Public Health and Wellbeing Amendment Bill 2019
Victorian Parliament - 27 of May 2019 -
Ms KEALY (Lowan) (15:04:18): I rise today to speak on the Public Health and Wellbeing Amendment Bill 2019. This bill will amend the Public Health and Wellbeing Act 2008 to remove requirements in relation to the provision of information before and after HIV testing and to make minor miscellaneous amendments. As lead speaker for the Liberals and Nationals, I will at the outset outline that we will support this bill. It builds on some good work that has been done in the past and is of course supportive of what we want to see when it comes to HIV testing in removing as many barriers as possible to ensure that people can access this type of testing rapidly within the community if they need to, but also that they are fully informed and that there are no barriers to them considering whether they should be tested or not. This bill does seek to harmonise Australian policy on HIV testing with state legislation, so it is a very sensible step forward and will hopefully ensure that people who are concerned about their HIV status have the ability to have better access to testing. Victoria is currently the only jurisdiction in Australia to impose requirements on who may conduct and provide information around HIV testing. This bill will therefore reduce stigma attached to HIV and allow HIV testing to be treated like testing for all other comparable bloodborne diseases. At the moment there is no requirement for pre- or post-counselling if you are being tested for hepatitis B, and there is no requirement for counselling before and after testing for hepatitis C, so this legislation will mean that in Victoria there will not be a mandatory requirement that you have counselling before and after HIV testing. I think that it aligns with those testing parameters quite well, and I do hope that it achieves what the industry wants it to and what other jurisdictions are doing in relation to making HIV testing far more accessible in the community. As some background, in the late 1980s and mid-1990s there certainly was increased public concern around HIV, particularly around the risk of public infection, and I think we can all recall even back to the early 1980s where AIDS at that time was something that was promoted, if I can say that—I do not think that is quite the accurate word, but it was certainly the subject of many advertisements. I think we all remember the Grim Reaper ad, and perhaps in hindsight we look back on whether that was the best way that we could manage and brand AIDS and HIV in the community. It did force some people into exclusion, into depression and into covering up their HIV status, rather than them being able to go out and get diagnosed and treated appropriately. Things have moved rapidly. I think now we are at a position where people are willing to check on their HIV status. There are far, far fewer incidences of AIDS in the community, which is great, and of course there have been amazing advances when it comes to treatment. It is no longer seen as a disease which should be associated with the Grim Reaper in any way, shape or form. Being HIV-positive is something that people manage quite well in the community. I do look back and think about some of the steps that were taken by the Liberal-Nationals coalition government. We actually made a commitment before the November 2014 election to Pronto!, which is a fantastic community-based HIV testing service based in Fitzroy. It is very good to see that that service will be provided for in this year’s budget —I found it in the budget papers—with $700 000 each year for four years. This is short of what the coalition was promising before the 2014 election. We were looking to commit $1 million a year. Certainly I ask the minister to continue to push for that increased funding if there is a demand for it. We need to ensure that those services are delivered, because supporting people in need, particularly around these health concerns, is something we should be doing for all Victorians. I also call on the government to ensure that this type of testing—and any counselling required around that—is provided to people in all corners of the state. To have an HIV-positive status in rural and regional areas can be extraordinarily confronting. Even just talking to your local GP about testing—it is difficult to find a health facility where you do not know somebody who works there, and while all medical records are private, you do not want somebody to inadvertently see some of that private health information if you do not want them to. So while I know that all our health professionals are amazing and they certainly would never do anything to deliberately exploit people or to find out what they should not know about people’s health status, I do encourage people to try to understand the challenges there are around HIV and other communicable diseases like HIV in the community, particularly in rural and regional Victoria. The requirements that singled out HIV testing in Victorian legislation as requiring special regulations around information collection, distinguishing HIV from other communicable diseases at the moment, really are unnecessary. There is no other Australian jurisdiction which has comparable legislative requirements regarding HIV testing policies in terms of certain information or counselling being provided before being tested and certain information and counselling being provided after being tested. These requirements are no longer necessary as they are covered by the National HIV Testing Policy, and removing them will reduce stigma and discrimination