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Outspoken: Facing the facts of HIV

Thu 15 Apr 2004 In: HIV

Maggie Barry The rate of HIV infections in New Zealand increased dramatically last year with findings in the latest report of the AIDS Epidemiology Group at Otago Medical School described by the Ministry of Health as a sharp wake-up call for all sexually active New Zealanders not engaging in safe sex. A total of 188 people in New Zealand were diagnosed with HIV last year, this is the highest number of new cases in any year since 1985. The biggest single concern is the increased number of gay men being infected, which reflects international trends. 93 new cases of HIV in men who have sex with men were diagnosed last year, a massive increase over previous years. So why is HIV on the increase in New Zealand? Is there a complacency growing from the misconception that HIV is no longer a serious threat to life? Do we have safe sex fatigue? To discuss these issues National Radio's Maggie Barry gathered a panel of experts on her current affairs programme “Outspoken,” with additional input from members of the public by phone. By arrangement with Radio New Zealand this is part one of an edited transcript of the programme. Maggie Barry: On tonight's panel to discuss the issues and implications of the rising rate of HIV infections we have in Dunedin Dr Nigel Dixon, a key researcher within the AIDS Epidemiology Group at the Otago Medical School. In Auckland we have Associate Professor Mark Thomas, an infectious diseases physician from Auckland University's Department of Molecular Medicine and Pathology. Kevin Baker is Positive Health manager for the NZ AIDS Foundation and Dr Douglas Lush is Acting Director of Public Health for the Ministry of Health. Also we have Jonathan Smith who has been HIV+ for the past 11 years. Nigel, as an epidemiologist, why do you think there was such an increase in HIV rates last year? Dr Nigel Dixon: I think the first thing we've got to think of is: could this be an ‘artifact' of the numbers. We're talking about the number of people who have been diagnosed with HIV, and clearly if there was a lot more testing among those people at risk then this could explain the increase. We have looked at the number of tests performed and although these have gone up somewhat in the last five years they haven't gone up as fast as the number of people being diagnosed with HIV. Barry: So why has there been such an increase? Dixon: Among men who have sex with men, the majority of whom were diagnosed in New Zealand, it does look likely that there were more such people being infected. This is something that has being seen in similar developed countries, in Australia and the UK and the USA. There have been more men who have sex with men being diagnosed. So we are led to conclude that the most likely reason is that there are more men who have sex with men being infected. Barry: HIV, of course, has a long incubation. How difficult is it to know how long they've been infected? Dr Nigel Dixon: It can be very difficult because it can have a long incubation period but it is variable. But one of the questions that we ask when we collect the anonymous information about people newly-infected with HIV is whether they have had a previous negative test, therefore we know that a proportion of those men who have sex with men have had a negative test relatively recently. So we certainly know that some of these are new infections. Barry: Kevin Baker, what does the AIDS Foundation believe are the reasons for the increase in HIV rates? Kevin Baker: Our concern is that since 1996 the availability of protease inhibitor anti-retroviral medications has made a dramatic difference to the health of people living with HIV. They were very much touted as being “the cure,” and for many years the public and the media have been wanting a cure for HIV. In fact the treatments aren't a cure but they certainly dramatically suppress the virus and help people manage HIV levels in their body. Barry: So, to the other reasons... do you feel that we are suffering from safe-sex fatigue, that the use of condoms really isn't regarded as a priority very much any more? Baker: Everyone's got their own take on that but I think that safe-sex fatigue is one of the factors... that people are now thinking that “well, I tried very hard but now I just want to have a normal life and I want to forget about HIV... I don't want to have that impediment in my sexual life, I don't want it to be complicated by a layer of rubber.” And there was always a certain degree of opposition to condom use. From the earliest days the gay community has generally taken to condoms and safe-sex practises very much more than, say, heterosexual men and women. And we know from the research that's been done here and overseas that there has been a very, very gradual reduction in terms of total levels of safe-sex practise. We've been watching internationally and doing our own local research which definitely shows that people are taking more occasional chances. But condom use is generally believed to be still a mainstay within gay men and men who have sex with men's sexual practises. Barry: Is there an age-group attitude difference as well? Is there a marked attitude difference with the younger people who didn't go through the 1980s when so many were claimed by the pandemic? Kevin Baker: Yes, interestingly enough younger people, from the sex survey which we