WA HIV Action Pla Aids 3

Healthy Workforce ● Healthy Hospitals ● Healthy Partnerships ● Healthy Communities ● Healthy Resources ● Healthy Leadership
Delivering a Healthy WA
2006-2008
Delivering a Healthy WA
Western Australian
HIV/AIDS
Action Plan
Sexual Health & Blood-borne Virus Program, Communicable Disease Control Directorate, Department of Health
This publication has been produced by
the Department of Health, Western Australia.
Sexual Health & Blood-borne Virus Program

Communicable Disease Control Directorate
Department of Health, Western Australia
Grace Vaughan House
227 Stubbs Terrace
Shenton Park WA 6008
PO Box 8172
Perth Business Centre
Western Australia 6849
Telephone: (08) 9388 4999

Facsimile: (08) 9388 4877
Web: www.health.wa.gov.au/hpg
While every endeavour has been made to

check the accuracy of information provided
in this document, the Department of Health,
Western Australia takes no responsibility for
any errors that may be contained within.
HP 8923
© DoH 2006
ii Western Australian HIV/AIDS Action Plan 2006-2008

FOREWORD
This is Western Australia (WA)’s second Plan for the prevention and control of human
immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The Plan has
been developed under the auspice and endorsed by the Western Australian Committee on HIV/
AIDS and Sexually Transmitted Infections (WACHAS). The Plan is also aligned to the Department
of Health’s (DoH’s) Strategic Intent 2005-2010: Delivering a Healthy WA, particularly in the priority
areas of healthy partnerships and healthy communities.
The Plan has been developed to provide WA with a framework under which proposed HIV/AIDS
education, prevention, treatment and care action areas can be developed and implemented. It has
also been prepared as part of a nationwide move for all States and Territories to have plans in place,
and to support the goals and principles that underpin the National HIV/AIDS Strategy – Revitalising
Australia’s Response 2005-2008. It should also be read in conjunction with the Western Australian
Sexually Transmitted Infections Action Plan 2006-2008, the Western Australian Hepatitis C Action
Plan 2006-2008 and the Western Australian Aboriginal Sexual Health Strategy 2005-2008. The DoH
recognises that similarities exist between the documents, but has produced separate documents to
mirror the National strategic approach.
The Plan provides a “blue-print” for best practice in HIV education, prevention, treatment and
care, which is relevant for WA and emphasises that current and future programs should be
equitable, accessible and culturally appropriate. It also recognises the rights and responsibilities of
people living with HIV/AIDS (PLWHA), their partners, family, carers and health care providers. In
recognising the rights of those infected with HIV to good quality care, it should also be recognised
that with rights come responsibilities, particularly with respect to knowingly placing other people at
risk of HIV infection.
There is already much valuable work being undertaken in HIV/AIDS education, prevention, treatment
and care throughout WA and the Plan will build upon this. I would like to acknowledge the support
of, and valuable contribution made by key stakeholders from both government and community-
based organisations, and the education, medical, health, scientific and research sectors in the
development of the Plan. I am optimistic that this spirit of partnership, collaboration and consultation
will carry through to the successful implementation of the Plan.
DR NEALE FONG
DIRECTOR GENERAL
Western Australian HIV/AIDS Action Plan 2006-2008 iii

TABLE OF CONTENTS
FOREWORD.......................................................................................................................iii
Acronyms.........................................................................................................................v
1. INTRODUCTION AND BACKGROUND...............................................................................1
1.1 Guiding Principles.......................................................................................................2
1.2 Goal and Objectives....................................................................................................2
1.3 HIV/AIDS Priorities......................................................................................................3
1.4 Organisational Framework..........................................................................................3
1.5 Policy and Legislative Context in Western Australia................................................... 4
1.6 Development of the Plan.............................................................................................5
1.7 Implementation............................................................................................................6
1.8 Monitoring, Reporting and Evaluation......................................................................... 6
1.9 Performance Indicators and Measures of Achievement............................................. 6
2. HIV/AIDS EPIDEMIOLOGY IN WESTERN AUSTRALIA..................................................... 8
2.1 Economic, Personal and Social Impact of HIV/AIDS.................................................. 9
3. RESPONSES TO HIV/AIDS IN WESTERN AUSTRALIA & EMERGING ISSUES........... 10
3.1 WA Response to HIV/AIDS.......................................................................................10
3.2 Emerging Issues/Challenges in WA.......................................................................... 11
4. PRIORITY AREAS..............................................................................................................12
4.1 Targeted Prevention Education and Health Promotion............................................. 12
4.1.1 Actions to address targeted prevention education and health promotion....... 15
4.2 Improving the Health of PLWHA................................................................................26
4.2.1 Actions to improve the health of PLWHA........................................................ 27
4.3 Responding to Changing Care and Support Needs.................................................. 29
4.3.1 Actions responding to changing care and support needs............................... 31
4.4 Surveillance...............................................................................................................38
4.4.1 Actions to address surveillance....................................................................... 39
4.5 HIV Testing................................................................................................................39
4.5.1 Actions to address HIV testing........................................................................41
4.6 Clearer Direction for HIV/AIDS Research................................................................. 44
4.6.1 Actions to address HIV/AIDS research........................................................... 45
4.7 WA Specific Issues....................................................................................................46
5. LIST OF CONTRIBUTORS TO THE PLAN........................................................................47
6. REFERENCES....................................................................................................................49
iv Western Australian HIV/AIDS Action Plan 2006-2008

ACRONYMS
ACCHS Aboriginal Community Controlled Health Services

ACSHM Australasian Chapter of Sexual Health Medicine
ACT Australian Capital Territory
ADA Australian Dental Association
AFAO Australian Federation of AIDS Organisations
AGPS Australian Government Publishing Service
AHCWA Aboriginal Health Council of WA
AHPA Australian Health Promotion Association
AHW Aboriginal Health Worker
AIDS Acquired Immunodeficiency Syndrome
AIHW Australian Institute of Health and Welfare
AMA Australian Medical Association
ANCAHRD Australian National Council on AIDS, Hepatitis C and Related Diseases
ANCARD Australian National Council on AIDS and Related Diseases
AOD Alcohol and Other Drug
ARCSHS Australian Research Centre in Sex, Health and Society
ART Antiretroviral Therapy
ASHM Australasian Society for HIV Medicine
ATSI Aboriginal and Torres Strait Islander
BBV Blood-borne Virus
CALD Culturally and Linguistically Diverse
CDCD Communicable Disease Control Directorate
CDHAC Commonwealth Department of Health and Aged Care
CDHFS Commonwealth Department of Health and Family Services
CDNA Communicable Diseases Network Australia
CMBS Commonwealth Medicare Benefit Scheme
Cth Commonwealth
CUCRH Combined Universities Centre for Rural Health
DALY Disability Adjusted Life Year
DAO Drug and Alcohol Office
DCD Department of Community Development
DGP Division of General Practice
DIMIA Department of Immigration and Multicultural and Indigenous Affairs
DoCEP Department of Consumer and Employment Protection
DoCS Department of Corrective Services
DoET Department of Education and Training
DoH Department of Health
DoHA Department of Health and Ageing
Western Australian HIV/AIDS Action Plan 2006-2008

DYHS Derbarl Yerrigan Health Service
EPC Enhanced Primary Care
FH Fremantle Hospital
FPWA FPWA Sexual Health Services
FTE Full Time Equivalent
GDHR Growing and Developing Healthy Relationships
GP General Practitioner
GUD Genital Ulcer Disease
HAART Highly Active Anti-retroviral Therapy
HAPAN HIV/AIDS Peer Advisory Network
HCP Health Care Provider
HCV Hepatitis C Virus
HCWA Hepatitis Council of WA
HDWA Health Department of WA
HIV Human Immunodeficiency Virus
HIV CMP-CDCD HIV Case Management Program - CDCD
HPV Human Papilloma Virus
HSV Herpes Simplex Virus
IDU Injecting Drug Use
IGCAHRD Inter-Governmental Committee on AIDS, Hepatitis C and Related
Diseases
IGCARD Inter-Governmental Committee on AIDS and Related Diseases
KAMSC Kimberley Aboriginal Medical Service Council
KEMH King Edward Memorial Hospital for Women
MACASHH Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis
MOU Memorandum of Understanding
NCHECR National Centre in HIV Epidemiology and Clinical Research
NCHSR National Centre in HIV Social Research
NGO Non-Government Organisation
NIASHS National Indigenous Australians’ Sexual Health Strategy
NMPHU North Metropolitan Population Health Unit
NPEP Non-occupational Post-exposure Prophylaxis
NRL National Serological Reference Laboratory
NSP Needle and Syringe Program
NSW New South Wales
OAH Office of Aboriginal Health
OATSIH Office for Aboriginal and Torres Strait Islander Health
OCYA Office of Child and Youth Affairs
vi Western Australian HIV/AIDS Action Plan 2006-2008

PATS Patient Assisted Transport Service
PEP Post-exposure Prophylaxis
PHC Primary Health Care
PHU Population Health Unit
PID Pelvic Inflammatory Disease
PLWHA People Living with HIV/AIDS
PMH Princess Margaret Hospital for Children
PREP Pre-exposure prophylaxis
PWID People who Inject Drugs
RACGP Royal Australian College of General Practitioners
RANZCOG Royal Australian & New Zealand College of Obstetricians and
Gynaecologists
RPH Royal Perth Hospital
SARC Sexual Assault Resource Centre
SCGH Sir Charles Gairdner Hospital
secca Sexuality Education Counselling and Consultancy Agency
SHBBVP Sexual Health and Blood-borne Virus Program
SOPV Sex on Premises Venue
SSAY Same Sex Attracted Youth
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
SWOPWA Street Worker Outreach Program WA
WA Western Australia/Western Australian
WAAC Western Australian AIDS Council Inc.
WACHAS Western Australian Committee on HIV/AIDS and Sexually Transmitted
Infections
WACHPR Western Australian Centre of Health Promotion Research
WACHS Western Australian Country Health Service
WACRRM Western Australian Centre for Remote and Rural Medicine
WAGPN WA GP Network
WAISHAC Western Australian Indigenous Sexual Health Advisory Committee
WANADA Western Australian Network of Alcohol and Other Drug Agencies
WASUA Western Australian Substance Users’ Association
WCHS Women’s and Children’s Health Service
WHCH Women’s Health Care House
WHO World Health Organization
YACWA Youth Affairs Council of WA
Western Australian HIV/AIDS Action Plan 2006-2008 vii

viii Western Australian HIV/AIDS Action Plan 2006-2008
1. INTRODUCTION AND BACKGROUND
Globally, there is still a significant HIV/AIDS crisis. By the end of 2003, 38 million people globally
were living with HIV/AIDS, a further 20 million people had died from AIDS and in 2003 there were
4.8 million new HIV infections (UNAIDS 2004).
In Australia, at the end of 2004, an estimated 21,400 cases of HIV/AIDS had been notified and there
had been 6,590 deaths (NCHECR 2005). In the five-year period, from 1994 to 1999, there was a
decline (over 30 per cent) in the number of new HIV diagnoses from 1017 cases in 1994 to 714
cases in 1999. In the five-year period thereafter, the number of new HIV diagnoses increased again
with 886 cases reported in 2004 (NCHECR 2005).
In WA, from 1983 to 2005, 1,220 HIV cases were notified amongst WA residents, of which 486 had
an AIDS diagnosis. In 2005, 60 new cases of HIV and nine cases of AIDS were notified to the DoH
(DoH 2006a). From 1983 to 2005, there were 390 deaths in HIV positive people (see section 2).
HIV/AIDS continues to be a very important public health issue in WA and needs to be addressed
using a comprehensive approach.
The Western Australian HIV/AIDS Action Plan 2006-2008 (the Plan) has been developed to provide
WA with a framework under which proposed HIV/AIDS education, prevention, treatment and care
action areas can be implemented and monitored. It has also been prepared as part of a nationwide
move for all states and territories to have plans in place that reflect the guiding principles, and
education, prevention, treatment and care priorities of the National HIV/AIDS Strategy – Revitalising
Australia’s Response 2005-2008 (DoHA 2005a) and the National Aboriginal and Torres Strait
Islander Sexual Health and Blood-borne Virus Strategy 2005-2008 (DoHA 2005b). The Plan is also
aligned with the principles of the WA DoH’s review, which resulted in the establishment of Explicit
Performance Standards (HDWA 1997). It should also be read in conjunction with the Western
Australian Sexually Transmitted Infections Action Plan 2006-2008 (DoH 2006b), the Western
Australian Hepatitis C Action Plan 2006-2008 (DoH 2006c) and the Western Australian Aboriginal
Sexual Health Strategy 2005-2008 (DoH 2005a). The DoH recognises that similarities exist between
the documents, but has produced separate documents to mirror the National strategic approach.
Programs such as professional development and workforce training, and coordination and
implementation of statewide policy and priority action areas for education, prevention, treatment
and care of HIV/AIDS, are addressed within the Plan. Many of the proposed actions are already in
place and have been developed over time.
The Plan will require metropolitan and regional health services, other government departments,
community-based organisations, primary health care providers, and the education, medical,
scientific, research and other sectors to examine their local protocols and resource commitment
to ensure best practice HIV/AIDS education, prevention, treatment and care. The Plan also
recommends links between specialist HIV treatment and care providers, and sexually transmitted
infection (STI) services throughout the State.

1.1 Guiding Principles
The Plan is guided by the following principles, which also inform the current National HIV/AIDS
Strategy (DoH 2005a):
• Leadership – The Australian Government provides national leadership and a policy framework.
Within WA, the DoH provides overall strategic direction for the control and management of
HIV/AIDS.
• The HIV/AIDS partnership – This recognises the importance of developing, maintaining and
strengthening partnerships between the government sector, community-based organisations
representing priority target groups, and the education, medical, scientific, health and research
communities, with a commitment to consultation and joint decision making.
• The centrality of PLWHA – This recognises the importance of PLWHA’s participation in policy
and program development, implementation, monitoring and evaluation.
• An enabling environment – The success of the Plan is dependent upon a supportive social,
legal and policy environment that encourages health education and prevention, promotes
access to appropriate testing, treatment and care services, and addresses stigma and
discrimination.
• A non-partisan response – According to the National HIV/AIDS Strategy, this involves
“support for pragmatic social policy and for innovative interventions that effect sustainable
behaviour change among more marginalised groups in society”.
• Health promotion and harm minimisation – Health promotion is set within the overall
framework of the Ottawa Charter for Health Promotion (WHO 1986). Harm reduction (one of
the three elements that make up the principle of harm minimisation) supports access to any
necessary and proven technologies, such as new or safe injecting equipment, or condoms,
which reduce or prevent the transmission of HIV/AIDS.
1.2 Goal and Objectives

Goal
In line with the current National HIV/AIDS Strategy (DoH 2005a), the goal of the Plan is:
• To reduce HIV transmission and to minimise the personal and social impacts of HIV/AIDS
infection in WA.
Objectives
The objectives of the Plan are also in line with the current National HIV/AIDS Strategy and are:
• To reduce the number of new HIV/AIDS infections in WA, through health promotion, harm
reduction policies, education and improved awareness of transmission and trends in
infections
• To improve the overall health and wellbeing of PLWHA in WA through equitable access to
treatments and improved continuum of care in health and human services
• To reduce HIV-related discrimination that impacts upon PLWHA and affected communities in
WA
• To develop and strengthen links with other related national and WA strategies and action
plans.

