Symposium on Strengthening the Global and Regional Fight Against AIDS, Tuberculosis and Malaria, Sydney, 24 February 2009

Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria/ Lowy Institute/ AusAID

Introduction

Thank you. I'd particularly like to thank the Lowy institute for hosting us here today, and the Pacific Friends of the Global Fund as well as AusAID for their co-sponsorship of the symposium.

Thank you for giving me the opportunity to speak.

As someone with a deep personal, professional and now official connection to the Pacific, I'm delighted to be here.

I particularly welcome the opportunity to learn from people with many years experience in the epidemiology of AIDS, tuberculosis and malaria and in developing strategies to combat them.

Last year's decision to establish the Pacific Friends of the Global Fund was an extremely promising development in the struggle against the serious threat that these diseases pose to the development of the Pacific region.

I take this opportunity to publicly thank the Bill and Melinda Gates Foundation for the support it has given to launch the Pacific Friends of the Global Fund.

My colleague Bob McMullan has already made clear the tremendous respect the Australian Government has for the Global Fund, and has outlined the key elements of our support in the global fight against AIDS, tuberculosis and malaria.

The Global Fund's performance-based approach and commitment to accountability and transparency have already helped it to achieve formidable results.

As Parliamentary Secretary for Pacific Island Affairs, however, I am acutely aware that there is much hard work ahead of us, right in our own neighbourhood.

My message today is that the Australian Government is determined to do all it can to ensure the Pacific is not left behind in the global fight against these diseases.

I'd like to give you my perspectives on the approach we are taking.

The Pacific context

Raising awareness is crucial to the process of engaging donors and increasing the resources available to combat preventable diseases like AIDS, tuberculosis and malaria.

The activities of the Pacific Friends of the Global Fund, with the support and commitment of senior regional leaders, will do much to further that goal.

Raising awareness is especially important in the effort to develop effective, targeted strategies - strategies that are tailored to the Pacific context.

Let me therefore warmly endorse the efforts of the Pacific Friends of the Global Fund to reach out to those in Australia and across the region who have detailed knowledge of Pacific countries and cultures.

It's important that we involve these people in our efforts and draw on their expertise in finding workable solutions.

I think our first challenge is to acknowledge the many different cultures that flourish around the Pacific, both between countries and within countries.

Individual countries and cultures bring unique perspectives and may also impose unique constraints on approaches to health issues.

It is vital that we develop and implement programs based on mutual respect and mutual responsibility, but also a clear-sighted understanding of the issues.

We cannot merely hope that generic public health messages contained in educational material will percolate through complex cultural filters and result in positive changes in behaviour.

Real progress will only be achieved if we work collaboratively with our neighbours, as equals, and in tailored ways, to realise shared goals.

That message - working together as equals and eschewing a "one-size-fits-all" approach - is at the heart of the Rudd Government's approach to the Pacific.

We can assist without being prescriptive.

This does not mean that we should tip-toe around cultural sensitivities. Instead, we need to work with governments and community leaders to counter dominant public discourses that ignore, or even dispute, sound public health messages.

The complexities here are formidable, and particularly so when addressing the spread of HIV.

Often those complexities will arise from the wide gap between expressed normative conduct and actual social behaviour.

Unless that gap is addressed, common transmission routes for the virus will be ignored and the people most at risk will remain vulnerable.

It is a gap that must be kept in mind when designing public awareness campaigns. In Australia, we had considerable success in this regard with an AIDS awareness campaign in the mid-1980s.

Advertisements screened on national television, including the famous "Grim Reaper" advertisement, acted to counter the common public perception that AIDS only affected intravenous drug users and the gay community.

I know Bill Bowtell was closely involved in Australia's early response to AIDS, including ensuring that the campaign found ways to reach and communicate directly and non-judgmentally with those involved in higher risk behaviours. I look forward to hearing more from him later today.

