the Melbourne Declaration

Galvanising Australia’s HIV Testing, Prevention and Treatment Responses & Meeting our Commitments under the United Nations 2011 Political Declaration on HIV/AIDS.

The last two years have seen major developments in political commitment and scientific evidence in the fight against HIV, principally the growing body of evidence that HIV treatment can prevent new HIV infections in addition to the life-changing benefits it provides to those already infected. The prospect of an AIDS-free generation is believed to be in reach.

Australia has signed the United Nations 2011 Political Declaration on HIV/AIDS, committing to bold actions and targets including, by 2015, reducing the sexual transmission of HIV by 50%, dramatically expanding access to HIV treatment and reducing HIV transmission among people who inject drugs by 50%. Australia is better placed than most countries to meet these targets, but concerted action is urgently required. We are calling on the Australian Government to seize the opportunity and work with State and Territory governments to remove several current barriers to enhanced HIV testing, treatment and prevention.

What are some of these barriers? There are no rapid HIV tests licenced for use in Australia. There are unhelpful restrictions on the ability of people with HIV and their doctors to decide the right time to start treatment. Dispensing arrangements for HIV treatments are unnecessarily restrictive. There are financial disincentives to taking HIV treatments. Doctors cannot prescribe antiretroviral drugs to prevent HIV infection before people are exposed. Criminal laws, policies and regulations in relation to sex work, people who inject drugs and HIV exposure and transmission undermine the public health approach and the enabling environment.

The successful Australian response to HIV is built on a partnership between governments, community organisations, clinicians and researchers. The leading role of affected communities such as people living with HIV, gay men, sex workers, Aboriginal and Torres Strait Islander people and people who inject drugs, has been crucial in the adoption of safe sex and harm reduction practices. We must sustain this strong response and enabling environment, continue to fight stigma and discrimination and defend the rights of people living with and affected by HIV.

In 2014, the International AIDS Conference will be held in Melbourne and the world's eyes will be upon us. Immediate action, leadership and commitment to the actions outlined below will galvanise Australia's HIV response and provide new tools to engage affected communities, increase the uptake of voluntary HIV testing, get people access to treatment and prevent new infections. We declare that the following actions must be taken urgently!

Action Area 1: Substantially increase access to and uptake of voluntary HIV testing in Australia

  • Make rapid HIV testing widely available in clinical and community settings.
  • Expedite TGA licensing of reliable rapid HIV tests and funding arrangements with States/Territories (including through Medicare).
  • States and Territories to set up access programs for rapid HIV testing pending Commonwealth licensing and funding.
  • Investigate options to make rapid HIV tests available for home use, with appropriate linkages to STI screening.

Action Area 2: Enhance access to and uptake of antiretroviral treatment for HIV

  • Enhance the scope for people with HIV and their doctors to initiate antiretroviral treatment, including the removal of the PBS indication limiting antiretroviral drug prescribing above CD4 counts of 500.
  • Remove financial barriers to treatment uptake arising from patient dispensing fees for HIV antiretroviral medications in all jurisdictions and broaden HIV dispensing arrangements beyond hospital-based pharmacies.
  • Establish programs to provide antiretroviral treatment to people with HIV not eligible for Medicare cover.

Action Area 3: Make HIV pre-exposure prophylaxis available

  • Establish demonstration projects that provide access to HIV pre-exposure prophylaxis to people at high risk of HIV infection.
  • Fast track TGA licensing and PBS funding of antiretroviral drugs for effective HIV pre-exposure prophylaxis.

Action Area 4: Strengthen the partnership response and enabling environment

  • Mobilise and inform people with and at risk of HIV about advances in treatment and prevention to support decisions about health and wellbeing.
  • Release the findings of the (Commonwealth) Ministerial Advisory Committee on Blood Borne Viruses and STIs (MACBBVS) Legal Working Group Report which considered legislative and regulatory measures that support and impede HIV programs and implement the recommendations taking a whole-of government approach.
  • Remove criminal sanctions relating to HIV transmission, implement drug law reform and decriminalise sex work.
  • Increase investment in current effective HIV prevention particularly among people who inject drugs, Aboriginal and Torres Strait Islander people, sex workers and gay men and other men who have sex with men to enhance the programs that have minimised HIV infections among these key affected communities.
  • Continue support for high quality national HIV research so that initiatives can be effectively monitored and can contribute to the ongoing development of evidence.