1.3 HIV/AIDS Priorities
The following six priorities were identified in the current National HIV/AIDS Strategy (DoHA
2005a):
• Targeted prevention and education
• Improving the health of PLWHA
• Responding to changing care and support needs
• Surveillance for HIV/AIDS
• HIV testing
• A clearer direction for HIV/AIDS research.
The Plan examines areas for action against each priority and proposes State-based actions, which
will address these areas (see Section 4).
1.4 Organisational Framework

The Plan builds on the previous State Plans (DoH 2001, DoH 2002a) and on previous and current
National Strategies, which continue to endorse the partnership approach to the overall management
of HIV/AIDS. The partnership approach strives towards an effective, cooperative effort between all
levels of government, community-based organisations, education, medical, health, research and
scientific communities, PLWHA and other affected people, working together to prevent and control
the spread of HIV, and to minimise the social and personal impacts of the disease (DoHFS 1996).
In WA, the partnership is based upon a commitment to consultation and joint decision making in all
aspects of the response.
The DoH provides overall strategic direction for the control and management of HIV/AIDS, STIs and
blood-borne viruses (BBV). The responsibility for implementing HIV/AIDS education, prevention,
treatment and care services is delegated through tertiary clinical services, Metropolitan and Regional
Health Services, and Population Health Units (PHUs) and through services purchased from and/or
provided by community-based organisations, including Aboriginal Community Controlled Health
Services (ACCHS) and primary health care (PHC) providers such as general practitioners (GPs).
Responsibilities and partnership

A number of organisations and other stakeholders will play vital roles in ensuring that the Plan is
implemented successfully in WA.
State Government
State government responsibilities include (DoHA 2005a):
• Investigating, monitoring and analysing HIV/AIDS epidemiology
• Developing, funding, delivering and evaluating a range of services (such as health promotion
and treatment and care services provided by community-based organisations) that reflect the
prevalence and changing needs of populations at risk
• Establishing advisory committees or structures with representation from all members of the
partnership in WA (see State Committees below)
• Establishing public policy and legislative frameworks consistent with the National HIV/AIDS
Strategy
• Establishing a state HIV/AIDS strategic action plan that complements and builds on the
National HIV/AIDS Strategy
• Ensuring that resources are allocated in accordance with guiding principles
• Measuring and reporting on the National HIV/AIDS Strategy’s implementation and agreed
performance indicators within WA

• Delivering appropriate, relevant and consistent sexual health education through the public
education system
• Management of custodial settings
• Participating in relevant national forums
• Ensuring effective inter-sectoral cooperation between state and local government.
State Committees
WA has two major advisory committees, which have an important role in the implementation of
the Plan. Both committees represent partnerships between State and Australian Government
Departments of Health, ACCHS, tertiary and primary health care (specialist and GP representation),
and other government and community-based organisations:
• The WA Committee on HIV/AIDS and Sexually Transmitted Infections (WACHAS), which has
overall responsibility for overseeing the implementation and monitoring of the Plan
• The WA Indigenous Sexual Health Advisory Committee (WAISHAC), which has a consultative
role and which will oversee the implementation of the WA Aboriginal Sexual Health Strategy
2005-2008 (DoH 2005a).
Research, medical, scientific and health care workers
The Plan acknowledges the important role played by research, medical, scientific and health care
professionals in the areas of HIV/AIDS treatment and care, health promotion, workforce training and
development, research, and policy development.
The research sector is important in informing best practice treatment and care and in providing training
and workforce development and inputting to prevention strategies and policy development.
Medical and other health care providers represent the frontline response to HIV/AIDS control, as
well as being critical in health promotion and education.
The community sector
As noted in the current National HIV/AIDS Strategy (DoHA 2005a), “the community sector brings a
unique and invaluable expertise to the partnership response to HIV/AIDS. Community involvement
in all aspects of the response is critical to its effectiveness. Community engagement in policy
development, and planning and delivery of services, ensures that policies and services are at the
forefront in identifying emerging issues, are responsive to needs and are informed by the values and
experiences of affected communities”.
The Plan recognises the crucial leadership role played by PLWHA and affected communities and
their community-based organisations in WA’s response to HIV/AIDS.
1.5 Policy and Legislative Context in Western Australia

Some WA and Commonwealth legislation, and other State plans and strategies address sexual
health and BBVs. The following documents and legislation are or will be complementary to the
Plan:
• HIV Case Management – A Program for People Knowingly Placing Others at Risk of
Infection
• Workforce and Education Framework for STD Management – Explicit Performance Standards
for a Statewide Plan to Improve the Quality of Health Outcomes for Sexually Transmitted
Diseases (HDWA 1997)
• Guidelines for Managing Sexually Transmitted Infections 2006 (DoH 2006d)
• Mental Health, HIV and AIDS – Policy Statement
• WA Health Clinical Services Framework 2005-2015

• WA Aboriginal Health Impact Statement and Guidelines
• Strategic Intent 2005-2010: Delivering a Healthy WA
• Western Australian Aboriginal Sexual Health Strategy 2005-2008 (DoH 2005a)
• Western Australian Sexually Transmitted Infections Action Plan 2006-2008 (DoH 2006b)
• Western Australian Hepatitis C Action Plan 2006-2008 (DoH 2006c)
• Health Act 1911 and Health Amendment Act 2006 (WA)
• Occupational Safety and Health Act 1984 (WA)
• Equal Opportunity Act 1984 (WA)
• Human Rights and Equal Opportunity Commission Act 1986 (Cth)
• Privacy Act 1988 (Cth)
• Disability Discrimination Act 1992 (Cth)
• Disability Services Act 1993 (WA)
• Poisons Act 1964 and Poisons Amendment Regulations 1994 (Needle/Syringe Programs)
(WA)
• Prostitution Act 2000 (WA).
The Plan has also been prepared in the context of the following national strategies:
• National HIV/AIDS Strategy – Revitalising Australia’s Response 2005-2008 (DoHA 2005a)
• National Hepatitis C Strategy 2005-2008 (DoHA 2005c)
• National Sexually Transmissible Infections Strategy 2005 - 2008 (DoHA 2005d)
• National Aboriginal and Torres Strait Islander Sexual Health and Blood-borne Virus Strategy
2005-2008 (DoHA 2005b)
• National Drug Strategy – Australia’s Integrated Framework 2004-2009.
1.6 Development of the Plan

The Plan has been developed by the Communicable Disease Control Directorate’s (CDCD’s)
Sexual Health and Blood-borne Virus Program (SHBBVP) in consultation with major stakeholders
from government, health care, research, education and community-based organisations throughout
WA. It is based on the current National HIV/AIDS Strategy but highlights specific actions, which are
relevant to WA. It addresses a diverse range of issues related to HIV/AIDS education, prevention,
treatment and care in metropolitan, rural and remote areas of the State. Furthermore, the Plan has
been developed in the context of the varied cultural and social perspectives that occur across WA.
WACHAS has been the reference group for the development of the Plan. In addition, the SHBBVP
hosted a Consultation Forum on 4 November 2005. Almost 50 stakeholders attended the Forum
and provided direction in respect of emerging challenges and priorities for HIV/AIDS education,
prevention, treatment and care in WA.
The final draft of the Plan was circulated to a wide range of stakeholders throughout WA for comment
in December 2005. Following consideration of feedback received, the Plan was endorsed by
WACHAS members in March 2006 and signed off by the Director General of Health in April 2006.

1.7 Implementation
National
The Department of Health and Ageing (DoHA), through the Ministerial Advisory Committee on AIDS,
Sexual Health and Hepatitis (MACASHH), in consultation with State and Territory Governments
and peak community-based organisations has developed an Implementation Plan to support the
National HIV/AIDS Strategy.
State
The DoH, through the SHBBVP, will be responsible for the coordination of the State Plan.
Implementation of the Plan will be overseen by WACHAS and will also involve a range of government
departments, health care providers, community-based organisations and other key stakeholders.
1.8 Monitoring, Reporting and Evaluation

The DoH will be responsible for the monitoring, reporting and evaluation of the Plan. The DoH will
monitor the Plan through the SHBBVP, with the assistance of WACHAS. Feedback will be provided
to the DoHA through established reporting processes.
It is anticipated that reporting on the Plan will also be provided to the relevant WA Clinical Network.
1.9 Performance Indicators and Measures of Achievement

National
The National HIV/AIDS Strategy 2005-2008 Implementation Plan includes a number of broad
performance indicators and measures of achievement, which States are required to respond to.
The Broad Performance Indicators include:
• The number of notifications of newly acquired HIV infection, including exposure category, age,
gender and Aboriginal and Torres Strait Islander (ATSI) status, as well as co-infection with an
STI. Also, country of birth/language spoken at home, collected where possible.
• The number of new diagnoses of AIDS, including by ATSI status
• Decreased rates of unprotected anal intercourse reported by gay and other homosexually
active men, by casual relationship status
• Monitor the rates of unprotected anal intercourse reported by gay and other homosexually
active men, by regular relationship status
• Increase in the percentage of needle and syringe program attendees who report having been
tested for HIV within the last 12 months
• Decreasing rates of STIs: chlamydia, gonorrhoea and infectious syphilis
• An increase in the number of gay and other homosexually active men who have been tested
for STIs
• An increase in the number of gay and other homosexually active men who have been tested
for HIV
• Development of a national minimum data set and data dictionary for HIV/AIDS and Sexual Health
Ambulatory Care, for use in States and Territories, to assist in the collection of epidemiological
and risk factor data on identified populations such as gay men, sex workers etc.
• Continuous mapping of education activities conducted

• Decreased number of people with a late HIV diagnosis, including by exposure category, age,
gender, and ATSI status. Also, country of birth/language spoken at home, collected where
possible
• Decrease in AIDS diagnosis, including by exposure category, age, gender, ATSI status and
country of birth/language spoken at home where possible
• Decreased rates of late HIV and AIDS diagnoses among people from priority culturally and
linguistically diverse (CALD) backgrounds.
State
The Plan examines the National HIV/AIDS priority actions, proposes State actions to complement
these, and includes measures of achievement against each State action in order to monitor and
evaluate the success of the Plan and to provide feedback to the Australian Government as required
(see section 4).
Review process
The SHBBVP will conduct a mid-term and final review of the implementation of the State Plan and
provide a report to WACHAS and WAISHAC.

2. HIV/AIDS EPIDEMIOLOGY IN WESTERN AUSTRALIA
From 1983 to 2005, 1,220 HIV cases were notified amongst WA residents, of which 486 had an
AIDS diagnosis. In 2005, 60 new cases of HIV and nine cases of AIDS were notified to the DoH
(DoH 2006a). From 1983 to 2005, there were 390 deaths in HIV-positive people.
The number and proportion of homosexually active men (men who have sex with men [MSM]) who
have become infected with HIV has declined. In 2005, MSM accounted for 45 per cent of all new
cases compared with 82 per cent in 1985. There has been an incremental rise in heterosexual
cases with 48 per cent due to heterosexual exposure in 2005, compared with three per cent in 1985.
Females accounted for 20 per cent of HIV cases in 2005 compared with five per cent in 1986, when
the first female case was notified. Females represented 12 per cent of cumulative WA cases (1983
to 2005) compared with eight per cent nationally (1983 to 2004) (NCHECR 2005).
Looking specifically at gender for all HIV notifications (1983 to 2005), heterosexual exposure
accounted for 81 per cent of female cases, and 13 per cent of male cases (DoH 2006a). Overall,
heterosexual exposure accounted for 21 per cent of cumulative HIV diagnoses in WA (DoH 2006a),
in contrast to the national figure of 12 per cent (1983 to 2004) (NCHECR 2005).
From the mid 1990’s to 2005, overseas-acquired HIV made up approximately 25-45 per cent of new
notifications in WA residents, and in 2005 this figure totalled 38 per cent. In 2004, 10 WA residents
(all male) were notified with an overseas-acquired HIV infection and in 2005, new notifications in this
category totalled 23 people (2 females and 21 males), which constitutes more than a third of the 60
new HIV notifications in WA residents in 2005. Migration to WA of people from countries with high
HIV prevalence suggests a need to provide general safe sex education for these groups, as well
as more investigation and targeted interventions for those travelling and working in high prevalence
countries
In 2005, injecting drug use (IDU) accounted for two per cent of new cases and there were two cases
among MSM who also injected drugs.
In WA, since the introduction of HIV screening in April 1985, there have been no new HIV infections
acquired as a result of exposure to blood or blood products through blood transfusion. There are a
stable, small number of cases resulting from ‘unknown’ or ‘other’ exposure.
Of the 76 HIV notifications (38 men and 38 women) reported among Aboriginal* people (as at 31
December 2005), 66 per cent acquired their infection via heterosexual contact, in comparison to 18
per cent of non-Aboriginal cases. Of all Aboriginal cases, 50 per cent are female, compared to nine
per cent of non-Aboriginal cases (DoH 2006a).
* This Plan acknowledges that Aboriginal and Torres Strait Islander people are the original people/s of Australia. For the purposes of this
Plan, however, the term Aboriginal is used in preference to “Aboriginal and Torres Strait Islander” in recognition that Aboriginal people
are the original inhabitants of Western Australia.

2.1 Economic, Personal and Social Impact of HIV/AIDS
The economic, personal and social impacts of HIV/AIDS are great. According to the National HIV/
AIDS Strategy, “social research indicates that PLWHA may experience difficulty accessing health
care services, housing, insurance, employment, education and other aspects of public life that
contribute to social exclusion and isolation. The cost burden of care on PLWHA is also significant”
(DoHA 2005a). The impact of many of these factors cannot be measured. However, data provided
by the DoH’s Epidemiology Branch highlights the burden of disease and the impact of HIV/AIDS on
the hospital system.
From 1983 to 2005, there have been 390 deaths in HIV-positive people (DoH 2006). Statistics for
Disability Adjusted Life Years (DALYs) are only available for 2000. Of the overall number of DALYs
due to infectious diseases, 7.6 per cent are attributed to HIV/AIDS (DoH 2005b).
Between 1989 and 2004, there were 43,918 hospital bed-days and the average length of hospital
stay was 5.05 days for HIV/AIDS recorded as either principal diagnoses or as secondary diagnoses
(both symptomatic and asymptomatic) (DoH 2005b).
Between 1994 and 2004, the total cost of hospitalisation for HIV/AIDS recorded as either principal
diagnoses or as secondary diagnoses (both symptomatic and asymptomatic) was $23,807,223
(DoH 2005b).

3. RESPONSES TO HIV/AIDS IN WESTERN AUSTRALIA &
EMERGING ISSUES
3.1 WA Response to HIV/AIDS

WA has always had a strong commitment to practical partnerships supporting the response to
HIV/AIDS. There has been a sustained relationship between the DoH, DoHA, other State and local
government organisations, community-based organisations, the education sector, and medical,
scientific, research and other health care sectors.
In the early days of the epidemic, the response to HIV/AIDS was guided by a series of National HIV/
AIDS Strategies. In addition to these strategies, the HIV/AIDS Treatment and Care Plan for Western
Australia 2001 (DoH 2001) and the HIV/AIDS and Sexually Transmitted Infections Education and
Prevention Plan for Western Australia 2002 (DoH 2002a) provided a framework for organisations
providing HIV/AIDS education, prevention, treatment and care.
The previous State plans were developed following extensive consultation with stakeholders, and
identified key strategies, target groups and responsibilities. A recent audit of the two plans revealed
that the vast majority of these strategies have been implemented and most are ongoing.
Achievements in the last five years in response to HIV/AIDS education, prevention, treatment and
care in WA have included:
• Ongoing workforce training and development for health professionals, local government
workers, custodial staff, and sex workers
• Ongoing peer-based education with gay and homosexually active men, sex workers, people
who inject drugs and other priority groups
• Increased access to and state-wide distribution of needles and syringes
• Health promotion campaigns, including:
◦ World AIDS Day, Travel Safe
◦ Support of the Australian Federation of AIDS Organisations’ (AFAO) Rises in New
Infections (RINI) campaign
◦ Non-occupational post-exposure prophylaxis campaign (NPEP)
• Development and distribution of the Growing and Developing Healthy Relationships (GDHR)
Curriculum Support Materials for school students (from pre-primary to Year 10) to all
government and independent schools and statewide implementation of training (DoH 2002b)
• Development of targeted resources for priority groups and the general community
• Development of policies, which address:
◦ NPEP
◦ Management of sharps injuries and other occupational health issues
◦ Safe travel
• Legislation
◦ Updating of the Health (Skin Penetration) Regulations and development and
implementation of a Code of Practice
• Development of the WA Aboriginal Sexual Health Strategy 2005-2008 (DoH 2005a)
• Establishment of Regional sexual health teams in the Pilbara, Kimberley and Goldfields
Regions
• Ongoing provision of HIV testing and contact tracing services
• Ongoing provision of an HIV Case Management Program for people knowingly placing others
at risk of HIV infection
10 Western Australian HIV/AIDS Action Plan 2006-2008

• Ongoing provision of high quality treatment and care services for PLWHA by both specialist
multi-disciplinary services and primary health care providers
• Collection, analysis and publication of epidemiological data
• Research, e.g.
◦ Gay Community Periodic Survey
◦ Aboriginal HIV Social research
◦ Clinical research and drug trials.
3.2 Emerging Issues/Challenges in WA