I am not, of course, suggesting that a successful Australian model could be simply transplanted to the Pacific context.

And any strategy to stop the spread of HIV in the Pacific needs to recognise the uneven prevalence of the disease in the region.

Papua New Guinea's HIV infection rates have reached epidemic levels. Prevalence in other Pacific Island countries is generally low, although risk factors remain high and data can be unreliable.

But while it is important to develop country and culture-specific strategies, I also believe it is important to recognise that successful information campaigns, including Australia's, often involve breaking a number of taboos.

For many Australians the Government-funded advertisements were, quite literally, shocking. I would suggest that to be successful, campaigns in the Pacific will in some cases need to be similarly shocking.

In particular, programs will need to confront openly the imbalanced gender relations that persist in many Pacific cultures.

We know that this imbalance disempowers women socially and economically. We need to give public recognition now to the fact that this imbalance puts women at a disadvantage in terms of sexual relations and health.

In 2007, AusAID developed a comprehensive policy framework which enshrined gender equality as an overarching objective of the aid program and integrates it into all aid initiatives, including public health.

Women's empowerment in the Pacific is vital. Regardless of cultural or religious considerations, effective programs to stop the spread of HIV must confront traditions in which women do not exercise full control over their own sexual relations.

The importance of leadership

Addressing such issues in an open, public discussion requires real leadership within governments and communities.

I have seen some encouraging examples of that leadership.

I'm thinking particularly of Papua New Guinean Prime Minister Somare who, in a groundbreaking statement in Parliament on 17 November 2007, called on his fellow citizens to speak up when they encountered violence against women.

More recently, His Excellency Anote Tong, President of Kiribati, personally encouraged men to take action to end violence against women.

In 2007, regional health ministers recognised in the "Vanuatu Commitment" the need, amongst other concerns, to ensure gender balance and equity as a means of preventing the transmission of HIV.

They also committed to targeted behaviour change interventions and condom promotion.

The Vanuatu Commitment was endorsed at last year's Pacific Island Forum Leaders meeting in Niue.

Last year we also saw the adoption of a new Pacific Regional Strategy on HIV and other sexually transmitted diseases for 2009-2013. Australia has committed $30 million to the Strategy's Response Fund, and the Global Fund has made a similar commitment.

This willingness to provide funds and the leadership shown at the government level is both welcome and necessary.

But, as the Secretariat of the Pacific Community's Deputy Director-General Falani Aukoso acknowledged at the launch of the Strategy, the challenge is now to harness that support at a national level - that is, within states.

Doing so will require leadership across governments and communities, which is an area I hope the Pacific Friends of the Global Fund will address through their advocacy in the region.

I know the Global Fund often operates through government systems. But in the Pacific we face the reality that in many countries government systems are not sufficiently robust to provide visible and effective leadership.

In many areas there may be strong societies, but not strong states.

It is therefore necessary to identify and engage those in the community with the standing and influence to deliver clear, strong messages on topics that will often be intensely personal.

It is not an easy task, but there are certainly inspiring examples of people working within their communities to raise awareness and prevent disease.

Tuberi Cati, for example, is an HIV positive woman living in Fiji who has strengthened the membership and resources of a network to support people living with HIV in Fiji.

Another example is Francesca Semoso, the Deputy Speaker of the Bougainville Parliament. Francesca works tirelessly to raise awareness of the challenge HIV poses for the Pacific.

She delivers a particularly strong message on the need for MPs to lead by example and encourages a bold approach in dealing with sensitive issues including the status of women, sexuality, drug use and sex work.

In addition, Steven Vete has been a strong advocate for HIV prevention and response through his coordination role with the Asia Pacific Leadership Forum.

Steven's work has focused on building strong leadership at all levels in the community, including at the political level, within church groups and in the private sector, helping to raise awareness and encourage appropriate responses to HIV in Pacific communities.

We need more people like these.

