Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce   Graham Brown
Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce <ul><li>Foun...
Community response to HIV <ul><li>Building on a range of human, gender and social rights and justice movements, HIV brough...
Community response to HIV <ul><li>Building on a range of human, gender and social rights and justice movements, HIV brough...
Core principles of HIV response have included… <ul><li>Human rights  principles and the  Ottawa Charter . </li></ul><ul><l...
Preventative Health Agenda <ul><li>Australia: the healthiest country by 2020  </li></ul><ul><li>and the Government Respons...
7 strategic directions from the NPHTF <ul><li>Shared responsibility and strategic partnerships  </li></ul><ul><li>Act thro...
Engage communities …inform, enable and support people to make healthy choices <ul><li>In HIV affected communities led the ...
Engage communities …inform, enable and support people to make healthy choices <ul><li>Broad based HIV social marketing did...
Reduce inequity through targeting disadvantage   <ul><li>Expertise on the taskforce ensured that  social determinants of h...
Reduce inequity through targeting disadvantage   <ul><li>There are important groups not identified within preventative hea...
Indigenous Australians  – contribute to ‘Close the Gap ’   <ul><li>Currently there is little gap epidemiologically in HIV ...
Influence markets and  develop   coherent and connected policies <ul><li>Similar to sex - eating is a natural function of ...
Refocus primary healthcare  towards prevention <ul><li>As indicated by WHO – the majority of the factors that determine pe...
What needs to be engaged with and advocated? <ul><li>When I lay back and think of core mobilisers in the gay community, wh...
…big, drinking, smoking, bears!
What needs to be engaged with and advocated? <ul><li>Reaction against dogma or dominant culture or can be part of a margin...
What needs to be engaged with and advocated? <ul><li>For HIV  - great opportunities in, but not a straight forward fit wit...
What needs to be engaged with and advocated? <ul><li>There is much that we can (and do) learn from the experiences and suc...
What needs to be engaged with and advocated? <ul><li>Need to share more effectively and with greater influence the real le...
<ul><li>Complementary Reading: </li></ul>
 
 
Strategic Partnerships <ul><li>HIV partnership and the role of affected communities has been at the core of the HIV respon...
Act throughout life – working with individuals, families and communities <ul><li>Healthy weight and chronic conditions, al...
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Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce - Dr Graham Brown

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Presentation from the AFAO National Symposium on Prevention, held in Sydney, Thursday 27 May, 2010.

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Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce - Dr Graham Brown

