Grassroots activities, national initiatives and HIV prevention: Clues to explain Australia's dramatic early success in controlling the HIV epidemic

During the mid-1980s Australia experienced a remarkable decline in HIV incidence that can rightly be considered a public health milestone of global importance. The effects of this decline lasted for about 20 years and greatly benefited all Australians. In contrast, as we enter the mid-2000s, we see the global epidemic continues to intensify, HIV vaccines remain a distant possibility, and Australia is experiencing rising HIV incidence again. Clearly, better understanding of HIV prevention has important implications both for Australia and the world. Therefore, we believe, it is timely to revisit Australian experiences of the mid-1980s in order to understand those early events better.To gauge the influence (if any) of government strategies, funding levels and other events during a period of dramatic decline in HIV transmission, incidence figures are mapped against Federal HIV/AIDS funding patterns and the occurrence of key national interventions and events. The analysis reveals that the greatest decline in HIV preceded almost all substantive initiatives undertaken at the national level, which are often held responsible for Australia's successful early containment of HIV. In particular, dramatic declines were already well advanced and/or preceded (i) substantive growth in national HIV/AIDS prevention education funding, (ii) publication of the first National AIDS Strategy, (iii) establishment of key national HIV/AIDS bodies and (iv) promulgation of the 'Ottawa Charter'. Explanations for, and lessons learned from Australia's dramatic early declines in HIV incidence are discussed.