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Sunday 24 February 2008

Australia: Review critical of Victoria's public health response to 'risky' HIV-positive individuals

A review of the Victorian Health Department's management of 'risky' HIV-positive people has been published. The Age puts its own negative spin on the story, but somewhat reassuring is the response from Dr John Carnie, Victoria's chief health officer.

He said cases warranting police intervention were rare and that the review reinforced education and counselling to change people's behaviour rather than criminal prosecution.

The full story, from The Age, is reproduced below.

'Reckless' HIV patients not reported
Julia Medew
The Age
February 23, 2008

HEALTH authorities failed to refer to police HIV-positive people who ignored warnings not to have unprotected sex, a report has found.

A review of the Department of Human Services' management of "risky" HIV-positive people has also revealed authorities lost track of people they were monitoring and did not take action against some who breached public health orders restricting their behaviour.

The review, of 15 cases before the department last year, urges an overhaul of procedures.

The review was ordered by former health minister Bronwyn Pike last year after she sacked Victoria's chief health officer Dr Robert Hall for his management of HIV-positive people who exposed others to the virus.

The review found that while swift and decisive action was taken against some people, there were "occasions where the evidence demanded action but none was forthcoming".

Most of the cases under review involve either recent migrants or gay men.

The examination, carried out by former Western Australian police commissioner Bob Falconer, and former health bureaucrat Dr John Scott, said: "The reviewers believe . . . that involvement of police without the client being referred to police has not always happened when it should have, and this is by no means a recent issue.

"The authors have found the system is in need of significant overhaul and improvement."

It is understood that more than one of the cases reviewed included examples of criminal behaviour that should have been referred to the police.

The report said people who had been served with public health warnings controlling their behaviour were often "uncontactable for a period of time" and that a number of clients who breached behavioural rules were not properly controlled.

The review also found:

■There was no dedicated facility to isolate HIV-positive people who posed a risk to public health under the Health Act.

■Internal procedures for managing cases left a perception that decisions about people's cases were made in an "ad hoc" fashion.

■Legal advice for "contentious" decisions resulted in "significant delays in action being taken" against people.

■Access to interpreters was minimal.

Victorian chief health officer Dr John Carnie yesterday said changes had been implemented to ensure the department returned to "world's best practice". He said the department had been working with Victoria Police to create a shared understanding of each agency's role in managing cases of concern. He said cases warranting police intervention were rare and that the review reinforced education and counselling to change people's behaviour rather than criminal prosecution.

A Canadian expert who reviewed the report said the department's new protocols were in line with world best practice.

Health Minister Daniel Andrews said the Government was committed to implementing the review's recommendations.



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