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The HIV surge: A hopeful future

Sat 12 Mar 2011 In: HIV View at Wayback View at NDHA

There's no doubt about it any more, gay and bi men have been contracting HIV over the past decade in ever-increasing numbers. And the advice of prevention experts such as the NZ AIDS Foundation is that our number of infections, already worse than at its previous height in the late 1980s, is going to get worse before it gets better. It's a bleak short-term forecast but the longer-term situation is far from hopeless. Two things give newly-appointed AIDS Foundation boss Shaun Robinson hope that the fight against the new HIV disaster can be won. He points to the increases in diagnoses at the start of the epidemic back in the late 1980s. “The trend line upwards then was pretty bad. We took some action and we got a result. It was delayed, so that should guide us that we shouldn't panic if next year is even higher.” He also sees hope in the continuing low and steady number of intravenous drug users testing positive for HIV in New Zealand. It has resolutely hovered in the single digits, and in the low single digits at that, since HIV was first detected and measured in this country. “Now, that's not an epidemic at all," he says. "And yet in America, in Russia, Thailand and a whole lot of lother countries intravenous drug use is a key driver of the epidemic.” Is that a valid comparison? Surely HIV got an early strong hold in the NZ gay and bi communities, unlike the IV community, before anyone even knew it existed? By the time it was identified and testing could begin it had already reached a critical mass amongst gay and bi men, but not amongst IV users. “But the overwhelming evidence is that most, and possibly all of those early cases were men who were infected overseas and returned to New Zealand,” says Robinson. So, if we set aside the epidemic's first rise, peak and fall, from 1985 through to about 1997 and then observe the slow but inexorable rise from, say, 1999 to the present day, that represnts the reality of our own locally generated HIV epidemic? “Yes.” Robinson pulls us back to the low IV dug user comparison with gay and bi men, pointing out that there are significant differences between the risk factors associated with each group. “It's not as if there are only a hundred or so IV drug users in the coutry,” he says. “And blood and needle sharing is hugely more risky than anal sex, which is why IV is such a driver overseas. We never got that critical mass going in New Zealand IV users but what we also got was the right response and a very large uptake of the right behaviour.” Robinson looks to the sex industry as another model of the right behaviour. “The sex industry bought into the safe sex message very early. For casual sex gay and bi men are sitting at around 70% of men always using a condom and around 85% using condoms most of the time. Which look like good results, but clearly they are not enough. For IV drug users [safe behaviour] is well up in the 90s, probably close to 99%. And we know for sex workers it's up around 89 – 99%”. How much higher than around our 70 – 85% do we have to get to before we can emulate the success of IV drug users and sex workers? “We don't exactly know what the tipping point will be," according to Robinson. "If we can get that 70% up to 75% we don't know what effect it will have, But eventually if we keep pushing it up the result we want is going to kick in.” Without that “kick in” where are we heading? “I would say that we are probably looking at at least three to five years to get a result. Given that the trend is up but that the annual figures can dip, even if we had a drop next year I wouldn't be celebrating. I'd be happy but I wouldn't be celebrating. Not until we're having a drop over a five year period.” And if nothing kicks in, how many gay and bi men would be getting HIV each year in five years' time? “You could be looking at 110 to 120 cases in a year.” Robinson continually stresses the need for the Foundation and community to work together. “It's the NZAF's responsibility to lead the charge on this. But the corollary of that is that it's everybody's responsibility to come with us.” How is the NZAF going to convince horny, sexually active gay and bi men that it is worth following, and that improvement in our rate of HIV infection is worth addressing and that it's even possible? “I think there is no single silver bullet. I think the things that we are doing are working but that we also need to try other things as well. One of the reasons we have the Get It On brand is so that it's not 'Follow the glorious flag of the NZ AIDS Foundation.' This is a social movement and the brand itself is all around telling you the message. That's one strand to what we are doing. We are active in the community and community development is still alive and well in the AIDS Founbdation. It's not as prominent as it might have been in the 1990s but it is there. The Christchurch example [Operation Condom] I think absolutely proves that. And even before the earthquake they had developed the bears movement for men who didn't like the highly sexualised environments... there was a gap so our people developed a regular bears gathering point. So there are examples where it is still happening. Health education still needs to be happening." "But what I want us to be doing, having set that basis up, we need to be understanding in more depth those groups in the community who aren't buying into this, for whatever reason," says Robinson. "If you look at the science of social marketing, the psychology side is around 'Is the message compelling? Does it catch my attention and make me think that it affects me? Is there something I can do about it? Do I believe that what I can do about it will work?'" “And the last bit is: “Do I believe that I can do it?' Now, that's the bit that I think in particularly interesting for us. I think there are gay men out there that go: 'Well, yeah, I don't like the idea of getting HIV... that's got my attention. I know that affects my sexual community, my sexuality community. I know that putting a condom on will protect me from that. I'm convinced that that would work. But I don't think that I could do it because I know that I go out and get trashed and can't be bothered. So I don't think I can do it so I won't even think about all this. I'll just shove it to the back of my head and carry on regardless.' That's one group. There might be a whole lot of other reasons and what we've got to do is go around those people so if enough other people can be convinced then those people who can't [change] aren't going to matter so much. But we also have to try and take some of those people with us... so we have to find the ways to kind of short circuit that logic that they have got in their heads. And that's going to take some very refined work. And staying in close contact with the community is going to be very important in helping us to do that.” Is getting HIV a scary thing any more? “Well, you do get some people, and we hear this through our counselling, who say 'I don't really care, you just take a pill.' But talk to positive people... it's great that people with HIV can live pretty good lives but its still not a good thing to have.” But hasn't HIV merged ino the general static of life's other fears and woes... like getting cancer or failing eyesight or getting old, and life doesn't go on forever... fatalism of the 'Who gives a stuff!' kind? “Well, enough people give a stuff that 85% of them are wearing a condom most times when they fuck a strange," he ripostes. "So I think the message has enough compulsion for the majority of people out there.” “We want to reduce HIV to zero here and around the world, says Robinson. “HIV infection is not a good thing despite the treatments. And those treatments really have only been available for fifteen years. We are speculating that people are going to live 40 years with HIV but we still don't know what impact it's going to have on people's bodies. These are heavy duty drugs people are on. It's not something to be taken lightly”. Robinson is clear, faced with the confirmation that we are well into an ongoing surge of HIV infections, that the NZAF and the gay and bi communities must re-apply themselves to finding solutions. “This is an epidemic of a virus that is chilling in its ability to take the opportuinity to spread. We must be persistent and vigilant.” GayNZ.com Daily News staff - 12th March 2011

Credit: GayNZ.com Daily News staff

First published: Saturday, 12th March 2011 - 6:16pm

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