Planning for the 2020 Joint Australasian HIV&AIDS and Sexual Health Conference in Melbourne was well underway when the COVID-19 pandemic emergency unfolded. Last week, following a deft reshaping by Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and the 2020 National Program Committee, the first ever virtual HIV and Sexual Health conference took place.
The conference offered a multidisciplinary live program and a seemingly endless range of on-demand presentations and posters, many of which revealed how HIV and sexual health are being recast by the COVID-19 pandemic. Health and community service providers from across Australasia outlined the way services were adapted to keep people connected to them, especially marginalised communities and others who rely on outreach, peer support and drop-in services.
Several presenters described how the expedited availability of e-health services, including telehealth, has started to shift the expectation of some consumers particularly in the area of preventive health. Claudia Estcourt’s opening keynote reminded us that while there is great potential for e-sexual health services to increase testing and reach into key populations, we need to account for the transactional nature of these clinical encounters, which she termed ‘the Amazonisation of sexual health services’, and work to balance what consumers want (convenience) with what is clinically needed and appropriate.
The HIV symposium Antiretroviral effects: Enhancement and transformation explored assemblages of HIV treatment. Stepping beyond the antiretrovirals themselves, presentations examined their varying effects including prophylaxis (elimination of risk of HIV transmission), optimism (transformation of sexual experiences and intimacies) and what is often termed ‘risk compensation’ (reduced condom use followed by increased rates of STI). Through this it was argued that for HIV pre-exposure prophylaxis (PrEP) to be effective we need to work towards health literacy in the target population, accessibility, supported affected communities (including partners and families), a culture that supports medicine taking, and low levels of HIV PrEP stigma.
PrEP was again an important theme in conference presentations and discussion, covering topics such as long-acting PrEP, the impact of the COVID-19 pandemic on PrEP usage, and PrEP users’ critiques of risk compensation narratives. The program explored PrEP use beyond gay and bisexual men, with several speakers making the clear point that broad and adjustable HIV prevention strategies are needed because PrEP is neither desirable nor feasible among some sub-populations.
The Trust in the machine: Data, surveillance and public health symposium challenged us to view the collection, storage and utilisation of data through a prism of power and consent. This session highlighted that trust in digital health is influenced by relational and structural factors and argued that the socio-political context that many communities live in simply does not justify trust. Speakers explored the tension between the concept of data justice – that use of patient data should be consent-based and of direct benefit to them – and the public health potential of phylogenetic data analysis to better understand epidemic dynamics and respond to clusters.
Midway through the conference South Australia was cast into a lockdown more severe than any in Australia (with the notable exception of the public housing tower lockdown in Melbourne). The lockdown was short-lived following the revelation that a COVID-19 positive person had provided inaccurate information to contact tracers. That an individual might conceal their financial precarity from health authorities only strengthens the argument that public health practice needs to focus on building relationships and trust with vulnerable communities rather than demonising people or their behaviours as irresponsible.
The Cultural and political responses to pandemics symposium further asserted that while a top-down health response may be needed to work through the biomedical problems of a pandemic, community involvement and trust in different types of expertise, evidence and lived experience are essential to good public health.
Dawn Casey’s keynote in the Indigenous Plenary described how the Aboriginal community-controlled health sector, with its high levels of trust and alignment between community-controlled organisations and community, was able to navigate the COVID-19 emergency. The sector effectively mobilised communities to codesign and operationalise a COVID-19 management plan for Aboriginal and Torres Strait Islander populations, resulting in very low rates of COVID-19 among Australia’s First Nations people.
A symposium entitled Can Australia be the first country to eliminate HIV transmission? examined the Australian public health goal of the virtual elimination of HIV. Targets have been set for virtual elimination in the areas of burden of disease, antiretroviral and PrEP coverage, quality of life and stigma. However, not all sub-populations are benefiting equally from our current investment in HIV elimination. Symposium attendees were urged to challenge each other and the sector as a whole to empower and trust less-represented communities to lead.
The 2020 Joint Australasian HIV&AIDS and Sexual Health Conference presented delegates with an opportunity to engage in dialogue about advances in HIV and sexual health research, policy and practice and consider these in full view of the many public health disparities exposed during the COVID-19 health crisis.