The following issues have been identified as emerging priorities for HIV/AIDS education, prevention,
treatment and care in WA, by a group of key stakeholders representing the education, prevention,
treatment, support and care and research sectors as well as people living with HIV/AIDS (PLWHA)
and people affected by HIV/AIDS:
• Increasing HIV notifications in WA amongst people born in countries with a high HIV prevalence,
and the development of strategies for people from CALD backgrounds and migrants from
countries with high HIV/AIDS prevalence
• More targeted education and prevention for travellers to countries with a high HIV/AIDS
prevalence, Australians who are employed to work in countries with a high or emerging
HIV/AIDS prevalence, overseas students from countries with a high or emerging HIV/AIDS
prevalence, Aboriginal women, and CALD sex workers
• Increasing numbers of PLWHA – many have complex health problems, including mental
health issues and cognitive difficulties, and as a result require considerable support
• Need for holistic models of care for PLWHA providing health enhancing services
• Treatment issues - adherence, resistance, treatment breaks, and complementary therapies
• Monitoring national developments with regard to pre-exposure prophylaxis (PREP) and non-
occupational post-exposure prophylaxis (NPEP) policy and recommendations
• Impact of National HIV Testing Policy review and recommended changes on State policy
• Research issues - the optimal use of and complications associated with antiretroviral therapy
(ART), disorders of immune reconstitution in severely immunodeficient patients, ageing issues
for PLWHA, HIV social research
• Improvement in access to HIV testing for all clients when they present for an STI
consultation
• Implementation of a more robust and systematic approach to contact tracing
• Improvement in modes of information delivery to health care providers
• Improvement in data collection and research to better inform future strategies
• Improvement in provision of harm reduction programs in school and community-based
settings
• Improvement in provision of health hardware such as condoms and dental dams
• Impact of the Infections and Selected Conditions Clinical Network on HIV/AIDS education,
prevention, treatment and care
• Impact of existing Medicare legislation on the accessibility and affordability of services
• Improvement in workforce development – upskilling GPs, training in situ for remote providers,
maintaining knowledge and skills
• Lack of services for PLWHA in rural areas
• Better engagement with the Department of Education and Training (DoET) and continued
training of teachers to deliver comprehensive sexual health education.
In section 4, actions have been proposed to address these and other state issues and challenges.
Western Australian HIV/AIDS Action Plan 2006-2008 11

4. PRIORITY AREAS
In this section, the Plan covers the six priorities identified in the National HIV/AIDS Strategy
2005-2008 (DoHA 2005a): targeted prevention education and health promotion, improving the
health of PLWHA, responding to changing care and support needs, surveillance, HIV testing, and
clearer direction for HIV/AIDS research. Under each priority area, the Plan highlights the National
priority actions and suggests complementary State-focused actions to be implemented by relevant
stakeholders.
No additional funds have been allocated for the implementation of the Plan, therefore, metropolitan
and regional health services, other government organisations, community-based organisations, and
the education, medical, scientific, research and other sectors will be required to prioritise actions
within their current funding levels, except where occasional one-off grants are able to be sourced.
4.1 Targeted Prevention Education and Health Promotion

In WA, a range of HIV/AIDS education and prevention programs exist, which:
• maintain health promotion through identifying risk factors and educating individuals to avoid
high-risk behaviours
• support interventions that target specific groups and reduce the risk amongst those people
considered to be at high risk of HIV/AIDS
• support the rehabilitation and ongoing management of PLWHA to maximise their wellbeing,
and to minimise further risk of transmission.
Priority target groups
The Plan addresses the needs of the following groups, which have been identified in the National
HIV/AIDS Strategy (DoHA 2005a) as priorities for prevention education and health promotion
initiatives. These groups are not mutually exclusive.
Gay and other homosexually active men
The majority of people with or at risk of HIV/AIDS in WA are gay and other homosexually active
men. In 2005, MSM accounted for 45 per cent of all new cases compared with 82 per cent in 1985.
Despite the decline in the number and proportion of gay and other homosexually active men who
have become infected with HIV over time, this group is still recognised as the highest priority for
health promotion.
The Plan also recognises the cultural diversity of gay and other homosexually active men including
Aboriginal gay men, transgender people, sistergirls (Indigenous transgender people) and gay and
other homosexually active men from CALD backgrounds.
PLWHA
From 1983 to 2005, 1,220 HIV cases were notified among WA residents. The Plan recognises
the crucial leadership role played by PLWHA and affected communities and their community-
based organisations in WA’s response to HIV/AIDS. According to the National HIV/AIDS Strategy,
“health promotion efforts for PLWHA should focus on initiatives relating to broader health education
and improving quality of life as well as on treatments and health maintenance initiatives” (DoHA
2005a).

Aboriginal people
From 1983 to 2005, 76 HIV notifications were reported among Aboriginal people in WA, comprising
38 men and 38 women. Even though the numbers are small, Aboriginal people in WA are at a
statistically greater risk of HIV transmission than non-Aboriginal people.
For Aboriginal people, heterosexual sex is the main mode of HIV transmission. Sixty-six per cent
of Aboriginal cases acquired their infection via heterosexual contact, in comparison to 18 per cent
of non-Aboriginal cases. Of all Aboriginal cases, 50 per cent are female, compared to nine per
cent of non-Aboriginal cases (DoH 2006a). Aboriginal women were also 10 times more likely to be
notified for HIV than non-Aboriginal women, which shows that Aboriginal women are at considerably
greater risk of acquiring HIV than non-Aboriginal women. Of those Aboriginal men diagnosed with
HIV, 42 per cent reported acquiring the virus from male-to-male sex and/or IDU. Thirty-nine per
cent of Aboriginal men reported heterosexual sex as their risk factor compared to 13 per cent of
non-Aboriginal men.
In Australia, between 2000 and 2004, a higher proportion of Indigenous HIV cases were attributed
to IDU (20 per cent) when compared to non-Indigenous cases (three per cent) (NCHECR 2005).
Gray et al (2001) found that the prevalence of IDU in Aboriginal people in WA had increased by
between 50 per cent and 100 per cent since 1994. This study provided a conservative estimate of
a prevalence of IDU among Aboriginal people aged over 15 residing in urban and major urban areas
of between 4.5 and six per cent. The study also revealed that 43 per cent of the 74 participants
had shared needles and syringes and that this group had less knowledge about BBVs and the risks
associated with IDU than Aboriginal injecting drug users elsewhere in Australia.
HIV/AIDS education and health promotion strategies should address the specific needs of Aboriginal
people.
People who inject drugs (PWID)
The 2004 National Drug Household Survey (AIHW 2005) showed that WA had the highest proportion
of the population aged 14 years and over using injected drugs of any state (0.9 per cent), and more
than twice the national average. Fortunately, rates of HIV/AIDS among PWID remain low. In 2005,
IDU accounted for two per cent of new HIV cases in WA and there were two cases among MSM
who also injected drugs. The low HIV rates can be attributed to the success of needle and syringe
programs.
According to the National Hepatitis C Strategy 2005-2008 (DoHA 2005c), PWID face discrimination
as a result of their drug use, particularly in health care settings. Lack of access to appropriate
primary health care services exists for this group, who often experience poor health. A more holistic
approach to the health and wellbeing of PWID will improve their health outcomes.
Despite the low HIV rates amongst PWID, the Plan recognises the importance of continuing and
enhancing HIV/AIDS education and health promotion strategies to address their specific needs.
People in custodial settings, including young people in detention
According to the National HIV/AIDS Strategy (DoHA 2005a), the prevalence of HIV/AIDS among
people in custodial settings remains low. However, the potential exists within custodial settings for
prevalence to rise as well as the increased risk of transmission by inmates on their return to the
community. High levels of needle sharing, availability of drugs, tattooing, violence (including sexual
violence) and the rate of transfer of inmates between and within custodial settings, along with the
cyclical movement between prison and the community all increase the risk. The high number
of movements between custodial settings is a risk because this may bring people from low HIV
prevalence areas into contact with people from high HIV prevalence areas.

Aboriginal people are markedly over represented in custodial settings. In September 2005, the WA
Department of Justice (now Department of Corrective Services [DoCS]) reported that 39.7 per cent
of the total adult prisoner population was Aboriginal while 78.9 per cent of the total juvenile custodial
population was Aboriginal (Read 2005).
Prevention and education on safe sex and safe injecting practices are key strategies to reduce and
prevent the risk of HIV transmission in custodial settings.
Sex workers
“Australia has the lowest rate of HIV/AIDS among sex workers in the world, due to the work of
community-based sex worker organisations and projects conducted in partnership with State … and
Australian Governments, and with other agencies” (DoHA 2005a). There has also been no recorded
case of HIV transmission in the sex industry setting in Australia (DoHA 2005a). However, the
potential for an increase in HIV/AIDS in sex workers remains. Marginalised groups such as street-
based sex workers or workers from CALD backgrounds generally experience higher rates of STIs
(DoHA 2005d). The high public health risk posed by the activities of some CALD sex workers has
been brought to the attention of the DoH and has received regular media attention with headlines
exposing ‘sex slavery’ and illegal immigrant sex workers. Magenta and the Street Worker Outreach
Program WA (SWOPWA) are also concerned about the increase in the number of women who are
taking up street-based sex work on release from prison.
According to the National STI Strategy (DoHA 2005d), “continued education and enablement of sex workers
is fundamental in maintaining a safe sex culture and protecting...both sex workers and their clients”.
Prevention efforts are often affected by resource constraints and sex industry legislation, and
different regulatory frameworks that govern sex work in Australia have the potential to influence
trends in HIV and STI infection. In some instances, working within a regulated industry provides sex
workers with an increased capacity to negotiate safer behaviours (DoHA 2005a).
People from priority culturally and linguistically diverse (CALD) backgrounds
People from a CALD background make up a significant proportion of new HIV diagnoses in Australia.
There is concern about late presentation and diagnosis among people from a CALD background
leading to increased infectivity in untreated individuals.
At 30 June 2001, WA had the highest proportion of overseas-born residents (29 per cent) compared
to other states and territories (ABS 2006). Given the recent increase in migration to WA from
countries with high HIV levels, there is a special need to provide HIV education for this group,
including prevention strategies when returning to visit their country of origin.
People at risk of acquiring HIV overseas
From the mid 1990’s to 2005, overseas-acquired HIV made up approximately 25-45 per cent of new
notifications in WA residents, and in 2005, this figure totalled 38 per cent (DoH 2006a). In 2004,
10 WA residents (all male) were notified with an overseas-acquired HIV infection and in 2005, new
notifications in this category totalled 23 people (2 females and 21 males), which constitutes more
than a third of the 60 new HIV notifications in WA residents in 2005. Migration to WA of people from
countries with high HIV prevalence suggests a need to provide general safe sex education for these
groups, as well as more investigation and targeted interventions for those travelling and working in
high prevalence countries.
Women
Women are more vulnerable to HIV infection compared to men for a number of biological and social
reasons (Chawla 2004). For example, women have a larger mucosal surface than men, and micro-
lesions can occur during intercourse. Coerced sex increases the risk of micro-lesions. It may also
be more difficult for women to negotiate safe sex and condom use.

In WA, females accounted for 20 per cent of HIV cases in 2005 compared with five per cent in 1986,
when the first female case was notified. Females represented 12 per cent of cumulative WA cases
(1983 – 2005) compared with eight per cent nationally (1983 – 2004) (NCHECR 2005).
The Plan also recognises that people with a disability, young people and people with mental illness
have particular prevention education and health promotion needs.
4.1.1 Actions to address targeted prevention education and health promotion

PRIORITY ACTION STATE ACTION MEASURE OF STAKEHOLDERS*
ACHIEVEMENT
Develop a culturally • Support the development and • Evaluation of National DGPs, PHUs,
appropriate targeted implementation of a culturally program SHBBVP, WAAC,
national education appropriate targeted national • Evidence of state-based WACHAS, WAGPN,
and health promotion education and health promotion activities WAISHAC
program aimed at program in WA, with state-based
prevention of HIV activities
infection in priority
groups, especially
gay and other
homosexually active
men:
• Ensure current • Promote general community • Evidence of activities
DoCS, DoET, FPWA,
education and awareness that STIs increase the risk • Evidence of GPs, PHUs, SHBBVP,
prevention of HIV effectiveness of general Teacher training
messages are community campaigns institutions, WAAC
refocused to • Provide and improve access to HIV/ • Information provided DoCS, FH, FPWA,
address the current STI information, screening/testing and • Number of clients seen GPs, Magenta, RPH,
epidemiology in treatment in high-risk settings at SOPV clinics SOPV clinics, WAAC,
HIV and sexually • Number of HIV/STI tests WASUA
transmitted • Provide outreach clinics for screening • Number of clients seen FH, FPWA, Magenta,
infections (STIs) and testing of marginalised people, at outreach clinics RPH, Street Doctor,
e.g. sex workers, street present • Number of HIV/STI tests WAAC, WASUA
Aboriginal people, marginalised youth
• Raise community awareness about • Evidence of resources DAO, DoCS, DoET,
the links between alcohol and drug • Evaluation of community GPs, PHUs, SHBBVP,
consumption and unsafe sex campaigns WAAC, WASUA
• Continue to promote HIV/AIDS • Number and reach of ACCHS, Community
education campaigns, e.g. World AIDS resources distributed health nurses, DoCS,
Day • Evidence of campaign DoHA, FPWA, GPs,
promotion PHUs, school health
• Campaign evaluation nurses, SHBBVP,
WAAC
• Continue to promote “travel safe” • Evidence of participation Department of Foreign
messages to people (including in events Affairs and Trade,
students) who are travelling, • Information on DoH DoHA, GPs, Health
particularly to and from countries with website Services Australia,
a high prevalence of HIV/AIDS • Number of resources PHUs, SHBBVP,
distributed tertiary institution
health services, travel
industry, WAAC
* Potential stakeholders have been listed alphabetically. Their inclusion does not necessarily indicate a commitment to be involved in the
implementation of the proposed actions. Other individuals and organisations may be identified during the implementation process.

• Ensure current • Provide targeted education programs • Number and type of Chamber of Minerals
education and for Western Australians working in education programs and Energy, DoCEP,
prevention countries with a high or emerging conducted FPWA, GPs, Health
messages are HIV/AIDS prevalence • Number of companies Services Australia,
refocused to involved Mining industry,
address the current PHUs, SHBBVP,
epidemiology in travel industry,
HIV and sexually WAAC
transmitted • Continue to educate the general • Evidence of educational DGPs, DoCS,
infections (cont.) community and at risk groups about activities DoET, FPWA, GPs,
safe sex practices Magenta, PHUs,
SHBBVP, WAAC
• Provide access to safe sex • Evidence of condom and ACCHS, DoCS,
equipment other safe sex equipment FPWA, GPs,
distribution Magenta, PHUs,
SHBBVP, WAAC
• Achieve the early • Encourage inter-sectoral links and • Evidence of intersectoral AHCWA, DGPs,
and comprehensive partnerships between agencies links and partnerships DoCS, NGOs,
involvement of (including mental health agencies) • Number of WACHAS Regional teams,
community-based to enhance health promotion and meetings SHBBVP, WAAC,
organisations education activities WACHAS, WAGPN,
(such as gay, IDU WAISHAC
and sex worker • Encourage and support Aboriginal • Evidence of Aboriginal AHCWA, PHUs,
organisations) people to be more involved in local involvement in planning Regional teams,
and the Aboriginal and Statewide planning and policy and policy development SHBBVP, WAAC,
community to ensure development processes WACHS, WACHAS,
that programs • Reports from regional WAISHAC
are appropriately teams
designed and • Support Aboriginal input and • Evidence of Aboriginal input AHCWA, DCD,
delivered expertise in HIV/STI education into education programs FPWA, PHUs,
delivered through community-based • Reports from regional Regional teams,
organisations teams SHBBVP
• Continue the Statewide and local • Evidence of networks and DGPs, FPWA, GPs,
health area sexual health networks number of subscribers PHUs, Regional
for communication and dissemination • Reports from regional teams, SHBBVP
of relevant information teams
• Recognise the key role played by • Evidence of involvement ofACCHS, HAPAN,
PLWHA in program design and PLWHA PHUs, SHBBVP,
delivery WAAC
• Identify specific • Provide comprehensive skills and • Evidence of health ACCHS, DGPs,
initiatives for each knowledge-based HIV and sexual education initiatives DoCS, FPWA,
of the priority target health education for all priority target Magenta, OATSIH,
populations groups PHUs, secca,
SHBBVP, WAAC,
WASUA
• Continue to raise awareness of PEP • Evidence of promotion of DGPs, DoCS, FH,
availability amongst high-risk priority PEP information FPWA, GPs, Health
groups • Evidence from Gay Direct/McKesson,
Community Periodic Survey HIV CMP – CDCD,
• Heath Direct data Hospital Emergency
• SHBBVP NPEP database Services, Magenta,
NCHSR, RPH,
SARC, SHBBVP,
SOPVs, WAAC,
WACHPR, other
clinical services

