Victorian HIV strategy 2017-2020 - Living Positive Victoria
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Victorian HIV strategy 2017–2020
The Department proudly acknowledges Victoria’s Aboriginal community and their rich culture and pays respect to their Elders past and present. We acknowledge Aboriginal people as Australia’s first peoples and as the Traditional Owners and custodians of the land and water on which we rely. We recognise and value the ongoing contribution of Aboriginal people and communities to Victorian life and how this enriches us. We embrace the spirit of reconciliation, working towards the equality of outcomes and ensuring an equal voice.
Victorian HIV strategy 2017–2020
To receive this publication in an accessible format phone (03) 9096 1790 using the National Relay Service 13 36 77 if required, or email bbvsti.information@dhhs.vic.gov.au. Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, June 2017. Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. This publication may contain images of deceased Aboriginal and Torres Strait Islander peoples. Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a report, program or quotation. ISBN 978-0-7311-7261-0 (Print) 978-0-7311-7262-7 (PDF/online) Available at https://www.health.vic.gov.au/sexualhealth Printed by Finsbury Green, Melbourne ii
Contents
Minister’s foreword iv
Our vision 1
Introduction 3
HIV in Victoria 6
What you told us 8
Prevent10
Test13
Treat14
Stigma and discrimination 17
Victorian HIV strategy 18
Priority focus area 1: Victorians are supported to
prevent HIV transmission 20
Priority focus area 2: Victorians with HIV will know their status 23
Priority focus area 3: Victorians with HIV have access to best
practice evidence-based treatment and care services, and are
supported to achieve an undetectable viral load 24
Priority focus area 4: Victorians and affected communities are
empowered to speak up about stigma and discrimination 27
System enabler 1: The Victorian workforce has the skills,
knowledge and attitudes needed to deliver best practice
HIV prevention, testing, treatment and care 28
System enabler 2: Victoria’s service systems across the
continuum of prevention, treatment, care and support
are coordinated and integrated, and meet the needs of
people living with and affected by HIV 31
System enabler 3: HIV services and outcomes are improved in
Victoria by supporting research and evaluation, and improving
the quality and completeness of data 32
Next steps: toward 2020 and 2030 34
Victorian HIV strategy 2017–2020 iii
Minister’s foreword
I am delighted to release the Victorian HIV strategy 2017–2020.
Our vision for people living with To achieve our bold targets we
HIV now is that they are able to must build on these successes,
lead long and healthy lives and and make prevention tools
participate fully in a Victoria like treatment as prevention
free from discrimination. and pre-exposure prophylaxis
This HIV strategy sets out easily understood and more
our pathway to this vision accessible, while sustaining
built around four key pillars: and revitalising traditional HIV
prevention, testing, treatment, prevention strategies such as
and the elimination of stigma condom use and safer injecting
and discrimination. practices. We must also
continue our efforts to research,
For the first time, eliminating
We are at a pivotal moment in trial and evaluate advances
stigma and discrimination
the HIV response. Our research, in testing technology and
is now front and centre in
policy and service delivery treatment.
our approach. The Andrews
innovations have created the
Labor Government wants to In undertaking these efforts,
opportunity, for the first time,
make it clear that stigma and we must never lose sight of
to virtually eliminate new HIV
discrimination experienced what matters most: the health
notifications in Victoria.
by people living with HIV is and wellbeing of people living
Victoria has been at the completely unacceptable. with, affected by, and at risk
forefront of pre- and post- of HIV. This is a period of
Ongoing consultation with the
exposure prophylaxis, treatment hope. Together we have the
sector and collaboration with
as prevention, the promotion opportunity to create a better
affected communities has
of risk-reduction practices and future for those living with and
informed and strengthened
the elimination of stigma and affected by HIV.
our approach. Now, in
discrimination. Our history
partnership with these and
of community activism and
other stakeholders, we will lead
advocacy, in partnership with
this charge to reinvigorate and
clinicians, researchers and
refocus our efforts to achieve
governments, has helped
our vision.
Australia maintain one of the The Hon. Jill Hennessy MP
lowest rates of HIV in the world. Minister for Health
iv
Our vision
By 2020 we aim to virtually eliminate
new HIV transmissions.
By 2030 Victoria will eliminate stigma
and discrimination associated with HIV
and achieve the 95-95-95 targets for
diagnosis, treatment and viral suppression.
Our objectives
Victorians are supported Victoria will sustain the virtual
to reduce their risk of elimination of HIV transmission
contracting HIV. among sex workers and from
mother to child.
Victorians with HIV know
their status. Victoria will sustain low rates
of HIV transmission among
Victorians with HIV will have
both people who inject drugs,
access to best practice
and also among Aboriginal and
treatment and care.
Torres Strait Islander people.
People living with HIV (PLHIV)
With this strategy Victoria
and affected communities are
will set bold targets to increase
free from HIV-related stigma
prevention, testing and
and discrimination.
treatment, and to reduce
stigma and discrimination.
“Overcoming HIV stigma is our greatest challenge.
When people live with fear of disclosing their HIV
status, are faced with ignorance and dismissed
by their families and communities or have to face
unnecessary scrutiny of health care providers then
shame overshadows their lives.”
Brent Allan
Chief Executive Officer
Living Positive Victoria
Victorian HIV strategy 2017–2020 1
“Victoria has a remarkable
opportunity to harness the
momentum in HIV science,
policy and advocacy to achieve
our ambitious goals: eliminating
new HIV transmissions by 2020
and improving the lives of
people living with HIV.”
Associate Professor Edwina Wright
The Alfred Hospital and the
Burnet Institute
2
Introduction
Recent significant advances in science, research and
technology make Victoria’s ambitious time-bound HIV
targets entirely achievable.
