Assessing the National HIV/AIDS Strategy evaluation.
The report is a useful compilation of data on Australia's HIV/AIDS epidemic and the response to it. The report produces firm evidence for endorsing Australia's success in limiting the spread of HIV by a number of routes. Australia has been successful in preventing iatrogenic spread, spread through commercial sex and spread through injecting drug use. In the latter case however, the hepatitis C epidemic cautions against complacency. The report, unfortunately, does not recognise very serious weaknesses in the evidence it uses as a basis for its endorsement of current efforts against HIV in the male homosexual community and the general heterosexual community. The report recognises failure of current policies in Aboriginal and Torres Strait Islander communities and recognises the threat posed here by HIV but recommends no major policy change. There is some recognition of the limitation of the data, but no recommendation for increased surveillance. The report ignores methods of prevention other than public health education. In my view, there is sufficient evidence to recommend routine neonatal circumcision, at least in Aboriginal and Torres Strait Islander communities. There is a clear need for a more effective approach to STD control, particularly in these communities. Adequate STD and HIV control may well require contact tracing and surveillance using traditional public health methods. Measurement of objective indicators of the success of HIV prevention campaigns needs to be improved with more comprehensive collection of data on HIV and STD incidence and condom sales, stratified by relevant covariates. Survey evidence of behavioural change should be collected from those too young to be affected by the selective mortality factor. The international comparisons await a proper statistical study which may be able to identify the elements of an effective approach to AIDS. In future reviews of the effectiveness of Australia's response to AIDS, all methods of limiting the spread of the epidemic should be considered objectively. It is unacceptable for the AIDS program to be declared optimal simply because it accords with current public health ideology.
Department of Mathematics and Statistics, James Cook University, Townsville. david.kault@jcu.edu.au
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D001315:Australia / Q000453:epidemiology; D015982:Bias; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006302:Health Services Research / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D000095283:Australian Aboriginal and Torres Strait Islander Peoples