Issue Mar - Apr 11
‘Sex Work: Just another job?’
FOR YOUR DIARY
To vaccinate or not vaccinate? With winter coming up it is time to think about and talk to your doctor about having a vaccination for the influenza virus. With H1N1 being the big news in the previous couple of flu seasons, we wish to remind you that the vaccination season for influenza will be upon us soon. Those of us with a chronic illness, such as HIV, renal disease or cancer etc, should consider the vaccination in consultation with our doctors. If you do plan to have the annual vaccination for the influenza virus, it is better to start considering it now before the flu seasons sets in. Discuss your options with your doctor now to avoid the rush that the colder months will bring.
March 1
Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm
5
Mardi Gras Parade, Oxford Street Sydney 8:00 pm
8
Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm
10 Looking Out workshop for same sex attracted men 26+ 6:00 – 9:00 pm 15 Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm 16 Volunteer Meeting: Getting into the Canberra Community 6:00 – 7:30 pm
And a reminder about whooping cough:
“To help control the spread of this infectious condition ACT Health is providing free vaccine to parents and grandparents who have regular contact with infants less than 12 months of age. Partners and grandparents can also access this vaccine in the last month of pregnancy. The vaccine can be obtained via GPs or through hospital maternity units for new mothers until 30 June 2011.” Pertussis (also known as whooping cough) fact sheet Act Health
17 Looking Out workshop for same sex attracted men 26+ 6:00 – 9:00 pm 22 Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm 24 Looking Out workshop for same sex attracted men 26+ 6:00 – 9:00 pm
Westlund House Legal Clinic 6:00 – 9:00 pm
29 Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm
Updated 30 November 2010.
31 Looking Out workshop for same sex attracted men 26+ 6:00 – 9:00 pm
Westlund Community Legal and Migration Service
April 5
The Westlund Community Legal and Migration Service is free and focuses on migration and related issues for the communities we work with. It will operate every Thursday afternoon with the fourth Thursday of each month being an evening clinic.
This service is open to the Canberra community and is in addition to the existing Legal Advice Service which we offer members of the AIDS Action Council.
Stepping Out workshop for same sex attracted women 6:00 – 9:00 pm
20 Volunteer Meeting: AIDS Remembrance 6:00 – 7:30 pm
May
18 Volunteer Meeting: Gender Diversity 6:00 – 7:30 pm
WORKSHOPS Looking Out:
However, please note that the service is by appointment only, and these can be made by calling 02 6257 2855.
Vitamin Service
For same sex attracted men 26 years and older Thursday Nights 6:00 – 9:00 pm 10 – 31 March, 2011 RSVP david.mills@aidsaction.org.au www.aidsaction.org.au/lookingout
At the AIDS Action Council we recognise that many of us living with HIV take vitamins and supplements to support our health and wellbeing. We are also aware that the added cost of purchasing vitamins or supplements can be prohibitive for some of us; in recognition of this situation our Living Well Program includes a vitamin service.
Stepping Out:
For further information please visit www.aidsaction.org.au/vitamins Or give us a call on 02 6257 2855.
For same sex attracted women Tuesday Nights 6:00 – 9:00pm 1 March – 5 April, 2001 RSVP stepping_out@hotmail.com
AIDS ACTION COUNCIL OF THE ACT aidsaction.org.au
GPO Box 229 Canberra ACT 2601 T: 02 6257 2855 F: 02 6257 4838
Out There:
For same sex attracted guys 25 years and younger Details pending Contact keiran@qnet.org.au for more information www.qnet.org.au/out_there www.aidsaction.org.au
Up Front: Telling it like it is Andrew Burry
I’ve just returned from a trip to Perth, where I went and had a look at something they call “M Clinic”. Astute readers will have worked out that the ‘M’ stands for Men, and that this is a clinic only for gay men.