The introduction of antiretroviral health services have been to the greater and meaningful
therapy in the mid-1990s enabled developed, led and delivered involvement of people living with
people with HIV to live longer by affected communities. This HIV. The Greater/Meaningful
and healthier lives. Over the world-class response is defined Involvement of People Living
past 10 years, the effectiveness by a unique partnership with with HIV/AIDS (GIPA/MIPA)
of antiretroviral therapy has community members, clinicians principles underpin this strategy,
improved considerably, changing and researchers. The Victorian and are the backbone of the
the clinical care needs of people Government is committed to Victorian partnership model.
living with HIV. As demand for maintaining and strengthening
Achieving the vision outlined
inpatient care has declined, this partnership.
in this strategy will require the
demand for community-
This HIV strategy provides Victorian HIV partnership to
based care and support has
a comprehensive plan for have a holistic understanding
grown. With it, new challenges
achieving the strategic of the individual within a social
associated with ageing and
directions for sexual and model of health framework.
chronic conditions have
reproductive health outlined in People will not be viewed
emerged. More recently, new
in the Victorian public health solely through the lens of their
science has driven significant
and wellbeing outcomes HIV status, but understood
advances in biomedical
framework 2015-2019. This will in the context of their social,
prevention and treatment
assist in tracking progress environmental, economic and
strategies for HIV.
and outcomes, and provide cultural status. By partnering
HIV continues to disproportionately a transparent approach to with communities, organisations,
affect gay and bisexual men. monitoring and reporting. In and the individuals they
While it has never been confined addition to the target of the represent, the Government can
to a single population or virtual elimination of new better understand and support
community, our awareness of HIV transmissions by 2020, the actions necessary to
how it affects different people the Victorian Government is improve their collective health.
has changed and increased. committed to combination
This strategy provides the
prevention strategies,
In the context of this change, framework and rationale for
increased testing rates for all
there is an opportunity and a whole-of-system approach
sexually transmissible infections
responsibility to strengthen to designing, targeting and
(STIs), access to treatment, and
the current service system evaluating Victoria’s system
the promotion of safer sex and
to ensure greater integration of HIV care. This system will be
harm reduction practices.
between mainstream primary sensitive and responsive to the
and community care and The Victorian Government changing needs of people living
specialist programs. recognises that the experience with and affected by HIV, and
of discrimination and stigma will work to ensure a refreshed
Victoria’s HIV response has been
remains an obstacle to people approach to integration along
defined by successes across the
seeking important prevention, the continuum of prevention,
spectrum of health promotion,
treatment, support and care testing, treatment and care.
prevention, testing, treatment,
services. Victoria is committed
workforce development and
surveillance. Victorian HIV
Victorian HIV strategy 2017–2020 3
Introduction (continued)
Importantly, this strategy will
also focus on building a clinical What is HIV?
HIV prevention and treatment
HIV (human immunodeficiency virus) is a virus that infects cells
system to coordinate access
of the immune system, destroying or impairing their function.
to pre-exposure prophylaxis
As the infection progresses, the immune system becomes
(PrEP), post-exposure
weaker and the person is more likely to be affected by other
prophylaxis (PEP), testing
infections and illnesses.
and treatment where people
live, through primary and If untreated, HIV infection can progress to AIDS (acquired
community care. Undertaking immunodeficiency syndrome). This means the body is unable
individual, community and to fight off most infections and illnesses. AIDS usually takes
system-level engagement many years to develop. In Australia, because treatment is
about the range of available widely available, very few people develop AIDS.
combination prevention
HIV is most commonly transmitted through sex without a condom
activities will renew Victorian
or through sharing needles and other injecting equipment.
efforts to virtually eliminate new
HIV transmissions by 2020 and With the success of antiretroviral therapy, HIV infection is now
achieve the 2030 diagnosis, considered a chronic condition rather than a fatal disease, as
treatment and undetectable these treatments can effectively manage and suppress it.
viral load targets.
Importantly, these treatments can effectively reduce the viral
load in people living with HIV to undetectable levels, meaning
that the risk of transmitting the disease to others is negligible.
HIV, wellbeing and the social determinants of health
HIV cannot be viewed in isolation. Many people violence, and the ability and autonomy of
living with or at higher risk of HIV experience people to manage their own health. All of
other conditions and complexities that affect these can affect the ability of people to adopt
their ability to manage their HIV, or their risk prevention strategies, test regularly for HIV
of contracting it. and other STIs, or adhere to HIV treatments.
Prevention, testing, treatment and stigma In supporting them to manage their health,
must be viewed in the context of various factors clinicians and community organisations
including: gender and gender identity; race, must consider these factors in providing
nationality and linguistic identity; disability; comprehensive care to affected people
education, employment, income and housing and communities. This requires all sectors
status; mental health; and other medical of the HIV response to collaborate on the
conditions. An effective HIV response must also development of clear, robust linkage strategies
consider personal and contextual factors such and referral pathways, ensuring everyone is
as the power dynamics within relationships able to access the care they need.
and social groups, family and intimate partner
4Changing health needs –
HIV and ageing
Across the developed world, people living with
HIV are ageing. With this comes increasing
complexity and comorbidities.
As this population ages, gaps in service provision
become evident, as do opportunities to evolve
programs that will enable people to age well
with HIV.
In 1985 the proportion of people living with HIV in
the over-55 age group was 2.6 per cent. By 2000 it
was 10.9 per cent, and by 2010 it was 22.3 per cent.
It is estimated that by 2020 the number of
people living with HIV aged over 55 years in
Victoria will be 38.5 per cent.
Our efforts should be directed to understanding
the long-term health consequences of HIV as the
population of people living with HIV ages.
