Victorian HIV strategy 2017-2020 - Living Positive Victoria

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Victorian HIV strategy 2017-2020 - Living Positive Victoria
Victorian HIV strategy
2017–2020
Victorian HIV strategy 2017-2020 - Living Positive Victoria
The Department proudly acknowledges Victoria’s Aboriginal
community and their rich culture and pays respect to their Elders past
and present. We acknowledge Aboriginal people as Australia’s first
peoples and as the Traditional Owners and custodians of the land
and water on which we rely. We recognise and value the ongoing
contribution of Aboriginal people and communities to Victorian life
and how this enriches us. We embrace the spirit of reconciliation,
working towards the equality of outcomes and ensuring an equal voice.
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Victorian HIV strategy
2017–2020
Victorian HIV strategy 2017-2020 - Living Positive Victoria
To receive this publication in an accessible format phone (03) 9096 1790 using the
National Relay Service 13 36 77 if required, or email bbvsti.information@dhhs.vic.gov.au.
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services, June 2017.

Except where otherwise indicated, the images in this publication show models and illustrative settings
only, and do not necessarily depict actual services, facilities or recipients of services. This publication
may contain images of deceased Aboriginal and Torres Strait Islander peoples.

Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people.
Indigenous is retained when it is part of the title of a report, program or quotation.

ISBN 978-0-7311-7261-0 (Print) 978-0-7311-7262-7 (PDF/online)

Available at https://www.health.vic.gov.au/sexualhealth

Printed by Finsbury Green, Melbourne

ii
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Contents
Minister’s foreword                                                 iv
Our vision                                                           1
Introduction                                                         3
HIV in Victoria                                                     6
What you told us                                                     8
Prevent10
Test13
Treat14
Stigma and discrimination                                           17
Victorian HIV strategy                                              18
Priority focus area 1: Victorians are supported to
prevent HIV transmission                                            20
Priority focus area 2: Victorians with HIV will know their status   23
Priority focus area 3: Victorians with HIV have access to best
practice evidence-based treatment and care services, and are
supported to achieve an undetectable viral load                     24
Priority focus area 4: Victorians and affected communities are
empowered to speak up about stigma and discrimination               27
System enabler 1: The Victorian workforce has the skills,
knowledge and attitudes needed to deliver best practice
HIV prevention, testing, treatment and care                         28
System enabler 2: Victoria’s service systems across the
continuum of prevention, treatment, care and support
are coordinated and integrated, and meet the needs of
people living with and affected by HIV                              31
System enabler 3: HIV services and outcomes are improved in
Victoria by supporting research and evaluation, and improving
the quality and completeness of data                                32
Next steps: toward 2020 and 2030                                    34

                                                                      Victorian HIV strategy 2017–2020   iii
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Minister’s foreword
I am delighted to release the Victorian HIV strategy 2017–2020.

                                    Our vision for people living with   To achieve our bold targets we
                                    HIV now is that they are able to    must build on these successes,
                                    lead long and healthy lives and     and make prevention tools
                                    participate fully in a Victoria     like treatment as prevention
                                    free from discrimination.           and pre-exposure prophylaxis
                                    This HIV strategy sets out          easily understood and more
                                    our pathway to this vision          accessible, while sustaining
                                    built around four key pillars:      and revitalising traditional HIV
                                    prevention, testing, treatment,     prevention strategies such as
                                    and the elimination of stigma       condom use and safer injecting
                                    and discrimination.                 practices. We must also
                                                                        continue our efforts to research,
                                    For the first time, eliminating
We are at a pivotal moment in                                           trial and evaluate advances
                                    stigma and discrimination
the HIV response. Our research,                                         in testing technology and
                                    is now front and centre in
policy and service delivery                                             treatment.
                                    our approach. The Andrews
innovations have created the
                                    Labor Government wants to           In undertaking these efforts,
opportunity, for the first time,
                                    make it clear that stigma and       we must never lose sight of
to virtually eliminate new HIV
                                    discrimination experienced          what matters most: the health
notifications in Victoria.
                                    by people living with HIV is        and wellbeing of people living
Victoria has been at the            completely unacceptable.            with, affected by, and at risk
forefront of pre- and post-                                             of HIV. This is a period of
                                    Ongoing consultation with the
exposure prophylaxis, treatment                                         hope. Together we have the
                                    sector and collaboration with
as prevention, the promotion                                            opportunity to create a better
                                    affected communities has
of risk-reduction practices and                                         future for those living with and
                                    informed and strengthened
the elimination of stigma and                                           affected by HIV.
                                    our approach. Now, in
discrimination. Our history
                                    partnership with these and
of community activism and
                                    other stakeholders, we will lead
advocacy, in partnership with
                                    this charge to reinvigorate and
clinicians, researchers and
                                    refocus our efforts to achieve
governments, has helped
                                    our vision.
Australia maintain one of the                                           The Hon. Jill Hennessy MP
lowest rates of HIV in the world.                                       Minister for Health

iv
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Our vision
By 2020 we aim to virtually eliminate
new HIV transmissions.
By 2030 Victoria will eliminate stigma
and discrimination associated with HIV
and achieve the 95-95-95 targets for
diagnosis, treatment and viral suppression.

Our objectives
Victorians are supported         Victoria will sustain the virtual
to reduce their risk of          elimination of HIV transmission
contracting HIV.                 among sex workers and from
                                 mother to child.
Victorians with HIV know
their status.                    Victoria will sustain low rates
                                 of HIV transmission among
Victorians with HIV will have
                                 both people who inject drugs,
access to best practice
                                 and also among Aboriginal and
treatment and care.
                                 Torres Strait Islander people.
People living with HIV (PLHIV)
                                 With this strategy Victoria
and affected communities are
                                 will set bold targets to increase
free from HIV-related stigma
                                 prevention, testing and
and discrimination.
                                 treatment, and to reduce
                                 stigma and discrimination.

