims that some figures are right and others are wrong. What are the real figures for HIV in Queensland?  Who knows? Who knows what the real figures are but we know that they are bad. When the diagnosis rates double in 10 years and the real hidden figures are probably much  higher because of the lack of awareness and testing. I suspect by raising awareness and refocusing it the way we are going to, I wouldn’t be surprised if, before we start to bring the rates down, we will see a spike in numbers due to awareness and better diagnosis in Queensland.

 A lot of people don’t even know this is a problem. I’ve had countless comments in the last week from the media and people in the general community who said “we didn’t know this existed, we thought it went out with the grim reaper.” Well no, it’s worse now than what it was when the grim reaper was around. It's just we can help people live a long and happy life with HIV/AIDS but still their lifestyle is cramped compared to what it would be if they didn’t have HIV.

Your ministerial advisory committee how it is going to work? How many people will be on the committee?

I haven’t actually set a maximum number the important thing is to have something that is large enough to be representative but small enough to be effective.

You are looking at probably around about 10 people, I think is a pretty good figure. I want to be guided on the establishment of that committee. The only real criteria I lay down is that the core philosophy is to make sure that we raise HIV awareness in our community and that we have the best possible prevention strategies and that it is targeted and representative of where high risk issues are. I am going to let it guide on the most effective ways to use the funds, and what sort of programs need to be delivered. I want to be consulted widely over the next couple of weeks to get a good broad wide ministerial advisory.

When do you hope to have this advisory committee established? Well I am working on establishment within the next six weeks or very soon thereafter. We need an organisation that has a very clear picture on what it wants to do and how it wants us to target our programs and funding, for when the existing programs winds up in three months time. 

Will it target solely HIV or other sexual health issues as well? Well my big concern has been around HIV/AIDS so I don’t think we would be surprised if that is its main focus. But if the committee comes to a conclusion that there is a benefit in actually wrapping up the HIV issue with other sexual health issues or other issues it identifies, then I would be happy to be guided in that area. Principally, I want to make sure that we press the issue of HIV in the community but if it actually sees that there is merit going beyond that then we will look into it.

There are certainly some very bright minds in QAHC who have a genuine passion for preventing HIV would you be open to having any current QAHC staff on the advisory committee? I don’t doubt that there are many dedicated people within QAHC. We will look at ways at being able to consider them and support them through this particular process. But the important thing is this is about refocusing the HIV strategy in Queensland, and if they feel they can play a role in that we don’t have a problem.

There is concern in the LGBT community that taking away funding is going to mean closure of programs that QAHC offers, do you think this will be detriment to the community? Well there a number of things that QAHC does at the moment which are going to come to a funding conclusion over the next couple of months. But simply we fund QAHC two million a year for HIV awareness, prevention strategies and campaigns, and it's not working. Now I am very concerned that the more I hear, and its any wonder that we are not actually hearing anything on HIV from QAHC because they are off on a fling everywhere else. You look at their whole election strategy you’ve basically got to go to page 4 before you see any mention of the word HIV. The 21 pages that they’ve got on their own website from the former Queensland treasurer Fraser back to them, I’ve been looking through it and I cant find any reference to HIV/AIDS. So to me this is the problem.

QAHC has a focus on health not just HIV, you being the minister for health, what advice do you have for them for any future funding they might seek? I personally believe in non-government organisations and working with the private sector to deliver programs for health awareness and prevention campaigns. It concerns me when we don’t get value for money, and what's happened under the previous government is that money has been given without a strict criteria and that’s been the problem. I am happy to have discussions with any organisation but there will be very very strict criteria around what we expect the results to be at the other end. This is taxpayer's money. We need to get maximum bang for our buck and we haven’t been getting it.

