All eyes on Brisbane
The 12th International AIDS Society Conference on HIV Science (IAS 2023) in Brisbane shines the global spotlight on our peer and community-based response to HIV.
Our stories from IAS 2023 feature a new HIV awareness campaign by Queensland Positive People, a project which unites HIV art and science at the conference, and Act Now, a community forum that refocuses global efforts to address HIV-based discrimination in health and migration systems.
The artwork in issue 103 of Poslink has been generously supplied by HIV Science as Art and the 'Hi' campaign.
All eyes on Meanjin
by Melissa Warner
Queensland Positive People CEO
A new HIV awareness campaign will reach more than 500,000 people as thousands descend on Meanjin (Brisbane) for the 12th International AIDS Society Conference on HIV Science.
Very few initiatives have aimed to update public opinion or wider community perception of HIV in Australia. As we know, a lot has changed since the ‘80s. Our communities have moved on, but the lived reality of HIV has remained largely hidden from public view.
In Brisbane, that’s all about to change. Between IAS 2023 and the Women’s FIFA World Cup there is estimated to be as many as 95,000 visitors in Brisbane from across Australia, the region and the world. Not to mention the press and media attention that comes with the world’s largest meeting of leading HIV researchers, scientists, clinicians and government and community representatives.
All eyes are on our city. And specifically, our community and peer-led movement of people living with HIV.
Hosting an international HIV conference in our ‘home’ city is a once in a lifetime event. It is a watershed moment of community mobilisation and engagement. There is a tsunami of extra work, but it is an incredible opportunity to shine a light on people living with HIV and celebrate how far we have come.
Generous dollar and in-kind contributions from government, industry, creatives, artists, and members of our community means that QPP and NAPWHA have launched Australia’s first mass-media HIV campaign of the 21st century.
‘Hi’ takes HIV in a positive, bold, and optimistic creative direction. It’s a self-educating campaign. If you get to know a person, you get to know that you can be HIV positive and still lead a long, vibrant, and positive life.
It celebrates how far the science of HIV has come and all that can be accomplished in a positive life. Myths and misconceptions are challenged directly, with a focus on the message that ‘HIV doesn’t discriminate, people do.’
‘Hi’ features the faces of real people living with HIV and gives insight into their lives. It plays on the idea that it’s the little things that make up a person. ‘I’m a dog person. I’m a person of colour. I’m a community worker. I’m a coffee lover,’ says Jimmy. We are not defined by one characteristic. ‘I’m HIV positive and living a positive life.’
A display of the diversity of our community shows that there is nothing for anyone to fear. ‘I’m a painter. I’m a proud mother,’ shares Susan. You can lead a long and healthy life, the way you choose. HIV is no barrier. As she continues, ‘I have a PhD in public health. I fight for the rights of women. I’m HIV positive and living a long positive life.’
The campaign was launched on Saturday July 22 at the Brisbane Powerhouse Pleasuredome with over 300 people living with HIV, and their friends, allies and media in attendance. It features prominently at The Brisbane Convention & Exhibition Centre for the duration of the meeting. Our community strategy includes television and radio ads, roadside and street level digital billboards, together with a social media campaign and bespoke webpage. In all, we expect to be able to reach more than 500,000 people in Brisbane during a three-week period.
With the participation of people living with HIV from all over Australia we hope that the ‘Hi’ campaign will be picked up by partners and funders across the country.
Our community activation doesn’t end there.
Locally, we have utilised the opportunity of the international platform to advocate for the decriminalisation of HIV in Queensland – which is involves amendments to the criminal code and police and prosecutorial guidelines – so that the law reflects HIV science and evidence-based public health practices.
As the official community partners of the IAS, QPP has also played a pivotal role in organising several pre-conference meetings and satellite events. These include Act Now on Global HIV Migration, Mobility and Health Equity, the Unity Vibes social event and the HIV Science as Art Exhibition. To do this, we have mobilized a small army of volunteers from across the country.
We are most proud of being able to bring the Positive Lounge to Brisbane.
