Futures: Victorian Rural Health Forum
Opening address by Chris Sidoti, Human Rights Commissioner, Country AIDS Network (Victoria), Bendigo, 2-5 June 1999
I am pleased to be participating in the opening of the Futures Victorian Rural Health Forum. I would also like to thank Neil Roxburgh and the Country AIDS Network (CAN) for inviting me to speak.
I am very happy to be back in Bendigo. I visited here in November last year as part of the Commission's Bush Talks consultations, a series of community consultations with people in regional, rural and remote Australia on human rights in the bush. At that time I was impressed by the level of community activity in Bendigo and the enthusiasm of those working, especially in youth services, to improve the lives of people in rural communities. Community action at the local level makes an enormous difference to solving the problems facing rural communities today, especially those most disadvantaged and isolated.
Statewide rural organisations such as CAN are vital to linking communities together and providing a voice for people who are isolated both geographically and socially. Not only do networks like CAN provide resources for individuals and community workers, but they raise the profile of non-government organisations and help to put issues which have been ignored on the political agenda. I think you can see the results of these alliances across the rural sector in the work of organisations like CAN and, nationally, the National Rural Health Alliance.
Health, HIV/AIDS and human rights
Issues affecting the health of people living with HIV/AIDS and other blood borne diseases are human rights issues. That's my principal concern and my responsibility under Australian law.
The right to an adequate standard of health is recognised in the International Covenant on Economic, Social and Cultural Rights, and in the Convention on the Rights of the Child, both signed and ratified by Australia. The Declaration on the Rights of Disabled Persons also specifies the rights of disabled persons to health care.
The International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights oblige governments to respect and ensure that people can exercise their rights without discrimination of any kind, including on the grounds of disability or sexual orientation.
Some of these international obligations are expressed in Australian legislation. These Acts give the Human Rights and Equal Opportunity Commission the power to investigate individual complaints of discrimination.
Disability Discrimination Act
Of these Acts, the Disability Discrimination Act 1992 is the most significant piece of domestic legislation relevant to people with HIV/AIDS.
The strength of the Act lies in its comprehensive coverage. Although the Act does not refer to HIV/AIDS specifically any more than it refers to other conditions of diseases specifically, the legislation covers comprehensively discrimination against people who are HIV positive, people with AIDS, Hep. C or other blood borne diseases.
It also covers disability which 'may exist in the future; or is imputed to a person'. This clearly covers many possible types of diseases which are blood borne, and targets discriminatory presumption that people with certain lifestyles have the AIDS virus.
The definition of discrimination in the Act also includes discrimination on the basis that a person is an associate of a person with a disability. This is particularly important in the case of HIV and AIDS where ignorance of the disease can lead to discrimination against carers who give so much of their support and energy to people with HIV and AIDS.
It is unlawful to discriminate against a person on the grounds of disability in employment and in the provision of goods and services or facilities.
Not all differences in treatment are discriminatory under the Act. It does not require that anyone be given a job which they cannot do: that is, if they cannot perform the 'inherent requirements of the job'. A person may be able to perform the inherent requirements of the job so long as some adjustments or accommodations are made, for example in job design or equipment. Employers need to review any job requirements which restrict the equal opportunity for people with a disability, including HIV or AIDS, to make sure these requirements are really necessary.
In some cases, ensuring equal treatment may require adjustment or accommodation by other people, such as employers or educational authorities. The Act does not require accommodation of special needs of people with a disability where this would impose a justifiable hardship on any person.
The Disability Discrimination Act also specifies that measures reasonably necessary to protect public health do not constitute unlawful discrimination. But this is not a 'licence to discriminate'.
It is unlawful to ask for information regarding a person's HIV/AIDS status for discriminatory purposes. In general employers should not require an HIV test or ask questions regarding HIV status. However, questions regarding HIV status are not unlawful if they are for a non-discriminatory purpose, for example a doctor may ask for this information to ensure that appropriate treatment is given.
Complaints under the Act
The Commission receives a large number of complaints about disability discrimination. In 1997-98, complaints under the Act formed the largest number of complaints to the Commission, although there was a 14 per cent decrease in complaints since the previous year.1
A few complaints of discrimination under the Act have been on the grounds of HIV/AIDS status.
The best known and the most widely litigated is the case of X v Department of Defence. This case illustrates both the strengths and the weaknesses of the legal response to discrimination. An HIV positive soldier complained to the Commission that he had been unfairly discharged from the Australian Defence Forces due to his HIV status. The Commissioner found that he was dismissed unlawfully as he was able to fulfil the inherent requirements of his job, a signaller in the Reserve. In 1998 the Full Court of the Federal Court found contrary to the Commission that it is not unlawful to discharge an army recruit with HIV because it is an inherent requirement of military service that every soldier be able to be deployed in any combat or combat related role and that a soldier's bleeding not endanger other comrades. However, the High Court has granted the soldier leave to appeal against this Federal Court decision. Defence Force cases in particular highlight the complexity of dealing with discrimination on the grounds of HIV/AIDS. Although the Commission took a different position than the ADF in this case, we acknowledge that it is not easy to weigh up competing considerations.
