Kim Gates

NTAHC Executive Director 2012 - Ongoing

    Stigma and discrimination, I think, always has been, always will be one of the big issues … STIs are through the roof in the Northern Territory. We have the highest rate of STIs and Hepatitis B in the country, and extremely high rates of gonorrhoea and chlamydia in Aboriginal communities. We’re currently seeing a really big increase in syphilis … We realise that Aboriginal people are not using condoms, not practising safe-sex, so that puts them at a bigger risk for HIV and other blood-borne viruses.

    My name is Kim Gates, and I’ve been employed at NTAHC since November 2012. My involvement with NTAHC goes back a little bit further than that because prior to working here I worked in the Department of Health and Ageing – I was the Assistant Director there and for quite a few years and I was responsible for the team that contract managed NTAHC. So, I had contact with the staff through that contract management and used to come over and visit occasionally, and get to know what the programs were doing and what the service was all about. So, I have been in touch with NTAHC probably since about 2008, 2009.

    I started as the Deputy Director. I was actually head-hunted for that position by the Executive Director at the time, Craig Cooper. When he first came to town and was on the NTAHC board he was new to the Northern Territory, and I was put in touch with Craig by a colleague who recommended that he might want to utilise me to get the lay of the land, as far as the political landscape in the Northern Territory, because I’d been here a long time. So, we would meet for coffee every now and again and talk about some of the issues the AIDS Council was encountering and some strategies to go forward.

    Over that time, I guess, we formed a relationship and he then encouraged me to apply for the position of Deputy. I said no a few times but then there was a change of the NT government and there was a change of the political direction around where funding should go, which morally didn’t sit with me very well. So I decided that maybe my time in the bureaucracy had finished. When they actually advertised the position I threw my hat in the ring and put an application in. I was selected for an interview and was successful.

    I started early November 2012. Obviously, after that Craig was my Executive Director for a couple of years and he was teaching me about the sector and what I needed to know, grooming me in a way. When he left he encouraged me to apply for his position. It was only after a very short time in the sector, about eighteen months, and I wasn’t sure I was quite ready. It was a little bit scary at the time but I did it and I hit the ground running.

    When I first came to NTAHC, I just remember the staff, you could tell they were all watching me because no one really knew who I was here. And there was, “Who’s she? What is she doing here? What’s her background?” You know. I got straight in the deep end because the Executive Director wasn’t available to talk at the World Aids Day 2012 event which we had at the Christ Church Cathedral in Darwin. It was on the lawns there and it was really beautiful, and I had to give a speech.

    I found that really challenging because I wrote the speech, a personal speech, about my experiences from the ’80s and the friends that I lost to HIV, and it was something I hadn’t really put pen to paper about for a long time and hadn’t thought about for a long time. Reading it was even more challenging but I just remember afterwards the staff that were there coming up and going, “Now we know, now we get you.” And it just – now I’m going to get upset – and it really just formed a bond with the staff that were questioning me in who I was. And from that moment on I was accepted and just went forward.

     

    So, the key issues now, still the same old ones. Stigma and discrimination, I think, is right up there; always has been, always will be as one of the big issues. But I think getting up with the latest treatments and latest prevention strategies, such as PEP and PrEP. And the NT’s a little bit behind the rest of the country with some of those things mainly because, I guess, because of small population size and our low numbers of HIV, but that doesn’t mean that we shouldn’t get access to some of these strategies.

    I sit on the AFAO board, which has been a really good learning experience for me because I have actually got to know more about the national perspective and what’s happening in other jurisdictions. So, there I’m able to identify what works or might not work in the Northern Territory and then say, “Yes, we want this” or “We don’t want that”, and then can start advocating for that. And I can use, through our membership with AFAO and NAPWHA, Scarlet, AIVL, etcetera, their expertise to help advocate through the NT government strategies that we want in the Northern Territory – using their evidence base.