T
he Western Australian AIDS Council (WAAC) has been operating it for almost a year and in that time it has been providing a peer-based testing service. This is far more innovative than it sounds, at least in an Australian context, but is the norm in many other parts of the world. The difference is that at the M Clinic you have pre and post-test discussions with a trained peer rather than a clinician. Whether this is significant, really depends on what we think a pre-test discussion should be achieving. First and foremost, it is about getting informed consent and that means that if we requested or were referred for an HIV test, we must be fully aware of what is involved, the implications of a positive result and crucially, the right to decline the test at any time. Secondly, this discussion should help us accurately understand the level of risk resulting from our current choices and practices, including how they can be reduced. Obviously, this involves the discussion of quite a lot of highly personal information, such as the number of sexual partners we have, the kind of sex we
practice and whether our sex involves the use of condoms or not. We should know the different level of risk in being a receptive partner (bottom) as opposed to an insertive partner (top) and if condoms were used, at what point were they worn? When assessing our personal level of risk, it is important to explore whether we feel comfortable at that level; be it low or relatively high. If it is higher than we feel comfortable with, what choices are available to reduce it to where we would be more comfortable? This kind of discussion is best undertaken in a frank and open way and the impact of the environment (where we are, who we are talking to) will have some effect on how relaxed we are, telling it like it is. For some of us, telling a doctor that we like to be on the receiving end of unprotected sex is like telling him/her the real number of cigarettes we smoke or the amount of alcohol or other drugs we consume. In other words, some of us fear judgement, so we modify our responses to avoid it, even if it is only imagined. When we are talking to a peer – a gay man just like us – this fear of judgement is greatly reduced because we instinctively feel that they will know
where we are coming from. If we access the peerbased testing centre regularly, our level of trust and confidence will increase and the discussion will become more and more empowering and help us make the choices we really want to make. And, this is what Perth’s M Clinic is finding. Traffic has been steadily increasing as clients return and word of mouth spreads the news that there is a friendly, no-hassle walk in place to get a sexual health check. There is a clinical side, though. A registered nurse does the testing procedures, other than those we may choose to self-administer. Inevitably, some clients have received a positive result for their HIV test, and this is traumatic for all involved. The advantage is that the newly diagnosed person is already interacting with an organisation that can provide care and support when they choose to access it, and without a further referral. Not every gay man will want to access the M Clinic model. Indeed many would never feel comfortable away from a purely clinical environment. In the end though, it is about ensuring that we can access HIV and other STI tests in a manner that suits us, and that means choice. If we go by the results of the M Clinic, the peer based approach is finding favour with a growing number of us.
If it ain’t Broke? Andrew Burry
W
hen the Prostitution Act became law in 1992, it was a moment when our jurisdiction stood fairly tall and proud. Even to this day, jurisdictions around Australia are grappling with their own sex laws; battling the nexus between public health and archaic and stigmatising opinions in some social quarters.
What made the ACT special was that the Act legalised something which had hitherto been criminal. This is vastly different from merely decriminalising commercial sexual activity. Legalising it means that it is government sanctioned as a legitimate industry and that then means that sex work is a legitimate profession and must be regarded as such. As a result of the act, sex workers are entitled to the same level of respect and the same freedom from discrimination and stigma as anyone else in any workplace. After almost 20 years in operation, the Prostitution Act is now subject to a review. The review is being conducted by a committee of the Legislative Assembly, chaired by Vicki Dunne and supported by all parties …. Not necessarily for the same reasons. Most would agree that the Act has been successful over the last two decades. This doesn’t mean that the industry hasn’t experienced the odd glitch from time to time, as has every other industry. We can conclude that the Act isn’t broken, so why then should we be trying to fix it? The answer is that 20 years on, we have an opportunity to consider ways in which the Act, as a legislative and regulatory framework can be made to work better. The place to begin is with the language. “Prostitution” is a loaded term, frequently used pejoratively and if continued in legislative terms, will add to a view that somehow sex work is not a legitimate occupation. The term actually has a number of meanings, which have changed over time. It can mean, for example, to put one’s talents or skills to an unworthy or corrupt use or sacrifice self-respect or honour for the sake of personal or financial gain. When used in the context of commercial sexual services, it clearly differentiates between those who supply and those who receive services. But why should there be a differentiation? We aren’t encouraged to think of doctors as being medical prostitutes, or airline pilots being transportation prostitutes, presumably because we don’t think that these professionals are putting their skills or talents to an unworthy or corrupt use. When thinking of the sex work industry, society tends to think of sex workers as women and clients as men, and there is likely an element of gender politics involved. What society deems as acceptable for men is frequently not considered acceptable for women. We have, therefore, an opportunity of addressing these misplaced notions in improved legislation by changing the language and eliminating terms like ‘prostitute’ and ‘prostitution’ in favour of sex worker and sex work.