A case with a more positive result is the Victorian complaint brought by Matthew Hall against the Victorian Amateur Football League (VAFA) to the Victorian Equal Opportunity Commission for refusing him permission to play in an amateur football competition because of his HIV Positive status. Although Mr Hall won the discrimination case, he is now seeking an assurance that VAFA will undertake HIV awareness training as he wishes to ensure that other people with HIV will be able to play the game.
Clearly there is still a great deal of anxiety and fear about HIV/AIDS in the community. The parameters of what constitutes discrimination against people with HIV/AIDS are still being tested, even many years after the epidemic. Education is the key to alleviating the unnecessary fears of employer and other organisations, so that people with HIV/AIDS can continue to lead lives free from discrimination.
Discrimination on the grounds of sexual orientation
HIV/AIDS is not an issue confined exclusively to the gay community. However, many people affected by the virus are gay and as such our responses to the virus require us to consider issues of discrimination and prejudice against people who do not conform to society's accepted norms of sexuality. Indeed, AIDS organisations and sexual health workers are among the most important sources of information, advice and support for young people struggling with their sexual orientation, especially in country areas. Issues of sexual orientation, therefore, are also issues of human rights and health.
The situation of young lesbian, gay and bisexual people in rural Australia is currently a major focus in the work of the Human Rights and Equal Opportunity Commission. These young people face serious difficulties and hardship in many areas. That hardship includes discrimination, violence, family conflict, lack of privacy, lack of support and in some cases mental illness and suicide. They experience all of the problems that confront young people living in non-metropolitan areas, with an added layer of pressures associated with their sexual orientation. In my work in rural communities I hear constantly of young gay men, lesbians and bisexuals whose self-esteem has been undermined and who feel the future holds nothing for them. The alarming figures on suicide of these young people attest to this. A study published last year found that suicide attempt rates in a sample of gay youth were approximately four times greater than the heterosexual sample.2 In 1998 the "Working it Out" Committee in Tasmania published a report on sexual minority youth in the north west region of that state. That project highlighted the strong link between sexuality and various risk factors including substance abuse, suicide and other self-harming behaviour. These were just several of numerous studies in different parts of the country that reached the same conclusion.
These facts leave no doubt about the need for more urgent attention to the problems of these young people. In response to this need the Commission recently commenced the "Outlink" project to establish a national network of young lesbians, gay men and bisexuals in rural Australia and the organisations that support them. The project, which is co-funded by the Australian Youth Foundation, was launched in Bathurst, New South Wales, on 4 May. Tasmanian gay activist Rodney Croome, who himself grew up in a country town, is the project co-ordinator. For the next nine months he will be working with young people, support services, advocates, gay groups, youth groups, parents groups and others in country areas to get the network established. I'm glad that Rodney has been able to come to this forum. I hope you will have a talk with him while you're here.
Of course, many organisations are already providing invaluable support for young gay, lesbian and bisexual people. The Country AIDS Network is an excellent example of this. The national network that will result from the "Outlink" project will support the work of existing bodies such as the Country AIDS Network by giving them a national network to tap into. The national body will facilitate greater collaboration, mutual support and exchange of information among existing advocates and services across the country. For young people themselves, it will increase their knowledge of, and access to, services and will also be a mechanism for peer support and advocacy.
Response to comments by Archbishop Pell
Addressing the human rights of people with HIV/AIDS and other blood borne diseases and of gay and lesbian people requires more than legislation and support. It also requires community education and fundamental changes in community attitudes. There is still a great deal of ignorance, misinformation and prejudice in the community about issues surrounding HIV/AIDS and sexuality. The extent of these was highlighted most recently in media reports of comments allegedly made by the Catholic Archbishop of Melbourne, Dr George Pell. Some of you would have read the article 'Being gay is riskier than smoking, Pell preaches' published in The Australian on Monday 24 May, and the Archbishop's reply in The Age on Friday 28 May.
The comments attributed to Archbishop Pell in The Australian were simply factually inaccurate and lacking in knowledge and compassion. Archbishop Pell reportedly denied that there was any link between youth suicide and the active condemnation of homosexuals that occurs in sections of the community, including many schools, churches and other institutions. He implied the same in his opinion piece in The Age. However, the link between youth suicide and homophobia has been confirmed repeatedly in studies all around the country. They leave no doubt that the rejection and isolation experienced by these young people is a major factor in their disproportionately high levels of suicide and suicide attempts, substance abuse and other self-harm.
Archbishop Pell also reportedly suggested that there is a causal connection between homosexual activity and the AIDS virus. HIV/AIDS is neither a homosexual nor a heterosexual disease. It is caused by unsafe sexual practices and a range of other activities that have no connection whatsoever with a person's sexual orientation. To suggest otherwise can only increase ignorance of the disease and its causes, thereby putting more people at risk of infection.
