The document provides an introduction to the HIV, viral hepatitis and sexual health sector. It covers the scope and development of the sector, including progressive strategy development from the 1980s onwards. Specific Aboriginal and Torres Strait Islander strategies were also developed due to disproportionately high rates of infections in these communities. The sector involves various conditions and diseases including HIV, viral hepatitis, sexually transmissible infections and blood-borne viruses. Key partner organizations in the sector are described along with their roles and relationships. Advisory and governmental committees that guide policy and implementation are discussed alongside some of the tensions that can emerge in a partnership-based sector with diverse stakeholders. The strategic approach of developing goals, objectives and indicators to guide practice at national and state levels is outlined.

1. INTRODUCTION TO THE HIV, VIRAL HEPATITIS
AND SEXUAL HEALTH SECTOR
Presented by: Levinia Crooks

2. Welcome
Years in the
Your name Organisation Your role
sector
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3. Scope
At an external At an individual
level, with an level, how this
understanding of impacts on
stakeholder management
State, National and
This including communication
International Strategies
with stakeholders
workshop
will provide
government policy and working efficiently with
you with an funding processes Committees
introduction
to the BBV policy, advisory and
Sector government committees
and their roles
key policy issues
currently affecting us
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4. PART 1:
DEVELOPMENT OF THE SECTOR
At the end of this session you will be familiar with:
• The strategy development which has occurred in the HIV, viral
hepatitis and sexual health sector
• Why specific Aboriginal and Torres Strait Islander strategies
and/or implementation plans have been developed
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5. Progressive Strategy Development
Grim Reaper Campaign launched in October 1987
AIDS Green paper: AIDS a Time to Care a Time to Act: Toward a Strategy for Australians –
1988
National AIDS Strategy -1989
2nd National HIV/AIDS Strategy -1993
3rd National HIV/AIDS Strategy Partnerships in Practice -1996
A strategy framed in the context or sexual health and related communicable diseases
National Indigenous Australians’ Sexual Health Strategy – 1996
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6. Progressive Strategy Development - continued
4th National HIV/AIDS Strategy: Changes & Challenges – 1999
National Hepatitis C Strategy – 1999
5th National HIV/AIDS Strategy – 2005
Revitalising Australia’s Response
2nd National Hepatitis C Strategy – 2005
2nd National Aboriginal and Torres Strait Islander Sexual Health & Blood Borne Viruses
Strategy – 2005
1st National Sexually Transmissible Infections Strategy – 2005
WDP/ASHM Pilot Course 6

7. Progressive Strategy Development - continued
6th National HIV Strategy – 2010
3rd National Hepatitis C Strategy – 2010
3rd National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually
Transmissible Infections Strategy – 2010
2nd National Sexually Transmissible Infections Strategy – 2010
1st National Hepatitis B Strategy - 2010
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8. Aboriginal & Torres Strait Islander People
• Comprise 2.3% of population and continue to be overrepresented in
STIs and BBV notification data
• Chlamydia and gonorrhea still reported at high rates
• Diagnoses of infectious syphilis remained stable in 2010
• HIV diagnosed at a similar rate to that in the non- Aboriginal, but
substantial differences in distributions of exposure
• Hepatitis C and B are reported at disproportionately high rates
• Remote and very remote communities continue to experience
significantly higher rates of chlamydia, gonorrhea and infectious
syphilis compared with regional and urban centres
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9. The Sector
HBV
STI
HCV
HIV
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10. Development of “sector”
• HIV response, community led and initiated
• Clinicians on Board early
• Government response fairly quick and effective
• Decline in infections occurs before funding of 1st National AIDS
Strategy
• Partnerships developed, sustained response heralded as world class
• Lots of planning for care needs in-hand with prevention
• Infrastructure from HIV can accommodate other conditions
