Healthy Communities’ Response to Reasons for Funding Cut
The Government is not interested in funding an LGBT organisation to deliver health services. Government funds and has Ministers for A&TSI, multicultural & disabilities and funds organisations of young people, older people, women, regional & rural. Why LGBT only population group not supported?
Queensland Health doesn’t fund Healthy Communities for ‘advocacy’. Current service agreement with Queensland Health requires us to deliver advocacy on LGBT health issues: “Funded Service Type: Advocacy The organisation will represent consumers and/or consumer groups to advocate for their health and wellbeing needs within the community as required. The organisation will target service providers and community organisations to promote community awareness of the needs and issues of consumers. The organisation will provide consultancy advice and support to health and community services on LGBT health and wellbeing issues.” Service Agreement 2010-2014. Healthy Communities also uses resources from other sources which it uses on advocacy as well as volunteer time of Board & members.
Queensland Health wants to fund an AIDS Council to deliver HIV services only. Queensland Health decided not to award the HIV care & support contract to us in 2004. This resulted in the dismantling of the AIDS Council and necessitated a refocusing of our remit to wider LGBT health issues, including HIV. This was supported and encouraged by Queensland Health. Other organisations now deliver other types of HIV services. It is too late to ‘unscramble the egg’. An AIDS Council that only delivers HIV services is an old fashioned concept. All AIDS Councils or organisations that were AIDS Councils in Australia now deliver a much wider range of services to a variety of population groups (including LGBT) and a variety of health issues (e.g. hepatitis, mental health, drugs & alcohol, community development, youth services).
HIV infections have increased in Queensland over the past 10 years, meaning Healthy Communities has failed. Healthy Communities contributes to reducing HIV infections among gay men. Other programs focus on other populations groups. While HIV has increased over the past 10 years it is still lower in numbers than NSW and Victoria. HIV as increased at a slower rate among gay men than other population groups and has been relatively stable over the past 5 years.
Healthy Communities is just one component of the HIV response in Queensland, lead by Queensland Health. We can not be held solely responsible for HIV or gay men’s behaviour. Queensland has no mandatory sex & relationships education in schools. Queensland Health has not delivered general community HIV or sexual awareness campaigns for over a decade. There is no access to modern technology such as rapid HIV testing. There is still a great deal of stigma & discrimination about HIV.
HIV prevention should not be delivered as part of a wider LGBT health approach, it dilutes the message. The decisions we make about our sex lives are influenced not just by our level of knowledge and skills about sex, but by our general environment. Drugs & alcohol, mental health, relationship issues, stigma & discrimination (for example) all impact on the decisions we make and our ability to implement those decisions. By promoting the wider health of gay men, we make HIV prevention more successful. Just talking about the mechanics of sex on its own is not an effective response.
Healthy Communities supports/has advocated for civil partnerships/marriage equality. As an organisation we have a duty to promote public policies which will improve the health & wellbeing of LGBT people. Stable relationships, facilitated by civil partnerships and/or marriage is good for people’s health, including same-sex couples. http://www.australianmarriageequality.com/wp/wp-content/uploads/2011/07/AME-facthealth-Jul11.pdf This is also the position of the Australian Medical Association: 6.6 The AMA is supportive of legislation that proscribes discrimination and provides legislative recognition of same-sex unions and families as this will lead to legal, societal, financial and healthcare equity within the community. http://ama.com.au/node/552
LGBT health is not a priority for this government in difficult economic times. The government wants to reduce HIV infections and STIs, reduce mental illness & suicide, reduce cigarette smoking, reduce illicit drug use, reduce problem drinking, reduce crime & violence. These are all areas were LGBT are overrepresented compared to non LGBT. If LGBT people aren’t specifically targeted, then government’s overall goals will not be met. Targeting programs at groups most at risk, against a backdrop of whole-of-community activity, is the most effective and efficient way to achieve improvements in health.