Archbishop Pell's reported assertion that homosexual activity is a greater health hazard than smoking was refuted by the author of the article in The Australian, Katherine Towers, who quoted statistics confirming overwhelmingly that the opposite is the case. She noted that in Australia and New Zealand AIDS has killed 5,732 people in total since the onset of the virus in 1982, whereas, according to Quit Australia, more than 18,000 Australians die each year from smoking-related illnesses. Archbishop Pell was reported the next day as having qualified his comments. He is reported as saying that he was comparing risks as a proportion of the relevant population. The facts still do not support these assertions. Then in The Age he gave another interpretation, that being gay was riskier because HIV can be contracted through one sexual encounter whereas smoking related diseases require repeated activity. Throughout these attempts at explanation and interpretation, Archbishop Pell has maintained his central message that same-sex relationships are inherently unsafe and unhappy.
The basis of Archbishop Pell's comments, his underlying fear, finally became clear in his piece in The Age. He speaks about people "recruiting" others into homosexuality. He speaks as if being gay were the same as being recruited as a soldier or an employee or even a priest. Archbishop Pell seems to think it is a matter of choice. But it is not.
The attitudes underlying Archbishop Pell's remarks will only exacerbate the problems faced by young lesbians, gay men and bisexuals. Indeed what is undoubtedly 'riskier than smoking' is ignorance, prejudice, intolerance and disrespect. And, dare I point this out to Archbishop Pell, they are also contrary to Catholic teaching. The Catechism of the Catholic Church, the most comprehensive statement of Catholic teaching issued by the present pope, says unequivocally, '[Homosexuals] must be accepted with respect, compassion and sensitivity. Every sign of unjust discrimination in their regard should be avoided' (paragraph 2358).
Let me emphasise that in this forum my comments do not relate to Catholic teaching on same sex activity - as a Catholic I save my comments on that for forums inside the church. Here my comments relate to statements that concern homosexual people and attitudes and practices directed towards them, statements that in my view are themselves contrary to Catholic teaching. While it may not be intended, remarks like those made by Archbishop Pell contribute to the climate of intolerance that in fact leads to suicide and to acts of hatred and violence against gay and lesbians. Instead of condemning our young people because of their sexual orientation, we should be giving them the support they need to deal with these issues, in an environment free from prejudice and discrimination. That's what the Commission is trying to do in its Outlink Project.
Rural health
The issues you will be discussing at this conference are part of a broader human rights question, the right of all people to good quality health care in regional, rural and remote areas of Australia. As part of the Commission's Bush Talks program I have visited more than 40 rural communities in the last year, listening to people's human rights concerns and relaying these concerns back to the wider community. One of the most persistent issues raised by country Australians has been their access to quality health care.
There is no doubt that these concerns are well founded. The general health of country Australians is poor in comparison to urban Australians. Country Australians have a lower life expectancy, higher rates of avoidable injury, higher suicide rates and higher rates of illnesses such as heart disease and cancer. This situation is even more serious for Indigenous people in rural and remote areas.
Health needs may be greater but the availability of health services is considerably less in rural areas than in urban. For example, 30% of the population lives in the bush - but only 16% of Australia's doctors.3 Even where there are doctors, it is often the case that there are no doctors who bulk bill. And we are talking about access to an ordinary GP. As I am sure many of you would be aware, gaining access to regular specialist care in rural and remote communities can be especially difficult and expensive. Compared with capital cities, small rural centres have less than half the supply per capita of specialists.4 For people with chronic and debilitating conditions, it can be near to impossible to regularly travel the distances to reach medical treatment.
People with HIV/AIDS, Hep C and other blood borne diseases in country Victoria are not only vulnerable to discrimination because of the nature of the disease. They are also at a disadvantage simply because of where they live.
Of course, the health care problems I encountered on Bush Talks were very different according to which region we visited - some towns have plenty of access to GPs but no services for the mentally ill. Others have a doctor but no hospital. There are also differences in the state of rural health depending on whether you live in a remote area or in a rural town, what the economic situation is like in that area, whether or not you are Indigenous.
Even though country Australians experience considerable disadvantage in the provision of health care, our visits to rural communities have revealed some inspirational community based responses to health care needs. This is the good news that can help us find a future for country people.
The Commission this year will respond to what we have heard by undertaking a project on rural health to identify successful rural and remote community initiatives and publicise them so that others working in this area are informed and inspired. Country Australians who have successfully responded to the challenge of providing health care in the bush will provide models for others who share this aim. I welcome any suggestions that you may have about successful community-based initiatives in the area of HIV/AIDS health in rural and remote Victoria.
Conclusion
Promoting the human rights to good health and good health care includes two elements you are all committed to: overcoming the ignorance and lack of understanding surrounding HIV/AIDS, Hep C and blood borne diseases and providing support and medical services to those affected by these diseases. Through your commitment and hard work you have helped to break down ignorance and provide a more accepting and supportive environment for those affected by these conditions. I commend you all for your achievements and wish you well as you continue to pursue this important goal.
Endnotes
1 Annual
Report 1997-98, page 51.
2 Jonathon Nicholas and John Howard, 'Better dead than gay?',
Youth Studies Australia, Vol.17, No.4, December 1998.
3 Northern Daily Leader, 26 July 1997, page 1, cited
in ACSWC: Valuing rural communities, 1998, page 12.
4 Australian Institute of Health and Welfare, Health in
rural and remote Australia, AIHW, Canberra, 1998, page 87.