    The NT is a more unique situation I think. WA’s a little bit the same, but I think we have very unique notifications in the fact that our HIV notifications are not predominately gay men, as it is in most other jurisdictions. So, having a high percentage of heterosexual, a lot of people coming from refugee or migrant backgrounds, it is different and we bring a level of expertise to the perspective and talk about our experiences.

    I don’t know that we run any different programs; I just think that we target them in a different way. So obviously the needs of gay men might be different to the needs of heterosexual women, and we obviously are a peer-base service – we like to engage with peers and have our programs delivered by peers. Picking the right people to deliver the programs, I think, is the key element to the success of our programs.

    We have Care and Support, obviously – which is the main reason that the AIDS Council was actually formed in the first place – providing care and support for people with blood-borne viruses and some really concentrated case management, but also a lot of referrals and just general support not just to people living with viruses but also people who are affected by, at risk of, or family members. It’s quite a broad program. We also have the Aboriginal Sexual Health Program which is there to not only educate Aboriginal people around STIs and blood-borne viruses but as well they do engage with the Aboriginal community to encourage them to get tested and sometimes do the more intensive case management support.

    I think in Aboriginal communities there’s so much going on for people and, when it comes to their health, there’s a lot more acute care is required. There’s a lot of people with chronic health conditions and so when they front-up at the clinic, sexual health or blood-borne virus testing is way down on the list of priorities. I think that’s no fault of the clinic staff, that’s what they have to deal with on a daily basis. And so they have to deal with issues as they come in the door. I think Aboriginal people don’t really understand that there are illnesses out there that don’t have any symptoms, and because you look well and you feel well, so you don’t worry about going to the clinic. So, having a test for something that you may or may not have just doesn’t seem important and just doesn’t come into their realm.

    Aboriginal people have, obviously, a very different lifestyle, very different diets, and so it can result in a lot of different chronic conditions. There’s a lot of diabetes which leads to renal issues, and heart conditions. But there’s also the other issues that happen in communities, so alcohol and drug abuse, and family violence, and so there’s also a lot of people presenting at the clinic for some of those things that fall out of that.

    STIs are through the roof in the Northern Territory. We have the highest rate of STIs and Hepatitis B in the country, and extremely high rates of gonorrhoea and chlamydia in Aboriginal communities. We’re currently seeing a really big increase in syphilis and that’s led to a couple of cases of congenital syphilis in young babies, which is really quite sad. We realise that Aboriginal people are not using condoms, not practising safe-sex, and that puts them at a bigger risk for HIV and other blood-borne viruses.

    I think I’m the first Executive Director that identifies as Aboriginal. I’m led to believe that there are a couple of former EDs who have believed that they have some Aboriginal heritage but they hadn’t been able to confirm that and so they didn’t identify as Aboriginal. I didn’t really grow up within an Aboriginal environment; I grew up the way most people grow up in a singular family environment in the suburbs. But throughout my life I’ve actually realised that I don’t know as much about my Aboriginal identity as I want to, so I’ve actually gone out and tried to increase my knowledge. Over the years, I think I’ve certainly gained a much better understanding of the situations that Aboriginal people live in, whether it be in town or in remote communities, and I’ve been to a lot of remote communities. And through that understanding, I think, I can transfer that to my work and I can actually apply that to the workplace and what we need to do around strategies for Aboriginal people.

    One of the things I’m encouraging all the programs to do is much more engagement with their peers to get involvement in the program themselves, like in the development of programs and how it’s delivered and what it should look like. SWOP are probably leading the way with that. They have a reference group, and basically all the decisions that SWOP make for sex workers, the reference group are engaged and involved in that decision making process. So you don’t have the one or two workers within the SWOP program making a decision for the whole community. And that’s really the principle that we want to see happening across the board.

    Certainly at the moment SWOP has achieved a level of autonomy more so than any of the others. I think other staff still feel they have to ask permission to do things and get reinforcement, and I’m trying to encourage staff to be more autonomous in some of their decision making because they’re making some really good decisions but the fact that they feel they need that reinforcement, there’s obviously some confidence issues.

