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Ministry in dark on HIV prevention cost benefits

Wed 8 Feb 2017 In: New Zealand Daily News View at Wayback View at NDHA

At a time of surging HIV infection diagnoses and continuing criticism of the Government for lessening its commitment to funding HIV prevention work it has emerged the Ministry of Health has no clear information on the cost-effectiveness of HIV prevention, treatment and research programmes on which to base funding decisions. Documents and information provided by the Ministry to Daily News under the Official Information Act reveal that despite deciding that the NZ AIDS Foundation should receive no additional funding for prevention work since 2009, even to keep pace with inflation, the Ministry is in the dark regarding cost/benefit information on which to make informed decisions on prevention funding levels. It has apparently also not generated or sourced clear information on the cost/benefits of core HIV prevention tools such as PrEP, which Pharmac has been accused of not working hard enough to advance, or access to HIV treatments immediately on diagnosis as is increasingly the norm overseas. Nor does the Ministry appear to know the actual costs versus benefits for the country's only way of understanding the changing HIV/safe-sex attitudes of gay and bisexual men, who are the majority of those exposed to the HIV epidemic, despite its refusal to fund the GAPS/GOSS survey for three years in a row annually. In Australia, for instance, similar research is carried out every year to quickly pick up on behavioural changes and monitor the effect of prevention programmes. The NZ AIDS Foundation has in recent years repeatedly but unsuccessfully called on the Government to increase its funding to stop more HIV infections in the face of rising numbers of newly-diagnosed HIV cases. The annual number of new diagnoses is now at the highest level since the epidemic emerged in the 1980s. However, it appears the Ministry is getting good value for what money it does provide to the NZAF. As far back as 2013, in the face of no Ministry or Treasury analysis on the effectiveness of public spending on HIV prevention, the NZAF commissioned an independent report from research, forecasting and public policy company Covec. The report indicated that the NZAF, funded then as now at approximately $4.5million a year, would only need to stop a dozen or fewer infections a year to justify the money it receives. Acknowledging some uncertainty over cause and effect, “the evidence is consistent with NZAF programmes having a significant impact on limiting the number of infections. In addition, the longer the programmes run the greater the benefits and the greater the costs of stopping the programmes,” the report states. “Under these circumstances it is important that the programmes are funded sufficiently to maintain at least the current level of activity.” The Covec report was apparently handed to the Ministry at the time of negotiations for the Foundation's current funding period which expires at the end of this June and for which no inflation-adjustment or increase was approved. In an attempt to maintain its prevention work the NZAF has for three years repeatedly re-mortgaged its Auckland office building and is now in debt to the tune of $500,000 according to its latest financial report. In their latest commentaries on the organisation's finances both the Chair and the Executive Director have indicated that there is no way for the NZAF to increase its debt and if a significant increase in funding is not secured cutbacks in prevention programmes and staffing are inevitable.    

Credit: Daily News staff

First published: Wednesday, 8th February 2017 - 11:02am

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