Compared with the general population,
people living with HIV are at higher risk for
diseases associated with the ageing process,
including cardiovascular disease, osteoporosis,
neurocognitive dysfunction and some cancers.
“Visibility is crucial for people living
with HIV. Each of us has different
needs based on our individual
identity and personal experience.
We need to support the
minorities within the minority
– women, Aboriginal and
Torres Strait Islander people,
and others – to help them
live well with HIV.”
Bev Greet OAM
Co-founder
Positive Women Victoria
Victorian HIV strategy 2017–2020 5HIV in Victoria
There are more than 7,800 people
living with HIV in Victoria.
Figure 1: Victoria’s progress Over time, the population of
against the 90-90-90 2020 people with HIV in Victoria has Did you know?
targets, December 2016 increased for several reasons,
including dramatically reduced
Melbourne is Australia’s
There are more than mortality due to the availability first Fast-Track City
7,800
of highly effective antiretroviral The Victorian Government,
therapies, migration of in partnership with the
people with HIV to Victoria City of Melbourne, has
Victorians living
from interstate and overseas, committed to a global
with HIV
and new transmissions. initiative to fast-track local
90%
In Victoria, men who have responses to HIV and AIDS.
sex with men – including gay The goal of Fast-Track Cities
and bisexual men – is the is to attain the UNAIDS
know their status
population most affected by 90-90-90 targets: 90 per
HIV. There are several known cent of people who are HIV-
of these risk behaviours associated positive know their status;
84%
are on treatment
with HIV transmission. The
most commonly reported
exposure to HIV in Victoria is
90 per cent of people who
are HIV positive are on
treatment; and 90 per cent
with antiretrovirals condomless anal intercourse of people on HIV treatments
without the use of biomedical have an undetectable viral
prevention strategies. load (see Figure 1).
and
78%
Almost one in five notifications Melbourne and Victoria
occur among other priority are among the most
populations such as women, successful Fast-Track
of those on treatment have travellers, Aboriginal Victorians, Cities participants to date.
an undetectable viral load young people and people from Along with Amsterdam,
culturally and linguistically San Francisco and Denver,
diverse communities. Melbourne has already
With increased use of PrEP, achieved its diagnosis
better understanding of target, and has some of the
treatment as prevention highest rates of treatment
(TasP), increased community and undetectable viral load
awareness and use of risk- in the world.
reduction practices, increased
migration and mobility between Victoria has been extremely
Victoria and high-prevalence successful in sustaining the
countries, and different virtual elimination of HIV
patterns of drug use, the transmission among sex workers
diversity, size and demography and from mother to child.
of Victoria’s HIV epidemic is Victoria has also successfully
continually changing. sustained a low incidence of HIV
in both Aboriginal people and
6 in people who inject drugs.Victoria’s priority populations
As the demographic profile of challenges these populations
HIV changes in Victoria we have face when living with or at
an urgent challenge, as well as risk of HIV. Both experience
an opportunity, to focus our significant disadvantage as
efforts on those who are most a result of the intersection of
vulnerable and most affected gender and gender identity
by HIV. These people include: with other socioeconomic
• people living with HIV factors, placing them at
greater risk of harm.
• gay, bisexual and other men
who have sex with men The Government acknowledges
• Aboriginal and Torres Strait that HIV can affect anyone,
Islander people regardless of whether they
• culturally and linguistically belong to a priority population.
diverse and refugee Victoria also acknowledges
communities that there are specific sub-
population groups, such as
• people from or who travel
international students, people
to high-prevalence countries
with disability, older people
• people who inject drugs
living with HIV, people who are
• prisoners co-infected with other blood-
• sex workers borne viruses (BBVs) and rural
• young people and regional residents, who will
• transgender and gender require tailored responses.
diverse people People living with and affected
• women at greater risk of HIV by HIV are central to Victoria’s
HIV response. Their experience,
The Victorian Government is
engagement and participation
strongly committed to equality
are essential in the development
regardless of gender or gender
of our programs and policies.
identity. Accordingly, this
People living with HIV must be the
strategy includes both women
focus of – and equal partners in
and trans and gender diverse
– their treatment, care and other
people as priority populations
decisions that affect their lives.
in their own right. This strategy
recognises the unique
“Our renewed focus on prevention, testing and
treatment must be mindful of the diversity of people
affected by HIV. Our collective efforts must consider
the whole person – not just their risk factors – and how
stigma impacts their engagement and wellbeing.”
Associate Professor Mark Stoové
Head of Public Health Discipline Victorian HIV strategy 2017–2020 7
The Burnet InstituteWhat you told us
The Victorian Government consulted with a wide range
of people living with and affected by HIV, as well as
the community, health professionals and researchers.
These consultations focused on prevention, treatment
and care, bringing together participants from a diverse
range of backgrounds and organisations.
The numerous ideas and comments summarised below reflect the energy and
enthusiasm of all involved to be part of a bold new vision for HIV. This invaluable
process helped inform Victoria’s strategic response to HIV.
‘Our society is changing and we are slowly gaining equality including naming
racism, trans and homophobia. HIV stigma is still very real. We have to work
together to ensure no one is left behind.’
‘Our services should reflect the changes that we are seeing and that they should
also be welcoming and safe for all people with or affected by HIV.’
‘We are at a pivotal point in the epidemic. We have exciting new tools and
science driving our ability to eliminate this virus. We must do everything to use
these opportunities.’
‘If we keep doing more of the same, we will get more of the same. It is time to do our
work differently, to be bold and innovative and move from merely managing this
epidemic to eliminating it.’
“Victoria’s inclusion of women as a priority
population is a significant step in addressing the
stigma, discrimination, and violence experienced
by women living with and at greater risk of HIV.
