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Editorial: HIV prevention - are we doing OK?

in NEW ZEALAND, 28/11/2009

Backgrounded by a continuing record high level - if that is semantically possible - of newly-diagnosed HIV infections in New Zealand the NZ AIDS Foundation holds its AGM today, during which two new Trust Board members will be elected and the organisation's governance will be reviewed by its members.

By anyone's definition the NZAF is now a mature organisation, with over twenty years of experience in dealing with the HIV epidemic amongst, primarily, gay and bi men. Headquartered in its own building in central Auckland and with regional offices in Wellington and Christchurch (the Hamilton office is in the process of being closed) it is crewed by around 45 full-time equivalent staff members supported by volunteer workers and has a membership which has grown to 300.

And staff morale, which reached its lowest ebb during the restructuring of recent years, appears to have bounced back. Polled by an independent company, 92% of NZAF staff believe in what the organisation is trying to accomplish, 89% feel a sense of commitment to the organisation, 87% take an active interest in what happens in the Foundation and 85% feel inspired to "go the extra mile to help this organisation succeed." All those figures are higher than industry benchmarks.

In the financial year ending June 2009 the NZAF received just on $4.5 million, primarily from the Ministry of Health, to fund its prevention, support and policy advice work (just for the record, according to its latest annual report 49% is spent on HIV prevention and communications, 28% on supporting HIV positive people's health, 6% on research and 17% on admin). It receives solid political support with major party leaders making fulsome commitments to the organisation and its objectives, particularly during the lead-up to general elections.

Our HIV epidemic has also matured, with much known about the mechanics of the debilitating virus, good community awareness of HIV, and a growing understanding of the social and sexual patterns facilitating the continuing spread of HIV amongst us. Sadly, the NZAF tells us, over the last five years, gay and bisexual men have accounted for 81% of the total HIV diagnoses by antibody testing in this country where infection has occurred here. That translates to two more men every week getting the shock of their lives by discovering they have contracted HIV.

And this high level of infections is not confined to HIV. All sexually transmitted infection levels are way up compared to the early days of the HIV epidemic when our increased use of condoms saw a marked drop. However, a bright spot is the rising popularity of rapid HIV and STI testing, currently through the NZAF and Body Positive Auckland and, more controversially, coming to an adult shop near you.

The NZAF continues to reinvent itself in the face of a changed epidemic... the latest re-think involving more focus on technology and electronic media, as witnessed by the slimming down of some regional office and community liaison operations, and the recent attendance at a Melbourne new media conference by its National Technology Development Coordinator.

And yet with all this resource, expertise and support, something is not working well enough in the NZAF or amongst men who have sex with men to keep our rate of locally-contracted infections down to an acceptable level. Which raises the question of what is an acceptable level and what should our HIV prevention target be?

Perhaps to eradicate HIV all together? Given that any cure or vaccine is still a pipe-dream, and that testing the whole population and physically quarantining those infected for the rest of their lives as well as blocking all possible channels of infection from overseas is likewise impossible and unpalatable, eradication is currently not a goer.

Perhaps to contain the epidemic within acceptable and manageable limits? But what is acceptable and what is manageable? HIV infection is costly to treat and creates marked drops in personal productivity and quality of life. It is also subject to a 'the more there is the more there is' pattern. With the HIV-related death rate a fraction of what it was a decade or more ago New Zealand has a slowly increasing pool of HIV positive people, some of whom don't know they have the virus, some of whom do and take rigorous steps not to pass it on and some whose commitment to keeping their infection to themselves is patchy or worse. So the more HIV there is around the more likely it is that more folks will contract it and thus more strain will be felt by support services and budgets. This is the difficulty that a 'containment' philosophy faces.

Perhaps to do as good as any other comparable country in not letting things get too out of hand? A variation on the containment objective this one can either be interpreted as pragmatic or lacking drive and vision.

For gay and bi men the NZAF remains our primary tool for dealing with the HIV epidemic. But it is only a tool, so it's how we use that tool which counts... what goals we set it and how closely we remain connected to and involved with its progress and its results. As the most affected population group in the country, we must subject the our most capable HIV prevention organisation to regular and careful scrutiny.

As its most significant and influential players gather for the NZAF's Annual General Meeting on today, with World AIDS Day this Tuesday, and with diagnosis rates maintaining their elevated levels, now seems a very good time for us all to pause a few moments, to remember our dead, to think of those struggling with their HIV infection and to review our prevention goals and progress.

And if the report card is not good enough we're going to have to work together to somehow achieve significant improvement in the use of condoms and lube for anal sex, still the only effective way of preventing HIV from destroying our communities.

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