When governments legislate or regulate industries, it is usually for a number of common reasons. Firstly, public health and safety will be of primary concern, meaning that the operation of the industry under the regulations is not deleterious to the health of society as a whole. Secondly, the safety and health of those working in the industry must be protected. Occupational health and safety is broadly protected by a whole range of legislation, and it is therefore only necessary for specific regulations that are directly relevant to that industry to be included. In the case of commercial sexual services, for example, this will include mandatory use of prophylactics and be equally the responsibility of both those providing and those receiving such services. Finally, and sometimes overlooked, is the need for regulations to avoid protectionism and allow for ease of entry and exit of the industry. This means that legislation and associated regulations should make it straightforward to be involved in the industry, whether as a consumer or a supplier. Similarly, there should be no implicit or explicit discrimination in the exercise of the Act. It is in this final area that we have a significant concern about the current Act, and one we will urge the review committee to give great attention to. Few would argue that it is wrong for a person to receive or provide commercial sexual services when they know or can reasonably expect to know that they have a sexually transmitted infection. However, within the Act, sexually transmitted infections include HIV. Whilst HIV is indeed a sexually transmissible infection, we have for more than two decades accepted that the use of prophylactics is an effective barrier to transmission. We therefore believe that HIV should be excluded from the list for the purposes of this legislation. Not to do so is to unfairly discriminate against those people living with HIV, who therefore have a lifetime ban from accessing the industry as either client or worker, and for no good public health reason. In support of this, it should be noted that no such requirement exists in non-commercial sexual situations, and that the Public Health Regulations 2000 provide that any person who knows or suspects they have a transmissible notifiable condition, or knows or suspects that they are a contact of such a person, must take reasonable and appropriate precautions against transmitting the condition. The Prostitution Act is not broken, so it doesn’t need fixing. It is 20 years old and in need of some refurbishment. Its language needs to be modernised with the removal of words and phrases no longer appropriate in these days and times. After two decades, we now know that by and large we have a successful regulatory environment and this means that we should now be focussing on making a legitimate industry friendlier for all those that choose to participate with it. And, that includes ensuring as many of those that choose, can indeed participate.
www.aidsaction.org.au
Mar - Apr 11
| 03
Listening to sex workers David Mills
F
ew occupations have such a long and delicate history with the law as the ‘oldest profession’ and in the normal course of business sex workers face a formidable range of laws and regulations that are different in every jurisdiction. Given the impact on sex workers lives and the necessary expertise in the laws that sex workers need to develop, isn’t it strange that in debates around sex industry laws that sex workers are rarely seen as key stakeholders? The Sex Worker Outreach Project (SWOP ACT) as a peer-run project has strong relationships and an intimate knowledge of the industry. We are arguably better placed than any other organisation to ask workers themselves about their own experiences and opinions of the laws. In January 2010 we distributed surveys in paper form to parlours around the ACT and created an online version of the survey promoted through social media. We received 46 completed surveys, 21 on paper and 25 online.
Understanding the obligations of being a sex worker Familiarity with the Prostitution Act is fairly high in this sample. 46% of respondents (21 respondents) have read the Prostitution Act and are confident in their understanding. The remainder use other sources to inform themselves of their rights and responsibilities, including from other workers in the industry (20 respondents) or SWOP ACT (21 respondents).