Our strength and resilience will help Victoria
end the HIV epidemic.”
Christabel Millar
Health Promotion Coordinator
Positive Women Victoria
Board of Directors
Living Positive Victoria
8Overview of consultation findings
• There have been significant • Scientific advances mean
achievements to date in HIV our services need to change
prevention and in challenging to capitalise on these.
stigma and discrimination,
• Models of care need to be
setting a positive precedent
collaborative, integrated,
for continuing success into
coordinated, linked to other
the future.
services and supports, and
• Legislative reform in Australia tailored to the individual/
has introduced a broader population. It was reiterated
acceptance, visibility and that empowerment of
mainstreaming of lesbian, gay, individuals and peer-led
bisexual, transgender and strategies will be critical to
intersex (LGBTI) communities. future success.
This has affected how
• Across all priorities the
connected people are
importance of targeting
to either mainstream or
and tailoring to diverse
LGBTI communities.
populations was emphasised.
• Technology and social media Of note, international students,
changes are reworking women at greater risk and
the way in which people travellers were highlighted as
are forming relationships, populations requiring targeted
socialising, connecting to and tailored programs.
communities and accessing
• Community health literacy,
health information and
sexuality education in schools
support. This is most
and clinical education present
apparent in people under 30 “It’s important for the
important opportunities to
years of age and presents
make real gains across all
HIV sector to listen to
opportunities for evolving our people from culturally
objectives.
prevention responses.
• There is also a significant
and linguistically
• There is a shared vision
need to continue to address diverse backgrounds.
for revitalising primary
stigma and discrimination, Understanding them
prevention, increasing early
detection and facilitating
improve workforce capacity, is important to better
and undertake further prevention and
early and rapid access to
targeted research.
treatment commencement. treatment of HIV.”
The refreshed strategies put
• Normalising and increasing Cristian Cortes Garzon
forward by participants had
testing and integration with Systems Project Officer
common elements of multi-
STI testing, and introducing Living Positive Victoria
sector partnership, community
an annual testing day, were
collaboration and peer leadership, Co-founder
all highlighted, as were
all of which set a basis for building LGBTI Latinx and Hispanics
innovative peer-led and social
collective impact for change. in Australia
media approaches.
Victorian HIV strategy 2017–2020 9Prevent
In the past five years, new evidence has
driven significant advances in biomedical
prevention and treatment strategies for HIV.
Combination prevention relies can reduce the risk of HIV
on the use of new rapid HIV transmission by around 99
testing technologies, biomedical per cent. It is transforming
approaches such as PrEP prevention efforts across the
and TasP, and community world. This is a game-changing
mobilisation and behavioural tool for preventing HIV.
strategies all working together
Increased awareness of PrEP,
to reduce the transmission of
TasP and undetectable viral load
HIV (Figure 2). Combination
has changed how individuals
prevention conceives of the role
and communities view HIV.
of treatments in a new way. In
It has prompted important
addition to its health benefits for
conversations about prevention
people living with HIV, treatments
and HIV status and had a
prevent onward HIV transmission
profound impact on HIV stigma.
by reducing the virus to
undetectable levels. It is essential to retain a central
focus on condom use and harm
Treatment as prevention (TasP)
reduction efforts in preventing
is one element of combination
transmission. Condoms and
“Victoria has a proud prevention. It is a term that
harm reduction approaches, like
describes the use of antiretroviral
history of community needle and syringe programs,
therapy to reduce HIV viral load
activism, in many ways not only protect against HIV but
to undetectable levels, preventing
also other BBVs and STIs. We
leading the country onward transmission of infection.
must incorporate and increase
in the HIV response. In this way, treatment is now
access to new biomedical tools
By breaking down being used as a community-level
and approaches.
prevention strategy.
barriers and forging
partnerships across the Improved understanding of TasP Figure 2: Key elements in the
and undetectable viral load has fight against HIV
sector, as we’ve done
resulted in a highly effective
with PrEP, Victoria can intervention being added to the Condoms
support communities growing suite of HIV prevention
to take charge of their strategies. It underlines the
importance of developing rapid PrEP
own health.”
linkage to care models, building
Chris Williams,
Co-founder
the primary care workforce to PEP
improve regular screening, and
PrEP’d for Change supporting treatment uptake
Michael Whelan and adherence. TasP/undetectable
Vice Chair PrEP is another highly effective
viral load
PrEPaccessNOW tool for HIV prevention. Clinical
studies have shown that, Harm reduction
when taken consistently, PrEP
10PrEPX study Taking action to prevent HIV
PrEPX is a landmark public health research study In addition to well-established
launched in 2016 that aims to provide HIV prevention prevention programs, the government
medication to 3,800 Victorians at greater risk of HIV. is implementing innovative and bold
The plan is to decrease HIV notifications by up to 25 approaches to achieving its prevention
per cent over the coming years. The PrEPX study is targets. Victoria’s response supports the
a co-designed and co-funded initiative between the development and funding of community-
Victorian Government, Alfred Health and the Victorian led campaigns and services that have
AIDS Council. The study will reorient the Victorian HIV been able to adapt to rapidly changing
testing and treatment model to achieve the target of science and technologies.
the virtual elimination of new HIV infections by 2020.
Importantly, the design of the study embeds access to
PrEP within primary care. This model provides a platform
“To improve sexual health
for supporting a comprehensive approach to improving
sexual health testing and treatment for Victorians at screening among communities
higher risk, potentially tripling the annual volume of like trans and gender
tests conducted. diverse people, we need to
Unique to the PrEPX study is the involvement of a understand the unique
number of community pharmacies, which have been and diverse needs of each
engaged to dispense PrEP to enrolled participants person. A one-size-fits-all
to support accessibility and a familiar model of care.
approach will not work.”
