Australia's HIV-prevention response: Introduction to the special issue.

Abstract

Australia is relatively unique in having, until recently, sustained an effective response to HIV in all of its affected communities. The first case of AIDS was diagnosed in 1982 in a gay man in Sydney, and between 1982 and 1985 HIV spread rapidly, with an estimated 4,500 men being infected, predominantly in the gay community in Sydney and to a lesser extent in Melbourne. The majority of these infections took place at a time when relatively little was known scientifically about HIV (then known as HTLV-III). In consequence, men within the gay community and their friends were forced to look to their own resources—organizing politically and socially, and drawing upon experience both at home and elsewhere in the world, to mount what in retrospect is perhaps best seen as something of a social revolution among gay and other homosexually active men. The difficulty of these early struggles should not be underestimated, especially since homosexual behavior between men remained illegal in many states in Australia until the mid 1980s, and into the 1990s in Queensland and Tasmania. Although there was concern that HIV was also spreading among people who injected drugs (PWID) and that it would be only a matter of time until heterosexual infections became more common, as the pattern of transmission became more established, it was apparent that spread via injecting drug use remained at a very low level (about 5% of the total, but closer to 1% if gay and other homosexually active men who also inject are excluded), that transmission from medical procedures such as the receipt of blood or blood products had declined from about 14% in 1985–1986 to about 1% in 1991–1992, and that onward transmission into the heterosexual community had not occurred to any great extent. The peak in HIV incidence occurred in 1987, and incidence declined year on year until 1999. Over that period, 1987–1999, there was a profound decline in the epidemic. Thereafter, there has been a small but steady increase in incidence. Gay and other homosexually active men remain the largest group affected by HIV in Australia. HIV transmission continues to occur mainly through sexual contact between men and in 2012 accounted for 70% of newly diagnosed HIV infections and 87% of newly acquired infection. The early and relatively sustained success of the Australian response can be attributed to a wide range of actions by communities and networks, supported by government. These include but are not limited to the following measures. Between