Communities Respond to HIV: Research Partnerships at the NCHSR

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Communities Respond to HIVResearch Partnerships
at the NCHSR

• May 2006

Susan Kippax Heather Worth
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Summary of HIV in Australia

• First diagnosis of HIV in 1983 homosexual
  transmission
• Increasing HIV incidence peaking in 1986/7
  dropping to around 600 new diagnoses per year
  (and has remained at this level)
• HIV transmission was and continues to be confined
  mainly to homosexual transmission and among gay
  identified and gay community engaged men (about
  80 -85 of all cases)
• There is little HIV among injecting drug users
  (around 4-5) and small but increasing proportion
  among heterosexuals
• Heterosexually driven transmission occurs
  disproportionately among migrants and refugees
  and among Indigenous population

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Social Health in Partnership

• Success was marked by a genuine partnership
  between government, communities affected by HIV,
  and researchers
• The partnership between researchers and
  communities was reflexive and each partner
  brought a different expertise to the table each
  informed and was informed by the other
• Policy was informed by the research/community
  partnership
• Governments/states resourced and enabled
  researchers to research and communities to
  advocate and educate their constituents

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What Worked and Continues to work?

• Communities will continue to sustain safe sex/
  safe injecting if informed and resourced so they
  can continue to support and educate their members
  
• Research and Governments enable
• Community norms are changed in response to
  threat of disease, changes in medicine and
  understandings of own sexual and other practices
• Social change normative structures
• Community members come together and exercise a
  collective rational agency
• Collective Agency

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Social Research in Health

• Effective strategic social research in HIV,
• hepatitis C and STIs /sexual health is
  dependent
• on
• multi-disciplinary teamwork psychology,
  sociology, anthropology, economics, politics
• collaboration with medical, epidemiological and
  public health researchers
• engagement with affected communities and NGOs
• ensuring research informs policy and practice

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Mechanisms Research Training Capacity
Building

• Reflexive practice communities and researchers
  working together
• Research Link/Liaison positions between NGOs
  and NCHSR
• Advisory committees
• Dissemination strategies
• Building research capacity in government and
  non-government organisations
• MA (Research) in Health, Sexuality and Culture
• Internships
• Workshops
• Training of PhD and MA (research) students

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Partnership Outcomes

• Getting research into policy and practice
• Knowledge transfer
• Research capacity building of government and
  non-government personnel
• Building social science research capacity in the
  region

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NCHSR Mapping of Risk

• Research in this area provides
• Monitoring risk practices and understandings of
  risk among those at risk of HIV, hepatitis C and
  STIs in the context of their social and personal
  lives
• Identification of harm reduction strategies
  adopted by those at risk with reference to their
  understandings of risk and their appropriation of
  medical and other knowledges

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Studies Mapping of Risk

• HIM and pH cohort studies of HIV-ve and HIV gay
  men
• Periodic Surveys of populations at risk
• homosexually active men in most states and
  territories in Australia
• young drug users in New South Wales
• Australian Study of Health and Relationships
• Sexual health of Australian prisoners
• Behavioural surveillance studies, Sri Lanka

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Trends in unprotected anal intercourse with
casual partners (full samples)

Sig. upward trend 2001-2005
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Trends in HIV testing in previous 6 months by
age category Sydney, Queensland and Melbourne
GCPS (non HIV-positive men)
Sig. downward trend 2001-2005
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Negotiating the Medical

• The studies undertaken here
• Examine the interface between health/illness and
  clinical practice in regard to the experience of
  living with disease, and the experience of the
  clinic
• Identify barriers and incentives to uptake of and
  adherence to treatment, including social and
  cultural factors
• Examine changes in community structures in
  relation to the introduction of new technologies
  ART, PEP, and recreational drugs

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Studies Negotiating the Medical

• Positive health (pH) cohort study
• Straightpoz study heterosexual men and women
  living with HIV
• Living with HIV stories of Indigenous
  Australians from Western Australia
• Barriers to HIV testing among people from
  non-English speaking backgrounds
• The experience of living with side effects

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PLWHA on ART at time of interview NSW PH,
Sydney, Queensland and Melbourne GCPS

Sig. downward trend
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Trends in serosorting with UAIC partners pH
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Cultural, Social Political Dynamics

• These studies raise broader issues. They are
  largely funded externally (by ARC or NHMRC). They
  are typically not strategic research and
  therefore they are unlikely to be funded by
  governments.
• the social and cultural production of risk and
  health-seeking behaviours
• the impact of public health and related policies
  on health and illness

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Studies Cultural, Social Political
Dynamics

• Analysis of the HIV/AIDS epidemics in Indonesia,
  PNG and East Timor (epidemiological, economic and
  social)
• Positioning of Responsibility, Autonomy and
  Agency in the seroconversion narratives
• Constructions of risk among long term injecting
  drug users attending the Medically Supervised
  Injecting Centre
• Pleasure consuming medicine an investigation of
  the political investment in notions of drug
  misuse

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Some Outcomes

• As well projects on a range of issues, this area
  of research has led to theoretical discussion and
  papers on a number of central topical/ issues
  including
• Impact of roll-out of testing
• The prevention-treatment nexus
• Globalisation of HIV medicine, moral
  conservatism and religion
• Future challenges for social research in HIV

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Current Challenges (1)

• Over the past three years in Australia there has
  been an increase in HIV among gay men - even
  though unprotected anal intercourse has not
  markedly increased. Why?
• HIV population viral load has increased (at the
  same time that successful treatments have meant
  that there are more people living with HIV, there
  has been a down-turn in the proportion of PLWHA
  on ART)
• Other possible factors
• The increase in STIs
• Cultures of sexual adventurism (esoteric sex,
  crystal and viagra use) and within this culture
  large partner numbers
• Growth of the sexual market place (Internet, sex
  parties,)

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Current Challenges (2)

• Some changes in safe sex strategies adopted by
  gay men the impact of Serosorting
• Place of
• Testing and
• Disclosure
• While serosorting makes sense for HIV-positive
  men it is extremely problematic for
  HIV-negative men (except under certain
  conditions)
• What does it mean to be told that one is
  HIV-negative?

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Time since last HIV test and UAIC among
HIV-negative gay men Sydney, Queensland and
Melbourne GCPS
Sig. downward trend
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Current Challenges (3)

• In Australia
• The sustaining of safe sex in the context of
• Living with HIV for over 20 years
• Government and community complacency (treatment
  optimism)
• In Asia and the Pacific (including Australia)
• Seeming unwillingness to address the social and
  cultural impact of biomedical prevention
  initiatives such as circumcision and PreP
• Treatment advances and associated increasing
  medicalisation and marginalisation of
  behaviour-related prevention
• Myth that behaviour-related prevention has
  failed and that treatment provides the solution