  1. 1. Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce Graham Brown
  2. 2. Community-based approaches to HIV prevention & priorities and strategies of the Preventative Health Taskforce <ul><li>Foundations within the HIV community response </li></ul><ul><li>Preventative Health Agenda </li></ul><ul><ul><li>Reflecting on strategic directions of PHTF </li></ul></ul><ul><ul><li>Implications to and from HIV and affected communities </li></ul></ul><ul><li>What needs to be engaged and advocated </li></ul>
  3. 3. Community response to HIV <ul><li>Building on a range of human, gender and social rights and justice movements, HIV brought a revolution in the way affected communities participated at all levels of public health initiatives </li></ul><ul><li>eg The “Denver Principles” in 1983 </li></ul><ul><ul><li>Positive activists announced a set of principles that would revolutionise responses to self-empowerment in a health crisis. </li></ul></ul>
  4. 4. Community response to HIV <ul><li>Building on a range of human, gender and social rights and justice movements, HIV brought a revolution in the way affected communities participated at all levels of public health initiatives </li></ul><ul><li>Innovative approaches developed by affected communities and activists. </li></ul><ul><li>It was later that the influence of a formalised health promotion frameworks and social research became more significant </li></ul><ul><li>Australia’s relative success in HIV demonstrated that an integrated, participatory, pragmatic and community driven response does work, and works better </li></ul><ul><ul><ul><ul><ul><li>(Lowe and Nutbeam, 1999,, Feachem, 1995, Nutbeam, 1998, Brown 2006). </li></ul></ul></ul></ul></ul>
  5. 5. Core principles of HIV response have included… <ul><li>Human rights principles and the Ottawa Charter . </li></ul><ul><li>Partnership of affected communities, PLHIV, Government, researchers, health professionals. </li></ul><ul><li>Strong and visible leadership by both Government and community. </li></ul><ul><li>An enabling environment with bi-partisan support. </li></ul><ul><li>Commitment to harm reduction principles. </li></ul><ul><li>Legislation and public policy reform to support healthy behaviours, protect those who are vulnerable or marginalised. </li></ul><ul><li>A resourced community and research sector , ensuring a community driven and evidence based foundation. </li></ul>
  6. 6. Preventative Health Agenda <ul><li>Australia: the healthiest country by 2020 </li></ul><ul><li>and the Government Response </li></ul><ul><ul><li>driven by evidence based contemporary practice, much which is consistent with the evidence that HIV response has provided </li></ul></ul><ul><ul><li>Highlights the success of HIV </li></ul></ul><ul><li>However does not articulate: </li></ul><ul><ul><li>How the methods used in HIV might be applied as a model for the development of strategies regarding obesity, alcohol and tobacco </li></ul></ul><ul><ul><li>How the approaches of the Preventative Health Framework could enhance areas outside of Alcohol, Tobacco and Obesity or with communities not identified in the high level reports </li></ul></ul>
  7. 7. 7 strategic directions from the NPHTF <ul><li>Shared responsibility and strategic partnerships </li></ul><ul><li>Act throughout life </li></ul><ul><li>Engage communities where they are </li></ul><ul><li>Influence markets and coherent connected policies </li></ul><ul><li>Reduce inequity through targeting disadvantage </li></ul><ul><li>Indigenous Australians and ‘ Close the Gap ’ </li></ul><ul><li>Refocus primary healthcare towards prevention </li></ul><ul><li>Reflect on a some of these </li></ul>
  8. 8. Engage communities …inform, enable and support people to make healthy choices <ul><li>In HIV affected communities led the debates in deciding and developing what the ‘healthy choices’ would be. </li></ul><ul><ul><li>Using condoms was not the first or only option presented to gay men in the early 80s by public health </li></ul></ul><ul><ul><li>Communities most affected by HIV, particularly gay men and sex workers, invented the concept of ‘safe sex’. </li></ul></ul><ul><li>What does community participation and control mean for Obesity, Tobacco and Alcohol initiatives? </li></ul><ul><ul><li>Clear principles with our Indigenous communities – others? </li></ul></ul><ul><ul><li>Who are the communities in a generalised epidemic? </li></ul></ul><ul><ul><li>Who decides the healthy choices? </li></ul></ul><ul><ul><li>Is participation just “people living with weight” being on committees? </li></ul></ul>
  9. 9. Engage communities …inform, enable and support people to make healthy choices <ul><li>Broad based HIV social marketing did not start on the right footing – utilising stigmatising fear based approach </li></ul><ul><li>I think to a large extent the taskforce has started from a much more informed place </li></ul><ul><ul><li>There is a momentum in Australia to still go down the fear and blame path </li></ul></ul><ul><ul><li>This is a joint challenge of HIV, HepC and NPA </li></ul></ul>
  10. 10. Reduce inequity through targeting disadvantage <ul><li>Expertise on the taskforce ensured that social determinants of health was recognised as a major factor </li></ul><ul><li>Stigma and discrimination has been one of the largest social barriers to the response in HIV. </li></ul><ul><ul><li>HIV and affected communities </li></ul></ul><ul><ul><li>long standing historical and cultural stigma and discrimination at the personal, social, legal and structural level. </li></ul></ul><ul><li>Health and social inequalities between LGBTI communities and rest of the community </li></ul><ul><ul><li>Higher alcohol and tobacco consumption higher within these groups? History of poor treatment from health professionals, educators, and authorities. </li></ul></ul><ul><ul><li>While things have changed a lot, for many of our community members these experiences are recent, and much has yet to change. </li></ul></ul><ul><ul><li>(Paul Martin speaking later today) </li></ul></ul>
