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NZAF: Adapting to the second wave of HIV

Mon 14 Aug 2006 In: HIV View at NDHA

As the number of HIV infections amongst men who have sex with men continues to soar, some might take comfort in the fact that we are no worse off than other, affluent, western nations with a primarily gay epidemic, such as Australia, Canada, the USA and the UK. Just like those countries we don't yet know what is driving this ongoing increase in new locally-contracted infections. But is that good enough? Isn't the job at hand to actually control the epidemic? And the NZ AIDS Foundation is the organisation charged with that duty in New Zealand. NZAF Trust Board chair Hoani Jeremy Lambert agrees that amongst gay men in New Zealand HIV is no longer under control, but is adamant that the Foundation is not at fault. “The Foundation never claimed credit for the figures when they were low. Likewise, I do not think that we can be blamed when the figures rise,” he says. “That being said, I don't think we can abscond from responsibility totally. That would be weak.” Lambert believes the NZAF needs to be recognised as the leading national resource in the fight against HIV and AIDS. But weak or strong, the resurgence of HIV has been on the up and up for nearly four years now. “I know the research team have been working overtime to try to find out the reasons for this latest spike. We are extremely grateful to men who have sex with men for cooperating so readily with the Gay Auckland Periodic Sex Survey research project. And it's this information that's going to be leading a new response to this epidemic throughout the country.” GETTING CLOSER TO THE ACTION If research is a science, changing the sexual habits of gay men is more of an art. The old ways of delivering effective messages may need, at the very least, freshening up? “I have some personal views on what we need to be doing differently,” Lambert admits. “I think we need to be more visible in our community, we need to be quite realistic about what happens when gay men place themselves in positions of potential risk. By that I think we need to be more up front about when men who perhaps have had too many drugs or are drunk leave a dance party or bar... maybe we need to get back in front of them and put a condom and lube in their hands as they are leaving the dance parties, basically acknowledging that people's abilities to act with reason are being compromised, and that we can't rely on them in the heat of the act to go into their bathroom and get a condom. We need to bring the intervention closer to the event itself.” It's a direct intervention approach that has parallels in NZAF campaigns of the early 1990s. The Foundation was out there, hands on where men were socialising, hooking up and having sex. But now the NZAF seems to be a more bureaucratic entity, more desk-bound and tied to paperwork. And the soaring epidemic is surely proof that but what pops out of the NZAF is lacking in relevance to sexually active gay men. The usually diplomatic Lambert bristles at the image of a disconnected, slow to respond Foundation. “It is an unfair criticism. There is value in being considered in responses to the epidemic. I believe that it is important to have interventions whose success can be actually measured [so] we are seen to be acting reasonably in the use of our limited resources.” But Lambert's defensiveness quickly passes. “That being said, I think there is room for us to be a lot more multifaceted in the way that we deliver information. So you are going to be seeing a far more aggressive approach, for instance, to the internet, more aggressive that we have ever been before, on the back of research that is telling us that men who are hooking up on the internet are the ones less likely to be using a condom when they are having anal sex. There's still more work we can do, but that's a start.” A rather late start surely, when internet ‘dating' has been picking up momentum for almost a decade? “I can understand that there are frustrations around delays in timing. But I do believe that we do need to be getting the best information possible so that we can design strategies that are going to be effective. I suppose that's the challenge that's in front of us.” IT COULD HAVE BEEN WORSE However, the second wave of HIV isn't in front of us any longer, its been here for at least three years. And it's four years since the NZAF itself warned “we've got a problem coming,” yet we still seem to be just talking about how to respond to that problem. Lambert rejects that kind of criticism. “It implies that we have been sitting back on our laurels for those years. In fact, we've been working hard. I wonder how much worse it might have been if we had not been doing the work we have been doing. But that's the intangible, that's why we don't take credit when the infection rate is low, because we can't say to exactly what extent our intervention may or may not be working.” But in Lambert's view the NZAF can take credit for some important basic changes in sexual behaviour amongst gay men. “Since the AIDS Foundation came into being we have reversed quite significantly a trend in condom use. Before the Foundation started, over 70 percent of men were not using condoms. We can now say that 90 percent of anal sex episodes now involve the use of a condom. That is measurable. And I don't think it is any accident that that turnaround in condom use has coincided with the work of the NZ AIDS Foundation.” With such high incidence of condom use, why are New Zealand gay men testing positive for HIV in increasing numbers? “We have some gaps in terms of our knowledge around testing. For instance, of the people who tested HIV positive in the 2005 calendar year we cannot be certain that all of those infections actually took place in that year. So there are some challenges for us in terms of working with the Ministry of Health to get more accuracy around testing data. Because it could just be that the reason for these recent spikes is because more people are presenting for testing. It's that sort of information that we need to be pushing the Ministry and GPs for, so that we're not working with such uncertainty.” POLITICIANS AND PROFESSIONALS GPs are frequently the first point of contact in any public health epidemic, even