    At NTAHC, it’s a little hard to sometimes engage peers in programs, particularly in the needle syringe program, obviously because people are probably participating in activity that’s considered illegal. It creates barriers for people in engaging in the service, so we’re just trying to find strategies and ways to engage rather than necessarily face-to-face, so we use platforms like social media and surveys and other events, and trying to get feedback at events to encourage people to have that involvement.

    One of the relationships that’s been strained on and off over the years is people probably the perception of NTAHC as an LGBTI service, and in fact we’re not. We’re not funded for that, although we do deliver services to people from within the community because they’re identified as the primary populations at risk of having HIV and other blood-borne viruses. But having said that, we also offer some other services over and above what we’re funded to do because there’s a community expectation and, at the end of the day, there are no other LGBTI services in the Northern Territory.

    We have relationships with Darwin Pride and Alice Pride, and we actually auspice them both and support them with their festivals each year. We have a reach into the community, as far as sending out newsletters and things like that, and hopefully we have a reasonable relationship. I’m not sure that we’ve done any evaluation on what that relationship currently looks like, or maybe that’s something we need to do in the future.

    We have a couple of signature events which are World AIDS Day and the Candlelight Vigil each year, and World Hepatitis Day. They’re three events that we recognise each and every year without fail and through one way or another. We’ve had different types of events and I think that’s our biggest challenge now, is how to come up with something bigger and better than the previous ones because we’ve set a bit of a standard around our events, and our Event Coordinator Alex Galeazzi can be thanked for that – he’s done a wonderful job.

    Our events now certainly have a regular audience and every time we also see a few new people. And we’re also broadening our audience-base in Alice Springs, which is really good to be able to re-engage with that community. Obviously it’s very difficult to manage a remote site, and I think anyone in any sector would agree. When you’ve got a satellite site, it’s very hard to make sure that staff feel included and they don’t feel left. It is challenging and I wouldn’t say that we’ve been expert at that, and I don’t think we still are and I don’t know that anyone is.

    When we have events now we always try to have one at the same time in Alice Springs and have it of similar capacity, so that people don’t feel that they’re like the poor cousins; that they’re getting the same events, the same opportunities as what happens in Darwin. It’s also quite difficult to manage that considering we’ve only got a small number of staff in Alice Springs office, but I think there’s quite a few board members from Alice Springs who have brought on a whole lot of support from the community as well, so it’s nice to see. We’ve actually got more volunteers in our Alice Springs office than we have in Darwin, so that’s a testament, I think, to the hard work of the staff and the board down there. So, I’d say that the partnership is healthy and I think it’s healing. I think we could still do it better, but I think it’s really quite good at the moment but it could be better.

    Our events are also directed at the more general community, and we do that by having them in very public spaces and engaging the general community. We get involved in other events as well – so just this week we’ve been involved in Harmony Day with Darwin City Council and the Malak monthly dinners at Darwin Community Arts. We actually go out and get ourselves involved in the greater community. So, we’ve gone to things like the Adelaide River Country Music Muster, an audience that we wouldn’t traditionally engage with but we go out as a way of trying to broaden our reach into the bigger community.

    Looking to the future, it’s certainly a changing landscape; what’s happening the HIV sector with changes in medications and treatments and prevention strategies, and we see new drugs in the Hepatitis sector which could possibly see the eradication of Hep C in the next five to ten years. It would be nice to say we’re doing ourselves out of a job, that maybe there won’t be a need for NTAHC into the future; I’m not sure that’s our reality but it’s nice thought. But, I guess, until we get on top of Hep B and there’s still always going to be something for us to do. So, it’s about diversifying what we do. At the moment, for example, we’ve got new Hep C treatments, so we’re spending more time now educating people around the medications and the treatments and how to go about getting them. We’re still doing the work, we’re just doing it in a different way.