PrEPX has been implemented across metropolitan
Melbourne and rural and regional Victoria. Jeremy Wiggins
Co-founder, PASH.tm
PrEP guidance for practitioners
Project Lead
The Victorian guidance on PrEP is now available Victorian AIDS Council
online at . It provides medical
practitioners with information on PrEP for preventing
HIV transmission and supports a high standard of
sexual health care when PrEP is prescribed.
PEP program
The administration of PEP for HIV represents secondary
prevention when primary prevention has failed. It
involves the use of medication (typically a combination of
antiretroviral drugs) within 72 hours to reduce the risk of
HIV transmission following a known or possible exposure
to infected blood or body fluids.
The Victorian PEP program works on a hub-and-spoke
model, with Alfred Health as the central hub providing the
primary access point. People who need PEP are referred
to the closest ‘spoke,’ which includes selected general
practitioners such as s100 prescribers, hospital emergency
departments or infectious diseases units, and sexual
health clinics across metropolitan and regional Victoria.
The antiretroviral treatments are funded and distributed
by Alfred Health to the PEP providers as required.
Victorian HIV strategy 2017–2020 11PRONTO!
PRONTO! is a peer-led,
community-based rapid
testing service run by the
Victorian AIDS Council, in
partnership with the Burnet
Institute. It facilitates easy “Effective HIV prevention
and frequent testing, which is more than providing
is critical to helping people condoms and PrEP.
know their status and linking
People at risk of HIV need
them into treatment.
information tailored to their
PRONTO! has increased its
particular needs, provided
reach through innovative
outreach strategies, and in places and communities
expanded its services. It now where they are safe and
offers STI screening, and is supported, living free from
co-located with Equinox, a stigma and discrimination.”
dedicated general practice
for trans and gender Simon Ruth
diverse people. Chief Executive Officer
Victorian AIDS Council
12Test
In recent years, innovative models of HIV testing have emerged
from new technologies and service redesign, improving access
to and frequency of testing and reducing waiting times for results.
To significantly increase HIV testing in populations at greater risk,
diversifying testing models and approaches should be central to
efforts to remove barriers so more people can test more often.
HIV testing is a key HIV remove barriers to testing and Regular testing also provides
prevention strategy for priority improve knowledge about the opportunity to test for
populations in Victoria and the need for regular testing other STIs and to reinforce
Australia. It aims to decrease among health professionals information about prevention
the number of people who and the community. messages and options.
are unaware of their HIV
Behavioural survey data
status. A growing body of
indicates that fear of stigma
evidence suggests that early
in health settings, the Melbourne
detection of HIV promotes early
commencement of antiretroviral
inconvenience of some current Sexual Health
treatment, before the immune
testing models, off-putting Centre Test and
clinical testing environments
system sustains significant
and difficulties in getting Go (TAG) clinic
damage. This leads to positive
appointments are common Test and Go (TAG) is
outcomes such as protection
barriers to testing. Home-based Melbourne Sexual Health
against opportunistic illnesses,
HIV testing could potentially Centre’s innovative
non-AIDS conditions such
address some of the barriers nurse-led sexual health
as cardiovascular disease
and may also be useful for testing service for gay
and cognitive impairment,
people who may otherwise and bisexual men and
and overall mortality. Earlier
be reluctant to return for other men who have sex
detection of an HIV infection
test results and/or to access with men. TAG provides
depends on increased coverage
traditional testing services. a convenient express
and frequent testing.
Models of care, including service offering 15-minute
Testing efforts should focus appointments, with tests
specialist outreach and
on identifying people with HIV for HIV, syphilis, chlamydia
consultancy, counselling and
who remained undiagnosed, and gonorrhoea.
rapid links into primary care
and providing support and
must adapt to support these The appointment involves
referral pathways to rapid
more flexible testing approaches. a short meeting with the
linkage to health care. It is
By expanding our targeted nurse followed by self-
critical to normalise HIV testing
sexual health screening and collection of samples
and to build a culture of early
BBV testing efforts through local for testing.
and regular screening for
primary and community care
priority populations such as
services we will decrease the
gay men, transgender people,
number of people undiagnosed
women at greater risk, and
and increase early detection of
men who have sex with men.
new infections.
To achieve this we need to
Victorian HIV strategy 2017–2020 13Treat
Supporting people to link into care and commit to it is
fundamental to HIV treatment and prevention efforts and
to improving the health and wellbeing of people living with
HIV. Improving the system response to treatment retention
in care and adherence to treatment will aid efforts to
achieve Victoria’s 95-95-95 goals by 2030.
The updating of the specialist care services, Comprehensive coverage and
antiretroviral guidelines to the provision of ongoing, access to antiretroviral therapy
remove restrictions for initiating patient-centred care in local is essential for increasing the
first-line antiretroviral therapy settings and support for self- number of people living with HIV
has allowed people to begin management. We also need to who have an undetectable viral
treatment immediately after consider the needs of people load. This will improve health
diagnosis and achieve viral living with HIV who are ageing outcomes for individuals and
suppression quickly. A focus and how HIV services are best strengthen the level of health
on rapid linkage to care post integrated into aged care protection in the community.
diagnosis is essential for support services.
Access to treatment can also be
individual and public health.