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11. PART 2
SECTOR PARTNERS - ORGANISATIONS
At the end of this session you will be familiar with:
• the main sector community organisations
• the relationship between organisations and
• start developing your own mud map of how these players inter-
relate
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12. Some definitions: NGO – CBO - NFP
CBO is a
NGO is a non-
community NFP is a not-for-
government
based profit
organisation
organisation
• They can all have members
• All can make money but the NFP has to put the money back into
furthering its objectives
• Ministry for Health can fund under the NGO program and CBO and
NFP are seen as subsets of NGO
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13. Sector NGO in NSW
ACON - AIDS Council of NSW AFAO
SWOP Scarlet Alliance
Positive Life NSW NAPWA
Bobby Goldsmith Foundation
Hepatitis NSW Hepatitis Australia
NUAA – NSW Users and AIDS Association AIVL
Cancer Council of NSW CC of Australia
Ethnic Communities Council of NSW FECCA
ASHM
Australasian Society for HIV Medicine(NSW)
Aboriginal Health & Medical Research Council NACCHO (affil)
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14. Roles and functions
NUAA – NSW
ACON - AIDS Bobby
Positive Life Hepatitis Users and
Council of Goldsmith
NSW NSW AIDS
NSW (SWOP) Foundation
Association
• Prevention, • Advocacy • Financial • Prevention, • Harm
care and policy and practical care, minimisation
support, for people assistance support and services
advocacy living with to PLWHA advocacy for people
and policy HIV/AIDS and policy who inject
people (PLWHA) people drugs
affected by affected by (PWID)
HIV VH
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15. Professional & Workforce Organisations
Aboriginal Health
& Medical
ASHM SH&FP NSW ASHA
Research
Council
• Supporting the • State org • Sexual Health • Australasian
HIV, viral representing and Family Sexual Health
hepatitis and health services Planning – Alliance –
sexual health which provides health services, workforce
workforce care to education and advocacy
through Aboriginal prevention (to
education, policy people, workers and
development professional and community)
and advocacy workforce
development,
health advocacy
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16. Governance
• Board of Directors or Committee – Governance
• Management of the organisation – CEO or Executive Director +/-
Management Committee
• Each organisation will have a constitution and will have the capacity
to develop committees through which to do its work
• N-F-P Boards are elected and have to be voluntary. They can not be
paid for supplying their governance function
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17. Government & QANGO Organisation
Local Health
Ministry of
Districts Medicare Locals
Health
(Formerly AHS)
Funds agencies
through the NGO Service gaps and
Program Hospital and out of hours
health services services and
(provided through education etc with
Provides funds for government) funding from
services through Commonwealth
to LHD
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18. Any questions?
Comments?
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19. PART 3:
COMMITTEES, ROLES & TENSIONS
At the end of this session you will have some insight into:
• The Partnership approach as the term is used in the sector
• The different advisory and governmental committees
• The relationships between these committees and the sector
• Tensions which emerge in a sector which is heterogeneous but
which works in partnership
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20. Partnership Approach
Government
Consumers
Policy
Programs
Laws
Actions
Medical
Scientific
Community
Professional
Workforce
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21. Policy & Advisory versus Governmental
Committees
BBV & STI Sub-committee – BBVSS of
Australian Public Health Development
Ministerial Advisory Committee on Principal Committee or the AHMAC
HIV/AIDS & STI Strategy – CAS
MACBBVS – The Ministerial Advisory
Committee of Blood Borne Viruses and STI
Ministerial Advisory Committee on
Hepatitis C – MACH
Highly Specialised Drugs Working Party -
HSDWP
CAS - Health Promotion Sub-Committee
Communicable Diseases Network of
Australasia – CDNA
HIV Testing Working Group (of CAS)
AWARE – Acronym Without A Reasonable
Excuse
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22. Who attends – what do they do?
