It’s May 18th, which is World HIV/AIDS vaccine day, where campaigners raise awareness of the need for research into and the development of a vaccine, as well as heightening awareness of the disease.

Last week I watched the documentary “Rampart: How a City Stopped a Plague” about how the unique and courageous approach taken by Australia’s politicians and activists – communicating with and utilising members of populations at highest risk, decriminalising and sometimes legalising sex work, providing needle exchange programs, utilising explicit advertising to educate MSM to use condoms, engaging and working with the communities instead of a top-down approach – meant we had one of the fastest, most effect and most comprehensive response and management strategies in the world.

I have been reflecting a lot recently on how anti-retroviral therapies, particularly HAART, transformed the face of HIV/AIDs, at least in the West. Five years ago the ward I work on amalgamated with the ID unit which, since the closure of Fairfield Hospital in 1986, has been a key statewide service for HIV/AIDS.

Working with positive patients as a student in 1991/92 was very different from working with positive patients now, in many respects. We can DO something now, which is amazing, and it’s not the inevitable death sentence it was. I never saw stigmatisation of patients from staff, and learned from very early on that the cause of infection was only relevant if it had an associated issue (like haemophilia, or ongoing drug use); I did see a lot of heart-breaking and legally-hand-tied restriction of visitors by often-estranged family members preventing friends and long-term partners from seeing the patients, something for which I am grateful beyond words is no longer the case. And though progress has been made regarding equality, there is still a distressingly long journey ahead. And the disease is still stigmatised, as has been made distressingly clear in the recent case of a NZ four-year-old boy allegedly suspended from his Whangarei preschool because of his status, in some kind of hideous mirror image of Eve van Grafthorst‘s experiences here in 1985 (note: the kindergarten refuted the allegation).

In Australia ~1% of IV drug users are HIV positive; in the US, where zero tolerance is used as the main method of risk reduction, the rate is 20%. Their general rate of infection is ten times ours. It is chilling to realise that, were HIV to emerge here now, odds are the Australian method would never have surfaced.

We need to see more of the courage from our politicians, more willingness to do what’s right instead of what the polls and the uninformed dictate. And we need to act ourselves – we saw during the acute public EBA campaign that nothing’s as effective for creating change as the united, consistent, committed actions of substantial numbers of people.

As EBA campaigns continue across a variety of fronts, for Victorian nurses and midwives, and for union members in other sectors, we need to stay active. For anyone reading this who hasn’t been active – it’s not hard, and it’s not too late: sign the petition in support of the Mental Health EBA, write to your local MP or (even better) ring and ask to speak to her or him.

Tomorrow, and every day for the next 925 days I’ll remember that politicians too often need the pressure of the electorate before they’ll do what’s right instead of what’s expedient or populist. That’s two years, six months and eleven days of continuing to remind myself, my colleagues, my fellow members and the population at large that without unions we have all the bargaining power and voice of just ourselves – without our collective action we’d have lost ratios, registered staff, a safe working environment, and the heart of a health care system that attracts nurses from around the world.

But today I’ll also remember the people I’ve known who had, have and could have contracted HIV/AIDS – friends, family, colleagues and patients. I remember nursing young men with bizarre bugs in atypical sites.

I remember pumping in 100mmol of potassium over six hours only to watch my patient’s K+ drop from 1.9 to 1.7, for no reason any of us could work out.

I remember diagnosing Stevens-Johnsons syndrome four days before the medical team, and seeing a middle-aged man go from healthy to dying in under a week.

I remember a family conference where every member of the health care staff took great pains not to reveal that the dying patient’s cancer was caused by his HIV status.

I remember arranging for a massage therapist to visit, and for privacy during the treatment, and telling the doctors they had to go away and come back at a time convenient to the patient and not just to them.

And I remember the triumphant discharge of one of the sickest patients I’ve looked after in a really long time, who racked up four admissions to ICU in three weeks of his admission (you have to be really, really unwell, to score an Alfred ICU bed).

I remember our campaign fight, and our success; I remember my patients’ fights, the wins and losses that are ours as well as theirs, and hope that, one day soon, I won’t have any new positive patients.

Note: this entry was originally posted on the ANF (Vic. branch)’s Facebook page on 18/5/12

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