Towards Closing Gaps in Public Health Interventions: A Theory-Based Analysis of Social Determinants in HIV Prevention in Queensland

Abstract

HIV is now a chronic and manageable disease in developed countries, treatment however is a substantial burden on people's health and countries' economic systems. In the industrialized world, an estimated 70 per cent of HIV transmission occurs through men who have sex with men (MSM); worldwide, the range is 5-10 per cent. Australian HIV infection rates have increased by more than 8 per cent in 2011 and by 50 per cent growth over the past 10 years. In Australia since 2001, HIV risk behaviour has declined in NSW, whereas it has increased iu Victoria and Queensland. Australian data from Gay Community Periodic Surveys 1998-2006 suggests that the increase in HIV infections rates can be attributed to the increase in HIV risk behaviour underpinned by social determinants (Zablotska et a!., 2008). The Social Determinants of Health (SDH) approach provides a framework for identifying and then addressing the many underpinning dynamics and factors that influence HIV risk behaviour. Based on decades of research UNAIDS developed guidelines to intensify HIV prevention, which recommend the SDH approach as a key component of HIV surveillance and policy. Recent SDH literature identified enacted stigma, intolerance and homelessness as key determinants. At-risk populations experience many of these factors, especially Gay males and men who have sex with men (MSM) populations. A preliminary review of Australia's HIV Policy evaluations identified a lack of measurement of the SDH in Australia and the subsequent lack of the required evidence base for implementation of the SDH approach for HIV prevention. Indeed current HIV policy continues to focus on individual determinants and behaviour change and does not adequately address the SDH.