“Overcoming HIV stigma is our greatest challenge.
 When people live with fear of disclosing their HIV
 status, are faced with ignorance and dismissed
 by their families and communities or have to face
 unnecessary scrutiny of health care providers then
 shame overshadows their lives.”
 Brent Allan
 Chief Executive Officer
 Living Positive Victoria

                                                                     Victorian HIV strategy 2017–2020   1
Victorian HIV strategy 2017-2020 - Living Positive Victoria
“Victoria has a remarkable
          opportunity to harness the
           momentum in HIV science,
     policy and advocacy to achieve
    our ambitious goals: eliminating
     new HIV transmissions by 2020
           and improving the lives of
               people living with HIV.”
         Associate Professor Edwina Wright
                The Alfred Hospital and the
                            Burnet Institute

2
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Introduction
Recent significant advances in science, research and
technology make Victoria’s ambitious time-bound HIV
targets entirely achievable.
The introduction of antiretroviral    health services have been             to the greater and meaningful
therapy in the mid-1990s enabled      developed, led and delivered          involvement of people living with
people with HIV to live longer        by affected communities. This         HIV. The Greater/Meaningful
and healthier lives. Over the         world-class response is defined       Involvement of People Living
past 10 years, the effectiveness      by a unique partnership with          with HIV/AIDS (GIPA/MIPA)
of antiretroviral therapy has         community members, clinicians         principles underpin this strategy,
improved considerably, changing       and researchers. The Victorian        and are the backbone of the
the clinical care needs of people     Government is committed to            Victorian partnership model.
living with HIV. As demand for        maintaining and strengthening
                                                                            Achieving the vision outlined
inpatient care has declined,          this partnership.
                                                                            in this strategy will require the
demand for community-
                                      This HIV strategy provides            Victorian HIV partnership to
based care and support has
                                      a comprehensive plan for              have a holistic understanding
grown. With it, new challenges
                                      achieving the strategic               of the individual within a social
associated with ageing and
                                      directions for sexual and             model of health framework.
chronic conditions have
                                      reproductive health outlined in       People will not be viewed
emerged. More recently, new
                                      in the Victorian public health        solely through the lens of their
science has driven significant
                                      and wellbeing outcomes                HIV status, but understood
advances in biomedical
                                      framework 2015-2019. This will        in the context of their social,
prevention and treatment
                                      assist in tracking progress           environmental, economic and
strategies for HIV.
                                      and outcomes, and provide             cultural status. By partnering
HIV continues to disproportionately   a transparent approach to             with communities, organisations,
affect gay and bisexual men.          monitoring and reporting. In          and the individuals they
While it has never been confined      addition to the target of the         represent, the Government can
to a single population or             virtual elimination of new            better understand and support
community, our awareness of           HIV transmissions by 2020,            the actions necessary to
how it affects different people       the Victorian Government is           improve their collective health.
has changed and increased.            committed to combination
                                                                            This strategy provides the
                                      prevention strategies,
In the context of this change,                                              framework and rationale for
                                      increased testing rates for all
there is an opportunity and                                                 a whole-of-system approach
                                      sexually transmissible infections
responsibility to strengthen                                                to designing, targeting and
                                      (STIs), access to treatment, and
the current service system                                                  evaluating Victoria’s system
                                      the promotion of safer sex and
to ensure greater integration                                               of HIV care. This system will be
                                      harm reduction practices.
between mainstream primary                                                  sensitive and responsive to the
and community care and                The Victorian Government              changing needs of people living
specialist programs.                  recognises that the experience        with and affected by HIV, and
                                      of discrimination and stigma          will work to ensure a refreshed
Victoria’s HIV response has been
                                      remains an obstacle to people         approach to integration along
defined by successes across the
                                      seeking important prevention,         the continuum of prevention,
spectrum of health promotion,
                                      treatment, support and care           testing, treatment and care.
prevention, testing, treatment,
                                      services. Victoria is committed
workforce development and
surveillance. Victorian HIV
                                                                        Victorian HIV strategy 2017–2020    3
Victorian HIV strategy 2017-2020 - Living Positive Victoria
Introduction (continued)
Importantly, this strategy will
also focus on building a clinical       What is HIV?
HIV prevention and treatment
                                        HIV (human immunodeficiency virus) is a virus that infects cells
system to coordinate access
                                        of the immune system, destroying or impairing their function.
to pre-exposure prophylaxis
                                        As the infection progresses, the immune system becomes
(PrEP), post-exposure
                                        weaker and the person is more likely to be affected by other
prophylaxis (PEP), testing
                                        infections and illnesses.
and treatment where people
live, through primary and               If untreated, HIV infection can progress to AIDS (acquired
community care. Undertaking             immunodeficiency syndrome). This means the body is unable
individual, community and               to fight off most infections and illnesses. AIDS usually takes
system-level engagement                 many years to develop. In Australia, because treatment is
about the range of available            widely available, very few people develop AIDS.
combination prevention
                                        HIV is most commonly transmitted through sex without a condom
activities will renew Victorian
                                        or through sharing needles and other injecting equipment.
efforts to virtually eliminate new
HIV transmissions by 2020 and           With the success of antiretroviral therapy, HIV infection is now
achieve the 2030 diagnosis,             considered a chronic condition rather than a fatal disease, as
treatment and undetectable              these treatments can effectively manage and suppress it.
viral load targets.
                                        Importantly, these treatments can effectively reduce the viral
                                        load in people living with HIV to undetectable levels, meaning
                                        that the risk of transmitting the disease to others is negligible.

    HIV, wellbeing and the social determinants of health
    HIV cannot be viewed in isolation. Many people      violence, and the ability and autonomy of
    living with or at higher risk of HIV experience     people to manage their own health. All of
    other conditions and complexities that affect       these can affect the ability of people to adopt
    their ability to manage their HIV, or their risk    prevention strategies, test regularly for HIV
    of contracting it.                                  and other STIs, or adhere to HIV treatments.
    Prevention, testing, treatment and stigma           In supporting them to manage their health,
    must be viewed in the context of various factors    clinicians and community organisations
    including: gender and gender identity; race,        must consider these factors in providing
    nationality and linguistic identity; disability;    comprehensive care to affected people
    education, employment, income and housing           and communities. This requires all sectors
    status; mental health; and other medical            of the HIV response to collaborate on the
    conditions. An effective HIV response must also     development of clear, robust linkage strategies
    consider personal and contextual factors such       and referral pathways, ensuring everyone is
    as the power dynamics within relationships          able to access the care they need.
    and social groups, family and intimate partner

4
Changing health needs –
   HIV and ageing
   Across the developed world, people living with
   HIV are ageing. With this comes increasing
   complexity and comorbidities.
   As this population ages, gaps in service provision
   become evident, as do opportunities to evolve
   programs that will enable people to age well
   with HIV.
   In 1985 the proportion of people living with HIV in
   the over-55 age group was 2.6 per cent. By 2000 it
   was 10.9 per cent, and by 2010 it was 22.3 per cent.
   It is estimated that by 2020 the number of
   people living with HIV aged over 55 years in
   Victoria will be 38.5 per cent.
   Our efforts should be directed to understanding
   the long-term health consequences of HIV as the
   population of people living with HIV ages.
   Compared with the general population,
   people living with HIV are at higher risk for
   diseases associated with the ageing process,
   including cardiovascular disease, osteoporosis,
   neurocognitive dysfunction and some cancers.