  11. 11. Reduce inequity through targeting disadvantage <ul><li>There are important groups not identified within preventative health agenda strategies </li></ul><ul><li>As with any marginalised affected community – there can be resistance when: </li></ul><ul><ul><li>messages seen as “health enforcement”, </li></ul></ul><ul><ul><li>an assumption that absence of disease is the priority goal, </li></ul></ul><ul><ul><li>culturally irrelevant or inaccurate, or </li></ul></ul><ul><ul><li>omits their community’s existence. </li></ul></ul><ul><li>In HIV we have had to grapple with “At what point does social and peer influence become stigmatising, discriminatory and exclusionary influence?” </li></ul>
  12. 12. Indigenous Australians – contribute to ‘Close the Gap ’ <ul><li>Currently there is little gap epidemiologically in HIV – suggesting non priority within Indigenous health. </li></ul><ul><li>However Indigenous communities may be our most vulnerable. </li></ul><ul><ul><li>Social determinants and cultural contexts </li></ul></ul><ul><ul><li>eg. For many Indigenous communities sharing is a core characteristic of the culture. Promotion of non-sharing injecting equipment can conflict the way culture is expressed. </li></ul></ul><ul><li>We have seen in Australia what happens when investment and leadership in HIV prevention is reduced – resulting in major increases in HIV transmission. </li></ul><ul><li>Danger of an unstrategic focus on only the “gaps”, and a reduction in the community mobilised HIV responses. </li></ul>
  13. 13. Influence markets and develop coherent and connected policies <ul><li>Similar to sex - eating is a natural function of life, full of emotion, culture, meaning and pleasure, power, regret, guilt and fantasy. </li></ul><ul><li>Similar to injecting - Alcohol and Tobacco is full of personal and peer expectations, cultural meaning and ritual, and social constructions and judgements. </li></ul><ul><li>Result: Moralising, stigma, and belief systems can compete against having evidence based coherent and connected policies (eg expansion of NSP, sex work law reform) </li></ul><ul><li>National Prevention Agency will be in a strong position to mobilise the translation of evidence into policy and practice with implications across many health areas. </li></ul>
  14. 14. Refocus primary healthcare towards prevention <ul><li>As indicated by WHO – the majority of the factors that determine people’s health are outside the control of the health sector </li></ul><ul><li>Much of the Taking Preventative Action report is more health service focused than broader health promotion. </li></ul><ul><li>Complexity of treatment as prevention, and the individualised focus, is as much a challenge for Obesity, Tobacco, Alcohol as it is for HIV </li></ul>
  15. 15. What needs to be engaged with and advocated? <ul><li>When I lay back and think of core mobilisers in the gay community, who rallied against dogma, stigma and the early oppressive responses to HIV – what do I see? </li></ul>
  16. 16. …big, drinking, smoking, bears!
  17. 17. What needs to be engaged with and advocated? <ul><li>Reaction against dogma or dominant culture or can be part of a marginalised group’s empowered identity. </li></ul><ul><ul><li>What if “health”, as presented, is rejected </li></ul></ul><ul><ul><li>“ How can we impact gay men who have railed against dominant messages about ‘perfect’ gay body type, lesbians rejecting patriarchal objectification of women’s bodies, or men who have lived long-term with HIV who consider the notion of ‘getting on a treadmill’ an anathema?” (Cameron, AFAO Briefing paper) </li></ul></ul><ul><li>Issue of health promotion verses health enforcement </li></ul><ul><ul><li>90’s backlash response in USA </li></ul></ul>
  18. 18. What needs to be engaged with and advocated? <ul><li>For HIV - great opportunities in, but not a straight forward fit with, wider preventative health strategies: </li></ul><ul><ul><li>Community participation and control, </li></ul></ul><ul><ul><li>Stigma/Discrimination </li></ul></ul><ul><ul><li>Harm reduction, </li></ul></ul><ul><ul><li>Use of evidence and policy, </li></ul></ul><ul><ul><li>Generalised and concentrated targeted approaches </li></ul></ul><ul><li>Alcohol, tobacco and obesity are critical health issues impacting directly on PLHIV and LGBT communities </li></ul>
  19. 19. What needs to be engaged with and advocated? <ul><li>There is much that we can (and do) learn from the experiences and successes of other community interventions and responses outside for HIV. </li></ul><ul><ul><li>From reducing social and structural stigma to self management of chronic conditions </li></ul></ul><ul><li>There are common challenges and goals for both HIV partnership and the NPA </li></ul><ul><ul><li>Key opportunities to collaborate and partner </li></ul></ul>
  20. 20. What needs to be engaged with and advocated? <ul><li>Need to share more effectively and with greater influence the real lessons we have learnt in HIV – its successes and failures . </li></ul><ul><li>Need to ensure our communities achieve improved health benefits from the NPA agenda </li></ul><ul><li>Need to ensure broader health agendas and reforms enhance and support our work in HIV prevention without: </li></ul><ul><ul><li>Losing the strengths and principles our non conforming LGBT, sex worker and IDU communities have built; or </li></ul></ul><ul><ul><li>Reducing the momentum we have built in HIV prevention and support </li></ul></ul>
  21. 21. <ul><li>Complementary Reading: </li></ul>
  22. 24. Strategic Partnerships <ul><li>HIV partnership and the role of affected communities has been at the core of the HIV response from the beginning, </li></ul><ul><li>Probably the largest difference between Australia’s response and the response of many other countries. </li></ul><ul><li>But partnerships do not just happen </li></ul><ul><li>Need all partners to have the capacity to play their full role </li></ul>
  23. 25. Act throughout life – working with individuals, families and communities <ul><li>Healthy weight and chronic conditions, alcohol and tobacco have been significant issues within LGBT communities and PLHIV. </li></ul><ul><li>Tobacco, Alcohol, Nutrition and Physical activity </li></ul><ul><ul><li>these are all influenced by social networks </li></ul></ul><ul><ul><li>GLBTI networks are likely to have higher proportions of members who smoke, drink at harmful levels, and have cultures with them that affirm larger body sizes as a social and political response </li></ul></ul><ul><li>Difference between concentrated and generalised responses – and the importance of targeting. </li></ul>

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