• Identify specific • Monitor evidence-based • Evidence of national ASHM, FH, FPWA,
initiatives for each developments and recommendations developments with regard NCHECR, RPH,
of the priority target with regard to PEP and update the to PEP SARC,SHBBVP,
populations (cont.) state policy as required • Updated state policy WAAC, WACHAS,
WAGPN
• Monitor developments and • Evidence of national ASHM, DoHA, FH,
recommendations with regard to pre- developments with regard RPH, SHBBVP,
exposure prophylaxis (PREP) to PREP WAAC, WACHAS
• Continue to monitor and raise • Evidence of initiatives FH, FPWA, GPs,
awareness among gay and other • Evidence from Gay NCHSR, RPH,
homosexually active men about the Community Periodic Survey SOPV clinics,
risks of HIV transmission, poorly WAAC, WACHPR
negotiated safety, drug use, and
impact of viral load on behaviour
• Promote strategies that encourage • Evidence of strategies FH, FPWA, GPs,
the adoption or maintenance of safe RPH, SOPV clinics,
sexual behaviour WAAC
• Continue to collaborate and • Evidence of collaborative LGAs, Police,
cooperate with local government “Beat” programs WAAC
authorities (LGAs) and the Police with
regard to “Beat” outreach programs
• Strengthen relationships with • Number of tests Clinicians at SOPVs,
specialist health service providers to • Number of men accessing DGPs, FH, FPWA,
increase gay and other homosexually SOPV clinical services GPs, PHUs, RPH,
active men’s access to clinical WAAC
services
• Strengthen the capacity in rural • Evidence of programs in ACCHS, AHCWA,
communities to deliver effective rural communities DGPs, OATSIH,
education initiatives for gay and other PHUs, WAAC,
homosexually active men WACHS
• Continue to promote and provide • Evidence of peer education DCD, FH, FPWA,
peer education programs that programs HCWA, OATSIH,
promote interpersonal skills, safe sex PHUs, secca,
practices, and safer injecting WAAC, WASUA
• Support campaigns that target risk • Evidence of targeted AFAO, DoCS, FH,
reduction amongst gay and other campaigns FPWA, OATSIH,
homosexually active men PHUs, RPH,
SHBBVP, WAAC
• Continue to provide one-to-one • Evidence of education FH, GPs, RPH,
and group education to gay, other WAAC
homosexually active men and
transgender people
• Develop and implement strategies • Evidence of health AHCWA, DGPs,
that promote men’s health promotion initiatives for
DoCS, FH, FPWA,
men GPs, OATSIH,
PHUs, RPH, WAAC
• Collaborate with relevant • Evidence of collaboration ACCHS, DGPs, FH,
stakeholders in metropolitan and rural • Development of appropriate FPWA, OATSIH,
areas to design and develop culturally messages PHUs, WAAC
appropriate messages that target gay
and other homosexually active men

• Identify specific • Provide services, and education • Evidence of culturally ACCHS, DoCS, FH,
initiatives for each and information that promote appropriate information FPWA, GPs, Migrant
of the priority target access to services by gay and other and services health services,
populations (cont.) homosexually active men from CALD OATSIH, PHUs,
backgrounds RPH, WAAC
• Continue to use existing surveys to • Report of Gay Community NCHSR, WAAC,
monitor behaviours that place gay and Periodic Survey findings WACHPR
other homosexually active men at risk
of HIV, e.g. Gay Community Periodic
Survey
• Develop tools to monitor risk • Results from Gay NCHSR, WAAC,
behaviours and evaluate the Community Periodic WACHPR
effectiveness of interventions Survey
• Evidence of other
monitoring tools
People living with HIV/AIDS (PLWHA)
• Educate PLWHA about the increased • Evidence from Gay Clinical services,
risk of HIV transmission associated Community Periodic FH, GPs, RPH,
with STIs Survey WAAC, WACHPR
• Ensure HIV-positive women and men • Evidence of culturally ACCHS, Clinical
have access to relevant and culturally appropriate information services, DoCS,
appropriate information and services and services DoHA, FH, FPWA,
that are sensitive to their needs GPs, HAPAN,
PHUs, RPH, Ruah,
WAAC
• Conduct education sessions/retreats • Number and content of HAPAN, RPH,
for PLWHA to encourage health education sessions WAAC
enhancing behaviours • Number and content of
retreats for PLWHA
• Raise awareness among PLWHA of • Evidence of educational GPs, HAPAN,
the importance of oral health care and resources Medical and dental
the implications for HIV prevention clinical services,
Ruah, WAAC
• Ensure HCPs and other support • Evidence of dissemination ACCHS, DGPs,
services are aware of how to access of resources and DoCS, GPs,
quality information for PLWHA information to HCPs HAPAN, Ruah,
SHBBVP, The Living
Centre, WAAC
• Promote the value and role of • Evidence of consultation ACCHS, DGPs,
involving PLWHA in community health with and inclusion of HAPAN, PHUs,
promotion programs to minimise PLWHA WAAC
discrimination
• Involve PLWHA in the planning, • Evidence of consultation FPWA, HAPAN,
development and evaluation of health with and inclusion of PHUs, SHBBVP,
promotion materials PLWHA WAAC
Aboriginal people – see page 25
• Support and conduct education • Evidence of education DAO, DoCS, HCWA,
campaigns and programs aimed at campaigns and programs PHUs, SWOPWA,
reducing IDU and encouraging safe WAAC, WASUA
sex and injecting practices
• Promote non-injecting routes of • Evidence of resources AOD agencies,
administration as an alternative to IDU DAO, DoCS, GPs,
HCWA, WAAC,
WANADA, WASUA

• Identify specific • Continue to promote and improve • Funding for NSPs ACCHS, AHCWA,
initiatives for each access to sterile injecting equipment • Number of needles and DoCS, HCWA,
of the priority target and information through needle and syringes distributed Pharmaceutical
populations (cont.) syringe programs (NSPs), particularly • Number of client contacts Council of WA,
for Aboriginal people, people from at needle and syringe pharmacists, PHUs,
remote and regional areas and youth exchange programs SHBBVP, WAAC,
• Number and type of WACHS, WASUA
outlets
• Promote the availability of and access • Evidence of referral to DAO, GPs, HCWA,
to treatment options to PWID treatment services SHBBVP, WAAC,
• Number of WASUA
people accessing
pharmacotherapy
• Encourage communication between • Evidence of ACCHS, DoHA,
community-based organisations and communication between HCWA, LGAs,
local government authorities (LGAs) community-based PHUs, SHBBVP,
to promote needle and syringe organisations and LGAs SWOPWA, WAAC,
services acceptable to PWID and local WASUA
communities
• Build ongoing relationships between • Evidence of partnerships DoHA, LGAs, PHUs,
LGAs, the Police and NSP providers Police, SHBBVP,
to encourage supportive relationships SWOPWA, WAAC,
with NSPs WACHS, WASUA
• Encourage school drug education • Evidence of inclusion of DAO, DoET, PHUs,
programs to include information about harm reduction information SHBBVP
harm reduction in relation to IDU in school curriculum
• Educate HCPs on the principles of • Number of workshops DGPs, DoCS, FH,
harm reduction and the needs of • Number of HCPs trained HCWA, PHUs,
PWID SHBBVP, WAAC,
WASUA
• Provide education and training • Number of programs FH, PHUs, SHBBVP,
programs, guidelines, protocols and • Examples of resources, WAAC, WASUA
resources for people working in NSPs guidelines, protocols
• Provide a comprehensive, multi- • Evidence of programs to DAO, DoCS,
agency collaboration to assist PWID assist PWID Outcare, PHUs,
to make the transition from a custodial SHBBVP, WAAC,
setting back into the community WASUA
People in custodial settings, including young people in detention
• Promote harm reduction measures • Number of condoms and DoCS, HCWA,
available to the wider community dental dams distributed PHUs, SHBBVP,
becoming accessible to people in within custodial settings WAAC
custodial settings, subject to security • Availability of harm
considerations within the prison reduction measures in the
system prison system
• Ensure that policies and procedures • Evidence of policies and ACCHS, DoCS,
for custodial settings address procedures and their HIV CMP – CDCD,
appropriate testing, treatment and effectiveness within PHUs, RPH, WAAC,
contact tracing, disclosure and custodial settings WACHS
confidentiality issues

• Identify specific • Continue to develop and deliver • Evidence of culturally DoCS, SHBBVP,
initiatives for each culturally appropriate educational appropriate resource WAAC
of the priority target resources and formats for staff and development and
populations (cont.) inmates in custodial settings, including dissemination
people in the juvenile justice system
• Provide inservice training for prison • Number of training DoCS, PHUs,
staff (nursing and medical staff, prison sessions for prison staff SHBBVP, WAAC
officers and vocational officers) on
HIV and other BBV-related issues
including disclosure, confidentiality,
non-discrimination, personal attitudes,
and protection issues
• Encourage discussion and liaison • Evidence of partnerships ACCHS, DoCS,
between ACCHS, PHUs, regional and joint programs OATSIH, PHUs,
health services and local prison Regional health
services services, WAAC
Sex workers
• Provide access to HIV information in • Number of brothels, Magenta, PHUs,
brothels, saunas, massage parlours saunas, massage parlours SWOPWA
and to street-based and private sex and street-based and
workers private workers contacted
• Encourage sex workers to use • Number of condoms, Clinical services,
condoms, dental dams and other dental dams etc. GPs, Magenta,
barriers, and to seek testing on a distributed SWOPWA
regular basis • Number of sex workers
seeking testing at Magenta
• Support the provision of peer-based • Number of brothels, Magenta, PHUs,
HIV/STI health promotion to sex saunas, massage parlours SWOPWA
workers and street-based workers
contacted
• Continue to provide outreach • Evidence of service FPWA, Magenta,
clinical services for assessment and provision RPH, SWOPWA
management of the health of sex • Number of attendees at
workers Magenta clinic
• Educate mainstream clinical services • Evidence of education for DGPs, DoHA, FH,
to provide a supportive environment mainstream services FPWA, Magenta,
for assessment and management of RPH, SHBBVP,
the health of sex workers SWPHU, WAGPN
• Trial programs aimed at reducing IDU • Evidence of programs FPWA, Magenta,
amongst sex workers and hence the SHBBVP, SWOPWA
economic necessity to undertake sex
work
• Strengthen the overall management • Evidence of capacity FPWA, Magenta,
capacity and strategic planning in building and extension PHUs, SHBBVP,
community-based organisations, of services to the sex SWOPWA, WAAC
to enhance effective sex worker industry
initiatives

• Identify specific • Ensure that sex workers have • Evidence of access to FPWA, Magenta,
initiatives for each access to safe sex and safe injecting safe sex and safe injecting SWOPWA, WAAC,
of the priority target equipment through NSPs, and ensure equipment WASUA
populations (cont.) that both opportunistic and structured • Evidence of education
education opportunities are available opportunities
• Provide a comprehensive, multi- • Evidence of programs to DAO, DoCS, HIV
agency collaboration to assist sex assist sex workers CMP – CDCD,
workers to make the transition from Magenta, Outcare,
a custodial setting back into the SWOPWA
community
• Provide education and resources, and • Numbers of contacts with FPWA, GPs,
promote clinical care appropriate to sex workers Magenta, SWOPWA
the health-related needs of CALD sex • Number of referrals
workers • Evidence of resources
produced
• Where possible, provide education • Evidence of programs and Magenta, SWOPWA
programs and resources for sex resources
workers involved in sex slavery to
address lack of knowledge about
rights, access to information,
screening, financial problems
People from priority CALD backgrounds
• Support and promote access to non- • Evidence of programs to DGPs, DoHA, FH,
discriminatory HIV-related services for improve access to HIV- FPWA, PHU, RPH,
people from CALD backgrounds related services for CALD WAAC, WAGPN
communities
• Provide education within CALD • Evidence of education DGPs, FPWA,
communities to overcome lack of programs targeting CALD GPs, Migrant health
support and discrimination faced by communities services, WAAC
HIV-positive CALD clients
• Provide services, education and • Evidence of services DoCS, FPWA,
information for gay and homosexually GPs, Migrant health
active men, women and heterosexual services, WAAC
men from CALD backgrounds
• Develop culturally appropriate • Evidence of training FPWA, Migrant
workforce development and training health services,
for people working for CALD PHUs, WAAC
agencies addressing information
about HIV, disclosure, confidentiality,
discrimination, and personal attitudes
• Ensure that policies and procedures • Evidence of policies and DIMIA, HIV CMP
for immigration detention centres procedures – CDCD, PHUs,
address appropriate testing, treatment Regional health
and contact tracing, disclosure and services, RPH,
confidentiality issues WAAC

• Identify specific Women
initiatives for each
• Provide a range of HIV health • Evidence of health DoCS, FH, FPWA,
of the priority target
promotion strategies for women to promotion strategies GPs, PHUs, WAAC,
populations (cont.)
ensure that different needs are met, WHCH
e.g. women from different cultural
backgrounds, lesbians
• Ensure HCPs recognise that lesbians • Evidence of information DHA, DoCS, FH,
are at risk of HIV provided FPWA, PHUs, RPH,
WAAC, WHCH
People with a disability
• Ensure that sexual health resources • Evidence of resources FPWA, PHUs, secca
and education material are designed
and appropriate for people with a
range of intellectual disabilities
• Increase the availability of programs, • Evidence of programs FPWA, PHUs,
which promote education about secca, TAFE
protective behaviours, power issues,
etc.
• Promote and provide ongoing training • Number of training Disability Services
for disability workers, carers and sessions Commission, FPWA,
families of people with disability in the • Number of workers PHUs, secca, WAAC
areas of HIV/AIDS knowledge, values attending training
and attitudes, discrimination, human
relationships and sexuality issues
• Educate HCPs about needs of people • Evidence of education DoCS, FPWA,
with an intellectual disability who programs PHUs, secca,
may be sexually active, but have WAAC,
limited access to services due to their
disability
• Provide counselling for people with • Number of counselling FPWA, GPs, secca
disability, their carers, partners and sessions
families using therapeutic frameworks
and resources relating to HIV/STIs
• Plan, develop and implement health • Evidence of programs ACCHS, FPWA,
promotion programs to enhance the developed GPs, PHUs, secca
health and wellbeing of people with
a disability and educate the wider
community about sexuality and
disability
Young people
• Work collaboratively to develop • Evidence and outcomes of AHCWA, DCD,
an intersectoral approach to youth focused programs DGPs, DoCS, DoET,
educate young people about health and services DoHA, FH, FPWA,
behaviours, which place them at risk • Specific initiatives included PHUs, SHBBVP,
of HIV/AIDS in the WA Youth Health WAAC, WAGPN,
Policy WASUA, WCHS,
YACWA, Youth
agencies
• Seek innovative ways to promote • Evidence of innovative DoHA, FH, FPWA,
and implement youth-led programs programs PHUs, SHBBVP,
that raise awareness about HIV Street Doctor,
transmission and the risks associated WAAC, WASUA,
with IDU and unsafe sexual behaviour YACWA, Youth
agencies

• Identify specific • Ensure that young people are • Number of youth consulted DoHA, FH, FPWA,
initiatives for each encouraged to participate in as part of the development PHUs, SHBBVP,
of the priority target developing the WA Youth Health and implementation of the WAAC, WCHS,
populations (cont.) Policy and to contribute to programs WA Youth Health Policy YACWA
aimed at reducing high-risk behaviours • Involvement of young
people in program
development
• Promote ongoing sexual health • Number of training DCD, DoHA, FH,
inservice training for local community programs FPWA, LGAs,
youth workers and others who work • Number of youth workers PHUs, Regional
with hard-to-reach youth to increase attending teams, WAAC,
the peer support network and increase • Regional team reports YACWA
the availability of harm reduction
information
• Provide ongoing professional • Number of training Concord Training
development and training for sessions Services, DoET,
teachers, in both the government and • Number of participants SHBBVP, Teacher
independent school sectors, in sexual training institutions
health education (including HIV/AIDS)
in both metropolitan and regional
centres
• Through the school curriculum, • Continued implementation DoET, PHUs,
continue to provide appropriate of HIV curriculum materials Regional teams,
education about HIV/AIDS for young (as part of sexual health SHBBVP, Teacher
people education) in WA schools training institutions
• Regional team reports
• Involve community-based • Evidence of partnership DoET, FPWA, PHUs,
organisations in school and community approach to school and SHBBVP, WAAC
education programs addressing sexual community education
health and HIV/AIDS awareness, programs
including discrimination
• Address needs of same sex attracted • Review of school DoET, FPWA,
youth in school and out-of-school curriculum Freedom Centre,
settings • Delivery of PASH SHBBVP, WAAC
programs
• Encourage specific involvement of • Evidence of involvement of FPWA, PHUs,
HIV-positive speakers in schools and HIV-positive speakers SHBBVP, WAAC
tertiary institutions
• Promote education about HIV/STI • Evidence of education DoCS, DoHA, HIV
screening in Juvenile Justice detention programs CMP – CDCD,
centres and ensure that adequate • Evidence of counselling, PHUs, WAAC
counselling, treatment, and contact treatment and contact
tracing occurs tracing
• Expand the use of appropriate youth • Evidence of training ACCHS, DCD,
sexual health education programs, in youth sexual health DoCS, DoHA, FH,
e.g. “PASH”, “Let’s Talk about Sex”, education programs, FPWA, PHUs,
Mooditj educational packages including number of WAAC
programs and participants
• Encourage youth, including Aboriginal • Evidence of youth ACCHS, DoHA,
youth, to be active participants in involvement in the FH, FPWA, PHUs,
the development of resources and development of resources WAAC, YACWA
prevention activities and activities

