Mobilisation, Politics, Investment and Constant Adaption: Lessons from the Australian Health-Promotion response to HIV

Issue addressed: The Australian response to HIV oversaw one of the most rapid and sustained changes in community behaviourin Australia’s health-promotion history. The combined action of communities of gay men, sex workers, people who inject drugs,people living with HIV and clinicians working in partnership with government, public health and research has been recognised formany years as highly successful in minimising the HIV epidemic.Methods: This article will show how the Australian HIV partnership response moved from a crisis response to a constant andcontinuously adapting response, with challenges in sustaining the partnership. Drawing on key themes, lessons for broader healthpromotion are identified.Results: The Australian HIV response has shown that a partnership that is engaged, politically active, adaptive and resourced towork across multiple social, structural, behavioural and health-service levels can reduce the transmission and impact of HIV.Conclusions: The experience of the response to HIV, including its successes and failures, has lessons applicable across healthpromotion. This includes the need to harness community mobilisation and action; sustain participation, investment and leadershipacross the partnership; commit to social, political and structural approaches; and build and use evidence from multiple sources to continuously adapt and evolve.So what? The Australian HIV response was one of the first health issues to have the Ottawa Charter embedded from the beginning,and has many lessons to offer broader health promotion and common challenges. As a profession and a movement, healthpromotion needs to engage with the interactions and synergies across the promotion of health, learn from our evidence, and resist the siloing of our responses

Increased rates of ENT surgery among young children: Have clinical guidelines made a difference?

Objectives: To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery. Methods: Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15. Results: ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%. Conclusions: The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare