Australia Using Agressive Measures to Combat HIV/AIDS; U.S. Continues to Push Abstinence
Tuesday, August 19, 2008
Originally aired on September 27, 2007.
Tom Fudge: AIDS is a disease that seems to have become less of a threat in the developed world. But some groups are still at risk of infection. The gay community is one, but also intravenous drug users and people who work in the sex industry.
Some developed countries have taken aggressive moves to combat AIDS by providing free, clean needles to drug addicts. Some have also decriminalized prostitution in order to regulate it and keep it disease free. One such country is Australia.
- Kenny Goldberg, news health reporter for KPBS.
- Jennifer Blanchard, associate clinical professor of medicine at UCSD. She works at the Owen Clinic , which is UCSD's HIV/AIDS treatment clinic.
- Terry Cunningham, head of the HIV, STD and Hepatitis branch of the County of San Diego's Health and Human Services Department.
KPBS Health Reporter Kenny Goldberg Talks to Australian Professor Dennis Altman
Kenny: One thing I’ve noticed in Australia is that the government seems to have a fairly progressive policy regarding harm reduction and HIV vis a vis clean needle exchange, prostitution, I understand, is legal. I mean, what’s going on here?
Altman: Can I just say that’s a very American way of putting it? Because we could reverse the questions and say, “Why is the United States out of kilter with the rest of the first world?” The United States behaves like a third world dictatorship in most issues of policy related to HIV. I think what happened in Australia was we were very lucky in the sense that the epidemic began at a period when we had a very strong progressive federal labor government, which actually drove a number of policy initiatives. There were a whole set of social changes anyway taking place in Australia that enabled the government to, in a sense, to ride that wave. And the things that you’re referring to, and I’m thinking now very much in terms of contrast with the U.S., firstly, from the first cases, there was a recognition by the federal government that they needed to work with the gay community. And there was a whole set of policy advisory committees established that included the gay community – a very different response to what was happening at the same time in the U.S. under the Reagan administration. Secondly, there was a real sense that we could stop an intravenous needle driven epidemic if we quickly brought in the necessary technical policies, which really involved needle and syringe exchange, policies that reached drug users with a very clear message of not sharing needles, methadone treatment, etc. That was controversial, but again with strong federal government backing – again very unlike the U.S. – that was possible. The decriminalization of prostitution, which had been an ongoing issue already in Australia, and again it was argued very much on pragmatic grounds, and we all know in the United States, it’s an absolute classic example: you cannot criminalize activities that large numbers of people will engage in and expect this to work.
HIV/AIDS Statistics in the U.S.
♦An estimated one million people are currently living with HIV in the United States, with approximately 40,000 new infections occurring each year.
Kenny: How could you explain how politicians in Australia embrace a public health approach to these problems and that politics don’t intrude?
Altman: I think that’s there’s a different political tradition in Australia – a tradition which to some extent has broken down over the last 10 years under the current government. But it was a tradition that placed a much greater emphasis on social good and on evidence-based policy. The second thing I’d say is Australia is a much more secular country than the United States. The religious right does exist in this country, but has far less influence. Australia, by and large, finds it easier to separate faith-based morality from public policy. And the third point I’d make is in fact a historical accident that happened in this case to work very much in our favor. The on-set of the epidemic coincided, as I said earlier, with the election of a federal labor government and we had a minister for health who took a strong interest. In fact, one of the first things that the then minister did was to go on a fact-find tour to the United States. I was actually with Neal Blewett who was then the minister for a couple of days in San Francisco in 1994. And Neil met with all the different community organizations who were then setting up all the structures of response to the epidemic in San Francisco, which at that stage was leading, certainly on the west coast. What the minister took from that was a very important message that I don’t think Americans at a federal level ever got. Namely, if you’re going to do something to prevent the spread of HIV, you do it in partnership with the people most affected. Now, at that time, you had an administration in Washington that had an ideological agenda that made it very difficult. The concept of having a national advisory committee with sex workers and drug users and gay men sitting around the table talking to the minister was just not on in Reagan’s America. Very luckily for us, with the government we then had, it became established as the norm.
Kenny: Is that to say that your current government wouldn’t have approved these kind of policies?