“Visibility is crucial for people living
 with HIV. Each of us has different
 needs based on our individual
 identity and personal experience.
 We need to support the
 minorities within the minority
 – women, Aboriginal and
 Torres Strait Islander people,
 and others – to help them
 live well with HIV.”
 Bev Greet OAM
 Co-founder
 Positive Women Victoria

                                                          Victorian HIV strategy 2017–2020   5
HIV in Victoria
There are more than 7,800 people
living with HIV in Victoria.
    Figure 1: Victoria’s progress   Over time, the population of
    against the 90-90-90 2020       people with HIV in Victoria has       Did you know?
    targets, December 2016          increased for several reasons,
                                    including dramatically reduced
                                                                          Melbourne is Australia’s
        There are more than         mortality due to the availability     first Fast-Track City

         7,800
                                    of highly effective antiretroviral    The Victorian Government,
                                    therapies, migration of               in partnership with the
                                    people with HIV to Victoria           City of Melbourne, has
          Victorians living
                                    from interstate and overseas,         committed to a global
              with HIV
                                    and new transmissions.                initiative to fast-track local

           90%
                                    In Victoria, men who have             responses to HIV and AIDS.
                                    sex with men – including gay          The goal of Fast-Track Cities
                                    and bisexual men – is the             is to attain the UNAIDS
         know their status
                                    population most affected by           90-90-90 targets: 90 per
                                    HIV. There are several known          cent of people who are HIV-
              of these              risk behaviours associated            positive know their status;

           84%
         are on treatment
                                    with HIV transmission. The
                                    most commonly reported
                                    exposure to HIV in Victoria is
                                                                          90 per cent of people who
                                                                          are HIV positive are on
                                                                          treatment; and 90 per cent
        with antiretrovirals        condomless anal intercourse           of people on HIV treatments
                                    without the use of biomedical         have an undetectable viral
                                    prevention strategies.                load (see Figure 1).
                 and

           78%
                                    Almost one in five notifications      Melbourne and Victoria
                                    occur among other priority            are among the most
                                    populations such as women,            successful Fast-Track
    of those on treatment have      travellers, Aboriginal Victorians,    Cities participants to date.
    an undetectable viral load      young people and people from          Along with Amsterdam,
                                    culturally and linguistically         San Francisco and Denver,
                                    diverse communities.                  Melbourne has already
                                    With increased use of PrEP,           achieved its diagnosis
                                    better understanding of               target, and has some of the
                                    treatment as prevention               highest rates of treatment
                                    (TasP), increased community           and undetectable viral load
                                    awareness and use of risk-            in the world.
                                    reduction practices, increased
                                    migration and mobility between       Victoria has been extremely
                                    Victoria and high-prevalence         successful in sustaining the
                                    countries, and different             virtual elimination of HIV
                                    patterns of drug use, the            transmission among sex workers
                                    diversity, size and demography       and from mother to child.
                                    of Victoria’s HIV epidemic is        Victoria has also successfully
                                    continually changing.                sustained a low incidence of HIV
                                                                         in both Aboriginal people and
6                                                                        in people who inject drugs.
Victoria’s priority populations

As the demographic profile of       challenges these populations
HIV changes in Victoria we have     face when living with or at
an urgent challenge, as well as     risk of HIV. Both experience
an opportunity, to focus our        significant disadvantage as
efforts on those who are most       a result of the intersection of
vulnerable and most affected        gender and gender identity
by HIV. These people include:       with other socioeconomic
• people living with HIV            factors, placing them at
                                    greater risk of harm.
• gay, bisexual and other men
  who have sex with men             The Government acknowledges
• Aboriginal and Torres Strait      that HIV can affect anyone,
  Islander people                   regardless of whether they
• culturally and linguistically     belong to a priority population.
  diverse and refugee               Victoria also acknowledges
  communities                       that there are specific sub-
                                    population groups, such as
• people from or who travel
                                    international students, people
  to high-prevalence countries
                                    with disability, older people
• people who inject drugs
                                    living with HIV, people who are
• prisoners                         co-infected with other blood-
• sex workers                       borne viruses (BBVs) and rural
• young people                      and regional residents, who will
• transgender and gender            require tailored responses.
  diverse people                    People living with and affected
• women at greater risk of HIV      by HIV are central to Victoria’s
                                    HIV response. Their experience,
The Victorian Government is
                                    engagement and participation
strongly committed to equality
                                    are essential in the development
regardless of gender or gender
                                    of our programs and policies.
identity. Accordingly, this
                                    People living with HIV must be the
strategy includes both women
                                    focus of – and equal partners in
and trans and gender diverse
                                    – their treatment, care and other
people as priority populations
                                    decisions that affect their lives.
in their own right. This strategy
recognises the unique

“Our renewed focus on prevention, testing and
 treatment must be mindful of the diversity of people
 affected by HIV. Our collective efforts must consider
 the whole person – not just their risk factors – and how
 stigma impacts their engagement and wellbeing.”
 Associate Professor Mark Stoové
 Head of Public Health Discipline                                      Victorian HIV strategy 2017–2020   7
 The Burnet Institute
What you told us
    The Victorian Government consulted with a wide range
    of people living with and affected by HIV, as well as
    the community, health professionals and researchers.
    These consultations focused on prevention, treatment
    and care, bringing together participants from a diverse
    range of backgrounds and organisations.
    The numerous ideas and comments summarised below reflect the energy and
    enthusiasm of all involved to be part of a bold new vision for HIV. This invaluable
    process helped inform Victoria’s strategic response to HIV.
    ‘Our society is changing and we are slowly gaining equality including naming
    racism, trans and homophobia. HIV stigma is still very real. We have to work
    together to ensure no one is left behind.’
    ‘Our services should reflect the changes that we are seeing and that they should
    also be welcoming and safe for all people with or affected by HIV.’
    ‘We are at a pivotal point in the epidemic. We have exciting new tools and
    science driving our ability to eliminate this virus. We must do everything to use
    these opportunities.’
    ‘If we keep doing more of the same, we will get more of the same. It is time to do our
    work differently, to be bold and innovative and move from merely managing this
    epidemic to eliminating it.’