HIV. Many men who have sex with men first discover that they are HIV positive after a visit to their doctor due to illness. How connected are New Zealand GPs to the NZAF, how effective a tool are the nation's doctors in addressing the HIV epidemic? “Like any profession you get good ones and bad ones. We have to be realistic about what we can expect from GPs... they are a cross-section of New Zealand, they display as much insight or ignorance as other New Zealanders. So we need to carry on our broader environmental work, combatting discrimination against people living with the virus, combatting discrimination against gay men generally, so that we affect the general environment in which all new Zealanders are operating, including GPs.” GPs are not the only ‘outsiders' who come into contact with, and influence, the lives of men who have sex with men. “One common thread that runs through many of those people who intersect with our lives, such as politicians and general community leaders, is that they have a professional responsibility to look after the health and well-being of all New Zealanders. Gay men are part of their community, so being professional, in a health context or political context, means taking an interest in everyone in the community. In NZ we have very strong support from central government and the Ministry of Health. [But] we have varying levels of success with other non-government organisations who work in the areas that we work in. Some we have strong, constructive partnerships with; others should be doing better and have a long way to go.” What is the NZ AIDS Foundation's message to men who have sex with men but are not yet completely committed to safe sex? “In the old days we would work on the basis that if you gave people the information they would do the right thing. We are slowly learning that there is a core group of men who have sex with men who are totally aware that wearing a condom is not only the right thing to do for their own health but also for the health of the people they are coming into contact with. I almost think that we need to get into the business of creating stigma against men who will put their own lives, and the lives of other people, at risk through not using condoms.” Lambert starts to radiate energy and determination as he departs from his role as NZAF Board spokesperson. “It's probably quite a radical thing to say, and it's only my personal point of view, but we are getting to the stage where we need to be aggressive. Far from being soft and wooly about this we need to paint these people into a corner where there is no choice for them other than to do the right thing by wearing a condom.” GETTING HIV BACK ON THE PUBLIC AGENDA In Lambert's view our glbt communities need to be talking about this epidemic again. “We need to be getting it back onto the agenda. Having discussions with our friends and family about exactly how bad this epidemic has become in New Zealand. In a editorial you asked just how many times does the NZAF have to say we are shocked about each rise in figures. But we have to keep saying those things because it's just not registering. We keep on saying it because we keep on finding people who say how shocked they are that last year was the highest year ever for HIV infections.” How engaged are we, as sexually active men who have sex with men, at a practical level? “There are many people in our community who, twenty years ago would have been far more active around the issue of HIV and AIDS, even though the level of infections was not as high as it is now. We have to start reengaging people around this epidemic. This is part of the problem of leadership... sure it's fine taking pot shots at the Foundation, saying ‘You failed over the last however many years,' but people have to ask themselves what they themselves have done, as an individual and as a community, around the epidemic. We have to deal with the misconception that it is only about the NZAF doing its job properly. Our communities must take some of the responsibility back, must ask some tough questions, not just of other people who they think might be having unsafe sex, but also review their own behaviour.” MEN IN LOVE ARE MEN AT RISK One of the more difficult behaviours to affect is the tricky issue of sex within relationships. One in three infections diagnosed last year were in men in relationships. “We know that more than half of men in relationships are not using condoms when having sex with one another,” says Lambert. “We also know that around 40% of them are also having casual sex with people outside the relationship.” It's an area that the NZAF doesn't address lightly, “because that whole area of private relationships is sacred. Men in love are men at risk. And that is one of the key messages that we need to be getting through to people. People do make mistakes when they are in a relationship. We are only human. But using a condom when you are having anal sex is not questioning your love and commitment to your partner .” Lambert believes that there is a misconception that HIV is only being spread amongst men having casual sex with men. “And that is just not true. HIV is spreading throughout our communities, it's hitting men who are in relationships, men in relationships who also have casual sex, and men who just have casual sex. The Foundation needs to be sending out separate messages to those audiences. We need to be breaking down those misconceptions.” Misconceptions, gay men's complacency, low visibility of the effects of HIV, burnout after 20 years of safe sex awareness and the ticking time bomb of relationship issues, all must be addressed by men who have sex with men, including those tasked with making changes in our sexual behaviour happen. The NZAF seems aware that it must review its internal and external relationships, hence the recent community consultation - a summary of suggestions received and observations made is due out shortly - and the Constitution Review currently underway. But the final objective must be another change in the sexual habits of men who have sex with men. All eyes are on the NZAF... and the increasingly HIV-infected gay and bi men of New Zealand. Jay Bennie - 14th August 2006    

Credit: Jay Bennie

First published: Monday, 14th August 2006 - 12:00pm

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