Altman: It was a bipartisan approach, and when the federal government changed in ‘96, the first conservative minister for health continued the policies totally and was deeply committed. Since then, we’ve had two other health ministers and there has been some decline in the partnership. But, to be fair to the current government, they have not undercut any of the basic assumptions. And interesting, the current health minister, who is a devout Catholic and talks publicly of his faith and of its relevance to his politics, has made clear that although he personally may have problems with some of the things that are done, he recognizes that as a minister for health he has to follow the weight of evidence and the weight of public health expertise. And I think that’s actually a really good example of how once policies have been implemented and have been shown to work, politicians in a sense get trapped. They cannot repeal successful policies if the consequence will be an increase in infections. Certainly a minister of health who did that would look very silly.
Kenny: Well, you know, in the United States, they preach abstinence. They won’t even consider federalizing clean needle exchange programs. How do you look at that from afar?
Altman: I think that we would understand that the United States is a much more complex society and a much more religious society than Australia. We’d also recognize that there are huge regional variations. There are certainly some local jurisdictions in the United States and some of the city governments and country governments in California have indeed risked breaking federal laws in order to institute things like needle exchange. So, I don’t want to get into an American-bashing exercise at all. I would say that the great difference really is the sort of leadership that comes from the federal government. And I would say that under President Clinton, who after all didn’t have the same links to the religious right that either his predecessor or his successors have had, a great opportunity was lost. And I think if Donna Shalala could be sitting here with us and could say what she really thought, I suspect she would agree entirely: they fucked up.
KPBS Health Reporter Kenny Goldberg Interviews Austalia Sex Worker
Kenny: Americans see this business as degrading and as exploitive. How do you see it?
Female: I don’t see it like that at all. I feel that everyone has the right to choose whatever occupation they choose. They have the right to explore the option to follow a certain career path. They have the right to stay or to move around within the industry that they choose. And they also have the right to leave the industry and to change occupations when they like. And all the way through this process, no one deserves to experience discrimination or stigma through their choices. And everyone should expect the same amount of respect and the same amount of rights – no matter if you’re a garbage collector, whether you’re a bank teller, whether you’re a lawyer, a politician, a journalist or a sex worker.
Kenny: So it sounds like you’re saying sex work’s no different from any other profession.
Female: That’s correct. People get very stuck up, and stuck in, the idea of this “sex with anonymous people.” The reality is people have sex with anonymous people all the time. Go to any bar, go to any club, go to any festival, and it’s happening everywhere. And no one minds that at all. It’s only when there is a negotiated exchange of services for money or other goods that people seem to get hung up on it. But in fact, when you’re a sex worker and you’re exchanging your services for money, then you actually can be in a more empowered environment, and you have a better chance of being able to say, “No, I will do this. And I won’t do that,” than if you are drunk at a bar at 2 in the morning, picking someone up and going home with a stranger where no one knows where you’re going. Sex workers are very empowered in the right circumstances when they’ve got a lot of support. And we negotiate what we do and don’t do. So, people shouldn’t be hung up on what we do.
Kenny: Could you describe how your clients hook up with you on a typical day or a typical call. How does it work for those that don’t know anything about it?
Female: Like I said, the diversity of the sex industry is quite broad, so when I was working in the massage parlor or a full service brothel, then some of those places are very well known, either through word-of-mouth – through having been there for 20, 30, 40, 50 years – or also advertising, so they may just turn up and the receptionist would let them in. Now being a private independent sex worker, I advertise and I answer my own phone, so I negotiate with my clients that way, and I have a system where by if both of us agree to me providing a certain service and them looking and wanting to pay for a certain service, then they will end up at my place on a very discrete appointment-based system only.
Kenny: And do you insist that your clients wear condoms?
Female: Of course. I mean, once again, if you would go to a surgeon, would you be asking, “Do you always wear gloves?” Do you ask a gynecologist or a dentist, “Do you always scrub your hands? Do you always use gloves and safety procedures?” For the sex industry, it’s the occupational health and safety standards, and in Australia the sex industry were one of the 1st sections of the community, when HIV came through, that really got together and it was self-regulatory. They were one of the first community groups that were insisting on condoms, that were using condoms at a very, very high level throughout the population. And from that, it is clearly shown through statistical research that the Australian sex industry has one of the highest level of sexual health. And in fact, has a very, very low rate of HIV and other STIs prevalent in the sex industry – a lot lower than in the general population.
Kenny: And how old are you? I’m sorry, I didn’t ask.
Female: (Laughing.) We never give out our age. I’m in my early 30s.