I’ve struggled to write about the prospect of ending HIV transmission in New Zealand in one short opinion piece. I didn’t know whether to focus on the real excitement I feel at how totally possible it all is or the frustration I feel at the seemingly growing number of things that are standing in our way. I’ve decided to do both.
Condoms have been the mainstay of the HIV prevention response in New Zealand. They are easy to get your hands on and they do an awesome job at preventing the transmission of HIV and STIs. They are also largely responsible for our enviable record in HIV management by world standards. We need to maintain high levels of condom use but there are additional tools in the toolbox. Firstly, pre-exposure prophylaxis (PrEP) taken by HIV-negative people who struggle with condom use dramatically reduces their risk of acquiring HIV. Secondly, immediate treatment for people living with HIV can also successfully suppress the level of HIV in their blood to virtually eliminate the chance of onward transmission. It is also the best thing for their health.
The golden equation then? Maintain rates of condom use, make PrEP available to those who need it, find undiagnosed HIV infection through increased testing and provide immediate treatment to people diagnosed with HIV. We also need to combat HIV stigma and support people living with HIV. The New Zealand AIDS Foundation (NZAF) is set to launch a bold new strategic plan that brings this vision to life as we mount the most serious and sophisticated attack on HIV that we possibly can.
Exciting right? Yes!
The frustrating irony is that as we face arguably the most critical junction in this country’s response to HIV we are seeing the highest numbers of new infections annually. The longer we take to make available the full suite of HIV prevention options the higher the numbers will grow.
HIV is not a priority for the government. PHARMAC is dragging the chain on making immediate HIV treatment available for all those diagnosed. PrEP is not yet approved for HIV prevention and guidelines around prescribing and use are therefore non-existent. NZAF has had to do more with less in an increasingly competitive funding environment and the GAPSS and GOSS surveys that drive the decision-making of the NZAF and broader sector have not been funded for repeat in 2017.
There is a sweet tasting pot of success waiting at the end of the rainbow but the road to getting there is looking bumpier than ever. We need urgent political commitment and investment that demonstrates real support for driving HIV transmission down. We need to triple our advocacy efforts and demand nothing more than the right to health equity. We need to talk to each other and collaborate in more meaningful and strategic ways.
I genuinely feel privileged every day as I lead the NZAF in this work but there is no way we will get the job done alone. We are up to the challenge, and with your support we can end HIV.