Shortening the time between supported by providing services
The requires us to acknowledge
diagnosis and treatment and close to where people live. This is
the increased health needs of
care assessment is essential particularly an issue for those
people living with HIV, notably
for improving the long-term living in rural and regional
the disproportionately high
health of people living with Victoria. Strengthening the
incidence of mental health
HIV. Strong referral pathways capacity of primary health
conditions.
to HIV treatment assessment, services to provide ongoing HIV
Because of the incredible management and peer support care and to provide innovative
advances in HIV treatment, HIV are vital to improving individual specialist outreach services are
is now considered a treatable and community wellbeing and just some of the ways access is
chronic illness rather than reducing the risk of further being improved for Victorians
a terminal condition. This is transmission. Amid efforts to living in regional areas, as
good news; people with HIV are achieve this goal, we must well as for those living in outer
living longer and with much acknowledge that the needs of metropolitan Melbourne.
improved health outcomes. We people with HIV will vary. Some
need to reframe our services people will be well supported
to best support access to by mainstream services, while
care, long-term adherence to others may require a more
treatments and optimal chronic intensive or specialist response.
disease management. Ultimately, the decision to start
treatment is up to the individual,
This requires improving
with information and advice
integrated pathways between
from their doctor.
community, primary and
14“This is the most important and
exciting time in HIV prevention.
Getting this right will prevent
countless infections. And
getting it right means
making access to
prevention, testing and
treatment as easy as
possible. We have a
real opportunity to
show the world how
it is done.”
Professor Kit Fairley
Director
Melbourne Sexual
Health Centre
Victorian HIV strategy 2017–2020 15“Stigma is its own sort of disease.
It injures and paralyses us,
preventing us from looking after
our own health and wellbeing.
As an HIV community,
our primary focus must
be reducing stigma, and
helping people build
resilience in order to
confront it.”
Richard Keane
President
Living Positive Victoria
16Stigma and discrimination
Stigma and discrimination are the greatest
challenges we face in the HIV response.
Addressing stigma is remarkably Government is committed to
difficult. It is often multifaceted, working in partnership with Repeal of
with elements of enacted or affected communities, carers section 19A of
external stigma, and internalised and clinicians to improve
or perceived stigma. It is the lives of Victorians living
the Crimes Act
exacerbated by its intersection with or affected by HIV. Their Victoria has worked hard to
with other stigmatised experience and participation is remove structural HIV-related
characteristics or identities. invaluable in dispelling the fear stigma and discrimination.
These include but are not limited and misconceptions that fuel The Victorian Government
to gender identity, injection drug stigma and discrimination. recently repealed s 19A of
use, sexual orientation, cultural the Crimes Act 1958, an
identity, religious affiliation HIV-specific provision that
and disability.
Involvement imposed severe penalties
of people living for intentionally infecting
Our efforts to reduce and
eliminate stigma must with HIV another person with HIV.
This change signifies the
acknowledge the intersectionality At the United Nations, Australia government’s commitment
of stigmatised identities as has endorsed the principles to advancing the dignity
they relate to HIV. The pervasive of the Greater Involvement of and human rights of
presence and significant impact People Living with HIV/AIDS people affected by HIV
of homophobia, transphobia and (GIPA) and the Meaningful and to counter stigma and
biphobia must be acknowledged. Involvement of People Living discrimination. Repeal of
We should focus on building and with HIV/AIDS (MIPA). GIPA s 19A removes barriers to
supporting resilience among and MIPA have informed testing for HIV, which will
those living with and at risk of HIV, Australia’s HIV response support early detection
and challenging interpersonal for nearly 20 years, and are and early treatment for
and community-level attitudes affirmed in this strategy. individuals, resulting in
toward HIV, and diverse genders
The greater and meaningful better health outcomes for
and sexualities.
involvement of people living Victorians and improved
All parts of the service system with HIV, and of all affected public health management
need to be free from stigma communities, is essential of the epidemic.
and discrimination, including to all aspects of the HIV
ensuring our services meet response. The Victorian
the differing needs of people Government is committed
affected by HIV from diverse to working in partnership
priority population groups. We with communities, carers
must also work in partnership and clinicians to improve
to remove barriers across the the lives of Victorians living
legal, regulatory, policy and with or affected by HIV. Their
social domains. experience and participation
The meaningful involvement of is invaluable in dispelling the
people living with HIV is critical fear and misconceptions that
in achieving this. The Victorian fuel stigma and discrimination.
Victorian HIV strategy 2017–2020 17Victorian HIV strategy
By 2020 we aim to virtually eliminate new HIV transmissions.
By 2030 we aim to eliminate stigma and discrimination
related to HIV and achieve the 95-95-95 targets for diagnosis,
treatment and viral load.
Priority objectives
Victorians with HIV PLHIV and affected
Victorians are
Victorians with will have access communities are
supported to
HIV will know to best practice free from HIV-
reduce their risk of
their status evidence-based related stigma and
contracting HIV
treatment and care discrimination
Priority focus areas
Victoria will achieve its objectives through actions that focus on people, communities and the health
system. It will act in partnership with researchers, clinicians, community organisations, policy makers,
and people living with and affected by HIV.
Increase Increase Increase Eliminate stigma
prevention testing treatment and discrimination
Victoria will sustain the virtual elimination of HIV transmission in people who inject drugs, among sex
workers and from mother to child.
System enablers
Strengthening the Victorian health system will:
• ensure the Victorian workforce has the skills, knowledge and attitude needed to deliver best practice
HIV prevention, testing, treatment and care
• integrate systems and settings to meet the needs of people living with, affected by, or at risk of HIV
• improve the quality and completeness of HIV data collection and support research.
Priority outcomes for 2030
The proportion of The proportion The proportion The proportion of
all people with HIV of all PLHIV who of PLHIV with an people experiencing
who are diagnosed are accessing undetectable viral and reporting HIV-
will be: appropriate load will be: related stigma and
treatment will be: discrimination will be:
95% 95% 95% 0%
18“The gender inequity
experienced by
women prevents them
from accessing the HIV
services they desperately
need. If women are to
receive effective support
in the HIV response, we need
to remove the structural and
cultural barriers that affect
their health outcomes.”
