Resetting the agenda: the makings of ‘A New Era’ of HIV policy in NSW

Abstract

The New South Wales Government's NSW HIV Strategy 2012-2015: A New Era represented a punctuated shift of policy direction, and was remarkable for its ground-breaking declaration that HIV transmission could be virtually ended by 2020. This significant policy shift occurred after a long period of stability and only incremental change, some of it represented by policy decline as political and public interest in HIV waned. This article uses punctuated equilibrium theory to explore the conditions that allowed for change, and the roles played by new and long-standing actors in the HIV policy subsystem. It explains the importance of challenges to the policy image and the policy venue as key mechanisms that allowed new possibilities, created by advances in the scientific understanding of HIV, to be incorporated rapidly into government policy.

Responding to HIV/AIDS: Mobilisation through partnerships in a public health crisis

“…Well-resourced, empowered affected communities provided rapid feedback loops to mobilise the community and identify solutions that fed into policy (Nous Group 2015). This participatory strategy was an essential contributor to policy success (Misztal 1991;Kippax and Race 2003;O'Donnell and Perche 2016).…”

“…Advocacy and investment were also critical to policy success (Brown et al 2014). Yet, despite international recognition of Australia's effort, fatigue, complacency, political drift and some fractured partnerships have impeded recent progress and sustained low incidence rates, and the success of new biomedical treatment and prevention has also contributed to HIV slipping from the centre of the policy agenda (Moodie et al 2003;Cameron and Godwin 2014;O'Donnell and Perche 2016). This slip began in the 1990s with the 'mainstreaming' of HIV funding and services (Bowtell 2005).…”

The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men

“…On the basis of clinical trial evidence, community agencies now promote the use of antiretroviral treatment as prevention. 85,86 Even in the context of 'drug-fuelled' multi-partner sex without condoms (as 'chemsex' is often sensationally characterised), the risk of HIV infection is reduced if the viral load of HIVpositive participants is suppressed by the use of antiretroviral therapy, 87 and/or when HIV-negative participants are using pre-exposure prophylaxis. 88 With increased rates of HIV testing, early initiation of antiretroviral therapy on the part of HIV-positive individuals, uptake of pre-exposure prophylaxis by at-risk individuals and effective adherence, the risk of HIV infection can be reduced (though the transmission of other STIs will not necessarily be mitigated).…”