Public Submission by Australian Federation of AIDS Organisations - Draft National Tobacco Strategy 2010 - 2018
Australian Federation of AIDS Organisations Inc.
ABN 91 708 310 631
PO Box 1
Tel: +61 2 9557-9399
Fax +61 2 9557-9867
Draft NTS 2012
Healthcare Management Advisors
PO Box 1311
Fitzroy North VIC 3068
By e-mail: email@example.com
25 June 2012
The Australian Federation of AIDS Organisations (AFAO) is the national federation for the HIV community response. AFAO’s members are the AIDS Councils in each state and territory; the National Association of People Living with HIV/AIDS (NAPWA); the Australian Injecting & Illicit Drug Users League (AIVL); the Anwernekenhe Aboriginal and Torres Strait Islander HIV/AIDS Alliance (ANA); and Scarlet Alliance, Australian Sex Workers Association. AFAO advocates for its member organisations, promotes medical and social research into HIV and its effects, develops and formulates policy on HIV issues, and provides HIV policy advice to Commonwealth, state and territory governments.
The Australian Federation of AIDS Organisations (AFAO) welcomes the consultation on the National Tobacco Strategy 2012-2018 (the draft Strategy). Our feedback relates to the question: are the priority areas (and the supporting evidence) appropriate and sufficient?
According to the 2011 HIV, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report, by 31 December 2010 an estimated 21 391 people in Australia were living with HIV.1 Effective HIV treatments have meant that for most people, HIV has become a chronic disease, and long-term health complications have become increasingly relevant to increasing numbers of people living with HIV infection. The number of new HIV diagnoses has remained relatively stable at around 1000 every year over the past five years.
The experience of living with HIV is a social determinant of health that can have a profound effect on many aspects of the life of an HIV-positive person, including risks associated with smoking. Data from the HIV Futures 62 study of Australians living with HIV showed that about half of respondents smoked (42.3%) - representing more than twice the rate of the general Australian population. This figure is concerning as many of the conditions associated with smoking are much more likely to occur in people who are HIV-positive whether or not they smoke, and smoking further weakens overall immune response. A recent US study found smoking cessation in symptomatic HIV-positive people can significantly improve a person’s HIV-related symptom burden within three months of cessation. Notably, HIV Futures 63 revealed that 28% of respondents had reduced or ceased smoking as a means to improve their health.
Recognition of the importance of social determinants of health is fundamental to the draft Tobacco Strategy and it includes a comprehensive list of priority populations and actions. Missing, however, is any reference to the fact that there is limited but persuasive Australian research on the intersection of sexuality and gender identity with the disproportionately high incidence of smoking, obesity and excessive alcohol consumption among LGBTI people and among HIV-positive people.
Given this intersection, AFAO has welcomed the opportunity to provide input regarding Australia’s various national preventative health strategies. In providing feedback and comments we have noted our concern that there is little cross-referencing of common priority populations and priority action areas contained in the national strategies. For example, at 6.3.1 of the Sixth National HIV Strategy, smoking cessation is included as a priority action area in respect of emerging issues affecting the treatment, health and wellbeing of people living with HIV. It would be useful if priority actions such as this, which directly relate to National Tobacco Strategy goals, could be cross-referenced. This would go some way to ensuring that actions across the national strategies which seek to address smoking are complementary, consistent and coordinated.
In 2009, AFAO commissioned Dr Jeanne Ellard from the National Centre in HIV Social Research to conduct a review of published research on smoking cessation, to provide AFAO and its members with evidence and information to inform development of community education campaign materials on smoking and HIV. The resultant paper, Smoking Cessation Interventions: A Literature Review 4 , provides an overview and discussion of research regarding:
- the impact of smoking cessation on disease burden and quality of life
- barriers to quitting
- the potential impact of smoking among the broader GLBT community
- willingness to quit
- social support
- tailored interventions
- behavioural and pharmacotherapy based interventions
- internet and phone interventions, and
- clinicians and health care providers.
In further developing the draft National Tobacco Strategy we propose that the disproportionately high rates of smoking among particular Australian communities such as people living with HIV and communities affected by HIV should be noted, and that Tobacco Strategy actions include the development of campaigns targeting LGBTI people and people with HIV. We note Dr Ellard’s study as an example of best practice in developing an evidence base to inform targeted interventions for specific communities.
AFAO is pleased to have been provided with the opportunity to take part in this consultation and looks forward to further opportunities for input.
Australian Federation of AIDS Organisations
1The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance
Report 2011. The Kirby Institute, the University of New South Wales, Sydney, NSW. p7. Available at http://www.med.unsw.edu.au/NCHECRweb.nsf/resources/2011/$file/KIRBY_ASR2011.pdf
2J Grierson, J Power, M Pitts, S Croy, T Clement, R Thorpe and K McDonald (2009) HIV Futures 6: Making Positive Lives Count, monograph series number 74, The Australian Research Centre in Sex, Health and Society, Latrobe University, Melbourne, Australia
4Available at Australian Federation of AIDS Organisations website
AFAO is the peak body for Australia's eight State and Territory AIDS Councils. AFAO's national members are the National Association of People Living with HIV (NAPWA), the Australian Injecting & Illicit Drug Users League (AIVL), Scarlet Alliance, Australian Sex Workers Association and Anwernekenhe National Aboriginal & Torres Strait Islander HIV/AIDS Alliance (ANA).
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