against people who may be HIV-positive. Additionally the amendments will increase access to HIV testing, particularly as advances in testing technology occur, such as peer-based rapid testing and HIV home testing kits. This is particularly significant for marginalised groups, such as Indigenous Australians and the LGBTIQ+ community, and as I said, also people who live in rural and regional Victoria, as it will reduce fear, stigma and discrimination in health settings and reduce ambiguity as to where and how to be tested. As I said, there are a number of other minor amendments within this legislation, but largely this is really focused around removing that requirement for pre and post-testing counselling. As many would know in this chamber, in a previous life I was a biomedical scientist. We were quite often exposed to blood products. We obviously would know the different testing which was occurring at any time and would often get different blood samples marked that somebody was HIV-positive or not. It was actually mandatory in some of the hospitals that I worked in that if a doctor was aware that somebody was HIV or hepatitis C-positive, it would be marked on the request form. It was really pleasing during my time in the health service that this was actually revoked in a number of hospitals. It was seen as not necessary information, and really as a scientist or a lab technician if you are handling bodily fluids or blood products, then certainly you should be taking all precautions and treating everything the same. There was no real need for that to be put on the request form. So in terms of what information is deemed essential to have a beacon put on it to make everybody, I guess, aware of what somebody’s HIV or hepatitis status is, we certainly have come a very long way in understanding that people should not be stigmatised because of their HIV or hepatitis status. I also understand some of the concerns that people have around HIV testing and the angst that people have if they have any thought at all that they may need to go through some testing. So while this legislation makes counselling non-mandatory, certainly I encourage people if they require any counselling around their HIV status or hepatitis status to seek that out. I was involved in an incident when I was working at the Alice Springs Hospital where I was exposed to an unknown blood product. I actually opened a blood tube and the glass of the collection tube shattered in my hand and of course I was exposed to blood. I had to go through all of that discussion around the risk of being exposed to hepatitis—hepatitis A was the greatest concern at that time—or HIV. It is quite intense to have to go through that. I knew that this was a fairly low-risk incident that had occurred, but I had to go through the process of being tested. I chose not to go through the treatment process, because I thought it was such a low risk. However, I can understand for higher risk groups when they are in the position where they decide to talk to a medical professional and want to be tested for their HIV status or hepatitis status that that would be an extraordinarily confronting thing to do. In some ways I think there would be an element of doubt, shame and blame that people would put upon themselves if they had to seek that testing, particularly if they had got a phone call that perhaps a partner had been recently diagnosed and were going through some testing protocols to find out their own status. I feel for those people. I think it would be extraordinarily stressful, but please, that should not motivate you not to go and get tested. I know that there are some people who would prefer not to know than to know, but with the advances that there are in HIV treatment then certainly if you are aware of your HIV status, you can receive medication, manage it quite well, live within the community and live a long and healthy life. I have had friends who have died of AIDS in recent years. Unfortunately it is because they did nothing about testing and checking their HIV status or alternatively when somebody felt there was so much stigma attached to declaring or managing an HIV status that they did not actually tell their family at all. It was very, very sad. His family was in another country and were not even aware that he was HIV-positive, let alone when he went and transitioned to that point of full-blown AIDS. It was terrible to see him pass away in hospital. His family came over at that time, but it was an extraordinarily challenging and sad period for him and of course for his family. There are ways we can manage HIV in a way that does lead to a long and healthy life, but it is important that you do get that testing and that you do take the medication that you are required to take and manage it in a positive way. Of course taking steps like removing this requirement for pre and post-counselling for HIV testing is one small step towards removing that stigma, removing the discrimination and ensuring that people who are at risk or who have concerns around their HIV status will go ahead, get the test and take further steps as necessary. So just in closing we do support this bill, we being the Liberal-Nationals. It is good to see the progress that was made over previous governments, including under the Liberal-Nationals government—particularly around that investment in Pronto!—has continued and I hope that there will be further support to ensure that people who are living in the community with HIV are properly supported and that research continues so that we can stamp out this disease.
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