                                   “Victoria’s inclusion of women as a priority
                             population is a significant step in addressing the
                            stigma, discrimination, and violence experienced
                               by women living with and at greater risk of HIV.
                                 Our strength and resilience will help Victoria
                                                         end the HIV epidemic.”
                                                                            Christabel Millar
                                                              Health Promotion Coordinator
                                                                    Positive Women Victoria
                                                                           Board of Directors
                                                                      Living Positive Victoria

8
Overview of consultation findings
• There have been significant       • Scientific advances mean
  achievements to date in HIV         our services need to change
  prevention and in challenging       to capitalise on these.
  stigma and discrimination,
                                    • Models of care need to be
  setting a positive precedent
                                      collaborative, integrated,
  for continuing success into
                                      coordinated, linked to other
  the future.
                                      services and supports, and
• Legislative reform in Australia     tailored to the individual/
  has introduced a broader            population. It was reiterated
  acceptance, visibility and          that empowerment of
  mainstreaming of lesbian, gay,      individuals and peer-led
  bisexual, transgender and           strategies will be critical to
  intersex (LGBTI) communities.       future success.
  This has affected how
                                    • Across all priorities the
  connected people are
                                      importance of targeting
  to either mainstream or
                                      and tailoring to diverse
  LGBTI communities.
                                      populations was emphasised.
• Technology and social media         Of note, international students,
  changes are reworking               women at greater risk and
  the way in which people             travellers were highlighted as
  are forming relationships,          populations requiring targeted
  socialising, connecting to          and tailored programs.
  communities and accessing
                                    • Community health literacy,
  health information and
                                      sexuality education in schools
  support. This is most
                                      and clinical education present
  apparent in people under 30                                               “It’s important for the
                                      important opportunities to
  years of age and presents
                                      make real gains across all
                                                                             HIV sector to listen to
  opportunities for evolving our                                             people from culturally
                                      objectives.
  prevention responses.
                                    • There is also a significant
                                                                             and linguistically
• There is a shared vision
                                      need to continue to address            diverse backgrounds.
  for revitalising primary
                                      stigma and discrimination,             Understanding them
  prevention, increasing early
  detection and facilitating
                                      improve workforce capacity,            is important to better
                                      and undertake further                  prevention and
  early and rapid access to
                                      targeted research.
  treatment commencement.                                                    treatment of HIV.”
                                    The refreshed strategies put
• Normalising and increasing                                                Cristian Cortes Garzon
                                    forward by participants had
  testing and integration with                                              Systems Project Officer
                                    common elements of multi-
  STI testing, and introducing                                              Living Positive Victoria
                                    sector partnership, community
  an annual testing day, were
                                    collaboration and peer leadership,      Co-founder
  all highlighted, as were
                                    all of which set a basis for building   LGBTI Latinx and Hispanics
  innovative peer-led and social
                                    collective impact for change.           in Australia
  media approaches.

                                                                       Victorian HIV strategy 2017–2020   9
Prevent
                           In the past five years, new evidence has
                           driven significant advances in biomedical
                           prevention and treatment strategies for HIV.
                           Combination prevention relies         can reduce the risk of HIV
                           on the use of new rapid HIV           transmission by around 99
                           testing technologies, biomedical      per cent. It is transforming
                           approaches such as PrEP               prevention efforts across the
                           and TasP, and community               world. This is a game-changing
                           mobilisation and behavioural          tool for preventing HIV.
                           strategies all working together
                                                                 Increased awareness of PrEP,
                           to reduce the transmission of
                                                                 TasP and undetectable viral load
                           HIV (Figure 2). Combination
                                                                 has changed how individuals
                           prevention conceives of the role
                                                                 and communities view HIV.
                           of treatments in a new way. In
                                                                 It has prompted important
                           addition to its health benefits for
                                                                 conversations about prevention
                           people living with HIV, treatments
                                                                 and HIV status and had a
                           prevent onward HIV transmission
                                                                 profound impact on HIV stigma.
                           by reducing the virus to
                           undetectable levels.                  It is essential to retain a central
                                                                 focus on condom use and harm
                           Treatment as prevention (TasP)
                                                                 reduction efforts in preventing
                           is one element of combination
                                                                 transmission. Condoms and
“Victoria has a proud      prevention. It is a term that
                                                                 harm reduction approaches, like
                           describes the use of antiretroviral
 history of community                                            needle and syringe programs,
                           therapy to reduce HIV viral load
 activism, in many ways                                          not only protect against HIV but
                           to undetectable levels, preventing
                                                                 also other BBVs and STIs. We
 leading the country       onward transmission of infection.
                                                                 must incorporate and increase
 in the HIV response.      In this way, treatment is now
                                                                 access to new biomedical tools
 By breaking down          being used as a community-level
                                                                 and approaches.
                           prevention strategy.
 barriers and forging
 partnerships across the   Improved understanding of TasP         Figure 2: Key elements in the
                           and undetectable viral load has        fight against HIV
 sector, as we’ve done
                           resulted in a highly effective
 with PrEP, Victoria can   intervention being added to the                 Condoms
 support communities       growing suite of HIV prevention
 to take charge of their   strategies. It underlines the
                           importance of developing rapid                      PrEP
 own health.”
                           linkage to care models, building
Chris Williams,
Co-founder
                           the primary care workforce to                        PEP
                           improve regular screening, and
PrEP’d for Change          supporting treatment uptake
Michael Whelan             and adherence.                           TasP/undetectable
Vice Chair                 PrEP is another highly effective
                                                                        viral load
PrEPaccessNOW              tool for HIV prevention. Clinical
                           studies have shown that,                   Harm reduction
                           when taken consistently, PrEP
 10
PrEPX study                                                   Taking action to prevent HIV
PrEPX is a landmark public health research study              In addition to well-established
launched in 2016 that aims to provide HIV prevention          prevention programs, the government
medication to 3,800 Victorians at greater risk of HIV.        is implementing innovative and bold
The plan is to decrease HIV notifications by up to 25         approaches to achieving its prevention
per cent over the coming years. The PrEPX study is            targets. Victoria’s response supports the
a co-designed and co-funded initiative between the            development and funding of community-
Victorian Government, Alfred Health and the Victorian         led campaigns and services that have
AIDS Council. The study will reorient the Victorian HIV       been able to adapt to rapidly changing
testing and treatment model to achieve the target of          science and technologies.
the virtual elimination of new HIV infections by 2020.
Importantly, the design of the study embeds access to
PrEP within primary care. This model provides a platform
                                                              “To improve sexual health
for supporting a comprehensive approach to improving
sexual health testing and treatment for Victorians at          screening among communities
higher risk, potentially tripling the annual volume of         like trans and gender
tests conducted.                                               diverse people, we need to
Unique to the PrEPX study is the involvement of a              understand the unique
number of community pharmacies, which have been                and diverse needs of each
engaged to dispense PrEP to enrolled participants              person. A one-size-fits-all
to support accessibility and a familiar model of care.
                                                               approach will not work.”
PrEPX has been implemented across metropolitan
Melbourne and rural and regional Victoria.                     Jeremy Wiggins
                                                               Co-founder, PASH.tm
PrEP guidance for practitioners
                                                               Project Lead
The Victorian guidance on PrEP is now available                Victorian AIDS Council
online at . It provides medical
practitioners with information on PrEP for preventing
HIV transmission and supports a high standard of
sexual health care when PrEP is prescribed.

