This note considers the performance of the South African courts in deciding environmental cases and suggests that, notwithstanding some good decisions, there are still too many decisions where the courts are not applying relevant legislative provisions or misinterpreting the law. It is suggested that the future acceptable performance of the courts not only rests on correct interpretation and application of the legislation, but also increased familiarity by judges with the technical environmental context within which the cases are situated. The role of legal practitioners in achieving this is also highlighted.
Community-based health services which provide HIV care in Australia are typically known as 'gay-friendly', but little is known about what this might mean for engaging the broader diversity of people with HIV, particularly heterosexual men. We conducted a secondary analysis of qualitative interviews with key informants and clinicians to capture the meanings attributed to gay-friendly HIV clinics and to explore what these also reveal about the dynamics between sexual identity and HIV care today. Described as safe and welcoming for gay men, and promoting a politics of inclusion, the 'branding' of HIV health services as gay-friendly was also believed to have unintended effects, including the misconception that others are not welcome and that heterosexual men will stay away for fear of being misidentified as gay. Countering this were stories about heterosexual men who had challenged their own assumptions about HIV health services and clinicians who viewed the changing demographics of their patient population as both a challenge and an opportunity. Taking account of the shifting meanings ascribed to HIV health services is essential in responding to the changing needs of the positive community and in understanding the new cultural politics of the waiting room.
Objectives HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of 'key informants' described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. Methods A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. Results The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. Conclusions While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs.
The population of people living with HIV in Australia is increasing, requiring an expert primary care workforce to provide HIV clinical care into the future. Yet the numbers of family doctors or general practitioners (GPs) training as community-based HIV medication prescribers may be insufficient to replace those retiring, reducing hours or changing roles. We conducted semi-structured interviews between February and April, 2010, with 24 key informants holding senior roles in organisations that shape HIV-care policy to explore their perceptions of contemporary issues facing the HIV general practice workforce in Australia. Informed by interpretive description, our analysis explores how these key informants characterised GPs as being 'moved' by the clinical, professional and political dimensions of the role of the HIV general practice doctor. Each of these dimensions was represented as essential to the engagement of GPs in HIV as an area of special interest, although the political dimensions were often described as the most distinctive compared to other areas of general practice medicine. Our analysis explores how each of these dimensions contributes to shaping the contemporary culture of HIV medicine and suggests that such an approach could be useful for understanding how health professionals become engaged in other under-served areas of medical work.