did here in Auckland which is a large population which has also a significant men who have sex with men population, younger people who have been brought up in a safe sex culture are much more into practising safe sex and using condoms reliably. In the latest statistics the highest rate of new infections is in the 30-39 age group. Now these would be people that have seen HIV, who know about the impact of AIDS in the community eighteen years ago when it first manifested itself in New Zealand. So younger people have got the safe-sex message, younger men are practising safe sex more reliably than, say, the middle aged cohort, which is really surprising. So we believe that they have been indoctrinated into it and have accepted it as the normal acceptable part of managing sexual behaviour. Barry: Dr Douglas Lush, from the Ministry's perspective there does seem to be an idea that the improved drug regimes have led to this complacency. It's something of a poisoned chalice. How do you think you're going to be able to counter that complacency? Dr Douglas Lush: Certainly that is one factor that might be contributing to this problem... it's really information for people to know that HIV is preventable, and that although the drugs work very well there are problems when taking drugs, there are side-effects. And also there is resistance that can develop in the virus to the drugs so it may not be possible for the drugs to continue to be effective against the virus. Barry: A poll taken a few years showed that the proportion of Americans who call AIDS “the nation's top problem” has declined from 44% in 1995 to 26% in 2001. Do you think that's the sort of worrying trend that is starting to emerge here in New Zealand? Lush: I guess the USA has other things on their mind but, yes, I think that is a problem and this is a reminder that because of the higher than ever total of HIV infections last year it certainly is a wake-up call and we need to be very aware of where those infections are occurring and let everyone know that they are preventable and give them the education so they can prevent them. Barry: Jonathan Smith, you've been living with HIV for the past 11 years. What's your response when you hear that people have become complacent about it because they think the drugs are going to be an easy ride. Jonathan Smith: I find that rather scary Maggie, because I can assure you that living with the virus is not an easy thing. This complacency issue is for me a top priority. But I suppose that some of that complacency is because these drugs are around and if you looked at me there is now way you could tell that I am HIV positive. And these drugs are keeping people alive longer. So you're not seeing those people walking around the city like we did ten or fifteen years ago who were obviously in the advanced stages of HIV... where you could actually see that these people were visibly dying. So you're not seeing that any more now. People are able to live “a fairly normal life,” although realistically what happens in the home when taking these drugs and dealing with the side effects is a totally different issue. It's a great concern to me that there is complacency out there. Barry: How many pills are you taking, what are the side-effects, the real day to day reality, of living with this? Jonathan Smith: I take eleven tablets a day which is quite a small number compared to some other HIV positive people. However, in addition to those tablets you also need to take other medications to deal with the side-effects and the more obvious ones are nausea and diarrhoea. However, the long-term side-effects are the ones that I worry about , like lipodystrophy - which is to do with [fat] distribution - and also I've just had a reaction which is like a dermatitis outbreak on my face. So these are the longer-term side-effects of the drugs which are the great worry for me but at the moment things are good for me and the drugs are working well and I'm able to work. Barry: Joining us on the phone now from Wellington is Shane. You have the virus? Shane: I do. Barry: And how has it affected your life? Shane: I've had discrimination at work... I worked for a middle-aged straight man and he found out from somewhere that I was positive and decided that it was the best thing for the company was to get me out. Barry: That's illegal though. Shane: It didn't work though, because I had some people that were on my side, but he had a plan and that was what he wanted to do. It may be illegal but he can still do it. Barry: Did you fight it through the legal system? Shane: No, I didn't need to do that because somebody else within the company above him knew my situation and just said: “no, not doing it.” Barry: Have you experienced much stigma, apart from that workplace situation, when people have known that you are HIV positive? Shane: Even within the gay community people still don't want to come out and say “I'm HIV positive.” No matter how much the community has come to accept HIV as part of life, within the gay community there is still a stigma attached to it. Barry: The fact that it is illegal, to have unprotected intercourse with somebody if you know you have HIV, do you think that has any impact at all with what you've just described? Shane: I think it does. But I have been diagnosed... I can tell you exactly the time, 3.30, 20th of July 1998... Barry: You remember it well? Shane: I remember it well. But after finding out I was positive