PEP program
The administration of PEP for HIV represents secondary
prevention when primary prevention has failed. It
involves the use of medication (typically a combination of
antiretroviral drugs) within 72 hours to reduce the risk of
HIV transmission following a known or possible exposure
to infected blood or body fluids.
The Victorian PEP program works on a hub-and-spoke
model, with Alfred Health as the central hub providing the
primary access point. People who need PEP are referred
to the closest ‘spoke,’ which includes selected general
practitioners such as s100 prescribers, hospital emergency
departments or infectious diseases units, and sexual
health clinics across metropolitan and regional Victoria.
The antiretroviral treatments are funded and distributed
by Alfred Health to the PEP providers as required.

                                                                  Victorian HIV strategy 2017–2020   11
PRONTO!
 PRONTO! is a peer-led,
 community-based rapid
 testing service run by the
 Victorian AIDS Council, in
 partnership with the Burnet
 Institute. It facilitates easy       “Effective HIV prevention
 and frequent testing, which             is more than providing
 is critical to helping people               condoms and PrEP.
 know their status and linking
                                      People at risk of HIV need
 them into treatment.
                                  information tailored to their
 PRONTO! has increased its
                                    particular needs, provided
 reach through innovative
 outreach strategies, and           in places and communities
 expanded its services. It now         where they are safe and
 offers STI screening, and is       supported, living free from
 co-located with Equinox, a         stigma and discrimination.”
 dedicated general practice
 for trans and gender                                  Simon Ruth
 diverse people.                            Chief Executive Officer
                                            Victorian AIDS Council

12
Test
In recent years, innovative models of HIV testing have emerged
from new technologies and service redesign, improving access
to and frequency of testing and reducing waiting times for results.
To significantly increase HIV testing in populations at greater risk,
diversifying testing models and approaches should be central to
efforts to remove barriers so more people can test more often.
HIV testing is a key HIV            remove barriers to testing and       Regular testing also provides
prevention strategy for priority    improve knowledge about              the opportunity to test for
populations in Victoria and         the need for regular testing         other STIs and to reinforce
Australia. It aims to decrease      among health professionals           information about prevention
the number of people who            and the community.                   messages and options.
are unaware of their HIV
                                    Behavioural survey data
status. A growing body of
                                    indicates that fear of stigma
evidence suggests that early
                                    in health settings, the                Melbourne
detection of HIV promotes early
commencement of antiretroviral
                                    inconvenience of some current          Sexual Health
treatment, before the immune
                                    testing models, off-putting            Centre Test and
                                    clinical testing environments
system sustains significant
                                    and difficulties in getting            Go (TAG) clinic
damage. This leads to positive
                                    appointments are common                Test and Go (TAG) is
outcomes such as protection
                                    barriers to testing. Home-based        Melbourne Sexual Health
against opportunistic illnesses,
                                    HIV testing could potentially          Centre’s innovative
non-AIDS conditions such
                                    address some of the barriers           nurse-led sexual health
as cardiovascular disease
                                    and may also be useful for             testing service for gay
and cognitive impairment,
                                    people who may otherwise               and bisexual men and
and overall mortality. Earlier
                                    be reluctant to return for             other men who have sex
detection of an HIV infection
                                    test results and/or to access          with men. TAG provides
depends on increased coverage
                                    traditional testing services.          a convenient express
and frequent testing.
                                    Models of care, including              service offering 15-minute
Testing efforts should focus                                               appointments, with tests
                                    specialist outreach and
on identifying people with HIV                                             for HIV, syphilis, chlamydia
                                    consultancy, counselling and
who remained undiagnosed,                                                  and gonorrhoea.
                                    rapid links into primary care
and providing support and
                                    must adapt to support these            The appointment involves
referral pathways to rapid
                                    more flexible testing approaches.      a short meeting with the
linkage to health care. It is
                                    By expanding our targeted              nurse followed by self-
critical to normalise HIV testing
                                    sexual health screening and            collection of samples
and to build a culture of early
                                    BBV testing efforts through local      for testing.
and regular screening for
                                    primary and community care
priority populations such as
                                    services we will decrease the
gay men, transgender people,
                                    number of people undiagnosed
women at greater risk, and
                                    and increase early detection of
men who have sex with men.
                                    new infections.
To achieve this we need to

                                                                     Victorian HIV strategy 2017–2020     13
Treat
Supporting people to link into care and commit to it is
fundamental to HIV treatment and prevention efforts and
to improving the health and wellbeing of people living with
HIV. Improving the system response to treatment retention
in care and adherence to treatment will aid efforts to
achieve Victoria’s 95-95-95 goals by 2030.
The updating of the                  specialist care services,            Comprehensive coverage and
antiretroviral guidelines to         the provision of ongoing,            access to antiretroviral therapy
remove restrictions for initiating   patient-centred care in local        is essential for increasing the
first-line antiretroviral therapy    settings and support for self-       number of people living with HIV
has allowed people to begin          management. We also need to          who have an undetectable viral
treatment immediately after          consider the needs of people         load. This will improve health
diagnosis and achieve viral          living with HIV who are ageing       outcomes for individuals and
suppression quickly. A focus         and how HIV services are best        strengthen the level of health
on rapid linkage to care post        integrated into aged care            protection in the community.
diagnosis is essential for           support services.
                                                                          Access to treatment can also be
individual and public health.
                                     Shortening the time between          supported by providing services
The requires us to acknowledge
                                     diagnosis and treatment and          close to where people live. This is
the increased health needs of
                                     care assessment is essential         particularly an issue for those
people living with HIV, notably
                                     for improving the long-term          living in rural and regional
the disproportionately high
                                     health of people living with         Victoria. Strengthening the
incidence of mental health
                                     HIV. Strong referral pathways        capacity of primary health
conditions.
                                     to HIV treatment assessment,         services to provide ongoing HIV
Because of the incredible            management and peer support          care and to provide innovative
advances in HIV treatment, HIV       are vital to improving individual    specialist outreach services are
is now considered a treatable        and community wellbeing and          just some of the ways access is
chronic illness rather than          reducing the risk of further         being improved for Victorians
a terminal condition. This is        transmission. Amid efforts to        living in regional areas, as
good news; people with HIV are       achieve this goal, we must           well as for those living in outer
living longer and with much          acknowledge that the needs of        metropolitan Melbourne.
improved health outcomes. We         people with HIV will vary. Some
need to reframe our services         people will be well supported
to best support access to            by mainstream services, while
care, long-term adherence to         others may require a more
treatments and optimal chronic       intensive or specialist response.
disease management.                  Ultimately, the decision to start
                                     treatment is up to the individual,
This requires improving
                                     with information and advice
integrated pathways between
                                     from their doctor.
community, primary and