YOUR FEEDBACK

QNews created a snap poll to determine people's views on the QAHC HIV funding debate and we also asked “How Can We Stop HIV in Qld”?  We asked people who have a vested interest in QAHC, Qld Health and the QLD Government to abstain from commenting.  Here are some of the comments we received

There are 3 crucial steps in disease management. Prevention, treatment of symptoms and cure. Prevention being the cheapest, which is through education mainly. Too many are blasé about their sexual health which is why HIV is rampant, and if more men thought with their heads instead of their dicks, far less would be regretting the consequences of their actions. Also there are too many negligent people who knowingly sleep around without protection who are positive and don't inform the sexual partner.  Maurice

If you gave a man $2 million and asked him to fill in a hole and kept giving him money every year and after 10 years the whole is twice as big, would you sack him?  Let's move on and stop HIV. Tony

HIV is not a homosexual disease and funding for education and testing should be made available to all demographics Mike

If public funds aren't working, then we need to be innovative in new ways to make use of that money. If infection rates are doubling and the highest in Australia then I think a new approach is needed. Michael

How about a short real good film life look at HIV and what it does to life in 2012 what it does to one and all their family & friends. Maybe the hard look will bring condoms back. Christopher

You can't when guys know they have it and don't tell others they have it. Terry

I think that with the diversity of sexuality in our communities now, that HIV should be somewhat of standard testing, rather than just specific for QAHC or sexual health clinics, however, any group likes to be identified and that's where QAHC comes in. It would be great if somehow QAHC can continue but for a broader community rather than just for the homosexual community, as we are all sexual beings. Dave

Education is imperative along with easy access to condoms. Condom vending machines in schools should also decrease unwanted teenage pregnancies. HIV/AIDS is not a gay disease - its a virus that preys on people who have unprotected sex or share needles - simple as that.  David

So perhaps now is the time to start funding "the community" rather than "a community" initiative. After-all if the broader community is having issues with infection rates, surely the knowledge our community has gathered over the past many years is better off shared with all. I know, I know, I'm naive, I'm also non-political. John

Education and testing! We need to reach everyone (straight and gay!) and inform them of the consequences of unprotected sex! Eamonn

We have shock adds for car crashes and smoking but nothing for HIV. Bring back the grim reaper adds!! They left an impression on me as a young child. Keep people scared of the disease. Not continue telling them it's ok to be positive!!! All this positive promotion of HIV has helped spread it! Young guys are all to happy to become infected and take a tablet a day. Easy way to save the worry in the back of one's mind!! It is a shame the disease has taken its toll on so many Australians but at the end of the day it is a death sentence!! Let's make that clear again!! Kris

QAHC should fight this all the way. So they take 2.6 mill from QAHC and then give a race course in Brisbane 2 mill for track upgrade WTF? Darren

Further investigation needs to be made of who, how, when people are contracting HIV. I am sure it's not only gay men having unsafe sex in major cities. Aaron

Only an idiot would start from from scratch again when they show no interest in supporting the hetro's only, why would any intelligent being throw all the experience that HC have gained away? Gort

Perhaps QAHC's so called "failure" to reduce HIV transmissions as in other states could be because other state health departments and AIDS Councils have a better working relationship? The fact that senior public servants are resigning does not indicate that it is a productive workplace which engages with NGO's to provide services Anonymous

This has to be the most disturbing article I have seen in months !!! Come on people stand up for your rights and freedoms so far won. this would seem to be the start of a slippery slope to put everyone back in the closets! QAHC has done a great deal of good work supporting the LGBTI people from a place of understanding and fighting for improvements, is everyone just going to lie down and let Newman's underlings remove the LGBTI people and replace them with his pro right-wing Christian church thugs. Anonymous

Education = prevention LL

Why does it have to be "gay" vs "straight"? HIV is a disease, which affects people. If the current funding is being used well in "the gay community" but that "gay community organisation" isn't really help "the straight community" there's a fucking problem. We shouldn't have "gay" money and "straight" money. We should have money that should be directed towards lowering HIV rates, REGARDLESS of which fucking "community" you belong to. I don't want to detract from the work QAHC do - they do a bloody good job, but if they're ONLY helping one section, either a) expand who they help or b) redistribute the funding and start helping everyone. We're all fucking people, wtf we have to segregate ourselves I'll never know; other people do that enough for us, let's try to be inclusive. Brett