Article Title:The State of the HIV Nation
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Published on:22nd November 2001 - 12:00 pm
Story ID:16
Text:Early in the HIV pandemic the New Zealand AIDS Foundation grew from a gay community determination to come to terms with the presence of a new, frightening, ill-defined illness amongst us. A decade and a half later the virus is different, our community is different and gay infection patterns are changing. NZAF director Kevin Hague considers the virus and the attitudes towards it in our 2001 New Zealand gay community. If you are a man who has anal sex without a condom with another man today you are more likely than ever before to be taking the risk of being infected with HIV. This is true regardless of whether you are young, old or somewhere in between, whether you are Maori, Pakeha, Pacific, Asian or any other ethnicity, whether you live in a city or a rural area, whether you're unemployed or a highly paid professional, whether or not you have travelled overseas, whether or not you also have sex with women, and regardless of the number of your sexual partners or frequency of sexual activity. It is simply a result of probability and the fact that there are more people than ever before living in New Zealand with HIV - most of them gay and bisexual men. When the New Zealand AIDS Foundation began its work in the mid 1980s, a groundbreaking initiative from the New Zealand gay community, it would have taken a very far-sighted person to predict just how devastating this pandemic was going to be. Certainly there were nightmare scenarios based on wild speculation hitting the headlines, but most people believed that sooner rather than later the pandemic would be over, that AIDS would be a temporary problem. The chilling reality is that on a global scale we are still in the early stages of this pandemic. In this country we need to provide support for an ever-increasing number and more diverse range of people living with HIV and to prevent further transmission in an environment where risks of transmission are higher, but some of the people at greatest risk are pretending there's no longer a problem. Gloomy? You bet. But wait . . . there really is more. In trying to keep people well we have to factor in the rapidly growing resistance of HIV to the treatments we have available. Most HIV scientists agree that HIV's ability to develop resistance to treatments will outstrip our overall ability to develop new treatments (or at least new categories). The major implication is that those people who become infected with HIV in the future will be increasingly likely to have strains that are already resistant to the treatments we have available. At least one case has been reported overseas of a person newly infected with a strain of HIV that is already resistant to all treatments. We can predict that this will become more and more common in the foreseeable future. In some ways this will plunge us back into the pre-treatments world of the 1980s, only with a much larger number of people affected. In trying to prevent new transmissions we have to deal with more and more examples from overseas of erosion in our basic safe sex culture. The latest example is our recent debunking of the romanticisation of "barebacking". It's just one of the latest excuses to attempt to rationalise the irrational. What's really going on is that some men deal with their fear of HIV by pretending it can't hurt them and conclude that they don't need condoms. That thinking threatens themselves, and it threatens our community. In countries where this type of thinking has taken hold, safe sex culture has been severely weakened, and gay communities are sliding towards oblivion. How should we respond to these prospects? In New Zealand we need to look to our own successes. We need to reverse the Kiwi mindset that assumes that "if it's from overseas, it must be better than our own". The reality is that along with a handful of other countries (Senegal, Uganda, Thailand and Sweden spring immediately to mind) the New Zealand approach to the epidemic has been the most successful in the world. New HIV infections amongst injecting drug users have been virtually eliminated, we seem to be sustaining the gains that we made in reducing new infections amongst gay and bisexual men and a heterosexual epidemic has not become established. We need to continue the directions that we have been following. Key to our success has been the partnership between the Government and the communities affected by the epidemic, particularly the gay community through the New Zealand AIDS Foundation. Also critical has been the strong health promotion approach we have taken in this country, in which communities at risk are empowered to develop their own responses, while the social and policy environments are made as supportive of these communities as possible. Again the Foundation has led the way in this area. We've also been working to strengthen our service delivery programmes. These three programmes - Positive Health, Hau Ora Takataapui, and Gay Men's Health -have all been renamed recently to reflect our central orientation of keeping people living with HIV and gay, bisexual and Takataapui men at risk from HIV as well as possible. This is how we will achieve the Foundation's vision - to end the HIV/AIDS epidemic in this country. So the Foundation's work - and the commitment of the gay community - are going to be needed for many years to come, and some of the challenges we face will be bigger than those we've tackled to date. This column is being written in the lead up to World AIDS Day activities. This year's international theme is "I care - do you?" Well do you? If you care about HIV/AIDS in our community, the New Zealand AIDS Foundation needs your support. Yes, financial support - please give generously to one of the street collectors, at the BNZ or through the 0900 Ribbon donation line. But more important is your practical support for people living with HIV, and by making a stand for safe sex culture - a stand for our community. - 22nd November 2001    
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