14
“This is the most important and
 exciting time in HIV prevention.
 Getting this right will prevent
 countless infections. And
 getting it right means
 making access to
 prevention, testing and
 treatment as easy as
 possible. We have a
 real opportunity to
 show the world how
 it is done.”
Professor Kit Fairley
Director
Melbourne Sexual
Health Centre

                                    Victorian HIV strategy 2017–2020   15
“Stigma is its own sort of disease.
            It injures and paralyses us,
      preventing us from looking after
         our own health and wellbeing.
                  As an HIV community,
                 our primary focus must
                be reducing stigma, and
                    helping people build
                    resilience in order to
                              confront it.”
                              Richard Keane
                                    President
                      Living Positive Victoria

16
Stigma and discrimination
Stigma and discrimination are the greatest
challenges we face in the HIV response.
Addressing stigma is remarkably         Government is committed to
difficult. It is often multifaceted,    working in partnership with                Repeal of
with elements of enacted or             affected communities, carers               section 19A of
external stigma, and internalised       and clinicians to improve
or perceived stigma. It is              the lives of Victorians living
                                                                                   the Crimes Act
exacerbated by its intersection         with or affected by HIV. Their             Victoria has worked hard to
with other stigmatised                  experience and participation is            remove structural HIV-related
characteristics or identities.          invaluable in dispelling the fear          stigma and discrimination.
These include but are not limited       and misconceptions that fuel               The Victorian Government
to gender identity, injection drug      stigma and discrimination.                 recently repealed s 19A of
use, sexual orientation, cultural                                                  the Crimes Act 1958, an
identity, religious affiliation                                                    HIV-specific provision that
and disability.
                                          Involvement                              imposed severe penalties
                                          of people living                         for intentionally infecting
Our efforts to reduce and
eliminate stigma must                     with HIV                                 another person with HIV.
                                                                                   This change signifies the
acknowledge the intersectionality         At the United Nations, Australia         government’s commitment
of stigmatised identities as              has endorsed the principles              to advancing the dignity
they relate to HIV. The pervasive         of the Greater Involvement of            and human rights of
presence and significant impact           People Living with HIV/AIDS              people affected by HIV
of homophobia, transphobia and            (GIPA) and the Meaningful                and to counter stigma and
biphobia must be acknowledged.            Involvement of People Living             discrimination. Repeal of
We should focus on building and           with HIV/AIDS (MIPA). GIPA               s 19A removes barriers to
supporting resilience among               and MIPA have informed                   testing for HIV, which will
those living with and at risk of HIV,     Australia’s HIV response                 support early detection
and challenging interpersonal             for nearly 20 years, and are             and early treatment for
and community-level attitudes             affirmed in this strategy.               individuals, resulting in
toward HIV, and diverse genders
                                          The greater and meaningful               better health outcomes for
and sexualities.
                                          involvement of people living             Victorians and improved
All parts of the service system           with HIV, and of all affected            public health management
need to be free from stigma               communities, is essential                of the epidemic.
and discrimination, including             to all aspects of the HIV
ensuring our services meet                response. The Victorian
the differing needs of people             Government is committed
affected by HIV from diverse              to working in partnership
priority population groups. We            with communities, carers
must also work in partnership             and clinicians to improve
to remove barriers across the             the lives of Victorians living
legal, regulatory, policy and             with or affected by HIV. Their
social domains.                           experience and participation
The meaningful involvement of             is invaluable in dispelling the
people living with HIV is critical        fear and misconceptions that
in achieving this. The Victorian          fuel stigma and discrimination.

                                                                             Victorian HIV strategy 2017–2020   17
Victorian HIV strategy
By 2020 we aim to virtually eliminate new HIV transmissions.
By 2030 we aim to eliminate stigma and discrimination
related to HIV and achieve the 95-95-95 targets for diagnosis,
treatment and viral load.
Priority objectives
                                                      Victorians with HIV       PLHIV and affected
        Victorians are
                              Victorians with           will have access         communities are
        supported to
                               HIV will know            to best practice           free from HIV-
     reduce their risk of
                                their status            evidence-based          related stigma and
       contracting HIV
                                                      treatment and care          discrimination

Priority focus areas
Victoria will achieve its objectives through actions that focus on people, communities and the health
system. It will act in partnership with researchers, clinicians, community organisations, policy makers,
and people living with and affected by HIV.

          Increase               Increase                   Increase              Eliminate stigma
         prevention               testing                  treatment             and discrimination

Victoria will sustain the virtual elimination of HIV transmission in people who inject drugs, among sex
workers and from mother to child.

System enablers
Strengthening the Victorian health system will:
• ensure the Victorian workforce has the skills, knowledge and attitude needed to deliver best practice
  HIV prevention, testing, treatment and care
• integrate systems and settings to meet the needs of people living with, affected by, or at risk of HIV
• improve the quality and completeness of HIV data collection and support research.

Priority outcomes for 2030
     The proportion of        The proportion             The proportion           The proportion of
     all people with HIV      of all PLHIV who          of PLHIV with an        people experiencing
     who are diagnosed         are accessing           undetectable viral        and reporting HIV-
           will be:             appropriate                load will be:         related stigma and
                             treatment will be:                                 discrimination will be:

       95%                    95%                        95%                         0%
18
“The gender inequity
 experienced by
 women prevents them
 from accessing the HIV
 services they desperately
 need. If women are to
 receive effective support
 in the HIV response, we need
 to remove the structural and
 cultural barriers that affect
 their health outcomes.”
Alison Boughey
Executive Officer
Positive Women Victoria

“People from refugee and migrant
 backgrounds, asylum seekers and
 international students are all
 important parts of the solution
 to achieving the elimination
 of new transmissions by 2020.
 HIV prevention and care
 needs to be accessible and
 inclusive in order to meet
 the needs of all priority
 populations.”
Alison Coelho
Manager
Multicultural
Health & Support Service
Centre for Culture,
Ethnicity & Health