Alison Boughey
Executive Officer
Positive Women Victoria
“People from refugee and migrant
backgrounds, asylum seekers and
international students are all
important parts of the solution
to achieving the elimination
of new transmissions by 2020.
HIV prevention and care
needs to be accessible and
inclusive in order to meet
the needs of all priority
populations.”
Alison Coelho
Manager
Multicultural
Health & Support Service
Centre for Culture,
Ethnicity & Health
Victorian HIV strategy 2017–2020 19Priority focus area 1:
Victorians are supported
to prevent HIV transmission
Priority actions:
What will be
Increase knowledge of Increase access to
different: HIV prevention biomedical prevention
• Victorians know what to
• Sustain and refresh HIV • Expand PrEP and PEP access,
do to prevent HIV and
health promotion strategies particularly in rural and
are supported to do so.
including implementing regional areas, pending a
• Victorians are supported new and innovative social listing on the Pharmaceutical
to use harm reduction media strategies. Benefits Scheme (PBS).
strategies to reduce
• Promote PrEP and PEP • Advocate with the
the risk associated
access among priority Commonwealth to list PrEP
with BBV transmission.
populations, and identify and PEP on the PBS to
• Health professionals new access points. support universal access.
have the knowledge
• Provide contemporary • Increase frequency of testing
and understanding to
prevention programs in a and use of prophylaxis
provide contemporary
range of settings including medication (PrEP and PEP)
prevention advice.
schools, community health among priority populations.
• There is an overall and services and prisons through
• Enhance harm-minimisation
ongoing reduction in a collaboration between the
and HIV risk-reduction
new HIV notifications departments of Health and
approaches, working with
in Victoria. Human Services, Justice and
people who use drugs by
• Biomedical prevention Regulation, and Education
providing sterile injecting
drugs are made and Training.
equipment, safe injecting
available to enable • Work with Aboriginal and other drug harm
Victorians to manage Victorians living with or at reduction education.
their health. higher risk of HIV to develop
• Increase sexual health testing
• Safe sexual and tailored prevention and
in priority populations and
injecting practices health promotion activities.
key communities at higher
are practised among • Improve TasP literacy among risk of HIV.
priority populations. people living with HIV and
• Maintain peer education
• Victorians who other priority populations.
and outreach efforts for
experience greater • Ensure people living with or at sex workers and ensure
inequity and who are higher risk of HIV understand non-discriminatory
at increased risk of HIV the action required to stop access to regular sexual
are the focus of renewed transmission of HIV. health screening.
prevention efforts.
• Ensure Victorian health
professionals have the
knowledge to provide current
and accurate advice on
prevention options.
20“PrEP has transformed the way people think about HIV risk. It has empowered many in their sex lives while leading major reductions in HIV transmission. Raising PrEP awareness and expanding access will be key to achieving virtual elimination of HIV transmission.” Brian Price Business and Community Services Manager Alfred Health Victorian HIV strategy 2017–2020 21
“Young people’s experiences and
understanding of HIV, stigma,
and belonging are unique to
this generation. If we are to be
meaningfully involved in the HIV
response of the future, we need
appropriate, equitable and
responsive ways to engage.”
Tim Krulic
Health Promotion Officer
Living Positive Victoria
22Priority focus area 2:
Victorians with HIV
will know their status
Priority actions:
What will be • Promote and support peer-
Increase knowledge of the
different: need to test led community-based rapid
• Victorians with HIV know HIV testing programs across
• Increase awareness among regional and rural Victoria,
their sero-status, are
priority populations about the targeting key settings,
diagnosed early and are
benefits of testing regularly locations and populations.
supported to do so.
for HIV and knowledge about
• Victorians at greater • Increase primary-care-
how often they should be
risk of HIV understand based testing to improve
tested, especially among
the need for frequent access and normalise regular
communities historically
regular testing. testing in primary and
considered at low risk.
community settings.
• Regular testing is • Implement a strategy to
normalised within • Review and modernise the
promote testing every
priority populations requirements for training and
three months.
and is available across competencies for pre- and
• Investigate systems for opt-in post-test counselling.
community and
testing reminders to support
primary care settings, • Work with a range of
individuals to undertake
particularly in areas of providers, including Primary
regular testing.
high need. Health Networks, to increase
• Ensure Victorian health regular and opportunistic
• Testing services meet
professionals are aware of testing for BBVs and STIs
the needs of priority
the need for regular testing across primary care and
populations.
of those at greater risk and community health.
• There is high coverage how frequently testing should
and frequency of • Coordinate Victorian HIV
be offered.
HIV testing. programs to support and
Increase access to testing strengthen pathways
and early diagnosis between testing services and
prevention programs, and
• Increase access to and adherence to repeat testing.
uptake of high-quality, safe
and appropriate testing • Explore the potential role
services that facilitate early of self-testing in improving
diagnosis, and continue to access to testing for
reduce structural, social and particular populations.
community barriers to testing. • Improve the knowledge of PEP
• Advocate with the and HIV risk across relevant
Commonwealth to consider health services, including
listing both rapid point-of-care primary, community and
testing and self-testing on the emergency care providers.
Medicare Benefits Schedule.
Victorian HIV strategy 2017–2020 23Priority focus area 3:
Victorians with HIV have access
to best practice evidence-based
treatment and care services,
and are supported to achieve
an undetectable viral load
Priority actions:
What will be
different: Increase access to early • Improve the service models
treatment for older people living
• Victorians living with with HIV to ensure access
or at greater risk of HIV • Reduce the time between to respectful, inclusive,
are aware of the long- diagnosis and treatment high-quality care and
term consequences of initiation by streamlining support services.
untreated HIV infection and strengthening linkages
between testing, treatment • Strengthen the care
and know how to access
and support. coordination and self-
appropriate treatment
management models for
and support.