Most scientists and conference delegates can clock off at the end of the day, but living with HIV is twenty-four-seven.
The Positive Lounge is there for people living with HIV to recharge and connect with the global community. If you’re going to be at the conference, we’d love you to come by for a massage, chat or to view the ‘You and U=U Exhibition,’ which displays how various communities across the globe have conveyed the science of treatment as prevention.
‘Hi’ will run for three weeks in the Brisbane region. We would like to thank our partners, Wonderkarma, Gilead Sciences, ViiV Healthcare, Queensland Health, QMS Media, Zenith Media, Aubery Jossen, Dy Copeman, Q Think Consulting and NAPWHA. You can view stories and photography from the campaign at the QPP website. Pictured: a portrait of Crissy from the 'Hi' campaign.
The politics of HIV, art and science
by Timothy Krulic with Brent Allan and Daniel Cordner
A project that unites art and science at the 12th International Conference on HIV Science (IAS 2023) in Brisbane reminds us that any action to combat HIV and AIDS is political.
‘HIV is political, economic, and cultural,’ Camila Arce reminded us, when Poslink asked about her hopes for the future of the global HIV response. ‘Many people die from AIDS every year in Argentina, even with free antiretroviral treatment.’
The activist and audiovisual artist explained that doctors and scientists often see nonadherence as a personal and individual problem. What they do not treat are the root causes. ‘The social issues. The lack of decent work, the lack of housing, food, comprehensive sexual education, discrimination, not having basic needs met.’
HIV Science as Art, which exhibits 24 July to August 5 at Metro Arts in Brisbane, has paired twelve artists living with HIV and leading researchers whose work and findings are presented at IAS 2023. The aim of the project is to communicate the latest in basic, clinical, epidemiological and social research in a visual and emotional language that speaks to the lived realities the community faces.
Arce’s contribution to the exhibit responds to the research of social epidemiologist, Arjee Restar from the University of Washington. The focus of Restar’s work is to generate high-quality, rigorous science on transgender health and policy, including HIV. She aims to place trans community ‘at the heart of research and policy — as decision-makers, policy leaders, scientists, and innovators.’
The challenge for Arce was to convey the agency, diversity and complexity of the trans experience of HIV without assuming their voice. ‘I don’t want to be the cis white girl who speaks for trans people,’ she said.
After they met, Arce and Restar chose to focus on the life and work of Jackeline Romero, who now works to protect human rights in the Argentinian government. Having known Jackeline from a very young age and both living with HIV, Arce describes her as a trans aunt. How much is a life worth? is a series of intimate portraits of Jackeline in the first workplace where she has had stable employment and labour rights in the 27 years that Arce has known her.
The social dimension of antiretroviral therapy (ART) was an issue several of the art and science pairs tackled. Jaewon Kim’s photographic series, Body Temperature builds on the concept of person-centred care he discussed with Krittapon Termvanich, who will speak in a symposium at the conference about the use of new technology to deliver HIV care in low- and middle-income settings.
The triptych transitions from blurred to clear images to explore the expanded possibilities for pleasure and sex that diagnostic measures, such as antigen tests and viral load counts, might offer people living with HIV.
Whether the sexual manifestations of HIV stigma will persist in the era of treatment as prevention is a question Australian social researcher Kane Race poses in his work.
Race points out that the prominence biomedical investment and narratives has made treatment adherence and engagement in care the primary focus of prevention efforts worldwide. Yet ‘as long as HIV infection is perceived as a moral verdict on sexual or bodily deviance,’ he argues, ‘HIV stigma will persist.’
These manifestations of stigma, in turn, create complications for people living with HIV, in their sexual and intimate lives, but also how they engage in treatment and medical care.
Untransmittable, by Kairon (Ren-Kai) Liu reveals the ways in which these tensions express themselves in sexual cultures and gay life in cities like Taipei. A two-foot 3D scan and print of the artist's penis serves as container for discarded and surplus ART. Liu sourced the pills, like Truvada but also older medications such as 3TC, among the HIV positive community in Taiwan, for whom cultures and discourses of sexual morality and personal responsibility pose a significant burden and barrier to the use treatment as prevention.