State, National & International HIV Frameworks Healthy Communities fully works within the HIV frameworks produced by the Queensland Government and Australian Government and which Australia signed up to through the UN Political Declaration on HIV/AIDS in 2011. The Queensland HIV, Hepatitis C and Sexually Transmissible Infections Strategy 2005-2011 states:
Re: approach of Strategy - “... it allows Queensland to take a wider social determinant view of health needs, by incorporating psychosocial and social justice issues into a broader health and wellbeing framework.” Pg 5 Guiding Principles – “The creation of an enabling environment relies on principles that respect the contribution of individuals and communities to improve their own health outcomes. Elements of success include:... (c) systems that ensure people affected by HIV, HCV and STIs have equitable opportunities for access to programs and services... (e) local and statewide political environments that assists communities to actively participate in the improvement and delivery of local programs; and (f) recognition that social determinants and cultural factors contribute to a person’s ability to negotiate safer behaviours.” Pg 20 Enabling Environment – Objective 3 – “Target populations and people with HIV, HCV and STIs in Queensland have the opportunity to participate in decision making to improve their health and wellbeing outcomes. Key Strategies - 1. Promote structures and programs that encourage the active participation of and decision making by individuals with and local communities affected by HIV, HCV and STIs in the development of policies and programs impacting on their health, relationships and wellbeing. 2. Include input from those communities who are being targeted, including peers, in partnership with service providers, government and researchers.” Pg 21 Partnerships and Governance – Non-government Sector and Community Based Organisations “Nongovernment service providers offer a range of services across Queensland and advocate for the interests of affected individuals, communities and/or those at risk of HIV, HCV and/or STIs. These important organisations provide services to target populations that are complementary to government and private sector services.... The non-government sector and community based organisations are well place to provide programs to target populations such as the gay community...” Pg 31 The Sixth National HIV Strategy 2010-2013 states: Roles & Responsibilities of Parties to this Strategy – “While governments are the formal parties to this document, a partnership approach has been central to the development of this strategy. This has included significant consultation with, and input from, community organisations, researchers, clinicians and health sector workforce organisations”. Pg 1 “...funding arrangements are provided jointly by the Commonwealth and the states and territories under the National Healthcare Agreement, which is a Schedule to the Council of Australian Governments (COAG) Intergovernmental Agreement on Federal Financial Relations (which came into effect on 1 January 2009).” Pg 2 “It is essential that a partnership approach be reflected in all jurisdictional and non-government agency planning, implementation, monitoring and evaluation and that lessons learned are shared.” Pg 4 “A guiding principle of this strategy is the meaningful participation of people living with HIV and affected communities in development, implementation, monitoring and evaluation of programs and policies. Their participation is essential because it ensures that policies and programs: • are effective • are informed by the experiences of those with HIV and affected communities • are responsive to need • take into account the full range of personal and community effects of policy directions.” Pg 5
Guiding Principles – “The Ottawa Charter for Health Promotion provides the framework for effective HIV, STI and viral hepatitis health promotion action and facilitates the: ~ active participation of affected communities and individuals, including peer education and community ownership, to increase their influence over the determinants of their health ~ formulation and application of law and public policy that support and encourage healthy behaviours and respect human rights as this protects those who are vulnerable or marginalised, promotes confidence in the system and secures support for initiatives. ... An effective partnership of governments, affected communities, researchers and health professionals is to be characterised by consultation, cooperative effort, respectful discussion and action to achieve this strategy’s goal. This includes: ~ non-partisan support for the pragmatic social policy measures needed to control HIV, STIs and viral hepatitis.” Pg 11, 12 Priority Areas for Action – “Targeted resourcing of the prevention response is highly efficient and critical to the success of the national response, but may need increased support to reach highly marginalised populations. Poorly targeted investment and disinvestment in prevention have led to a resurgence of HIV in some jurisdictions.” Pg 19. Priority Areas for Action “...The effectiveness of peer-based responses to HIV has been clearly demonstrated in gay communities.” Pg 22. Human rights, legislation and anti-discrimination – “Taking a human rights approach to HIV means creating a supportive social and legal environment where rights are respected and protected and the equitable right to health is fulfilled. A commitment by governments to human rights is particularly important in seeking to establish the cooperation and trust of communities that are marginalised and disadvantaged and that may be subject to legal sanction. Australia’s approach to HIV/AIDS has demonstrated the protection of human rights to be both compatible with and essential to the effective protection of public health.” Pg 39
The U.N. Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS (to which Australia is a signatory) states: 29. Note that many national HIV-prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk, specifically men who have sex with men, people who inject drugs and sex workers, and further note, however, that each country should define the specific populations that are key to its epidemic and response, based on the epidemiological and national context; 40. Recognize that close cooperation with people living with HIV and populations at higher risk of HIV infection will facilitate the achievement of a more effective HIV and AIDS response, and emphasize that people living with and affected by HIV, including their families, should enjoy equal participation in social, economic and cultural activities, without prejudice and discrimination, and that they should have equal access to health care and community support as all members of the community; 44. Recognize the role that community organizations play, including those run by people living with HIV, in sustaining national and local HIV and AIDS responses, reaching all people living with HIV, delivering prevention, treatment, care and support services and strengthening health systems, in particular the primary healthcare approach; 57. Commit to continue engaging people living with and affected by HIV in decisionmaking and planning, implementing and evaluating the response, and to partner with local leaders and civil society, including community-based organizations, to develop and scale up community-led HIV services and to address stigma and discrimination; 62. Commit to working towards reducing sexual transmission of HIV by 50 per cent by 2015;
77. Commit to intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV and promote access to HIV prevention, treatment, care and support and non-discriminatory access to education, health care, employment and social services, provide legal protections for people affected by HIV, including inheritance rights and respect for privacy and confidentiality, and promote and protect all human rights and fundamental freedoms, with particular attention to all people vulnerable to and affected by HIV; 78. Commit to review, as appropriate, laws and policies that adversely affect the successful, effective and equitable delivery of HIV prevention, treatment, care and support programmes to people living with and affected by HIV and to consider their review in accordance with relevant national review frameworks and time frames;