Strengthening Governance

Cultural and leadership issues are not, of course, the only challenges faced by efforts to combat AIDS, tuberculosis and malaria in the Pacific.

Practical issues, issues of logistics and administration, are equally important and formidable.

We may educate populations about condom use but we have to ensure condoms are readily available in remote regions, and their use is not stigmatised. We may secure funding for insecticide-treated mosquito nets but we need systems to distribute them.

We may teach health officials in the treatment of contagious pulmonary tuberculosis, but we must also find ways to help spread this knowledge through local health networks.

In many instances these challenges involve issues of governance.

Governance is a fundamental building block of development.

It is a key feature of Australia's collaborative work with Pacific neighbours and is central to building the institutional strength which - amongst many things - helps to implement health strategies and campaigns.

Under our four-year Pacific public sector capacity program Australia is investing $107 million to strengthen public sector administration in the Pacific.

In Papua New Guinea, for example, we are working in close consultation with the government through the Strongim Gavman Program to improve governance at different levels.

This includes our joint efforts to enhance financial management and budget controls, and to help strengthen the administration of service providers.

Australia has also been working closely with agencies in other countries such as Vanuatu and the Solomon Islands to identify and overcome governance obstacles to broad based growth.

These efforts are leading to real progress on public health issues. Solomon Islands and Vanuatu are now leading members of the Asia Pacific Malaria Elimination Network [mentioned by Mr McMullan this morning].

Solomon Islands has set itself challenging goals, including ending malaria related deaths and reducing parasite incidence by 65 per cent. AusAID and the Global Fund have provided much-needed resources towards this.

Solomon Islands' Ministry of Health and Medical Services has now developed a detailed strategy and action plan. New equipment and supplies have been purchased.

The aim is to eliminate malaria in Temotu Province by 2014 and then progressively in all other provinces to create a malaria-free Solomon Islands.

Bold programs such as this will only be achieved through good governance in the health sector.

That is why the need to take practical, country-specific measures to build and strengthen governance and institutional capacity lies at the heart of Australia's Partnerships for Development, announced by the Prime Minister in Port Moresby last year.

Conclusion

I'd like to conclude by emphasising again that the Australian Government is an active and willing partner in the work of Global Fund to fight AIDS, Tuberculosis and Malaria.

We recognise the devastating effect these diseases already have in some parts of our region, and we are equally aware of the potential catastrophe we face if we do not act now.

Sobering statistics and predictions abound. Unless more is done to address the spread of HIV in PNG, for example, the country's workforce may decline by 12.5% by 2025.

That is why the Australian Government is the lead donor supporting Papua New Guinea's national HIV response, including the PNG-Australia Sanap Wantaim program.

We are aware, however, that simply allocating resources will not always be enough. I'm sure many of you have read the criticism leveled against the so-called "AIDS industry" by Elizabeth Pisani and others over recent years.

We may not agree with everything that critics say, but we can not afford to brush aside their criticism, especially where it concerns ineffective use of donor money.

In particular, I think we need to be creative in tackling health problems and, as I have already said, we need to tailor solutions to particular cultures. And we need to make sure they work.

One of my favourite examples of success in this regard is the so-called "condom tree" in Fitzroy Crossing, a remote, largely indigenous town in the north of Western Australia.

Faced with very high rates of STDs and very low rates of condom use among the indigenous population, the local health service started hanging condoms from first one, then many trees where people would gather in the shade.

Condom use rose dramatically, STD rates fell, and the strategy has since been employed successfully in other towns.

This is an isolated case, a vignette of success. It's a far cry from the "Grim Reaper" campaign. But it's also the sort of innovative, simple and effective solution that I believe we should be looking for in many cases in the Pacific.

Thank you again for inviting me today. As Bob McMullan has already said, this subject is of great importance to the Australian Government.

I look forward to our discussions over the course of the day and to working with you over coming years to ensure a bright future for the Pacific.

Media inquiries: Mr Kerr's office - 02 6277 4991