• ACON, Positive Life, NUAA (observer), ASHM,
AHMRC all attend, but appointments are on
CAS individual basis, researchers, clinicians,
Ministry
• Hepatitis NSW, NUAA, AHMRC, ASHM
MACH (attends if invited for specific items),
researchers, clinicians, Ministry
• Policy development
• Consider changing epidemiology/issues
• Develop and advise on strategy for prevention, harm minimisation,
care etc
• Provide strategic advise of contentious issues and media
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23. Tension
Sexual
Hepatitis C health
did not have added to
foundation mix – in
3rd National community NSW sexual
Initial HIV
HIV/AIDS sector which health
response to investment
Strategy was active funded
hepatitis C level never
Partnerships in HIV as a initially from
included matched in
in Practice - function of HIV to
with HIV HCV, HBV
1996 organised provide
political gay foundation
rights clinical
movement services
across state
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24. Tension in the Sector
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25. PART 4:
THE STRATEGIC APPROACH
At the end of this session you will have some insight into:
• The different levels at which strategy is developed
• How this guides practice
• How high level strategy can be used as a call to action
• How action is called for
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26. National Strategies Indicators
•
National HIV Strategy 2010 - 2013 March 2010
Endorsed by States, 3. Objectives and indicators
Territories and This section details objectives and indicators for use in monitoring progress under the strategy. Indicators are
measurable targets that apply to the related objective. The primary indicators are those that have been
agreed under the National Healthcare Agreement (NHCA). These have been specified and will be regularly
Commonwealth reported during the life of the agreement. Additional indicators have been included for the more specific
objectives relevant to this strategy. Further work will be undertaken during the implementation phase to
develop a surveillance and monitoring plan. This will include further work on specifications for the indicators,
•
and development of an agreed process for reporting them. In some circumstances further data development
Indicators are included but may also be needed.
precise targets not stated GOAL OBJECTIVE INDICATOR(1)
To reduce the transmission of Reduce the incidence of HIV Incidence of HIV infection
and morbidity and mortality (National Healthcare
caused by HIV and to minimise Aqreement Indicator)
the personal and social impact of
HIV. Reduce the risk behaviours Proportion of men who have
associated with the transmission Of engaged in any unprotected anal
HIV intercourse with casual male
partners in the previous six months
(National Healthcare Agreement
Indicator)
Proportion of people who inject
drugs who re-used another person's
used needle and syringe in the
previous month
Increase the proportion of people Proportion of people receiving
living with HIV on treatments antiretroviral treatment for HlV
with undetectable viral load infection whose viral load is less
than 400 copies/ml
Decrease ttio number of people with Proportion of cases of newly
undiagnosed HIV infection diagnosed HIV infection that are a
late HIV diagnosis (defined as newly
diagnosed HIV infection with a CD4+
cell count of <200 cells/p.1)
Improve the quality of fife of Proportion of people with HIV who
people living with HIV report their general health status and
their general well being to be
excellent or good.
(1) In areas where data are available
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27. Calling for Targets
• Some commentators all calling for the translation of the UN
commitments into domestic targets. Bill Whittaker has called for
ambitious targets:
– Reducing sexual transmission of HIV among men who have sex with
men by 80 per cent by 2015.
– Eliminating HIV transmission from injecting drug use by 2015.
– Eliminating HIV transmission among sex workers and clients by 2015
• This is going to be one of the important issues for the sector as there
will be some people resistant to targets, while others will be much
more eager to include them
INTRODUCTION TO THE
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28. PART 5:
IMPLEMENTATION – CALL TO ACTION
At the end of this session you will have some insight into:
• Steps that are taken to translate policy and strategy to practice
• How a responsibility framework is developed to measure activity
against strategy
• The relationships between strategies and their implementation
• The establishment of targets, performance measures
INTRODUCTION TO THE
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29. Translation to implementation
High level implementation plans A detailed surveillance and monitoring
developed by States, Territories and frame work has been developed which
DoHA. Include responsibilities for will help to provide the data against which
community and professional organisation to measure the success or otherwise of
peaks, governments and others the National Strategies
• ........National and State StrategiesNationalNational strategy
implementation plansNat Strats Imp Plan FINAL.pdf
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30. Translation to policy & practice
• States and territories take from the national documents:
– Review existing state policies and strategies
– Agree to move to implementation plans, strategies and policies
which emanate from National strategies
• A requirement for BBVSS to report back through to AHMAC on
implementation
• It is this requirement to report back to AHMAC which provides the
strategies with some teeth. As the States and Territories are required
to report.
INTRODUCTION TO THE
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31. Approach to targets in the NSW HIV Strategy
• NSW has Strategies. They Targets
include numerical targets • To reduce newly acquired HIV infection by 25
per cent by 2009.
• In HIV the strategy called for an
increase in 20% of prescribers, • To achieve annual reductions in the rates of
gonorrhoea, infectious syphilis and Chlamydia
which was changed to 20% of among priority populations.
doctors involved in HIV
• To reduce the physical and psychological
management (which is largely disorders and associated disabilities in people
immeasurable) living with HIV/AIDS.