Working as a ‘sole operator’ Sex workers in the ACT have two options for working legally: A worker can either work in a registered parlour (brothel), or alternatively on a private premises on the condition that he or she works alone and is registered as a ‘sole operator’. Many workers work in a combination of parlour and private work. Registration as a sole operator is seen as an unreasonable hurdle by the respondents of our survey. Of the 15 workers in our survey who have worked privately only four workers have registered as a sole operator, and of those only one has a current registration. One worker expresses a concern that “the legislation if policed could make life hard.” One of the respondents who had previously registered no longer registers when working for “a short period of time”: I registered initially every year ... when I worked on a full time basis and let it lapse in the last five years since I only advertise for a couple of weeks a year ... it is too much of a hassle given I only work for a short period of time. Another worker stopped registering because of a concern that “my man [will find out], I have to hide it.” The currently registered worker has strong feelings against the registration requirement, and after registering once is forced to continue to renew his or her registration: I am angry that I registered in the beginning because now my details are on the system I feel I have to keep registering. I would never have done it if I knew the scope of the information collected and the way it is handled. I do not feel safe in the registering process and think it is a breach of privacy that does nothing to help any person in the community. Many other respondents share this worker’s view that registration does not benefit the worker and call for the requirement to be abolished: I would like to see the whole process of registration of sole operators completely struck out as I do not believe it serves any purpose. The government must make a case for continuing with this ... what has it been used for & what has been achieved through this? -Other forms of registration are for purposes of professional affiliation where you get something in return ... representation in respect to award wages etc. Registration of sex workers, mostly female, is a punitive measure to control women’s lives and bodies. Get rid of this humiliating and discriminatory control. A common opposition to registration in this sample appears to be an apprehension for what the registration data might be used for and who the data might be provided to: I don’t feel safe when my personal information is collected by police and bureaucrats. I feel that corrupt individuals could threaten me with disclosure to loved ones and employers. Several respondents call for an amendment to the laws to allow sole operators to work on the same premises as another sole operator: I would like to see amendments that enable ‘up to 2 sex workers’ to work in a private situation. Doubles are a common service & currently it means that if 2 workers get together to provide this service they are breaking the law ... It would also enable workers to either work together or take turns at shifts (1 may work during the day & the other in the evening & share the rental costs & with 2 workers on the premises it provides extra security). -Having only one worker is dangerous, limiting my work choices and prevents me from having peer support.
04 | Mar - Apr 11
-I would ... make it legal for two workers to work privately together.
Working in parlours The most common issue raised in relation to working in parlours are the limited locations parlours can operate. Currently regulations limit registered brothels to Fyshwick and Mitchell. Some workers propose allowing parlours in commercial areas: Prescribed locations for commercial brothels should include shopping centres or other locations where other personal services are provided (e.g. hairdressers, masseurs, etc). Brothels should not be restricted to the industrial areas - sex work is NOT an industrial activity. One respondent raises the Fyshwick and Mitchell restriction as a safety concern: Brothels in industrial areas are extremely difficult to travel to, unless you own a private vehicle or can afford an expensive taxi ride. I have been in a situation where I haven’t made enough money working a shift in a brothel to afford a taxi ride home at the completion of the shift, and as public transport to Fyshwick/Mitchell is extremely limited, I have had to walk home during the dark, cold winter morning.
Working in the ACT compared to elsewhere Respondents were not asked in this survey about their experiences working in other jurisdictions; however the experience of SWOP ACT is that the majority of workers regularly work in other states and territories while travelling. Workers reported that the following aspects were relatively positive in the ACT: •“[It is] easy to come to brothels to get work” •“[It is] safe for us to do the job” •“Being a sex worker is permitted and a little accepted within society” •“[There is] no mandatory testing, not [required] to register if working in a brothel.” •“I especially like s26 and s27 of the Act.” (Section 26 prohibits the use of a sexual health check-up to make a client believe that the sex worker does not have an STI. Section 27 requires condoms and dams for vaginal, oral and anal sex. Both put obligations on parlour and escort agency operators.) •“It is legal to do private and parlour sex work” •“Advertising in the paper is easy” •“Freedom of choice and condom safety laws” •“Freedom to work confidentially” •“OH&S standards” •“Anonymity, protection of my personal identity for example my working name only.’” •“It is legal” The sex industry in the ACT is ‘legalised’ in the sense that the Prostitution Act exists, explicitly permitting sex work under conditions prescribed in the Act. This differs from some other jurisdictions where sex work has been ‘decriminalised’ by abolishing anti-sex work legislation. The issue of legalisation vs. decriminalisation is clearly contentious, with several respondents preferring decriminalised environments in other jurisdictions: Remove registration and replace with decriminalised model similar to that in NSW or NZ. -I would like to see a full decriminalisation of sex work in the ACT. Four respondents call for people living with HIV to be sex workers or clients: Remove the prohibition for sex workers with HIV and clients with HIV. One respondent states that “underage workers are too common.”