• Identify specific People with a mental illness
initiatives for each
• Where possible, provide state-wide • Evidence of training DGPs, DoCS,
of the priority target
education and training for HCPs to FH, Mental health
populations (cont.)
promote safe sex behaviour to people services, PHUs,
with a mental illness SHBBVP, WAAC
• Ensure that appropriate sexual health • Evidence of appropriate ACCHS, DGPs,
resource material is available for resource material DoCS, FH, PHUs,
people with a mental illness RPH, WAAC
• Encourage initiatives which teach • Evidence of initiatives DoCS, DoHA,
protective behaviours to people with a FH, Mental health
mental illness services, PHUs,
WAAC
• Raise HCP awareness of the need to • Evidence of programs/ DGPs, DoCS, FH,
educate, counsel and assess people resources to raise HCP HIV CMP – CDCD,
with a mental illness who practice awareness Mental health
high-risk behaviours services, PHUs,
WAAC
• Ensure that policies and procedures • Evidence of policies and ACCHS, DoCS,
for mental health institutions address procedures and their HIV CMP – CDCD,
appropriate testing, treatment and effectiveness within mental Mental health
contact tracing, disclosure and health institutions services, PHUs,
confidentiality issues RPH, WAAC,
WACHS
Homeless people
• Work with staff and volunteers at • Evidence of programs PHUs, Ruah, WAAC
boarding houses or accommodation
for the homeless to develop education
and prevention strategies for those at
risk of HIV transmission
Enhance workforce • Ensure education and training • Content of training ASHM, DGPs,
development and programs for HCPs and other workers programs DoCS, DoET,
training with HCPs and address issues of discrimination, FPWA, SHBBVP,
other workers working attitudes, confidentiality, disclosure WAAC, WAGPN
with priority target • Support the maintenance of training • Evidence of support and ACCHS, Clinical
groups skills and knowledge gained maintenance of skills etc. services, FPWA,
PHUs, SHBBVP,
WAAC, WACRRM
• Where possible provide training in • Evidence of training ACCHS, DGPs,
situ for health care workers in remote DoCS, FH, Magenta,
areas PHUs, Regional
teams, RPH, secca

Develop culturally • Increase awareness of HIV/AIDS • Evidence of culturally ACCHS, AHCWA,
effective health and risk behaviours amongst the appropriate projects DoCS, FPWA, GPs,
promotion programs Aboriginal community, including and information for the OATSIH, PHUs,
to increase the specific programs for gay and other Aboriginal community Regional teams,
awareness of HIV/ homosexually active men, women and SHBBVP, WAAC,
AIDS risk among PWID WASUA
Aboriginal people in • Implement initiatives that promote • Number of Aboriginal ACCHS, DoCS,
rural/remote and urban harm reduction amongst the Aboriginal people accessing harm FPWA, OATSIH,
settings, including community reduction services (e.g. PHUs, Regional
specific programs NSPs) teams, SHBBVP,
focused on gay and • Number of harm reduction WAAC, WASUA
other homosexually services targeting
active men, women Aboriginal people
and people who inject • Monitor HIV notification
drugs data
• Develop an active program to de- • Evidence of programs ACCHS, DCD,
stigmatise HIV/AIDS in the Aboriginal DoCS, DoET,
community using trained sexual health FPWA, OAH,
educators, who are culturally sensitive OATSIH, OCYA,
to Aboriginal issues PHUs, Regional
teams, SHBBVP,
WAAC, WAGPN
• Increase and sustain delivery of good • Evidence of a variety of ACCHS, FPWA,
quality sexual health and HIV health programs PHUs, Regional
promotion and prevention programs, teams, youth
which recognise diversity, include agencies
different media, work within and
outside school settings and include
substance use as a risk factor for HIV
• Establish (if possible) a statewide • Availability of Aboriginal ACCHS, PHUs,
Aboriginal HIV-positive speakers’ speakers Regional teams,
program or develop video resources • Development of video RPH, WAAC
for community education resources

4.2 Improving the Health of PLWHA
Improved therapies, including monitoring of treatments and recent HIV therapy advances, provide
hope that HIV will be suppressed for prolonged periods of time, and that most PLWHA will stay
in optimal health. In developing standards of care, it needs to be recognised that PLWHA may
participate in long-term, complex health maintenance programs.
The advances in treatment have both lengthened and improved the quality of life for some PLWHA,
although treatment failures can occur or patients may develop a drug-resistant host response. As a
result, many people may not benefit from these new advances and people continue to die.
PLWHA who participate in treatment come into contact with a broad range of health services, health
professionals and community support services. Therefore, continuing care must operate in a way
that supports people and allows them to maintain health-enhancing behaviours. In addition, it is
important that HIV-positive people do not abandon protective measures that decrease the risk of
transmitting the virus. Recent research documents some of the challenges and responses for
PLWHA in ongoing serodiscordant relationships in maintaining safe sex practices (Brown 2005).
In addition, consideration should be given to education, information and advice about treatment;
promotion of HIV-specific health literacy; prevention of blood-borne viruses (BBVs), STIs and
other co-infections; obstetric and gynaecological services; alcohol and other drug (AOD) services;
disability support; and transport services. Patients’ rights should also be taken into consideration.
These include rights to safety, to be informed, to choose, to be heard, to redress and to consumer
education.
Thus, any education, prevention, treatment and care plan should reflect the numerous service
provision areas that embrace this continuum of care, and ensure that a full range of services
remains accessible and available. Services should be client-orientated, whether involving clinical,
psychosocial, or personal issues. The Plan supports a strong partnership with the community,
PLWHA, core HIV/AIDS service providers and health policy makers.
Health services need to be reorientated towards a model of care that encourages or views the
individual from a holistic wellness approach. A holistic model of care acknowledges that HIV is now,
for the most part, a chronic manageable condition. For PLWHA who are managing quite well, there
is a need for health enhancing services, life skills coaching and return to work training in order that
their health can be maintained. Specific strategies regarding “secondary prevention” are required.
Strategies also should be put in place to address the needs of Aboriginal PLWHA. These should be
established with Aboriginal people and based upon the findings of the Aboriginal HIV social research
conducted in WA (Bonar, Greville & Thompson 2004).
GP Training
The training and recruitment of HIV specialist GPs, in particular HIV s100 drug prescribers, needs
to be addressed.
Training of new HIV s100 prescribing GPs is extremely difficult due to the increasing complexity of
HIV treatment with the number of antiretrovirals on the market and in the pipeline, viral resistance,
and the issues around salvage therapy.
GPs could also be up-skilled in HIV “troubleshooting” (i.e. having the capacity to understand when
problems are occurring for PLWHA on stable regimens with stable results and being able to refer
them to HIV physicians or HIV s100 drug prescribers if these results change).
Specific training could also be provided to GPs who have HIV-positive patients but are not actually
involved in their HIV care. This model may be applicable to GP practices where one doctor is an
HIV s100 drug prescriber but other GPs could assist with other medical management matters.

4.2.1 Actions to improve the health of PLWHA
ACHIEVEMENT
Support the update of • Provide State input to the ASHM • Evidence of feedback ASHM, DGPs,
the “Models of Care Clinical subcommittee updating DoCS, FH and RPH
for HIV Management “Models of Care for HIV Management Clinical services, HIV
in Adults” including in Adults”, as required Psychology Service,
allied health support SHBBVP, WAAC,
and a specific focus on WAGPN
the psychosocial and • Examine the feasibility of different • Evidence of findings DGPs, FH, PHUs,
physical wellbeing of coordinated and shared care RACGP, RPH, Ruah,
PLWHA approaches to HIV client care (e.g. SHBBVP, WAAC,
NSW Enhanced Care Project) WACRRM, WAGPN
Strengthen current • Promote the importance of and provide • Evidence of GP DGPs, FH, GPs,
training programs practical experience in diagnosis and placement programs, PHUs, RPH, Sexual
and continuing management of sexual health issues location and number of health services,
medical education for GPs in both metropolitan and rural GPs SHBBVP, WAGPN
in HIV/AIDS for areas
general practitioners, • Provide training for non-treating GPs • Number of training ASHM, Clinical
recognizing the with HIV-positive patients updates services, DGPs,
differing needs of • Number of GPs FH, RACGP, RPH,
general practitioners attending SHBBVP, WAAC,
with low and high WAGPN
caseloads • Provide GP training on early detection • Evidence of training ACSHM, ASHM,
of HIV and seroconversion • Number of GPs DGPs, FH, RACGP,
attending RPH, SHBBVP,
WAAC, WAGPN
Ensure that HIV • Ensure links are established and • Evidence of links ACCHS, DGPs, FH,
practitioners delivering maintained between specialist HIV between rural and PHUs, RACGP, RPH,
complex care services, and both primary health care metropolitan services Ruah, SHBBVP,
are appropriately providers and those with specialist WAAC, WACHS,
supported sexual health expertise in rural and WACRRM, WAGPN
metropolitan areas
• Encourage GPs to make use of • Number of GPs involved DGPs, GPs, RACGP,
programs (e.g. Enhanced Primary in EPC programs WAGPN
Care [EPC]), which better support
management of chronic diseases in
the primary care sector
Ensure that important • Participate in consultation on the • Evidence of consultation Clinical services,
new diagnostic and introduction of new diagnostic and Diagnostic
management tools management tools for routine clinical laboratories, SHBBVP,
can be incorporated care WAAC, WAGPN
into routine clinical
care, with appropriate
national clinical
management
guidelines for their use
Support MACASHH • Provide State feedback to MACASHH • Evidence of consultation DoCS, HIV CMP
to continue to play with regard to monitoring and and feedback – CDCD, SHBBVP,
a central role in advocating for best practice standards WAAC, WACHAS
monitoring and of care for PLWHA in prisons, as
advocating for best required
practice standards of
care for PLWHA in
prisons

Support the possibility • Provide State input into a national • Evidence of input DoCS, SHBBVP,
of a national summit summit to discuss approaches to WAAC, WACHAS
of all involved parties ensuring quality treatment and care in
and stakeholders to correctional facilities, as required
discuss approaches
to ensuring quality
treatment and care in
correctional facilities
Support a collaboration • Collaborate with other State and • Evidence of DoCS, SHBBVP,
of State and Territory Territory Governments to develop and collaboration WAAC, WACHAS
Governments to implement HIV/AIDS education and • Evidence of models of
develop and implement prevention in custodial settings and care
HIV/AIDS education to encourage sharing models of care
and prevention in between jurisdictions
custodial settings
and to encourage
sharing models of care
between jurisdictions
Provide opportunities • Provide social support for PLWHA to • Evidence of activities HAPAN, The Living
for education and enhance psycho-social and emotional provided Centre, RPH, Ruah,
support to optimize the functioning WAAC
well-being of PLWHA • Provide targeted education and • Evidence of activities HAPAN, The Living
support to address the needs and provided Centre, RPH, WAAC
enhance the well-being of older
PLWHA
• Provide education, information and • Number of groups, Clinical services,
support for PLWHA through groups, workshops and retreats HAPAN, The Living
workshops and retreats (including life held Centre, WAAC
skills coaching, health enhancement) • Number of participants
• Provide ongoing education and • Number of clinical ASHM, DGPs,
training to inform HCPs of advances in updates, treatment FH, HAPAN, RPH,
treatment for PLWHA (e.g. drug trials, forums SHBBVP, WAAC,
drug resistance, treatment breaks, • Number of GP training WAGPN
complementary therapies) workshops on HIV
treatment
• Provide “women specific” information • Summary of services ACCHS, FH, FPWA,
and support about women’s health provided GPs, RPH, WAAC,
issues for HIV-positive women (e.g. • Number of clients WCHS, WHCH
Pap smears, menstruation, pregnancy,
antenatal care and treatment)
• Facilitate access for PLWHA • Evidence of services DoCS, HIV CMP –
in custodial settings to all HIV • Number of PLWHA CDCD, PHUs, Tertiary
prevention, treatment and care in custodial settings hospitals, WAAC
services necessary to maintain accessing HIV treatment
good health, i.e. medication at the
correct times, dietary requirements,
skilled counselling and support, and
combination therapies

4.3 Responding to Changing Care and Support Needs
According to the fourth National HIV/AIDS Strategy (CDHAC 2000), the continuum of care is defined
as:
an intevgrated, client-orientated system of care consisting of services and integrating
mechanisms that support clients over time, across a comprehensive array of health and
social services, and spanning all levels of intensity of care.
The course of HIV infection is complex and its management requires a range of interventions. These
were outlined in the third National HIV/AIDS Strategy (CDHFS 1996):
• HIV testing and counselling services
• counselling and peer support services for people with HIV
• specialist general practitioner (GP) services for the primary management of HIV disease
• community and home care services
• outpatient and ambulatory services
• inpatient services
• welfare and housing advocacy and assistance
• day care
• mental health services
• dental health services
• dementia care services
• palliative and respite care services.
The following services are currently available in WA for the treatment, care and support needs of
PLWHA, their families, friends and carers:
• Clinical services and management for PLWHA in primary and specialised care, including
assessment of viral load levels, STI management for all HIV-positive patients, and management
of HIV-positive women during pregnancy.
• Counselling, support and education for PLWHA, their families, friends and carers
• Psychological and neuro-psychological assessment and psychological therapies
• Services for the management of PLWHA with “chaotic lifestyles” and/or serious adherence
difficulties
• Rural statewide HIV shared care service provided by Royal Perth Hospital (RPH)
• Specialised home-based nursing care, if required, for PLWHA in the community
• Short-term respite care for PLWHA.
Even though the number of PLWHA requiring palliative care has decreased sharply since the advent
of highly active antiretroviral therapy (HAART), the number of PLWHA has increased. About 20 per
cent of these people have complex needs and require considerable support (Langdon 2005).
There are new issues around HIV and ageing with growing evidence that PLWHA over the age of
55 to 60 years are experiencing worse health and psycho-social outcomes than younger PLWHA
(Langdon 2005). The problem is exacerbated because aged care facilities are generally not set up
to care for PLWHA and in some cases may be reluctant about providing care. For gay and other
homosexually active men with HIV and other PLWHA, extended families may not be in a position to
assist with care. Specific strategies need to be developed for this group.
In WA, emerging groups, which require attention, include people from CALD communities who are
increasingly accessing HIV care and support. Heterosexual men and Aboriginal people from remote
and rural areas also need to be recognised as groups with special needs. Therefore, appropriate
actions need to be developed and implemented to address the treatment and care needs of these
groups. The mobility of Aboriginal people impacts upon the continuity of care.

Management of HIV-positive women during pregnancy is vital. Currently the Multidisciplinary
Inter-hospital Pregnancy Team coordinates this service. Between 1991 and 2005, 59 pregnancies
occurred in 41 HIV-positive women and resulted in 56 live births (including two sets of twins)
(Department of Clinical Immunology and Biochemical Genetics 2006). Fifteen of the women lived
in non-metropolitan areas of WA. Of the 41 mothers, 39 per cent were of Aboriginal descent
and 32 per cent were born overseas. Of the 59 pregnancies, 50 were managed intensively by
the Multidisciplinary Inter-hospital Pregnancy Team. Of the managed pregnancies, the majority
of women received antiretroviral therapy during the second and third trimester, 97 per cent of
the babies received postnatal medication as per current protocols and none of the babies were
breastfed. Only one of the 50 babies born to HIV-positive women, who were actively managed,
acquired HIV infection (the mother had advanced disease and was treated with AZT monotherapy
in 1991). In contrast, five (55 per cent) of the nine babies from unmanaged pregnancies contracted
HIV.
Some PLWHA have special oral health needs. Access to dental health services for people on low
incomes is extremely limited and needs to be addressed. This also has important implications for
HIV prevention.
Homeswest and Centrelink need to make provisions in their rules and regulations that accommodate
PLWHA who are attempting to return to work. This is a treatment and care issue, due to the health
implications of people living on low incomes and in poverty.
New models of treatment and care for PLWHA need to be looked at. These may include
recommending six-monthly checks rather than three-monthly. Access to complementary therapies
is limited and needs to be better resourced. This includes complementary therapies within the
hospital setting.