Wool and fibre artist Andrew Chan picks up on the thread of mobility and the human rights of people living with HIV in their piece of fashion design, Caught Between States. As a migrant living with HIV in Australia, the human rights abuses uncovered by the research of Ryan Whitacre, which included legal frameworks that enable refugee people living with HIV to be funnelled into economies of transactional sex, struck a personal chord.
The installation draws inspiration from the traditional textiles and embroidery of the research participants’ cultural backgrounds. The ties from home and away represent the resilience and survival of refugees living with HIV as they uphold their cultural identities, which are themes Whitacre explores in a manuscript he shared with Chan.
Featured, too, is original work by Dani Marti, Jerome Kugan and Kia LaBeiija, among others.
The original artworks on display at HIV Science as Art were auctioned online through the run of the exhibition. Anyone in the world can bid on the pieces. A limited edition set of art prints of each work, an exhibition catalogue and set of postcards are available for sale on QPP’s Website. All funds raised through the sale of the original artworks and merchandise will be used to fund micro grants towards projects supporting people living with HIV in Asia and the Pacific.
HIV Science as Art is a collaboration between the IAS and NAPWHA, supported by QPP, Q Think Consulting and ViiV Healthcare. Pictured: Unstransmittable#2 (2023), photographic print, 100 x 125cm by Kairon (Ren-Kai) Liu.
Act Now
by Timothy Krulic
‘I was twenty-five years old when I arrived at the Māngere refugee centre just south of Auckland’ Alice tells a crowd of three hundred conference delegates. It was here that she was diagnosed with HIV. ‘It was shocking, terrifying news for me. And I worried that they would send me back.’
The New Zealand refugee resettlement program accepts all people assessed as refugees, regardless of their health. Alice was told that as a refugee her HIV status would not affect her pathway to residency or citizenship. ‘It was a huge relief,’ she said. Now, at the age of fifty, the beautiful land she likes to call Aotearoa has been her home for twenty-five years.
Alice told her story as part of Act Now on Global HIV Migration, Mobility and Health Equity, a community forum hosted by QPP and NAWPHA alongside the 12th International AIDS Society Conference on HIV Science in Brisbane.
The Act Now forum aimed to refocus global efforts to address the impact that HIV-based discrimination in migration policy has on public health and the wellbeing and human rights of people living with HIV.
Discrimination most commonly takes the form of mandatory HIV tests and bans on entry, stay and residence based on HIV status. The UNAIDS counts 46 counties and territories which impose HIV-related restrictions, mostly in the Middle East and North Africa but also countries in eastern Europe, Asia, and the Pacific, including Australia and New Zealand.
The picture painted by speakers and delegates at Act Now suggests that HIV-based discrimination may be more widespread than these estimates. Discrimination can be hidden in bureaucracy, opaque and contradictory policy settings or present as restricted access to treatments and healthcare.
Rather than protect public health, bans on entry, stay and residence based on HIV status limit access to treatments, undermine local prevention efforts and perpetuate HIV stigma.
The reasons people living with HIV seek to move are much like those of anyone else. Though the social determinants that influence the health of international migrants means that they are more likely to be living with HIV than native born populations.
The World Health Organisation estimates that there are 1 billion people on the move today, roughly 1 in 8 of the global population. There are currently 108 million refugees and asylum seekers who have been forcibly displaced by persecution, conflict and violence.
Miłosz Parczewski of the European AIDS Clinical Society described the impact that the humanitarian crisis in Ukraine is having on the HIV epidemic in Eastern Europe. The urgent inclusion of refugees in national HIV programs is needed to contain the spread of HIV subvariants of concern in countries like Poland.
Regional director of UNAIDS in Asia and the Pacific, Eamonn Murphy, revealed that there are only a handful of countries in these regions which afford refugees and asylum seekers living with HIV the same access to treatments and services as citizens.