• Develop early treatment people with more complex
• All Victorians diagnosed linkage pathways between needs, aligned with the
with HIV are linked into specialist services and Health Independence
rapid treatment initiation primary care for people who Program, with clear links to
and are supported to stay are newly diagnosed, and services, community networks
on treatment. build the capacity of existing and peer support.
• People living with HIV community-based clinical
receive the treatment, care services to deliver care Improve community
and support they need and support. engagement and
(including monitoring, • Promote and support understanding
viral load testing and continued engagement in • Enhance community-based
antiretroviral therapy). care and the benefits of peer support approaches
• People living with HIV adherence to treatment. from initial diagnosis through
can easily access care • Explore methods to enhance to adherence to treatment.
and medications in local partner notification for HIV, • Support independence,
primary and community and increase the likelihood resilience and health literacy
health settings. of early diagnosis and programs for people living
• Treatment services meet treatment of sexual contacts with HIV.
the needs of affected of people newly diagnosed.
communities through • Promote awareness of the
• Increase the use and individual and community
a process of co-design
effectiveness of shared health benefits of overall
and integrated pathways
care and outreach models reduction in viral load, with
between community,
between general practitioners an understanding that not
primary and specialist
and HIV specialists. all people are able to achieve
care services.
undetectable levels.
24“Treatment is our most valuable
tool in the HIV response. It enables
people living with HIV to take
charge of their health and
wellbeing, and also ensures
a public health benefit by
minimising the risk of
onward transmission.”
rofessor Jenny Hoy
P
Director
Victorian HIV Service
Alfred Health
Victorian HIV strategy 2017–2020 25“Working with people living
with HIV who are speaking in
the community every week of
the year, I see how stories of
individual experience transform
people’s understanding of HIV.
The more people are visible
in the community, the less
stigma there will be now
and into the future”
Max Niggl
Positive Speakers
Bureau Coordinator
Living Positive Victoria
26Priority focus area 4:
Victorians and affected communities
are empowered to speak up about
stigma and discrimination
Priority actions:
What will be
Reduce stigma and Increase understanding of
different: discrimination stigma and discrimination
• People living with HIV
• Address organisational • Support affected
feel safe to disclose
and structural stigma and communities to address
their status.
discrimination in community stigma and discrimination,
• People living with or and healthcare settings for including the use of peer-
affected by HIV are people with HIV. based approaches.
engaged in all aspects
• Work to remove legal, • Develop measures for better
of the HIV response.
regulatory and systemic understanding the impact of
• No person living with barriers to equality of care in stigma and discrimination
HIV experiences stigma the health sector for people on people living with HIV
or discrimination living with or affected by HIV. and other BBVs.
when seeking or using
• Support a systematic • Promote better
Victorian health and
approach to reducing stigma understanding of the impact
community services.
aligned with the Victorian of stigma and discrimination
• Victorians feel confident Government’s equality and the impacts of policy,
accessing services for reform agenda. planning and service delivery
HIV testing, treatment decisions across all sectors
• Incorporate GIPA/MIPA
and support, regardless (including the health, housing,
principles in all aspects of
of their gender, gender education and legal sectors)
the Victorian HIV model of
identity, cultural on the health of people
care, from policy to program
identity, ethnicity, age, living with HIV.
implementation.
sexual orientation,
disability status or • Embed awareness of HIV
residential location. stigma and discrimination
in public health and
wellbeing plans across local
government authorities.
• In collaboration with people
with HIV, identify individual,
community, systemic and
policy barriers in accessing
HIV testing, treatment and
care and develop evidence-
based strategies to address
these barriers.
Victorian HIV strategy 2017–2020 27System enabler 1:
The Victorian workforce has the skills,
knowledge and attitudes needed to
deliver best practice HIV prevention,
testing, treatment and care
Priority actions:
What will be • Work with Primary Health
Increase knowledge
different: among key workforces Networks and community
• Primary care providers’ health to strengthen BBV/STI
• Ensure high-quality training testing across primary care
knowledge of HIV
and support to mainstream and community settings.
transmission, diagnosis
and specialist service
and management • Train and provide ongoing
providers to support evolving
in allied health and support to primary care
models of testing, prevention
community service clinicians (medical and
and treatment.
settings is high. nursing) on how to monitor
• Ensure workforce and manage the health of
• Health professionals
development initiatives people with HIV.
have the knowledge to
support culturally appropriate
deliver appropriate and • Explore expanding the model
services for priority
evidence-based care of workforce support in
populations and facilitate
that meets the needs of hospital settings, exemplified
optimal person-centred care
priority populations. by the HIV Health
and psychosocial support for
• Health professionals Independence Program.
each individual.
understand the • Ensure training is provided on
• In key workforce sectors,
impact of stigma and the GIPA/MIPA principles and
increase health literacy about
discrimination on people that they are implemented
HIV, including prevention,
living with HIV and by organisations and
testing, treatment and risk
actively work to eliminate service providers.
among priority populations,
it from their services.
particularly those populations • Improve knowledge of PEP
• Victoria’s workforce historically considered at and HIV risk across relevant
responds to the broader low risk. health services, including
health and psychosocial primary, community and
• Develop the skills of the
care needs of people emergency care providers.
mainstream healthcare
living with or at higher
workforce to reduce stigma
risk of HIV.
and discrimination in the
health system.
• Promote and target s100
prescriber training and
accreditation, particularly in
areas of high need and for
health professionals working
with priority populations.
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