• These are from the previous • To decrease the number of late diagnoses of
HIV infection by 25 per cent by 2009.
strategy but the new HIV
Strategy is currently being • To achieve successive annual reductions in
AIDS related deaths by 2009.
finalised
• To increase the number and distribution of
s100 prescribers across NSW, and increase
the number of genera! practitioners (GPs)
involved in HIV care by 20 per cent by 2009
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32. Approach to targets in the NSW HCV Strategy
• In the hepatitis C Strategy the targets are less pronounced, but are
very specific with individual projects named.
• This approach can provide protection for projects under threat, but it
also puts the spotlight on performance
Provide culturally appropriate Continue to support hepatitis C prevention and education efforts DCS
education programs and for Aboriginal inmates and detainees, and those about to be DJJ
services for Aboriginal people released from prison. Aboriginal
SH&BBV
Prisons Project
ACCHS
Justice Health
Maintain access to the means Maintain access to appropriate disinfectant solutions. DCS
of prevention Justice Health
AIDB
Scope the potential for initiatives to strengthen access to hepatitis DCS
C prevention strategies, to inmates and detainees Justice Health
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33. Strategy through to implementation process
Policy is set at high level and flows thru to
Implementation plans, which
• May involve State and Territory level policy
• May impact or be impacted by other policy
Programs , may also contain
• Projects which will be conducted by government and
non-government agencies
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34. Strategy to implementation process
National
Highest level Strategy
National
State/Territory
Jurisdictional Plan or Strategy
Implementation
Plan
Identified
Funding NGO Strategic
Implementation Policy Directive
program
partner funding
program
Policy Process
Plan/Process
Facility Funded project Contract/funding S&T adoption
Application Procedure with CBO/LHD agreement Local adaptation
Advocacy
Report against Report against Report against Report against Report against
Evaluation indicators indicators indicators indicators indicators
Cycle back into mid-
term review & next
strategy
WDP/ASHM Pilot Course 34

35. Performance Indicators
 Performance indicators are
negotiated with the funding
proposal
 BBVSS needs to report
against its progress to the
APHDPC & thru to AHMAC.
1. Helps us to push for project
activity in priority areas
2. Provide impetus for funding
3. Provide some protection, for
threatened programs/projects
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36. PART 7:
STAKEHOLDER MANAGEMENT
At the end of this session you will have some insight into:
• The importance of stakeholders
• Some approaches for managing stakeholder relationships
• Some of the issues you may confront working with committees
• Some approaches for good committee management
• The importance of a good communication strategy
INTRODUCTION TO THE
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37. Working with Committees
Sometimes committees are difficult
Some committees are more motivated
May be significant variation between members
Working for a committee or working with a committee
Share responsibility, sign-on/off, commit, collaborate
Provide advice, we MUST provide expertise
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38. What are some of the difficulties or good
features of committees you’ve been involved
with?
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39. Features of good committee management
Clear objectives, duration, arrangements and the
expectations you have of members
Not just being a rubber stamp
Not just a reporting mechanism, “since we last
met…..”
Contribution from members. if they are an Expert
Group, how to you get and value their expertise
If they are supervisory, ask “what do you want
from me and in what form would you prefer it?”
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40. Role delineation
Consumer/ Personal
Representative
worker? experience
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41. Supporting consumer representative (and other
members)
• How does the committee work
• What are minutes
• Rules of engagement – chatham house rules
• Speaking thru the chair
• Terms of reference
• Personal versus representational rule
• Travel, reading time commitments over and above the face time
• Confidentiality and reporting back
• Representing:
– a class of people,
– being from a class and contributing personal experience garnering input from
INTRODUCTION TO THE
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42. Communication strategy
• Essential part of a project – breadth will vary, could be put on website
• If you make commitments, these must be adhered to, frequency,
format etc
• A call to action
– what action is this
– duration
– amount of work
• Using the development phase as the precursor to endorsement
• Getting the ducks in a line:
– what will the steps be
– how can you simplify these
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43. Communications approaches can take different forms
FUNDAMENTALS OF PROJECT
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44. Any questions?
Comments?
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45. Thank You
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