Working towards better laws This survey reveals a community of sex workers in the ACT which is well informed about the laws and regulations in the industry and strong positions of different issues affecting them. The current framework provides an environment where most sex workers are able to work safely, with the exception of registration for sole operators. The low rate of registration appears to be currently overlooked by the authorities, but some workers fear a possible crack-down. The survey includes a report of underage workers in the industry. This is a serious issue that needs to be investigated further to find appropriate ways to help underage workers out of the industry and prevent underage workers entering the industry in the future. This survey raises current implications of the current Prostitution Act that would not have been intended when the Act was first drafted, including workers walking home alone late at night from light-industrial areas and over-worked and unprotected private sex workers unable to share a property and costs. These situations must be considered in any reviews of the current framework. Many workers find provisions of the Prostitution Act and services in the ACT to be positive compared to other jurisdictions, and it is a minority of provisions that are points of contention in the industry. In reviewing the Act it is important that the provisions that have made the ACT generally a safe and legal place to be a sex worker continue.
www.aidsaction.org.au
Legality of sex work in Australia based on state legislation and regulations (as at January 2011)
ACT
Working in a Brothel
Sole Operator
Street Work
Working as an Escort
Legal from a legal brothel. Must register.
Legal from own premises. Workers must register.
Illegal
Legal but must register.
Legal, however zoning restrictions
Legal
Legal but must register. Must work
Illegal
Legal from licensed agency if worker issued with police certificate stating no violence or drug related criminal history.
Legal but must work alone (allows for licensed bodyguard)
Illegal
Illegal
Illegal
Illegal
Ambiguous: Agencies operate on the condition that they provide staff for the company of clients.
Legal and may work with one other
Illegal
Ambiguous: Agencies operate on the condition that they provide staff for the company of clients.
Legal but must register. Regulated by local councils.
Illegal
Legal for workers employed by an agency or working as a small owner operator.
Legal from own premises. Must work alone
Illegal
Ambiguous: Agencies operate on
(Brothel must operate within a prescribed location.)
Legal from a legal brothel.
NSW1
(Brothel regulation controlled by local council through planning policies.)
Illegal
NT Legal from a legal brothel.
Qld
(Brothel regulation under state zoning laws. Brothels cannot have more than 5 rooms.)
Illegal
Legal but regulated by local councils.
apply.
Same zoning requirements as brothels. alone.
SA2 Illegal
Tas Legal from a legal brothel.
Vic
(Brothel regulation controlled by local council through planning policies.)
Illegal
WA3
worker.
the condition that they provide staff for the company of clients.
(Endnotes) 1
Sex work is decriminalised in NSW.
2
The act of commercial sex itself is not illegal in South Australia but a number of laws relating to commercial sex in a brothel effectively rendering brothel based sex work activities illicit, e.g. living on the earnings, soliciting, keeping a brothel.
3
The Western Australian Government is considering significant changes to sex work laws. The Government’s Prostitution Law Reform Working Group’s thorough Prostitution Law Reform for Western Australia report recommended that sex work be largely decriminalised. A change of government in 2009 slowed law reform, with the current government reviewing a range of approaches to sex work. Wietzer’s 2009 analysis of the state as a dynamic actor in morality politics was, unfortunately, applied to a very different end. See Weitzer, R. (2009). Legalizing Prostitution: Morality Politics in Western Australia. British Journal of Criminology, 49, 99-105.
A Gender Agenda: Working with trans and intersex communities We have been overwhelmed with the response to our calendar of events since we officially launched it on 21st January. Our first event, held on 5th February was a great success in terms of attendance and positive feedback. Registrations for the other events are filling fast. The Art course we are running in May is already fully booked – we are running another art course in September so if you’re keen to participate you’ll need to get in quickly! Our first discussion group “Doing it Differently” also generated a huge amount of interest – we received twice the number of registrations we were able to cater for, and are hoping to be able to run a second session of “Doing it Differently” for those people who missed out the first time round.
To download a copy of the calendar visit: www.genderrights.org.au To register for events, email: register@genderrights.org.au This project is supported by the ACT Government under the ACT Health Promotion Grants Program www.aidsaction.org.au
Mar - Apr 11
| 05
Hanging Out or Hooking Up? Matt Teran
sexuality, HIV, relationships and other health issues affecting our community. Ultimately, we hope to extend the program to other networking sites such as Manhunt and the popular iPhone application, Grindr. Though similar Internet outreach programs are already running in other states and territories, the NetReach project is not without controversy. This is because gay men’s chat sites, such as Gaydar, are often presented in the media and some research literature as sexual ‘risk environments’. These representations reflect concerns that the growing popularity of such sites and the speed with which men can anonymously find each other online lends itself to high-risk behaviour for HIV transmission or infection. While studies have found that men seeking sex online are generally more sexually active, it should be remembered that the Internet as a medium does not necessarily cause gay men to have more sexual partners, or engage in risky or unsafe sexual behaviour.
