Guide to Australian HIV Laws and Policies for Healthcare Professionals
Managing HIV transmission risk behaviours
Australia’s public health system has produced impressive results in limiting HIV transmission. The public health response has occurred within a environment/framework of respecting human rights, which has meant that there has been strong engagement and collaboration with at-risk and affected communities. HIV prevalence in Australia is as low or lower than in most comparable countries. In 2016, Australia had an estimated national HIV prevalence of 0.1, lower than the United Kingdom in 2016 (0.15) and approximately four-fold lower than the United States in 2012 (0.4-0.8). Estimated HIV prevalence in several neighbouring countries is substantially higher than that in Australia.
If not appropriately conducted, the public health management of individuals accused of putting others at risk of HIV infection (and the subsequent media coverage associated with the event) threaten to undermine faith in the public health system. Patient management must be expert and responsive to the needs of both the person with HIV and any possible sexual contacts. Moreover, it must be supportive of individuals so that they may successfully change their behaviours.
In general, health care providers should not hesitate to contact their health department for support and guidance from their state expert panel on those who place others at risk of HIV infection. There is a strong commitment to assist health care providers to manage challenging and difficult cases, with faith in health care providers’ competence to understand the dynamics of each therapeutic relationship, and their capacity to exercise expert clinical judgment. There is unlikely to be pressure to disclose confidential information about a patient in the first instance, with health care workers frequently remaining responsible for the patients about whom they contact others.
The following section is adapted from Scamell and Ward (2009):
“Each Australian state and territory, either through statute alone or a combination of statute and complementary departmental policy, have public health mechanisms in place to manage people with HIV infection who are at risk of transmitting the infection to others. These mechanisms have been designed to facilitate behavioural change of individuals identified as posing a risk of passing on HIV to others. As such, these public health management tools represent a more individualised and coercive aspect of the public health response to HIV transmission than the health promotion and education activities that are generally directed towards at-risk population groups.”
It is important to note that the number of individuals for whom these mechanisms apply at any one time is small. The overwhelming majority of people with HIV in Australia actively take steps to ensure that transmission of HIV to others does not occur. However, owing to a range of psychological, social and other factors, there are some people who engage in behaviour that could or does place their sexual partners at risk of HIV infection. Public health mechanisms are enacted at the point where the public health system recognises an individual’s needs more than the provision of information. Sometimes responses may be considered supportive, and sometimes they are clearly coercive.
The National Guidelines for Managing HIV Transmission Risk Behaviours 2018 (‘the National Guidelines’) are designed to ‘inform, support, and harmonise approaches by Australia’s States and Territories to the management of people with HIV who place others at risk of HIV infection’. Several states and territories have indicated that they will review revise their jurisdictionally-specific guidelines and policies, to ensure a level of consistency with the National Guidelines.
State Based Information
- Scamell D, Ward C. Public health laws and policies on the issue of HIV transmission, exposure and disclosure. In: Cameron S, Rule J, editors. The Criminalisation of HIV Transmission in Australia: Legality, Morality and Reality, Sydney: NAPWA; 2009. p. 48-59.