4.3.1 Actions responding to changing care and support needs
ACHIEVEMENT
Ensure that PLWHA • Ensure PLWHA have knowledge of • Summary of services Clinical services,
can access appropriate and improved access to treatment provided DoCS, GPs, HAPAN,
treatments, care and options including complementary • Number of clients OATSIH, PHUs, WAAC
support, including therapies
appropriate income • Provide appropriate information • Evidence of information ASHM, DoCS, GPs,
support, disability to PLWHA in treatment and their provision HAPAN, SHBBVP,
support and carer primary care providers to help WAAC, Ruah, Silver
allowances improve understanding of treatment Chain, Tertiary
options and compliance with hospitals
treatment regimes, drug resistance,
complementary therapies and how to
deal with problems associated with
long-term therapy
• Regularly reassess the current • Review of current AHCWA, FH, RPH,
services available in WA to determine services and SHBBVP, WAAC,
if they meet current needs, and are identification of areas of WACHAS, WACHS,
equitable, accessible and culturally need WAGPN
appropriate on a Statewide basis
• Continue to support and enhance the • Evidence of programs ACCHS, DGPs, DoCS,
present integrated continuum of care and initiatives to FH, GPs, PHUs, RPH,
improve integrated care WAAC, WAGPN
• Promote the availability of support for • Number of PLWHA from ACCHS, DoCS,
PLWHA from non-metropolitan areas non-metropolitan areas HAPAN, PHUs, RPH,
required to visit Perth for treatment accessing services WAAC, WACHS,
and care WAGPN
• Provide a range of services that offer • Evidence of services GPs, PHUs, Ruah,
good support and promote compliance • Number of patients SHBBVP, Silver Chain,
with treatment attending Tertiary hospitals,
• Client feedback survey WAAC
• Encourage the provision of outreach • Evidence of outreach HAPAN, PHUs, secca,
services by metropolitan community- services SHBBVP, WAAC
based services to rural areas on an
as-needs basis
• Facilitate increased coordination • Evidence of shared care DGPs, GPs, RPH,
of client management between arrangements Ruah, Silver Chain,
appropriate care teams WAAC
• Recognise the need for crisis • Monitor crisis GPs, RPH, Ruah,
accommodation for PLWHA, and accommodation Silver Chain, WAAC
encourage agencies to work together requirements
on a case-by-case basis to address
the need when it arises
• Ensure social support and practical • Evidence of HIV-positive Living Centre, RPH,
assistance related to work, housing people accessing social Ruah, WAAC
and income support are available to support services
PLWHA
• Facilitate appropriate access for • Evidence of PLWHA ADA, Dentists, DoCS,
PLWHA to specialist dental treatment accessing specialist GPs, WAAC
from specialists with particular dental services
knowledge and expertise in HIV/AIDS • Provision of HIV/AIDS
training for dentists and
dental services

Ensure that PLWHA • Continue to support and provide • Number of FTE in rural ACCHS, DGPs, DoCS,
can access appropriate shared care for HIV-positive patients statewide HIV shared Mental health services,
treatments, care and involving GPs, remote area nurses, care service PHUs, RACGP, RPH,
support, including specialist services and other HCPs, • Evidence of shared care WACHS, WACRRM,
appropriate income including mental health professionals and number of clients WAGPN
support, disability
support and carer
allowances (cont.)
• Support the availability of specialist • Evidence and evaluation HAPAN, RPH,
HIV consultation for treatment and of specialist services SHBBVP, WAGPN,
care on a statewide basis coverage within WA WCHS - KEMH, PMH
• Monitor and respond to issues of • Evidence of responses Clinical services,
access to HIV/AIDS drugs and waiting to HIV/AIDS drug HAPAN, SHBBVP,
times in hospital pharmacies access issues WAAC
• Provide training to staff at health care • Evidence of training GPs, HAPAN, PHUs,
services on issues of discrimination WAAC
and confidentiality for gay and other
homosexually active men
People in custodial settings
• Promote the availability of culturally • Evidence of services DoCS, GPs, Outcare,
appropriate treatment, care and PHUs, WAAC
support services for PLWHA whilst
in prison and on discharge into the
community
Aboriginal people (also see page 35)
• Maintain provision of social support • Evidence of support ACCHS, PATS, PHUs,
to HIV-positive Aboriginal women who structures WAAC, WACHS,
are relocated for antenatal care and WCHS
delivery
People with a mental illness
• Ensure PLWHA with a mental illness • Evidence of services DoCS, DoHA, GPs,
have access to non-discriminatory Mental health services,
services PHUs, WAAC
People who knowingly place others at risk of HIV
• Ensure a partnership approach to the • Ongoing implementation ACCHS, DGPs, DoCS,
continued implementation of the HIV of HIV CMP policy GPs, HIV CMP -
Case Management Program (CMP) CDCD, PHUs, RPH
Policy in both metropolitan and rural
WA
• Ensure the cooperative development • Evidence of protocols ACCHS, DGPs,
of multi-agency protocols arising DoCS, GPs, HIV CMP
from the HIV CMP Policy for the - CDCD, PHUs, Ruah,
management of those who knowingly WAAC
place others at risk of HIV
Sex workers
• Assist HIV-positive sex workers to • Evidence of program HIV CMP - CDCD,
cease working in situations that bring outcomes to reduce Magenta, SHBBVP,
them into sexual contact with clients risk of transmission SWOPWA, WAAC
where there is the possibility of an from HIV-positive sex
exchange of body fluids workers
• Anecdotal evidence of
workers leaving the sex
industry

Ensure that PLWHA • Provide advisory services to sex • Evidence of services for HIV CMP - CDCD,
can access appropriate workers wishing to leave the sex workers wishing to leave Magenta, SWOPWA
treatments, care and industry the sex industry
support, including Women
appropriate income
support, disability • Provide training to HCPs on specific • Evidence of training DGPs, DoCS, PHUs,
support and carer issues for HIV-positive women such addressing women’s RPH, WAAC, WCHS
allowances (cont.) as treatment choices and pregnancy, needs - KEMH
harm reduction, and issues of
discrimination and confidentiality
• Encourage HIV-positive women to • Number of HIV-positive ACCHS, DoCS, FH,
attend a pre-conception assessment if women attending pre- GPs, PHU, RPH,
pregnancy is planned conception assessment WAAC, WAGPN,
WCHS - KEMH
• Provide HIV-positive women with • Evidence of resources ACCHS, FH, GPs,
information about antenatal treatment and distribution of RPH, WAAC, WCHS
options information - KEMH
• Provide ongoing opportunities for HIV- • Number of women’s WAAC
positive women to meet to discuss retreats
HIV-related issues on minimising the
personal and social impact of their
infection
• Continue to provide intensive • Number of women being Multidisciplinary Inter-
management for HIV-positive women treated hospital Pregnancy
and their babies during pregnancy and • Number of pregnancies Team (including DoH,
after delivery and their outcomes FH, RPH, WCHS
– KEMH and PMH)
PLWHA co-infected with HCV
• Encourage ongoing liaison between • Evidence of partnership DoCS, FH, HCWA,
HIV and HCV services in order to projects and outcomes RPH, SCGH, SHBBVP,
address the needs of PLWHA co- to address HIV and WAAC, WASUA
infected with HCV HCV co-infection
• Maintain a local implementation • Evidence of protocols Clinical services, DAO,
protocol to include support measures DoCS, PHUs, WAAC,
such as counselling and a range of WASUA
detoxification options for HIV-positive
PWID
• Ensure that treatment guidelines for • Evidence of guidelines Clinical services,
HIV-positive PWID are kept up-to-date being updated and DAO, DoCS, FH,
disseminated PHUs, RPH, SHBBVP,
WAAC, WAGPN,
WASUA
People with a disability
• Ensure HCPs are aware of services • Evidence of DGPs, DoCS, FPWA,
available to HIV-positive people with a information for HCP PHUs, secca, WAAC
disability and dissemination of
resources
• Ensure PLWHA with an intellectual • Evidence of PLWHA with DoCS, FPWA, PHUs,
disability have access to non- an intellectual disability secca, WAAC
discriminatory services accessing services
People with medically acquired HIV
• Recognise that people with medically • Evidence of appropriate DoCS, GPs,
acquired HIV have special needs, care provision Haemophilia
and support provision of care to these Foundation WA,
clients WAAC

Ensure that PLWHA • Ensure that mainstream services are • Evidence of training and DGPs, FH,
can access appropriate sensitive to the needs of people with information on medically Haemophilia
treatments, care and medically acquired HIV acquired HIV Foundation WA, PHUs,
support, including RPH, WAAC
appropriate income People from priority CALD backgrounds (see page 35)
support, disability
support and carer Infants and children
allowances (cont.) • Support and promote the service for • Evidence of services DGPs, PHUs, WAAC,
HIV-positive infants and children at • Number of clients WACHS, WCHS -
PMH and ensure that treatment and PMH
support services are available in rural
areas as required
• Promote a treatment and care protocol • Evidence of DGPs, PHUs, WACHS,
for HIV-positive infants and children, dissemination and WAGPN, WCHS -
ensuring it is applicable to rural areas engagement with key PMH
stakeholders, especially
in rural areas
• Ensure that services are responsive • Evidence of responsive DGPs, PHUs, WAAC,
to the needs of HIV-negative children services WCHS - KEMH,
born to HIV-positive parents • Number of clients WCHS - PMH
Improve collaboration • Facilitate increased coordination • Evidence of case DGPs, DoCS, DOH
between mental health, of case management between management (Mental health
clinical and welfare appropriate care teams services), HIV CMP
services to address - CDCD, RPH, Ruah,
the care and support WAAC
needs of PLWHA • Maintain a regular forum where • Evidence of forum DoCS, GPs, Mental
with cognitive illness management of HIV-positive patients health services, RPH,
and drug and alcohol with mental health problems can be Ruah, WAAC
dependency issues discussed as a means of addressing
appropriate care
• Ensure that HCPs within the mental • Evidence of training DoCS, Mental health
health area are aware of issues programs services, PHUs,
(prevention, and treatment and care) SHBBVP, WAAC
related to HIV/AIDS
• Continue to provide HIV clinical • Number of clients FH, RPH, Ruah,
psychology services to PLWHA, their accessing HIV WAAC
partners, families and carers psychology services
• Promote the availability of the • Evidence of promotional DGPs, Living Centre,
Statewide specialist HIV Clinical resources RPH, Ruah, Silver
Psychology Service at RPH • Number of referrals Chain, WAAC
to the HIV Clinical
Psychology Service
• Encourage HIV treatment and • Number of referrals DGPs, FH, GPs, RPH,
care providers to consult with the to the HIV Clinical WAAC
HIV Clinical Psychology Service Psychology Service
regarding patients with co-morbid
mental health issues including referral
for assessment and psychological
therapies
• Provide education and prevention • Evidence of strategies DAO, DoCS, FH,
strategies for HCPs working with Mental health services,
PLWHA with a dual diagnosis (e.g. PHUs, RPH, WAAC
psychiatric disorder or alcohol and/or
drug dependency)

Improve collaboration • Ensure the availability of services with • Evidence of services Mental health services,
between mental health, expertise to deal with AIDS-related Psychiatric services,
clinical and welfare dementia RPH, WAAC
services to address
the care and support
needs of PLWHA
with cognitive illness
and drug and alcohol
dependency issues
(cont.)
Develop long-term • Support provision of appropriate • Evidence of services DGPs, HAPAN, RPH,
support for PLWHA services for care in the community SHBBVP, WAAC
who are ageing for PLWHA who are ageing or have
or have chronic chronic disabilities
disabilities • Coordinate access to locally available • Evidence of respite ACCHS, GPs, PHUs,
respite care at regional levels, options and access in RPH, WAAC, WACHS
including seeking respite options and regions
funding support
• Encourage generic palliative care • Number of training FH, PHUs, RPH,
services to develop knowledge around programs Ruah, Silver Chain,
HIV management and care, and to • Evidence of HIV-positive WAAC, WACHS
participate in the care of HIV-positive patients receiving care
patients as required in generic services
Strengthen existing • Ensure that migrants, and health • Evidence of HIV testing DGPs, DoCS, GPs,
programs to encourage service providers working with them protocols Health service
HIV testing for are made aware of the need for pre- providers, Migrant
people from CALD test discussion and informed consent health services,
backgrounds who may prior to HIV testing WAGPN
be or have been at risk
of exposure to HIV
Provide appropriate • Ensure HIV-positive CALD clients • Evidence of HIV-positive DGPs, DoCS, FH,
training and skills have access to comprehensive, CALD clients accessing RPH, WAAC
development for staff culturally appropriate health care services
of HIV/AIDS health services
services to improve • Provide training for HCPs about the • Evidence of training FPWA, Magenta,
service accessibility needs of HIV-positive people from • Number of training Migrant health
for people from CALD CALD backgrounds sessions services, WAAC
backgrounds
Support the HIV/AIDS • Improve the capacity of the HIV/AIDS • Evidence of programs DoH, FPWA, Magenta,
community sector to community sector to work with people for people from CALD SWOPWA, WAAC
improve its capacity to from CALD backgrounds backgrounds
work with people from
CALD backgrounds
Share innovative • Conduct a forum to identify needs and • Forum conducted Migrant health
strategies, across share strategies to provide support for • Feedback provided services, SHBBVP,
jurisdictions, to provide gay and other homosexually active WAAC
support to gay and men from CALD backgrounds
other homosexually • Provide training to staff at health care • Evidence of training DoCS, FH, FPWA,
active men from CALD services on issues of discrimination PHUs, RPH, WAAC
backgrounds and confidentiality, and about
understanding the needs of gay and
other homosexually active men from
CALD backgrounds
Provide HIV-positive • Encourage peer support networks for • Evidence of the ACCHS, HAPAN,
peer support for HIV-positive Aboriginal people living establishment and PHUs, WAAC
Aboriginal PLWHA in rural and remote areas to reduce extension of peer
social isolation support networks

Recognise the • Support and encourage the • Evidence of consultation ACCHS, AHCWA,
importance of involvement of the Aboriginal with Aboriginal Clinical services,
Aboriginal input community in the development of communities PHUs, Regional
and the role of improved HIV/AIDS health services for teams, Ruah,
Australian Government Aboriginal communities SHBBVP, WAAC
organisations, in
advocating for
improved health
services for HIV/
AIDS appropriate to
Aboriginal communities
and frameworks
Develop mechanisms • Participate in cross-jurisdictional • Evidence of cross- ACCHS, AHCWA,
to enable cohesive forums and planning in response border plans and OATSIH, PHUs,
work across State and to international and cross-border program outcomes, e.g. SHBBVP, WAAC,
Territory jurisdictions emerging issues Tristate WACHAS, WAISHAC
as well as international
borders in relation to
the Torres Strait
Provide access to • Encourage and support Aboriginal • Evidence of consultation ACCHS, AHCWA,
appropriate HIV health people to be more involved in the with Aboriginal people in HAPAN, PHUs, Ruah,
care for Aboriginal and planning and development of HIV program planning and WAAC
Torres Strait Islander treatment and care programs development
people • Recognise the need to involve and • Evidence of training ACCHS, FPWA, PHUs,
give appropriate training to Aboriginal programs WAAC
people working with HIV-positive
clients
• Broker links between HIV specialist • Evidence of culturally ACCHS, AHCWA, FH,
services and clients to provide holistic, appropriate services PHUs, RPH, Ruah
culturally appropriate and confidential
services that meet the needs of
Aboriginal clients
Provide workforce • Ensure adequate education and • Number of education ADA, PHUs, SHBBVP,
development for training programs for dental and oral and training programs WAAC
health care workers health professionals that address conducted
and other services effective management requirements
with the particular for PLWHA, including discrimination
aim of maintaining issues, confidentiality and standard
high quality expert precautions
knowledge and skills • Provide ongoing training for primary • Evidence of training ADA, DGPs, DoCS
in relation to HIV/AIDS HCPs in the importance of dental and • Number of primary GPs, PHUs
and STIs in both oral health for PLWHA HCPs trained in dental
government and non- and oral health for
government health and PLWHA
community services • Provide professional education and • Evidence of training in ACSHM, ASHM,
training in HIV/AIDS, which is specific curricula DGPs, DoCS, FH,
for the ongoing needs of different • Number of HCPs trained FPWA, PHUs,
HCPs by type Professional training
• Training evaluation bodies, RPH, SHBBVP,
Tertiary institutions
WAAC