It goes without saying that the Internet has become a popular source of partners for gay men. In some reports, the Internet actually outranks traditional venues such as gay bars or sex-on-premise venues as places for gay men to meet partners. This pattern is consistent with our own community, with recent Gay Community Periodic Surveys showing the Internet to be the most commonly used venue in Canberra where men look for male sexual partners - 56.5% of men surveyed said they had used the Internet to seek sexual partners and 41.2% reported having looked for partners online in the last six months (2006, 2009). The AAC recognises that the use of the Internet by gay men must be reflected in the Council’s education and prevention programs. As has been discussed in earlier newsletters, NetReach is the AAC’s newest venture and will be launched in the coming months. Specifically, NetReach is a peer-based sexual health promotion and outreach program targeting at-risk groups via the Internet. The pilot program will be staffed by trained volunteers who will maintain on online presence in Gaydar chat rooms. When approached by chatters, volunteers will offer referrals and advice on sexual health,
Rather, it is perhaps more appropriate to think of gay men’s chat sites such as Gaydar as the equivalent of gay bars; while some go there to pick up, others go there to reconnect with regular sexual partners, to ‘hang out’ in a gay space, to see other gay men and to meet with friends. The NetReach project, then, is as much about offering sexual health information, as it is ensuring the AAC has a presence in these online spaces that reflects the Council’s ongoing commitment to the communities it serves. Moreover, it has been established that men using the Internet to seek partners are significantly more likely to look online for information about their sexual health. NetReach will ensure Internet users have access to the best quality sexual health information, knowledge of the local resources available to them, and the opportunity to discuss sexual health issues with a peer who understands. The most significant challenge we face with the NetReach project is respectfully working within the unique culture and dynamics of online chat rooms. That’s where volunteers come in! Your working knowledge of networking sites such as Gaydar is invaluable and will be a key ingredient in helping this project work. If you are interested in being a NetReach volunteer, or would like more information about the NetReach program, please contact Matt Teran on 6257 2855 or email matt@aidsaction.org.au.
New Service Delivery Model Nada Ratcliffe
As indicated in the associated article, Raising the Standards is about the quality of the services the Council provides and as part of ensuring the best possible services for individuals and communities, we are currently implementing a new service delivery model. As providers of human services, it is imperative that we continue to strive towards providing easy access to a range of services that are most appropriate to a person’s needs. Many agencies make the mistake of expecting new people to fit in with existing programs rather than taking a people-centred approach and delivering services that are most appropriate to a person’s needs. For this very reason, the Council is taking on a remodelling of the way we deliver services.
Examples of important changes include reviewed service hours to better suit client needs – particularly for those who have work commitments. Outreach visits and off-site services will also be increased for those who, for a number of reasons, are unable to access Westlund House. This includes our counselling services. For those of us at the Council who work with PLHIV and the GLBT communities, the greatest benefit of this change is the knowledge that services delivered to a client are of the highest possible quality and the appreciation that quality can always be improved. Diagrammatically, the new model can be viewed below:
AAC SERVICE DELIVERY MODEL Points Points of ofEntry Entry
Assessment Assessment Phase Phase
Planning Planning Phase Phase
Service Service Delivery Delivery
Negotiated NegotiatedEnd Endof of Service ServiceDelivery Delivery&& Evaluation Evaluation
Progress ProgressMonitoring Monitoring &&Evaluation Evaluation As you can see an important step is now included in that a person wishing to access Counselling or other AAC services for the first time (or are returning after a long time), can connect with an experienced and qualified staff member to discuss their individual needs so that the best possible service options and resources can be made available. It is important to us that all people using our services do so in a safe and secure environment and participate in every step along the way. As I mentioned this initial assessment will now apply to the AAC Counselling Service but also other important areas of our work such as health interventions, referral, advocacy, and group work.