I was really sick because I had gone for so long without finding out. They told me I could have been positive for between 5 and 12 years before that. Barry: So it would be pretty difficult for you to know who you contracted it through. Shane: Yep. And probably 90% of the time I used condoms within that time. I was in a relationship for four years before I was diagnosed, for the first year we used condoms religiously, but for the three or so years before I was diagnosed we had stopped using condoms. Barry: Was your partner infected? Shane: Thankfully no. Barry: How do you tell people when you're HIV positive when you meet them and you feel they might be a prospective lover? Shane: Unfortunately I haven't had that particular problem for some time. Barry: Have you prepared a thought though if that problem does emerge? Shane: Yes, I'm in the process of talking to someone at the moment that I quite fancy and I have just been struggling with how and when I am going to tell that person. Barry: Good luck with that Shane and thank you very much for joining us this evening. Kevin Baker, from the AIDS Foundation's perspective, you advise people on these sort of things, what would you say to Shane or others in that dilemma of wondering how to tell someone that they're HIV positive. Baker: That's a vary common scenario for positive people. In fact it's one of the most stressful situations, having to start a new relationship and then thinking “I like this person but I'm going to have to tell them the big factor and then are they going to reject me?” And it's quite common because I think there's still a huge amount of fear around HIV in the gay community and in the wider community. It's due to a lot of ignorance in the wider community but it's mainly fear in the gay community. So we talk about this a lot amongst our counseling and support staff around the country. It's a common hurdle you have to broach or, in some cases I know people who just don't have relationships for long time, who just stay away from that because it's just too hazardous. Barry: Jonathan, how did you approach it. You'd been with your previous partner for 14 years and after his death when you knew you were HIV positive, what did you go through there? Jonathan Smith: There was a period of time after my previous partner died that I had casual sex and didn't disclose. Back then I don't know if it was legal or illegal, it still probably needs to be tested through he courts. However, when I got to know my present partner of ten years he was aware of my positive status before then so, I can assure you Maggie that was a lot easier to deal with. I just don't know how I would have told him if he hadn't known. I would have found it very difficult, I would have been scared of losing him. Barry: Do you think that's why a lot of people are walking around not having been tested at all... because they'd rather not know than deal with it? They're in denial? Smith: I think it's one of the issues, absolutely. Maggie Barry: How can we encourage people to come forward and be tested? because that is the “walking timebomb” factor isn't it, there are a lot of people out there who have the blinkers on and just don't want to know. So what can we do about that do you think? Smith: Well, if I look at the way I was diagnosed, I was diagnosed at the same time as I sero-converted so I know the exact time when I was infected. Therefore because because I was tested early and was diagnosed early my whole health management plan was started immediately. Whereas if you've been tested maybe five or six years down the track your viral load and your immune system has been quite badly damaged. Therefore your progression into advanced HIV is probably far quicker. Maybe Mark Thomas could comment on that but the earlier you catch the diagnosis the earlier that you start on a health management plan the better it is for your health. Thomas: I think the message is that people who think that they might have infection and who think that they are potentially placing other people at risk need to consider the potential harm that they are doing to other people. I think that in the end it comes down to being a member of society and caring for those around you. And if you think that you have HIV infection you have a responsibility to others to find out if you are continuing to place other people at risk. So that at least if you know you have HIV infection you can make a decision about either avoiding having sex with other people or being very, very careful about having safe sex. This is a horrible disease and nobody wants to think that they've passed it on to anybody else. Barry: Dr. Lush, do you think there is a way ahead, in terms of public education for this, that the Ministry needs to lead from the front on? Douglas Lush: People need to be aware that free and confidential testing is available and that is an important part of it, but yes, on-going education about what the virus is and how it is spread is really important... and the simple ways that you can prevent it... those are the important messages. END OF PART ONE GayNZ.com will publish Part Two of this National Radio panel discussion next week, with subjects covered including community attitudes, stigma and life with HIV. GayNZ.com/Radio New Zealand - 15th April 2004    

Credit: GayNZ.com/Radio New Zealand

First published: Thursday, 15th April 2004 - 12:00pm

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