18 September 2017
(Bill Consideration in Detail, 13 September 2017, Legislative Assembly NSW Parliament)
The Public Health Amendment (Review) Bill makes a number of amendments to laws surrounding public health following the statutory review of the Public Health Act 2010.
My contribution will focus on changes to the state’s response to sexually transmitted infections on which the bill takes both forward and regressive steps.
On a positive note, the bill removes the need to de-identify a HIV test request form. I understand that this will help clinicians know whether a HIV test has been ordered, which is important when there are more than one clinicians involved in the care of a patient. Each clinician should be able to know what tests have been ordered so that they are not repeated – or worse – not done because it is assumed that they have already been ordered.
While we no longer see ads with the grim reaper inciting fear of people with HIV and AIDS, stigma associated with the conditions has not disappeared and I welcome the government’s decision to continue to require that positive results be de-identified.
I support provisions in the bill that remove the current requirement for persons with an STI to notify sexual partners of their STI status.
No other state or territory has such disclosure laws and they fail to acknowledge the shared responsibility of practicing safe sex to prevent the spread of infections. They also increase stigma and provide a disincentive for getting tested.
However, unfortunately the government is choosing to undermine these improvements and previous advancements in STI care and prevention by making it a criminal offence for someone with an STI to not practice safe sex, with excessive penalties of up to $11,000 or six months in prison.
Sexually transmitted infections are a health matter and making them a criminal matter will have serious consequences and add to stigma and discrimination.
The threat of criminal sanctions could discourage people with an STI to contact former partners to tell them of their STI status. Alarmingly, getting tested will be less attractive because a positive result would create the potential for criminal consensual sex.
More people could be captured by the already overburdened criminal justice system, especially young people, people from culturally and linguistically diverse backgrounds, Aboriginal people and drug users.
There is no evidence that these changes are needed. The spread of sexually transmitted infections is no more widespread than other infections to warrant criminal justice intervention. Most STIs are quickly and painlessly treated with antibiotics and HIV treatment can achieve viral suppression so that most people living with HIV are undetectable and not transmittable.
People with a positive STI status are the least likely to pass on their infection and existing laws in the Crimes Act can already deal with someone who intentionally or recklessly puts others at risk.
The highest risk of infection comes from people who have not been tested and don’t know their STI status. They may be less likely to practice safe sex because they don’t know they are infectious, and they may be more infectious because they have a higher viral load and have not started viral suppressant treatment. The focus must be on early testing and this is not promoted under a model that criminalises sex in private relationships between consenting adults when someone has knowledge of their STI status.
New South Wales should be proud of its response to HIV and AIDS. Contracting HIV is no longer a death sentence, and the rate of infection in the state has been stable for the past decade. The number of people dying or having serious health crises has dropped significantly. Health services no longer need to provide dedicated wards for people with HIV-defined illnesses, and most have integrated their responses to HIV into broad health services.
Massive advances in treatment and understanding of how to prevent transmission of the HIV virus have been made. These advances mean that the lives of people with HIV are almost the same as the rest of the population. Early treatment can reduce the presence of the HIV virus in the body and help prevent HIV-related illnesses, as well as transmission to others.
We did not become a world leader in HIV prevention and treatment through criminal sanctions: we did it through a health based approach and we must continue with this approach if we want to reach our target of ending HIV transmissions by 2020.
Testing for STIs is at a record high, but about 250 gay men a year still contract HIV in New South Wales and the new criminal approach to private sexual behaviour is counterproductive to slowing this rate.
Instead of creating a new criminal offence, we should legislate a statement of principles that cover the responsibilities of a person with an STI or are at risk of contracting one. This works well in Victoria and is what the experts in the field tell us will encourage safe sex, frequent testing and early treatment – the key to reducing STI transmissions.
Criminalising health matters has never worked and is inconsistent with other health policies. We need to encourage people who don’t know their STI status or that of a sexual partner to have a conversation about safe sex practices, make responsible decisions together and get tested.
I call on the government not to undermine its great work and the great work of previous governments in HIV prevention and treatment and withdraw these retrograde criminal sanctions.
I ask the minister in reply to commit to continuously monitoring these concerning provisions to ensure that they will not have a perverse impact on STI testing in the community.
See other members consideration HERE.
I move amendment No.1:
No.1 Review of amendments relating to public health orders and sexually transmitted diseases Page 11. Schedule 1. Insert after line 6:
 Section 136
Omit the section. Insert instead:
136 Review of amendments made by the Public Health Amendment (Review) Act 2017
(1)The Minister will review the amendments made to section 62 and Division 1 of Part 5 by the public Health Amendment (Review) Act 2017 to determine whether the policy objectives of those amendments remain valid and whether the terms of those provisions as amended remain appropriate for securing those objectives.
(2)The review is to be undertaken as soon as possible after the period of 2 years from the commencement of the amendments to section 62.
(3)A report on the outcome of the review is to be tabled in each House of Parliament within 12 months after the end of the period of 2 years from the commencement of the amendments to section 62.
New South Wales is a world leader in the treatment and prevention of sexually transmitted infections, particularly HIV and AIDS. This has been achieved through a health-based approach that has encouraged frequent testing, early treatment and safe sex practices. I share the concern expressed by the STI sector that amendments in proposed section 79 risk undermining that achievement by discouraging people at risk of contracting an STI from being tested. I know that is not the Government's intention, so it is vital these changes are monitored to ensure we maintain our high rate of testing.
This amendment provides for a review of the new provisions two years after they commence ahead of the five-year review of the entire Act. This is an important part of achieving our goal of no HIV transmissions by 2020. The amendment is similar in substance to those flagged by the Opposition and followed discussions with the Minister. In supporting the amendment, this Parliament is continuing its multi-partisan approach to the prevention of HIV and AIDS and supporting those with those conditions. The amendment provides for the Minister to review section 62 and, as flagged, section 79, which is in division 1 of part 5 of the Public Health Amendment Act, to determine whether the policy objectives remain valid and whether the terms of the provisions, as amended, remain appropriate for securing those objectives. I commend the amendment to the House.