Provide workforce • Encourage HCPs to examine their • Evidence of HCP ACCHS, ACSHM,
development for attitudes, interactions and behaviours, training AHCWA, ASHM,
health care workers to ensure there are no discriminatory DGPs, DoCS, FH,
and other services practices, and that practices do not PHUs, Professional
with the particular involve breaches of confidentiality training bodies,
aim of maintaining RACGP, RPH,
high quality expert SHBBVP, Tertiary
knowledge and skills institutions, WAAC,
in relation to HIV/AIDS WACRRM
and STIs in both
government and non- • Encourage primary HCPs and HIV • Number of referrals ACCHS, DGPs, DoCS,
government health and treatment services to refer PLWHA to community-based FH, GPs, PHUs, RPH,
community services to relevant community-based organisations WAAC, Other clinical
(cont.) organisations to assist with provision services
of information and support

4.4 Surveillance
The National Centre in HIV Epidemiology and Clinical Research (NCHECR) coordinates national
HIV/AIDS surveillance. The objectives of HIV/AIDS surveillance programs are:
• To collect sufficient good quality and relevant data nationally to be able to monitor the number
of new diagnoses and heath consequences of HIV/AIDS
• To assist with planning of appropriate public health strategies (DoHA 2005a).
The National HIV/AIDS Strategy (DoHA 2005a) encourages all States to ensure active surveillance
occurs throughout their jurisdictions. As part of the National Prisons Surveillance program, the
DoCS reports quarterly to NCHECR with the number of HIV tests conducted and positive results
obtained.
Under the Health Act 1911, all medical and nurse practitioners practising in WA and pathology
laboratories are legally required to report the diagnosis of infectious diseases that are of public
health significance. These infectious diseases include HIV infection.
Medical and nurse practitioners must complete the appropriate notification forms for all patients
diagnosed with a notifiable STI/HIV, as soon as possible after confirmed diagnosis. Notifications
are forwarded to the CDCD, for cases resident in the metropolitan area, or to the appropriate PHU
for cases resident in regional areas.
The HIV/AIDS notification form is used for surveillance of HIV/AIDS. A new notification form must
be completed for each stage of infection, i.e. HIV infection, AIDS diagnosis.
Reporting Aboriginal status is important for surveillance purposes. Without a record of Aboriginal
status, the ability to resource and support service providers and communities to address HIV and
other STIs is impaired. In WA, race data is complete for HIV cases notified.
The National HIV/AIDS Strategy (DoHA 2005a) suggests the investigation of the collection of
nationally consistent data on ethnicity to enhance the ability to identify trends in HIV notifications
among people born overseas, as well as among Australian-born ethnic communities. In WA, HIV
notification forms include information about a patient’s country of birth, residency status and most
likely place of acquiring infection.
An HIV pregnancy database was established at RPH by the Multidisciplinary Inter-hospital
Pregnancy Team to help keep track of pregnant HIV-infected women managed by the hospital since
1991. Data have been provided by all members of the Team, which has enabled an audit of all HIV
pregnancies managed in WA to be undertaken. The DoH has been informed that further resources
may be required to maintain and improve the database.

4.4.1 Actions to address surveillance
ACHIEVEMENT
Ensure active • Maintain statewide HIV/AIDS • Notifications of HIV/ CDCD, DoCS, GPs,
surveillance occurs surveillance systems and reporting AIDS Laboratory services,
• Data reported to NCHECR, Nurse
NCHECR practitioners
• Maintain and investigate ways to • Evidence of database Multidisciplinary Inter-
improve the collection of data on HIV • Outcomes of HIV hospital Pregnancy
pregnancies in WA pregnancies Team (including DoH,
FH, RPH, WCHS
– KEMH and PMH)
Maintain data • Maintain collection of Aboriginal • Percentage of ACCHS, CDCD,
collection regarding identification data, through the WA notifications where DoCS, OATSIH, PHUs
Aboriginal status infectious disease notification system Aboriginal status is
recorded
Investigate the • If required, update HIV/AIDS • Evidence of updated CDCD, GPs, NCHECR
collection of data on surveillance based on national HIV/AIDS surveillance
ethnicity recommendations as a result of national
recommendations
4.5 HIV Testing

HIV testing with appropriate counselling and peer support is “critical in diagnosis, in facilitating early
intervention as a management strategy for the disease, and in minimising transmission of HIV”
(ANCARD/IGCARD 1998).
In 1998, the four key principles identified by the joint ANCARD/IGCARD HIV Testing Policy Working
Party Report were that:
• voluntary testing with counselling and confidentiality is fundamental to Australia’s HIV/AIDS
response
• testing should be of the highest possible standard
• testing is to be accessible for those at highest risk of HIV infection, and
• testing policy is critical to determining the extent and location of HIV infection in the
community.
In WA, testing is available widely from GPs and other points of primary health care, e.g. FPWA
Sexual Health Services (FPWA); Women’s Health Care House; sexual health clinics at RPH,
Fremantle Hospital (FH) (including two outreach clinics) and selected PHUs; and at outreach clinics
situated at Magenta, the WA Substance Users’ Association (WASUA) and some commercial sex on
premises venues (SOPVs).
HIV screening testing has now been placed on the Commonwealth Medicare Benefit Schedule
(CMBS) and therefore, a much larger proportion of testing will be conducted by private laboratories.
If private laboratories charge more than the Medicare rebate (85 per cent of CMBS) then there will
be a small charge to patients. PathWest bulk-bills Medicare and will continue to provide screening
testing free of charge to the patient. Testing performed on patients of public hospitals will now be
billed to the hospitals. The DoH will continue to fund PathWest to provide free diagnostic testing
that is not covered by the CMBS or hospitals, e.g. for anonymous testing for some at risk groups.
Supplementary testing will continue to be provided by PathWest at no cost to the patient.

Currently, there is no mandatory testing for HIV within the WA prison system, although the DoCS has
a policy that all prisoners are offered BBV and STI testing 14 to 21 days after entry. Testing is also
offered at annual medicals, following assault or consensual sexual activity and pre-release. Annual
testing is mandatory for all members of the defence forces, including the Army Reserve. The first
test is conducted during initial training.
It appears that people diagnosed with STIs are not always tested for HIV. Therefore, HIV testing
should be offered to all clients when they present for an STI consultation.
The National HIV Testing Policy is currently undergoing a review and recommended changes will
impact upon some of the actions of the Plan. Some of the issues under consideration at a national
level include:
• The context in which HIV testing is conducted, including:
◦ Pre- and post-test discussions
◦ Appropriate referral
◦ Maintenance of anonymity
◦ HIV testing at sexual health clinics and SOPVs
◦ HIV testing conducted by GPs both with and without HIV prescribing rights
• Antenatal HIV testing
• HIV testing for people from an Aboriginal background
• Capacity for an appropriate response to changing technologies in HIV testing (including rapid
point of care testing, salivary testing and home-based testing)
• Quality assurance issues
• Effective risk counselling and risk identification in HIV testing
• HIV testing of pre-operative and unconscious patients
• HIV testing of organ donors.
The Plan needs to incorporate the new “testing” guidelines as they become available. This will also
include guidelines for antenatal testing, and rapid testing including the possible introduction of saliva
testing.
Other testing issues include implications for refugees with regard to visa and residency status.

4.5.1 Actions to address HIV testing
ACHIEVEMENT
Review and revision of • Undertake a State consultation with • Consultation held AHCWA, DoCS, HIV
the 1998 HIV testing regard to HIV testing policy • Feedback provided and sexual health
policy in accordance clinical services,
with changing PathWest, PHUs,
epidemiology, SHBBVP, WAAC,
technology and social WACHS, WAGPN
context of the HIV
epidemic in Australia
with special attention
to:
• The appropriateness • Continue to fund and provide • Evidence of funding CDCD, PathWest,
of current funding laboratory testing for HIV infection, • Number of HIV tests RPH
mechanisms, while which is cost effective and uses conducted per year
protecting and evidence-based practice • Number of confirmatory
maintaining the tests conducted per
capacity for free and year
anonymous tests
• Pre-and post- • Promote pre- and post-test information • Distribute resources DGPs, DoCS, FH,
test information “best practice” amongst primary HCPs PHUs, SHBBVP,
procedures WAAC, WAGPN
• Raise awareness among clients of the • Evidence of client DoCS, FH, FPWA,
need for pre- and post-test information resources GPs, PHUs, RPH,
• Client feedback WAAC
• Provide training for HCPs in pre- and • Number of training ACSHM, ASHM,
post-test information procedures sessions conducted DoCS, WAAC,
WAGPN
• Ensure HCPs and their staff are aware • Number of reports of ACCHS, Clinical
of the importance of confidentiality for breach of confidentiality services, DGPs,
all medical records and procedures • Evidence of DoCS, GPs, PHUs,
(not just for HIV) confidentiality protocols SHBBVP, WAAC,
WAGPN
• Clinical role of • Include information about new • Updated guidelines Clinical services,
new rapid testing technologies in State clinical FH, RPH, PathWest,
technologies, and guidelines SHBBVP
formal guidelines for
use
• Non-blood testing, • Raise awareness of innovative • Promote programs ASHM, DoHA, FH,
e.g. saliva research findings and acceptable and protocols that PHUs, RPH, WAAC,
approaches to testing demonstrate best WAGPN
practice in research and
approaches to testing
• Antenatal testing • Continue to discuss antenatal HIV • Uptake of antenatal ACCHS, DoCS,
protocol testing with all pregnant women. testing FH, FPWA, GPs,
Women with high risk behaviours or RANZCOG, RPH,
risk histories for HIV infection should Sexual health services,
be strongly advised to be tested WCHS
• Develop a State antenatal testing • Evidence of appropriate AHCWA, RACGP,
policy following and in accordance consultation and RANZCOG, SHBBVP,
with national antenatal HIV testing completion of protocol WAAC, WACHAS,
policy (currently under review) WACHS, WAGPN,
WCHS

• Antenatal testing • Provide education and training • Number of training ASHM, DGPs,
protocol (cont.) programs for HCPs working with programs RANZCOG, RPH,
pregnant women to enable them to • Evaluation of programs WAAC, WACRRM,
identify women at risk and to promote WCHS
testing where necessary
• Improved access for • Examine barriers to accessing HIV • Evidence of ACCHS, DGPs, DoCS,
priority populations testing and develop strategies to implementation FH, PHUs, Regional
overcome these strategies to improve teams, RPH, Sexual
access to HIV testing health services,
SHBBVP, WAGPN
• Promote availability of HIV testing to • Evidence of information ACCHS, DoCS,
priority groups in resources DoHA, FH, FPWA,
GPs, Health Services
Australia, PHUs, RPH,
SHBBVP, WAAC
• Negotiate with key stakeholders to • Evidence of free DoCS, PathWest,
minimise financial barriers for people testing for vulnerable PHUs, SHBBVP,
seeking testing and treatment and disadvantaged WAAC
populations
• Provide anonymous HIV/BBV/STI • Numbers of tests GPs involved with
testing, vaccination, treatment and conducted outreach services,
referral in settings appropriate for at- • Number of vaccinations Magenta, Sexual
risk populations, e.g. through outreach provided health services, SOPV
services (commercial sex on premises clinical services,
venues, sex worker clinic, WASUA WAAC, WASUA
clinic, etc.)
• Encourage health services to promote • Evidence of sexual ACCHS, DGPs, DoCS,
HIV/STI testing opportunities through health testing and adult DoHA, FH, FPWA,
appropriate education health checks Health Services
Australia, PHUs, RPH,
SHBBVP, WAAC,
WAGPN
• Increase access to HIV screening • Number of HIV tests in ACCHS, Nurse
and testing in rural and remote rural communities practitioners, PHUs,
communities Regional teams,
WACHS, WAGPN
• Encourage local service providers to • Evidence of HIV/STI ACCHS, DoHA, FH,
expand the HIV/STI testing franchise testing protocols PHUs, RPH, SHBBVP,
to ensure a high quality service in • Adult health checks WACHS, WAGPN
remote areas and that appropriate
testing is maximised
• Develop local protocols for handling • Evidence of protocols ACCHS, DGPs, DoCS,
positive HIV test results to ensure and staff training Health Services
confidentiality and appropriate follow- Australia, PHUs,
up SHBBVP, WAGPN
• Promote maintenance of “best • Review, evaluate DGPs, DoHA, DoCS,
practice” standards to ensure and disseminate best FH, FPWA, PHUs,
confidentiality, and continuity of practice policy and Regional teams,
service provision protocols SHBBVP, WAAC,
WAGPN
• Provide training and professional • Number of training DGPs, DoCS, DoHA,
development in the provision of programs and results of FH, FPWA, PHUs,
HIV testing, with quality assurance clinical audits Regional teams,
demonstrated through regular audits SHBBVP, WAGPN
of clinical practice

• Consideration of • Investigate the possibility of • Evidence of sentinel DoCS, DoH, WACHAS
targeted testing in conducting sentinel (non-mandatory) testing in the WA prison
priority groups with testing within the WA prison system system
higher rates of late
HIV presentation
• Consideration of • Offer testing, with informed consent • Evidence and DoCS, FH, GPs,
targeted testing in and appropriate counselling, on all dissemination of clinical PHUs, WAAC
people who present occasions when clients present for protocols and results of
with an STI STI consultations or for any illness clinical audits
that may be indicative of an underlying
immunodeficiency
• Surveillance • Where systematic screening of BBVs • Report on results of CDCD, DoCS, PHUs
occurs, collate results in sentinel BBV screening and
populations notifications
• Continue to monitor and report on the • Report on HIV/AIDS CDCD, selected PHUs
epidemiology of HIV/AIDS epidemiology through
quarterly STI reports
and STI forums
• Testing of individuals • Raise awareness amongst HCPs • Evidence of HCP ASHM, DGPs, DoCS,
from high prevalence about the importance of offering education about testing FH, PHUs, RPH,
countries HIV testing to people from high HIV people from high HIV SHBBVP, WAAC,
prevalence countries prevalence countries WAGPN
• Improve partner • Continue to implement a • Number of FTE ACCHS, CDCD, FH,
notification for HIV/ comprehensive contact tracing system providing contact tracing GPs, NMPHU and
AIDS according to best practice guidelines services other PHUs, RPH
taking into account approaches • Number of contacts
promoted through the Communicable traced
Diseases Network Australia (CDNA)
• Provide and update client resources • Evidence of resources CDCD, FH, PHUs,
with information about contact tracing including information RPH, WAGPN
about contact tracing
• Continue to provide training, support • Number of STI ACCHS, ACSHM,
and resources for HCPs who conduct Guidelines distributed to ASHM, DGPs, FH,
contact tracing in the metropolitan and GPs and other HCPs PHUs, RPH, SHBBVP
rural areas • Evidence of training
sessions for HCPs
(including number
of and type of HCPs
trained)
• Participate in National Forum on • Feedback from National AHCWA, CDCD,
partner notification Forum on partner Clinical Services,
notification PHUs, WACHAS,
WAGPN

4.6 Clearer Direction for HIV/AIDS Research
According to the National HIV/AIDS Strategy (DoHA 2005a), research plays a critical role in providing
much of the evidence base for policies and programs at all levels. It also produces valuable data
to enable monitoring of the effectiveness of public health strategies.
A number of research projects in WA have been conducted in collaboration with interstate and
overseas researchers and have received international recognition. The Plan recognises the
ongoing importance of research.
In WA, consideration needs to be given to research in a number of areas:
• the optimal use and complications associated with antiretroviral therapy (ART)
• disorders of immune reconstitution in severely immunodeficient patients
• current experiences of serodiscordant relationships
• ageing issues for PLWHA
• examination of adherence to treatment
• the impact of treatment breaks
• provision of HIV education to priority groups
• assessment of knowledge, attitudes and behaviours within high-risk groups.
Another identified area for research is seminal viral load testing. This is an important concern for
couples in serodiscordant relationships that knowingly and in an informed way consent to sex
without condoms.
The Perth Gay Community Periodic Survey is a cross-sectional survey of gay and other
homosexually active men recruited from a range of gay communities in Perth. The fourth Perth
survey was conducted in 2004 and provided a snapshot of sexual and HIV-related practices within
the gay community (Hull et al 2005). The survey should be continued and provides a valuable
tool for comparing data over time. In addition, the survey could be complemented by qualitative
research into cultural changes and emerging issues for gay and other homosexually active men.
Pre-exposure prophylaxis (PREP) has been identified has an emerging issue in the National HIV/
AIDS Strategy and WA needs to monitor the results of PREP studies and to develop evidence-based
protocols as required based upon research findings. This has been highlighted in section 4.1.