                                   Victorian HIV strategy 2017–2020   19
Priority focus area 1:

Victorians are supported
to prevent HIV transmission
                              Priority actions:
 What will be
                              Increase knowledge of               Increase access to
 different:                   HIV prevention                      biomedical prevention
 • Victorians know what to
                              • Sustain and refresh HIV           • Expand PrEP and PEP access,
   do to prevent HIV and
                                health promotion strategies         particularly in rural and
   are supported to do so.
                                including implementing              regional areas, pending a
 • Victorians are supported     new and innovative social           listing on the Pharmaceutical
   to use harm reduction        media strategies.                   Benefits Scheme (PBS).
   strategies to reduce
                              • Promote PrEP and PEP              • Advocate with the
   the risk associated
                                access among priority               Commonwealth to list PrEP
   with BBV transmission.
                                populations, and identify           and PEP on the PBS to
 • Health professionals         new access points.                  support universal access.
   have the knowledge
                              • Provide contemporary              • Increase frequency of testing
   and understanding to
                                prevention programs in a            and use of prophylaxis
   provide contemporary
                                range of settings including         medication (PrEP and PEP)
   prevention advice.
                                schools, community health           among priority populations.
 • There is an overall and      services and prisons through
                                                                  • Enhance harm-minimisation
   ongoing reduction in         a collaboration between the
                                                                    and HIV risk-reduction
   new HIV notifications        departments of Health and
                                                                    approaches, working with
   in Victoria.                 Human Services, Justice and
                                                                    people who use drugs by
 • Biomedical prevention        Regulation, and Education
                                                                    providing sterile injecting
   drugs are made               and Training.
                                                                    equipment, safe injecting
   available to enable        • Work with Aboriginal                and other drug harm
   Victorians to manage         Victorians living with or at        reduction education.
   their health.                higher risk of HIV to develop
                                                                  • Increase sexual health testing
 • Safe sexual and              tailored prevention and
                                                                    in priority populations and
   injecting practices          health promotion activities.
                                                                    key communities at higher
   are practised among        • Improve TasP literacy among         risk of HIV.
   priority populations.        people living with HIV and
                                                                  • Maintain peer education
 • Victorians who               other priority populations.
                                                                    and outreach efforts for
   experience greater         • Ensure people living with or at     sex workers and ensure
   inequity and who are         higher risk of HIV understand       non-discriminatory
   at increased risk of HIV     the action required to stop         access to regular sexual
   are the focus of renewed     transmission of HIV.                health screening.
   prevention efforts.
                              • Ensure Victorian health
                                professionals have the
                                knowledge to provide current
                                and accurate advice on
                                prevention options.

20
“PrEP has
 transformed
 the way
 people think
 about HIV risk.
 It has empowered
 many in their sex
 lives while leading
 major reductions
 in HIV transmission.
 Raising PrEP awareness
 and expanding access
 will be key to achieving
 virtual elimination of
 HIV transmission.”
Brian Price
Business and Community
Services Manager
Alfred Health               Victorian HIV strategy 2017–2020   21
“Young people’s experiences and
         understanding of HIV, stigma,
          and belonging are unique to
        this generation. If we are to be
      meaningfully involved in the HIV
       response of the future, we need
            appropriate, equitable and
           responsive ways to engage.”
                                  Tim Krulic
                  Health Promotion Officer
                    Living Positive Victoria

22
Priority focus area 2:

Victorians with HIV
will know their status
                              Priority actions:
 What will be                                                      • Promote and support peer-
                              Increase knowledge of the
 different:                   need to test                           led community-based rapid
 • Victorians with HIV know                                          HIV testing programs across
                              • Increase awareness among             regional and rural Victoria,
   their sero-status, are
                                priority populations about the       targeting key settings,
   diagnosed early and are
                                benefits of testing regularly        locations and populations.
   supported to do so.
                                for HIV and knowledge about
 • Victorians at greater                                           • Increase primary-care-
                                how often they should be
   risk of HIV understand                                            based testing to improve
                                tested, especially among
   the need for frequent                                             access and normalise regular
                                communities historically
   regular testing.                                                  testing in primary and
                                considered at low risk.
                                                                     community settings.
 • Regular testing is         • Implement a strategy to
   normalised within                                               • Review and modernise the
                                promote testing every
   priority populations                                              requirements for training and
                                three months.
   and is available across                                           competencies for pre- and
                              • Investigate systems for opt-in       post-test counselling.
   community and
                                testing reminders to support
   primary care settings,                                          • Work with a range of
                                individuals to undertake
   particularly in areas of                                          providers, including Primary
                                regular testing.
   high need.                                                        Health Networks, to increase
                              • Ensure Victorian health              regular and opportunistic
 • Testing services meet
                                professionals are aware of           testing for BBVs and STIs
   the needs of priority
                                the need for regular testing         across primary care and
   populations.
                                of those at greater risk and         community health.
 • There is high coverage       how frequently testing should
   and frequency of                                                • Coordinate Victorian HIV
                                be offered.
   HIV testing.                                                      programs to support and
                              Increase access to testing             strengthen pathways
                              and early diagnosis                    between testing services and
                                                                     prevention programs, and
                              • Increase access to and               adherence to repeat testing.
                                uptake of high-quality, safe
                                and appropriate testing            • Explore the potential role
                                services that facilitate early       of self-testing in improving
                                diagnosis, and continue to           access to testing for
                                reduce structural, social and        particular populations.
                                community barriers to testing.     • Improve the knowledge of PEP
                              • Advocate with the                    and HIV risk across relevant
                                Commonwealth to consider             health services, including
                                listing both rapid point-of-care     primary, community and
                                testing and self-testing on the      emergency care providers.
                                Medicare Benefits Schedule.

