Bureaucracy must be battle-ready to combat HIV/AIDS
December 10, 2007
FEW things are undeniably a matter of life and death, but the battle against the spread of HIV/AIDS is one. Unfortunately in Victoria, the fight against this insidious condition is taking place not only against the background of a disturbing increase in infection rates but also of concerns about how well equipped the state's health bureaucracy is to manage it. In April this year, serious questions were raised about the administration of health policy after the sacking of chief health officer Dr Robert Hall by the then health minister, Bronwyn Pike.
Dr Hall was sacked over the alleged non-disclosure of three HIV-positive people under police investigation and for rejecting a recommendation from an advisory panel to the Department of Human Services that another HIV-positive person, Michael John Neal, be removed from the community. Neal is now before the courts on more than 100 charges, including allegations that he deliberately infected two men and tried to infect 14 others.
The affair was described by Michael Wooldridge, chairman of the Federal Ministerial Advisory Committee and a former federal health minister, as a "catastrophe". For her part, Ms Pike would go only so far as to admit that the management of the Neal case had been bungled, and she quickly commissioned a review of the department's handling of the case and the issues concerned, the most pressing being the breakdown in bureaucratic communication and the existence of conflicting protocols of disclosure.
The findings of that review, which was completed in September, have yet to be made public. But as The Age revealed on Saturday, the report provides disturbing evidence of a bureaucracy in disarray and urgently in need of reform if the risk to community health from any people who may recklessly seek to infect others with HIV is to be properly managed.
The review, by former West Australian police commissioner Bob Falconer, and a former senior bureaucrat with the Queensland Health Department, Dr John Scott, shows a department more concerned about not offending Melbourne's gay community than about protecting broader public health. This hypersensitivity contributed to the department's reluctance to use the criminal justice system to discipline HIV-positive people having unprotected sex.
The review also found that an entrenched fear of litigation from alleged offenders subject to public health orders or detention further undermined the effective handling of cases. (Ironically, some of Neal's alleged victims have sought advice from Melbourne law firm Maurice Blackburn Cashman about a possible class action against the department for negligence.)
Thankfully, this culture of misplaced political correctness has changed and DHS staff are now regularly referring cases of concern to the police. This can only be to the benefit of the wider community, whose interests should be paramount. However, the report makes it clear that several problems still exist, including the lack of a suitable facility to detain those felt to be "risky" and the absence of a proper communications protocol for keeping track of HIV-infected people who enter Australia and move between states. While the latter concern may raise understandable issues about privacy, the overriding aim must be to prevent the spread of infection.
The strongest weapon in the fight against HIV/AIDS is public awareness, and with this in mind, the Government must release as soon as possible the findings and recommendations of the Falconer report. The Government should then outline what action it plans to take over the recommendations. The right policies must be in place if the public's confidence in the Department of Human Services is to be restored and, crucially, for Victoria to properly manage a rate of infection that is at its highest level in this state for two decades. There is no time to waste.
This story was found at: http://www.theage.com.au/articles/2007/12/09/1197135284016.html
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