4.6.1 Actions to address HIV/AIDS research
ACHIEVEMENT
Maximise opportunities • Conduct research into better ways • Evidence of research Clinical services, FH,
for HIV strategic to use current therapies, and better published RPH,
research to devise options for side effects management • Evidence of funding
better ways to use received
current therapies, and
better options for side
effects management
Ongoing research into • Ensure PLWHA and HCPs are kept up • Evidence of research ASHM, Clinical
adherence strategies, to date with research findings • Dissemination of services, FH,
treatment breaks and research findings HAPAN, RPH,
the role of treatments in WAAC, WAGPN
the lives of PLWHA
Support consultative • Provide State input into consultative • Evidence of input SHBBVP, State
mechanisms and mechanisms and processes as • Evidence of WA issues research institutions,
processes to set required on research agenda WACHAS
the agenda for the
National Centres in HIV
Research
Support an annual • Provide State representation at annual • Number of stakeholders State representative
roundtable consultation roundtable consultations through attending the roundtable from community-
on research priorities IGCAHRD discussion based organisations,
for HIV/AIDS, STIs and DoH and research
hepatitis C centres, WACHAS
Identify priority areas • Support and participate in the • Number and range of Clinical services,
for the research agenda research roundtable and identify State HIV/AIDS research SHBBVP, Tertiary
including ordering research needs (e.g. optimal use projects institutions
priority areas according and complications of ART, disorders
to greatest need of immune reconstitution in severely
immunodeficient patients, needs of
ageing PLWHA, seminal viral load
testing, behavioural research etc.)
• Continue to conduct the Gay • Completion of survey NCHSR, WAAC,
Community Periodic Survey and and distribution of WACHPR
publish findings findings
Consider ways to build • Promote and support initiatives to • Evidence of economic DoH, WACHAS
capacity to analyse the assess the economic impact of HIV/ costs and benefits
economic costs and AIDS on the WA government and of HIV programs to
benefits to government community the government and
and the community of community
HIV programs
Assist to create • Facilitate collaboration between • Number of interactions ACCHS, SHBBVP,
opportunities for State-based researchers involved in between State-based Tertiary institutions
increased interaction Aboriginal health and the National researchers involved in (e.g. CUCRH,
and collaboration Centres Aboriginal health and the WACHPR),
between the National National Centres WACHAS, WAISHAC
Centres, and between • Evidence of collaborative
each of the National research between State-
Centres and WA based researchers
researchers in Aboriginal involved in Aboriginal
Health health and the National
Centres

4.7 WA Specific Issues
Clinical networks
Clinical networking has been recommended by the Health Reform Implementation Taskforce as
a means of providing “a new focus across all clinical disciplines toward prevention of illness and
injury and maintenance of health” (DoH 2005c). Networking aims to improve the delivery of health
services through coordination and integration of health and health-related services, whilst utilizing
principles of cooperation and partnerships between health care providers and key stakeholders.
The establishment of an Infections and Selected Conditions Clinical Network will support the
implementation of the Plan.
Review of Metropolitan Sexual Health Clinical Services
The impact of the Review of Metropolitan Sexual Health Clinical Services (DoH 2006 unpublished)
on HIV/AIDS prevention and control needs to be considered. The review addresses sexual health,
clinical and contact tracing services relating to STIs in the metropolitan area. It does not include
specialist HIV clinical and case management services nor does it include contraception, family
planning, sexual dysfunction or fertility/infertility services. The review is limited to the metropolitan
area of Perth and does not examine sexual health services in rural or remote WA. The review
also considers the demands placed upon current sexual health clinical services and recommends
strategies for increasing service capacity.

5. LIST OF CONTRIBUTORS TO THE PLAN
The Plan has been developed by the SHBBVP in consultation with major stakeholders from
government organisations, community-based organisations and the education, medical, health,
research and scientific sectors throughout WA. WACHAS has been the reference group for the
development of the Plan.
In 2005, the SHBBVP conducted audits of the HIV/AIDS Treatment and Care Plan for Western
Australia 2001 (DoH 2001) and the HIV/AIDS and Sexually Transmitted Infections Education and
Prevention Plan for Western Australia 2002 (DoH 2002a). The information gathered contributed
towards the development of the Plan. In addition, on 4 November 2005, the SHBBVP hosted a
Consultation Forum, which was attended by almost 50 stakeholders. The Forum provided direction
in respect of emerging challenges and priorities for HIV/AIDS education, prevention, treatment and
care in WA. Following the Forum, a draft of the Plan was distributed widely throughout WA for
comment.
The DoH thanks the following people for their generosity of time and commitment to contributing to
this Plan during the various stages of its development.
Ms Kiele Armstrong, Regional Sexual Health Team Coordinator, WACHS-GSE Population Health
Ms Jenny Atthowe, Senior Research Officer, Communicable Disease Control Directorate
Ms Maryrose Baker, Senior Policy & Planning Officer, SHBBVP
Ms Lisa Bastian, Manager, SHBBVP
Mr David Bell, Vice President, Haemophilia Foundation WA
Mr Steve Blackwell, Manager Clinical Services, FPWA
Mr Graham Brown, WA Centre for Health Promotion Research and Department of Health Promotion,
School of Public Health, Curtin University of Technology
Ms Allison Cain, Rural and Remote Coordinator, HIV Medicine Service, RPH
Mr Mark Coles, Pharmaceutical Council of WA
Ms Sandra Crowe, Manager, Public Health, Great Southern PHU
Mr Alex Coombs, Senior Social Worker, RPH
Dr Charles Douglas, Public Health Physician, WACHS-GSE Population Health
Mr Michael Doyle, GPET Project Officer, Aboriginal Health Council of WA
Dr John Dyer, Head, Infectious Diseases Department, Fremantle Hospital
Dr Christine Dykstra, Sexual Health Registrar, RPH
Ms Lynette Evans, Senior Project Officer, SHBBVP
Mr Gavin Finkelstein, President, Haemophilia Foundation WA
Ms Sandra Fox, Manager, WA Substance Users’ Association
Professor Martyn French, Clinical Director, Department of Clinical Immunology and Biochemical
Genetics, RPH and Clinical Professor of Immunology, University of Western Australia
Ms Carolien Giele, A/Epidemiologist, Communicable Disease Control Directorate
Mr Paul Gill, WA Substance Users’ Association
Dr Marisa Gilles, Senior Lecturer, Combined Universities Centre for Rural Health and Public Health
Physician, DoCS
Ms Naomi Green, Community Nurse, RPH
Ms Heath Greville, Program Coordinator, SHBBVP
Mr Noel Hyland, Clinical Psychologist, Sexual Health Service and Clinical Immunology, RPH
Ms Kathryn Kerry, A/Senior Policy & Planning Officer, SHBBVP
Mr Douglas Knox, Education Manager, WA AIDS Council
Ms Michele Kosky, Executive Director, Health Consumers’ Council
Ms Trish Langdon, Executive Director, WA AIDS Council

Ms Sue Laing, Senior Policy & Planning Officer, SHBBVP
Dr Richard Loh, Clinical Immunologist and Head of Department, Princess Margaret Hospital
Dr Heather Lyttle, Public Health Physician, South West Population Health Unit
Ms Tracey MacNaughton, Community Nurse, RPH
Dr Donna Mak, Medical Advisor, SHBBVP
A/Prof Simon Mallal, Department of Clinical Immunology, RPH
Mr Cipri Martinez, WA AIDS Council
Ms Katie Maskiell, A/Senior Project Officer, SHBBVP
Ms Lorel Mayberry, Lecturer in Sexology, Curtin University of Technology
Dr Jenny McCloskey, Sexual Health Physician, RPH
Ms Catherine Montigny, Senior Program Officer, SHBBVP
Ms Amanda Negus, Coordinator, Sexual Health & Disability Project, secca
Ms Linda Parsons, Program Officer, SHBBVP
Ms Suzanne Paust, Manager, secca
Perth and Hills Division of General Practice
Ms Vanessa Read, BBV Consultant, Department of Corrective Services
Ms Delia Riley, Public Health Nurse, WACHS-GSE Population Health
Ms Jill Robinson, Disease Control Coordinator, Great Southern PHU
Mr Damien Roper, Sexual Health and BBV Project Officer, Great Southern SPHU
Ms Megan Roseworn, Ruah Health Service
Mr Kevin Shanks, Senior Policy Manager – Capacity, WA GP Network
Ms Shauna Skinner, A/Policy & Planning Officer, Sexual Health and BBV Program
Mr Roy Smith-Ince, Indigenous Educator, FPWA
Mr Walter Stewart, Director, The Living Centre
Ms Sue Szalay, Community Nurse, North Metropolitan PHU
Ms Kate Turner, Senior Social Worker, HIV Medicine Service, RPH
Dr Simon Towler, Executive Director, Health Policy and Clinical Reform Division
Mr Ken Waddell, A/Manager, Case Management Program, Communicable Disease Control
Directorate
Ms Robyn Wansbrough, Nurse Educator, FPWA
Ms Narissa Wieland, Paediatric Immunology Liaison Nurse, Princess Margaret Hospital
Ms Liz Wilson, Clinical Nurse, WA Substance Users’ Association
Ms Deborah Wright, former Manager, Magenta
Mr Michael Wright, former Senior Policy & Planning Officer, SHBBVP
The members of the Western Australian Committee on HIV/AIDS and Sexually Transmitted
Infections (WACHAS).

6 REFERENCES
ABS – see Australian Bureau of Statistics
AIHW – see Australian Institute of Health and Welfare
ANCARD/IGCARD – see Australian National Council on AIDS and Related Diseases/Inter-

Governmental Committee on AIDS and Related Diseases
Australian Bureau of Statistics 2006, Migration, Australia 2004-05, cat. no. 3412.0, ABS, Canberra.
Australian Department of Health and Ageing 2005a, National HIV/AIDS Strategy – Revitalising
Australia’s Response 2005-2008, Commonwealth of Australia, Canberra.
Australian Department of Health and Ageing 2005b, National Aboriginal and Torres Strait Islander
Sexual Health and Blood-borne Virus Strategy 2005-2008, Commonwealth of Australia,
Canberra.
Australian Department of Health and Ageing 2005c, National Hepatitis C Strategy 2005-2008,
Commonwealth of Australia, Canberra.
Australian Department of Health and Ageing 2005d, National Sexually Transmissible Infections
Strategy 2005-2008, Commonwealth of Australia, Canberra.
Australian Institute of Health and Welfare 2005, 2004 National Drug Strategy Household Survey
– State and Territory Supplement, AIHW cat. no. PHE 61, AIHW, Canberra.
Australian National Council on AIDS and Related Diseases/Inter-Governmental Committee on AIDS

and Related Diseases 1998, HIV Testing Policy, ANCARD/IGCARD, Canberra.
Bonar M, Greville HS & Thompson SC 2004, Just gettin’ on with my life without thinkin’ about it: the
experiences of Aboriginal people in Western Australia who are HIV positive, DoH, Perth.
Brown G 2005, Perth gay men’s experiences of sexuality, risk and HIV, unpublished PhD (pre-
examination), Curtin University of Technology, Perth.
CDHAC – see Commonwealth Department of Health and Aged Care
CDHFS - see Commonwealth Department of Health and Family Services
Chawla R 2004, ‘Women are increasingly affected by AIDS epidemic, report shows’, BMJ, vol. 329,
p. 1257.
Commonwealth Department of Health and Aged Care 2000, Changes and Challenges: National
HIV/AIDS Strategy 1999-2000 to 2003-2004, CDHAC, Canberra.
Commonwealth Department of Health and Family Services 1996, Partnerships in Practice: National
HIV/AIDS Strategy 1996-97 to 1998-99, CDHFS, Canberra.
Department of Clinical Immunology and Biochemical Genetics 2006, Royal Perth Hospital,
unpublished data.

Department of Health 2001, HIV/AIDS Treatment and Care Plan for Western Australia 2002, DoH,
Perth.
Department of Health 2002a, HIV/AIDS and Sexually Transmitted Infections Education and
Prevention Plan for Western Australia 2002, DoH, Perth.
Department of Health 2002b, Growing and Developing Healthy Relationships Curriculum Support
Materials, DoH, Perth.
Department of Health 2005a, Western Australian Aboriginal Sexual Health Strategy 2005-2008,
DoH, Perth.
Department of Health 2005b, Epidemiology Branch data, DoH, Perth
Department of Health 2005c, Clinical networks in Western Australia, Background paper, DoH,
Perth.
Department of Health 2006a, Epidemiology and Surveillance Program data, Communicable Disease
Control Directorate, DoH, Perth.
Department of Health 2006b, Western Australian Sexually Transmitted Infections Action Plan 2006-
2008, DoH, Perth.
Department of Health 2006c, Western Australian Hepatitis C Action Plan 2006-2008, DoH, Perth.
Department of Health 2006d, Guidelines for Managing Sexually Transmitted Infections, DoH,
Perth.
DoH – see Department of Health
DoHA – see Australian Department of Health and Ageing
Gray D, Saggers S, Atkinson D, Carter M, Loxley W & Hayward D 2001, The Harm Reduction Needs
of Aboriginal People Who Inject Drugs, National Drug Research Institute, Curtin University of
Technology, Perth.
HDWA – see Health Department of Western Australia
Health Department of Western Australia 1997, Workforce and Education Framework for STD
Management – Explicit Performance Standards for a Statewide Plan to Improve the Quality of
Health Outcomes for Sexually Transmitted Diseases, HDWA, Perth.
Hull P, Brown G, Rawstorne P, Prestage G, Kippax S & Langdon T 2005, Gay Community Periodic
Survey Perth 2004, National Centre for HIV Social Research, Monograph 5/2005, University
of New South Wales, Sydney.
Joint United Nations Programme on HIV/AIDS 2004, 2004 Report on the Global AIDS Epidemic,
UNAIDS, Geneva.
Langdon – see Trish Langdon

National Centre in HIV Epidemiology and Clinical Research 2004, HIV/AIDS, Viral Hepatitis and
Sexually Transmissible Infections in Australia – Annual Surveillance Report 2004, NCHECR,
Sydney.
National Centre in HIV Epidemiology and Clinical Research 2005, HIV/AIDS, viral hepatitis and
sexually transmissible infections in Australia Annual Surveillance Report 2005, NCHECR,
Sydney.
NCHECR – see National Centre in HIV Epidemiology and Clinical Research
Read – see Vanessa Read
Trish Langdon 2005, WA AIDS Council, personal communication.
UNAIDS – see Joint United Nations Programme on HIV/AIDS
Vanessa Read 2005, Department of Corrective Services, personal communication.
WHO – see World Health Organization
World Health Organization 1986, Ottawa Charter for Health Promotion, First International Conference
on Health Promotion, WHO, Ottawa.


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Healthy Workforce ● Healthy Hospitals ● Healthy Partnerships ● Healthy Communities ● Healthy Resources ● Healthy Leadership

Sexual Health & Blood-borne Virus Program

Telephone: (08) 9388 4999

While every endeavour has been made to

ii Western Australian HIV/AIDS Action Plan 2006-2008

Western Australian HIV/AIDS Action Plan 2006-2008 iii

iv Western Australian HIV/AIDS Action Plan 2006-2008

ACCHS Aboriginal Community Controlled Health Services

Western Australian HIV/AIDS Action Plan 2006-2008 

vi Western Australian HIV/AIDS Action Plan 2006-2008

Western Australian HIV/AIDS Action Plan 2006-2008 vii

Western Australian HIV/AIDS Action Plan 2006-2008 

1.2 Goal and Objectives

 Western Australian HIV/AIDS Action Plan 2006-2008

1.4 Organisational Framework

Responsibilities and partnership

Western Australian HIV/AIDS Action Plan 2006-2008 

1.5 Policy and Legislative Context in Western Australia

 Western Australian HIV/AIDS Action Plan 2006-2008

1.6 Development of the Plan

Western Australian HIV/AIDS Action Plan 2006-2008 

1.8 Monitoring, Reporting and Evaluation

1.9 Performance Indicators and Measures of Achievement

 Western Australian HIV/AIDS Action Plan 2006-2008

Western Australian HIV/AIDS Action Plan 2006-2008 

 Western Australian HIV/AIDS Action Plan 2006-2008

Western Australian HIV/AIDS Action Plan 2006-2008 

3.1 WA Response to HIV/AIDS

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3.2 Emerging Issues/Challenges in WA

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4.1 Targeted Prevention Education and Health Promotion

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4.1.1 Actions to address targeted prevention education and health promotion

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4.5 HIV Testing

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