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How Australia Eliminated AIDS as a Public-Health Threat

The U.S. could be wise to take note.

By Madeleine Thomas


The Sydney Opera House and Harbour Bridge are lit red for World AIDS Day. (Photo: Lisa Maree Williams/Getty Images for RED)

AIDS is no longer a public-health threat in Australia, officials declared earlier this week. Thanks to a multi-pronged approach to battling the virus, the number of new diagnoses each year is now small enough to declare the epidemic effectively over.

Although more than 1,000 new HIV infections are still reported in Australia each year, the country could also stop the spread of infectionby 2020, experts say, through a continued push to make anti-retroviral treatments more accessible.

“Australia’s progress against AIDS is tremendous. We will never again in our communities have the horror of so many loved ones dying. We don’t have to worry that HIV will inevitably lead to illness and death,” said Darryl O’Donnell, chief executive officer of the Australian Federation of AIDS Organisations, in a statement on Monday. “But the job isn’t done. Too many people are still being diagnosed with HIV, and often they’re being diagnosed much later than we’d like.”

Officials attribute the milestone to public-health breakthroughs achieved by the immediate, country-wide grassroots mobilizationof gay men, sex workers, and drug users following Australia’s first reported death from AIDS in 1983. The country has experienced bipartisan success in combating AIDS, including state laws to decriminalize homosexuality; aggressive, if controversial, media campaigns aimed at gay men; and a universal health-care system that has made treatment affordable and readily available.

“Education reached all sections of the community,” wrote former High Court of Australia Justice Michael Kirby in the 2003 book, The AIDS Pandemic: Complacency, Injustice and Unfulfilled Expectations, describing the country’s success in curtailing new infections. “Sex education was introduced into schools. Condom distribution was stepped up. Free needle exchange was promoted. Law reforms were passed to proscribe HIV discrimination. Laws on homosexual offenses, drugs, and commercial sex work were changed.”

Australia’s drug policies—touted as some of the most progressive in the world—have gone a long way toward curbing HIV infection rates. The first clean needle and syringe programs began in 1986 in Sydney, just a year after the first case of HIV was reported in a drug injector. Now, there are more than 3,000 needle and syringe programs across the country, including a network of 24-hour vending machines that dispense low-cost sterile needles, syringes, and injecting equipment to drug users. Most of the machines are situated near hospitals, community and sexual health centers, and drug and alcohol centers.

Australia’s drug policies — touted as some of the most progressive in the world — have gone a long way toward curbing HIV infection rates.

Between 1991 and 2000, the Australian government invested some $130 million in needle and syringe programs, which, according to the Australian Government Department of Health, prevented 25,000 cases of HIV in injection drug users.

Similar efforts to curtail HIV infections in the United States have been less successful. While the number of new HIV diagnoses fell 19 percent from 2005 to 2014, more than 44,000 people were diagnosed with HIV that year, according to data from the Centers for Disease Control and Prevention. A decades-long ban on federal funding for needle and syringe programs was only just lifted by Congressional Republicans in January. As of last year, there were about 200 needle and syringe exchange programs across the country.

Although injecting drug users in Australia represented just 8 percent of HIV infections between 1994 and 2003, in the U.S., dirty needles are responsible for about one-third of all HIV infections between 1994 and 2000. Another telling comparison: In New York City, more than 17,000 cases of pediatric AIDS cases have been reported between injecting drug users and their children. But in New South Wales—which has one million fewer people than New York City—just 42 cases of pediatric AIDS have been reported among injecting drug users, according to a 2005 review of Australia’s Needle and Syringe Program.

In the early ’80s, following the first HIV/AIDS outbreak, sex workers also organized across Australia to address safe sex and to form national coalitions, like the Sex Workers Outreach Project and the Scarlet Alliance. Most of Australia’s states and territories either decriminalized or licensed sex work by the mid-’90s. New South Wales went a step further as the only state with full decriminalization; brothels were removed from police jurisdiction in 1995, and street sex work is only illegal if in view of a home, church, hospital, or school. (In the U.S., Nevada remains the only state to sanction prostitution.)

In the absence of anti-prostitution laws, data suggests that most sex workers will actually seek out and create safe-sex programs of their own. In the three years between 1985 and 1988, condom use among the clients of female sex workers in New South Wales increased from 5 percent to 88 percent, according to Scarlet Alliance. The organization also claims that a client has yet to become infected with HIV from an Australian sex worker. Even today, there is no mandatory state law in Australia to test sex workers for HIV.

There is still work yet to be done as officials now shift their efforts toward HIV prevention. “[T]he AIDS public health threat has morphed into an HIV prevention challenge.” said Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute (which leads the country’s HIV/AIDS surveillance), in a statement.

Cipri Martinez, president of the National Association of People Living with HIV Australia, echoed that sentiment:

Getting to zero new HIV infections in Australia means redoubling our efforts with vulnerable communities including, women, non-community attached gay men and people from non-English speaking backgrounds. These people are most likely to be diagnosed and treated late and can sometimes develop AIDS-defining conditions. Those few individuals can be confident that in most cases their symptoms can be quickly and easily addressed with effective treatments.

Australia’s success story could be a model for the world to follow; just a month ago, the United Nations announced a new global target to end the AIDS epidemic by 2030.