06 | Mar - Apr 11
Another essential part of the Service Delivery Model is the Progress Monitoring and Evaluation that takes place when a particular service draws to an end. By evaluating and obtaining your views on the services provided we are able to properly gauge client satisfaction and determine if we are “Getting It” and more to the point “Getting It.... Right”. Did you achieve the outcomes you desired? Were the staff professional? These are the sort of questions that can be answered with your input and feedback so that we can continue to reflect upon service delivery and maintain the highest of standards.
www.aidsaction.org.au
HIV-1 Vaccines: Pitfalls and Future Prospects Dr Charani Ranasinghe - Curtin School of Medicine
I
n 1984, after HIV (human immunodeficiency virus) was confirmed to cause AIDS (acquired immunodeficiency syndrome) it was declared by US health and human services that a vaccine would be available within few years. Unfortunately, now over two decades have passed since the identification of HIV-1 and finding a suitable vaccine has been a daunting task. It is estimated that 2.5 million people are newly infected each year with HIV-1. The health and financial burden to countries in sub-Saharan Africa or South East Asia to contain the infection means that an HIV-1 vaccine is the best strategy and also likely the only long-term solution to the HIV epidemic. An effective HIV-1 vaccine would not necessarily need to protect against infection but should have the capacity to reduce the viral load to a level that fails to result in transmission. Some problems associate in the development of an vaccine can be attributed to: (i) the extraordinary diversity of HIV-1, due to divergent clades, in different parts of the world, ii) virus envelop structure being highly complex preventing the generation of neutralizing antibodies and (iii) also not clearly understanding the immune correlates of protection in humans. Moreover, the ability of HIV-1 to lay dormant in infected cells, sheltered from both antiretroviral therapy and from host immune response, plus viral escape or emergence of new mutated strains of virus following treatment has also added another layer of complexity to HIV-1 vaccine development. Many of the human HIV-1 systemic vaccine trials or vaccines delivered to blood compartment have failed to elicit strong long lasting “high quality” protective immunity. Unfortunately, systemic vaccine studies that have generated high magnitude of immune responses in small animal models and non-human primates have failed to translate effectively into humans. Today, many researches around the world are trying to unravel “why” these vaccines have failed. Solving this puzzle has become a challenging task. Some including our research team at JCSMR/ANU now believe that rather than the magnitude of immune response generated following vaccination the “quality” of immune response could play an important role in protective immunity. We have found that mucosal vaccination (intranasal, intra rectal)
can generate T cell responses of lower magnitude but greater “quality” compared to systemic vaccination (intramuscular). Our recent studies have revealed that following systemic vaccination elevated expression of certain hormone like molecules known as Th2 cytokines for example interleukins-13 play an important role in dampening the quality of T cell immunity. Our small animal model studies indicated that in the absence of these molecules (in IL-13 gene-knockout animal studies), immunity to HIV-1 vaccine antigens is greatly augmented but more importantly the HIV-specific T cells generated have a greater capacity to destroy infected cells, indicating that the “quality” of the immune response is critically important for protective immunity. Thus, we are currently developing a heterologus prime-boost vaccine strategy to transiently inhibit host IL-13 activity through the vaccination process, with the ultimate aim of a Phase I clinical trial. (Note: prime-boost approach generally involves priming of immune system with one vaccine vector expressing HIV vaccine antigen(s) and subsequent boosting with same antigen(s) delivered using another vector system). We have shown that in small animal models this vaccine strategy can greatly enhance the capacity to stimulate a more robust, “high quality” immune response against HIV-1, both in systemic (i.e. blood compartment) and mucosal (i.e. gastrointestinal, genito-rectal, vaginal) compartments.
It is well established that majority of human pathogens enter through the mucosal routes of infection (oral, nasal, rectal, vaginal routes). Especially HIV-1 is 1st encountered via the genito-rectal mucosa, and primary CD4+ T cell loss occurs in the gastrointestinal mucosa prior to systemic dissemination of virus (enters the blood compartment). Hence, a vaccine that generates immunity at these primary sites of infection would be of great value in the fight against HIV-1. Interestingly, to generate long lasting mucosal immunity a vaccine should be delivered to the mucosae, not to blood. Therefore, we believed that (i) novel HIV-1 mucosal vaccine approaches that could enhance not only the magnitude but the “quality” of antibody and cellular immunity at both mucosal and systemic sites, (ii) as well as identifying better immunological parameters that could measure “protective mucosal immunity” in humans will enable the design of more effective HIV-1 vaccines in the future. Moreover, due to the past disappointing HIV vaccine outcomes, understanding the fundamental mechanisms of “how & why” these different vaccine vectors, routes of vaccine delivery alter immune outcomes in animals and humans, may also be of great importance. Some believe that total prevention of HIV-1 infection with a vaccine could possibly be a difficult task, and a successful strategy such as heterologous prime-boost immunization at least has a greater potential to control plasma viral load and virusinfected cell numbers and retard the disease progression. Collectively, the recent promising Thai HIV-1 heterologous prime-boost clinical vaccine trial which showed 31% efficacy, the lessons leant from many past clinical trials, and the ongoing research around the world into understanding the complex nature of HIV virus immunity offer good optimism for a future HIV-1 vaccine. Finally, we believe endurance and small leaps will be the key to any future success.