                                                               Victorian HIV strategy 2017–2020     23
Priority focus area 3:

Victorians with HIV have access
to best practice evidence-based
treatment and care services,
and are supported to achieve
an undetectable viral load
                                 Priority actions:
 What will be
 different:                      Increase access to early           • Improve the service models
                                 treatment                            for older people living
 • Victorians living with                                             with HIV to ensure access
   or at greater risk of HIV     • Reduce the time between            to respectful, inclusive,
   are aware of the long-          diagnosis and treatment            high-quality care and
   term consequences of            initiation by streamlining         support services.
   untreated HIV infection         and strengthening linkages
                                   between testing, treatment       • Strengthen the care
   and know how to access
                                   and support.                       coordination and self-
   appropriate treatment
                                                                      management models for
   and support.
                                 • Develop early treatment            people with more complex
 • All Victorians diagnosed        linkage pathways between           needs, aligned with the
   with HIV are linked into        specialist services and            Health Independence
   rapid treatment initiation      primary care for people who        Program, with clear links to
   and are supported to stay       are newly diagnosed, and           services, community networks
   on treatment.                   build the capacity of existing     and peer support.
 • People living with HIV          community-based clinical
   receive the treatment, care     services to deliver care         Improve community
   and support they need           and support.                     engagement and
   (including monitoring,        • Promote and support              understanding
   viral load testing and          continued engagement in          • Enhance community-based
   antiretroviral therapy).        care and the benefits of           peer support approaches
 • People living with HIV          adherence to treatment.            from initial diagnosis through
   can easily access care        • Explore methods to enhance         to adherence to treatment.
   and medications in local        partner notification for HIV,    • Support independence,
   primary and community           and increase the likelihood        resilience and health literacy
   health settings.                of early diagnosis and             programs for people living
 • Treatment services meet         treatment of sexual contacts       with HIV.
   the needs of affected           of people newly diagnosed.
   communities through                                              • Promote awareness of the
                                 • Increase the use and               individual and community
   a process of co-design
                                   effectiveness of shared            health benefits of overall
   and integrated pathways
                                   care and outreach models           reduction in viral load, with
   between community,
                                   between general practitioners      an understanding that not
   primary and specialist
                                   and HIV specialists.               all people are able to achieve
   care services.
                                                                      undetectable levels.

24
“Treatment is our most valuable
 tool in the HIV response. It enables
 people living with HIV to take
 charge of their health and
 wellbeing, and also ensures
 a public health benefit by
 minimising the risk of
 onward transmission.”
  rofessor Jenny Hoy
 P
 Director
 Victorian HIV Service
 Alfred Health

                                        Victorian HIV strategy 2017–2020   25
“Working with people living
         with HIV who are speaking in
        the community every week of
          the year, I see how stories of
     individual experience transform
       people’s understanding of HIV.
           The more people are visible
            in the community, the less
              stigma there will be now
                    and into the future”
                                 Max Niggl
                        Positive Speakers
                      Bureau Coordinator
                   Living Positive Victoria

26
Priority focus area 4:

Victorians and affected communities
are empowered to speak up about
stigma and discrimination
                               Priority actions:
 What will be
                               Reduce stigma and                      Increase understanding of
 different:                    discrimination                         stigma and discrimination
 • People living with HIV
                               • Address organisational               • Support affected
   feel safe to disclose
                                 and structural stigma and              communities to address
   their status.
                                 discrimination in community            stigma and discrimination,
 • People living with or         and healthcare settings for            including the use of peer-
   affected by HIV are           people with HIV.                       based approaches.
   engaged in all aspects
                               • Work to remove legal,                • Develop measures for better
   of the HIV response.
                                 regulatory and systemic                understanding the impact of
 • No person living with         barriers to equality of care in        stigma and discrimination
   HIV experiences stigma        the health sector for people           on people living with HIV
   or discrimination             living with or affected by HIV.        and other BBVs.
   when seeking or using
                               • Support a systematic                 • Promote better
   Victorian health and
                                 approach to reducing stigma            understanding of the impact
   community services.
                                 aligned with the Victorian             of stigma and discrimination
 • Victorians feel confident     Government’s equality                  and the impacts of policy,
   accessing services for        reform agenda.                         planning and service delivery
   HIV testing, treatment                                               decisions across all sectors
                               • Incorporate GIPA/MIPA
   and support, regardless                                              (including the health, housing,
                                 principles in all aspects of
   of their gender, gender                                              education and legal sectors)
                                 the Victorian HIV model of
   identity, cultural                                                   on the health of people
                                 care, from policy to program
   identity, ethnicity, age,                                            living with HIV.
                                 implementation.
   sexual orientation,
   disability status or        • Embed awareness of HIV
   residential location.         stigma and discrimination
                                 in public health and
                                 wellbeing plans across local
                                 government authorities.
                               • In collaboration with people
                                 with HIV, identify individual,
                                 community, systemic and
                                 policy barriers in accessing
                                 HIV testing, treatment and
                                 care and develop evidence-
                                 based strategies to address
                                 these barriers.

                                                                  Victorian HIV strategy 2017–2020   27
System enabler 1:

The Victorian workforce has the skills,
knowledge and attitudes needed to
deliver best practice HIV prevention,
testing, treatment and care
                                    Priority actions:
     What will be                                                      • Work with Primary Health
                                    Increase knowledge
     different:                     among key workforces                 Networks and community
     • Primary care providers’                                           health to strengthen BBV/STI
                                    • Ensure high-quality training       testing across primary care
       knowledge of HIV
                                      and support to mainstream          and community settings.
       transmission, diagnosis
                                      and specialist service
       and management                                                  • Train and provide ongoing
                                      providers to support evolving
       in allied health and                                              support to primary care
                                      models of testing, prevention
       community service                                                 clinicians (medical and
                                      and treatment.
       settings is high.                                                 nursing) on how to monitor
                                    • Ensure workforce                   and manage the health of
     • Health professionals
                                      development initiatives            people with HIV.
       have the knowledge to
                                      support culturally appropriate
       deliver appropriate and                                         • Explore expanding the model
                                      services for priority
       evidence-based care                                               of workforce support in
                                      populations and facilitate
       that meets the needs of                                           hospital settings, exemplified
                                      optimal person-centred care
       priority populations.                                             by the HIV Health
                                      and psychosocial support for
     • Health professionals                                              Independence Program.
                                      each individual.
       understand the                                                  • Ensure training is provided on
                                    • In key workforce sectors,
       impact of stigma and                                              the GIPA/MIPA principles and
                                      increase health literacy about
       discrimination on people                                          that they are implemented
                                      HIV, including prevention,
       living with HIV and                                               by organisations and
                                      testing, treatment and risk
       actively work to eliminate                                        service providers.
                                      among priority populations,
       it from their services.
                                      particularly those populations   • Improve knowledge of PEP
     • Victoria’s workforce           historically considered at         and HIV risk across relevant
       responds to the broader        low risk.                          health services, including
       health and psychosocial                                           primary, community and
                                    • Develop the skills of the
       care needs of people                                              emergency care providers.
                                      mainstream healthcare
       living with or at higher
                                      workforce to reduce stigma
       risk of HIV.
                                      and discrimination in the
                                      health system.
                                    • Promote and target s100
                                      prescriber training and
                                      accreditation, particularly in
                                      areas of high need and for
                                      health professionals working
                                      with priority populations.

28
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