Many more international migrants seek to move for work, study, travel, to flee climate change or to be with loved ones and family. People living with HIV are often denied these opportunities or placed within legal and policy frameworks which make them vulnerable to violations of their human rights.
Act Now delegates were told that migration for the purposes of work was common across Asia and the Pacific. This was the case for Rahmad who lives in Indonesia. ‘I wanted to take part in a government-to-government job recruitment program for industrial factory workers in South Korea’ he told the forum. Rahmad felt that the program provided a good visa and work opportunity for people without professional qualifications or experience. After returning an HIV-positive test as part of the required medical check-up he was told that there was no way he could ever be deemed ‘fit for work’ under the program.
‘I take treatment … my viral load is undetectable and my CD4 count is high’ Rahmad explained. ‘People living with HIV face a lot of discrimination.’ He was told that South Korean migration policy does not deny residency or visas based on HIV status. But the agreement between the Human Resources Development Service of South Korea and the Indonesian Migrant Worker Protection Agency was different. As someone who didn’t speak Korean or know where to take the matter further, Rahmad abandoned his plans.
Even some low prevalence, high-income countries like Australia and New Zealand require tests or disclosure of HIV status for certain vias. Migration policy in both countries views HIV as a condition which imposes too high of a cost on local healthcare and community services. This limits pathways to longer term visas and permanent residency for people living with HIV.
As someone who now works with people living with or affected by HIV in New Zealand, Alice is acutely aware of the human cost of these policies. ‘Unless you are a refugee like I was back then there is a high chance [your visa] will be declined if you test positive for HIV.’
Alexandra Stratigos, principal solicitor at the HIV/AIDS Legal Centre described the high demand for its services created by HIV-based discrimination in the Australian migration system. Of concern are the excessive process times people living with HIV experience, which places stress on relationships and puts them at risk of abuse from employers or partners as they seek sponsorship to progress in skilled migration pathways and partner visas.
One of theme leaders for table discussions, David Carter, emphasised the undue burden and expense the migration process places on Australia's healthcare system. 'It demands massively increased medical and health professional time.'
Clinicians first play a role in referral and the legal processes of migration. 'They then need to respond to the stress, mental health and other harms generated as people living with HIV navigate the migration process over many years.'
Aaron Cogle from the National Association of People Living with HIV Australia chaired the forum. He points to the risk that discriminatory migration policies pose to public health and the success of Australia’s HIV elimination strategy.
‘Mandatory HIV tests for longer-term visas discourage people on student visas or shorter stays from seeking a diagnosis sooner. People also delay treatment because of the perception that the cost of HIV medication will make it harder for them to pass the significant cost test. Discrimination at the border is not just stigmatising. It drives local transmission.’
Cogle noted that countries such as the UK have modelled offshore detention and boat turn backs on Australian immigration policy.
‘Australia has exported cruel and punitive models of immigration to other parts of the world. If we can do that we can also be an example of how to do immigration kindly, fairly and with compassion. The time is right for HIV immigration reform,’ he said.
Advocates and supporters of people living with HIV are currently working towards a solution which may increase the threshold at which applicants are deemed a ‘significant cost’ to the Australian healthcare system, effectively removing HIV as a condition which limits access to longer term residency. Though requirements for HIV tests may still discourage people from seeking a diagnosis or engaging with treatment earlier.
Long time advocate, David Haerry, said at the event that the global focus on HIV migration and related health equity issues has waned since the US lifted travel bans into the country in 2010. What is needed is mobilisation of local communities to push for law and policy reform.
Pictured: Caught between states (2023), 280 x 120cm, Various Natural Wool fibre, Acrylic, Fibreglass, Wood, Polyester, Metal by Andrew Chan.
Dani Marti is a Catalan Australian visual artist who works across video, installation and public art. His submissions to HIV Science as Art were an emotional response to the work of Australian cure researcher Melissa Churchill as someone who has lived with the virus for more than half his life. During their conversations Marti and Churchill discussed the stigma associated with HIV, the fear of 'awakening' the virus, and a sense of acceptance and surrender to that reality.
ISSN 1448-7764