International Perspective on HIV Khant Khant Kway
I
represented Carleton College at a ‘Model’ United Nations Conference in April 2009, as an ‘ambassador’ for Thailand’s UNAIDS Committee. It was then that I learnt about the issues surrounding HIV, especially stigma and discrimination.
At the time, stigma and discrimination seemed to me, like an abstract notion-like talking about the Eiffel Tower without having been in Paris or the discussion of rock formation in geography class -structures and concepts of significant importance that I could not fully conceptualise. Although I advocated for more funding for care and support services, particularly with regard to social networks and education to reduce stigmatisation at the Conference, I knew little about how important this issue of education for non-discrimination is, in the battle against HIV. My first close contact with an HIV positive person was in Cape Town, South Africa. We met at the International AIDS Society Conference 2009, where we both volunteered to pack over 2000 bags for the conference attendees. Amidst this mundane task, we started chatting, first on light topics such as the weather and sights, but soon moved on to discussing HIV issues. The next day, over afternoon tea, he told me of his HIV status. John (not his real name) has been HIV positive for several years. He is also gay. But because of societal pressure, he did not disclose his status about HIV or being gay. Instead, he tried to ignore his health and sexuality, got married and had a daughter. A few years later, the pressure became too unbearable for him to mask his status and he divorced to live with his boyfriend. He has gone through a great deal of emotional trauma. People like him need support, not discrimination, in times of such vulnerability. Stigma against HIV does not just affect the wellbeing but also has economic impacts. On a fieldtrip with WoFAK (Women Fighting AIDS in Kenya) in October 2009, I visited a family of five where both parents and the oldest child were living with HIV. The family relies solely on the meagre supplies provided by the welfare organisation. They were refused employment because of the stigma against positive people. Such an anecdote is but a small piece in the big puzzle of how HIV/AIDS impedes economic development. In Australia, HIV infection rates are low, compared to other countries. These statistics are celebratory but could also be detrimental for those most affected. Those living with HIV are a much smaller minority and hence, even more susceptible to stigma and
discrimination. Acceptance and recognition are indispensible tools against HIV. As much as AIDS organisations should try to educate and reduce stigmatization, these efforts are futile without the public’s acceptance. For its health, social, psychological and economic impacts (among many other consequences), we should reflect on our attitudes towards positive people to achieve positive change individually and as a global community.
Khant Khant Kyaw Bio Hi! My name is Khant Khant Kyaw and I am finishing up my last year of undergraduate studies in International Development Studies at Carleton College, Minnesota, USA. As the name of my degree suggests, I have been travelling around the world, engaging in experiential learning to complement my academic studies at Carleton College. In 2009, I interned at a local NGO in Cape Town, South Africa to facilitate sex-education and life-orientation workshops to Grade 8 students. While I was there, I participated in the International AIDS Society Conference 2009 (IAS) as a volunteer. What I learnt from scholars at the conference supplemented my experience at my internship. It also helped me to gain a deeper understanding of HIVV/AIDS issues in Kenya where I studied development and health for 15 weeks and in Myanmar/Burma where I interned with an international NGO working on migration and HIV issues. My prior exposure to HIV/AIDS has been in developing countries, so interning at the AIDS Action Council, Canberra (my third internship in AIDS organisation) gives me a completely different perspective. I was very impressed by the systematic operation of the organisation, as well as the cohesion and communication between the staff members. Things seem to get done very efficiently, and I believe that the extensive knowledge and commitment of the staff play a large role in the process. What I was not expecting to find, however, was the high level of stigma and discrimination that the HIV/AIDS population still face in Canberra and Australia, and the low level of discussion around HIV and women issues. But problems do not get unnoticed. Currently, I am assisting staff of the AAC to expand on HIV prevention and care services to women who they have named as a priority group. It is encouraging to observe the organisation in action, to tackle HIV/AIDS issues.
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