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Outspoken: Facing the facts of HIV III

Mon 10 May 2004 In: HIV

The rate of HIV infections in New Zealand increased dramatically last year with a total of 188 people in New Zealand diagnosed with HIV last year, 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. Is there a complacency that's growing from the misconception that HIV is no longer a serious threat to life? Do we have safe sex fatigue? National Radio's Maggie Barry gathered a panel of experts on her programme “Outspoken,” with additional input from members of the public by phone. This is the third and final part of an edited transcript of that programme. Barry: We have a caller now, Andy from Palmerston North. Andy: I've been thinking about something that's sprung to mind as regards the mention of acquiring a figurehead for the new campaign. I think that's why we were so successful earlier on because everybody had a focal point in Eve van Grafhorst, because, let's face it, she left an indelible mark on most people's psyche, the fact that she was denied access to Kindy in Australia and she came over here and she captured the hearts and minds of everybody. Barry: Why do you think that was? Do you think it was because she was wronged, is that why she touched our hearts? Andy: Well, probably that would be the initial case but just the mere fact that she was a poor little girl who didn't have a chance at life at all because the disease had taken her, it really made a lot of people think twice I think. Barry: Who do you think would be a modern day equivalent, someone who, in the year 2004 and beyond could capture the hearts and minds of the men who are most at risk? Andy: Well that's precisely it... are there any people out there? It's got have some sort of sentimental value to make you think: “God, what am I doing here.” And that's one question that does spring to mind, is there an actual age group statistic that is affected mainly? Barry: Dr. Nigel Dixon [AIDS Epidemiology Group at the Otago Medical School], from your point of view, having done the report and analysed it, perhaps you could tell us who is that age group? Nigel Dixon: I think we should recognise that all men who have sex with men are at risk. So I think we have to be careful, it's almost as if we're always trying to blame the other people. And I think it is very important to say that the whole population has a responsibility here for the epidemic. I was very struck by the first caller who clearly suffered from discrimination from the heterosexual population. Therefore the majority of people in this country, who are the heterosexual population, really have a major responsibility for this epidemic, as much as people who may be putting themselves at risk. Barry: Dr Lush, what do you think is the target group from the Ministry of Health's perspective? Lush: As we've already discussed, men who have sex with men, and this includes people who might be in a heterosexual relationship but may occasionally have sex with men and those people are an important target group. Youth unfortunately has quite high rates of sexually transmitted infections so although they understand the safe sex message it is clear that some of them are still having unsafe sex because they are spreading other sexually transmitted diseases such as chlamydia so they're a particular problem. Injecting drug users are a group that need to be aware of the risk of HIV infection. If they are meticulous about the equipment they use to make sure that there is no contamination with blood... Barry: Hepatitis C is more an issue for them isn't it? I was looking back at the figures and there wasn't such a growth in the intravenous drug users' group. Lush: That's right. When the needle and syringe exchange programme was introduced in New Zealand Hepatitis C unfortunately was already very prevalent in injecting drug users so it's continued to be a big problem. But HIV hasn't been a big problem in injecting drug users in New Zealand. Elsewhere in the world it's a very big problem, in New Zealand at the moment it's a very small problem. The other group that I think we need to be aware of is tourists who go overseas. They need to be extremely careful about having safe sex when they're overseas. Because the sort of practises that might exist for people may be different there and people with HIV may indicate their status in a different way. And people who come from New Zealand may not understand the culture and they may think they're safe and they won't be. So I think It's doubly important that people who're going overseas and want to have sex while they're there need to have safe sex. It's extremely important for everyone. Barry: Dr Mark Thomas, I'd like to talk more about the drug side of things, because that has obviously been something that has coloured people's perceptions of the risks to do with HIV... that they can relax a little because of these drugs. Let's determine just how difficult it is to get the right drug regime and the [drug] cocktails when you're treating someone with HIV. Thomas: We are fortunate in having a fabulous range of extremely powerful drugs available to us to control HIV infection. And a person who has HIV virus infection that is due to a virus that is not resistant to any of the drugs, and fortunately that is most people when they get infected, the drugs work extremely well. If you start a person on three HIV drugs of the sort that are available to us at the moment you can anticipate that in well over three quarters of the people their virus will be brought under control. You can anticipate that if the person takes their pills meticulously over the months and years ahead that the virus will remain under control. And the appearances are that the virus will remain under control for years as long as the person takes the pills reliably. Barry: At what point do they develop a resistance to the drugs? Thomas: There's absolutely no reason at all for them to develop resistance, unless they start taking the drugs unreliably. Barry: Do we have the appropriate range of drugs... you said it is “a fabulous range,” how does it compare to the range that is available, for example, to Australian HIV sufferers? Thomas: There is a marginally increased range of drugs available in Australia. The range that we have is replicated there with three or four extra drugs available in Australia. And for the vast majority of people with HIV infection that makes not a whit of difference because the basic drugs that we have available, the range that I talked about, that range is perfectly acceptable for the vast majority of people with HIV infection. However, for somebody who has the virus that has become resistant to the drugs that they are taking - and that may happen for one or more reasons, they may be infected with a virus that is resistant to one or more drugs, they may have been treated in years past when such a good range of drugs wasn't available, and they may have developed resistance back in those days as a result of their medical treatment - then access to drugs that can work better than the drugs that they are currently on can be important for helping to control their virus for a longer period of time and maintaining better health. And so access to a broader range of drugs will make a difference to people in New Zealand with HIV infection but at the moment fortunately it's a relatively small part of the picture. An important part of the picture if you are the person with a resistant virus, an extremely important part of the picture, but not an important part of the picture for the person who has recently become infected or who has had their infection recently diagnosed and needs to start on treatment. It would be important to stress that for those people we have an excellent range of drugs available and if they take them reliably the drugs will work extremely well at controlling the virus. People don't become resistant unless they stop taking their drugs reliably and the virus is allowed to replicate again. Barry: Jonathan Smith [who has been HIV+ for the past 11 years], you're someone who has had difficulties with the drugs, what is your attitude to the availability of medication? Jonathan Smith: I would have been one of those people who has built up resistance to one group of drugs and secondary resistance to another group. I can assure you it's not from being non-compliant with my drug regime. I am. But it's because I've been on a number of drugs for years. So I've got very limited availability and when I had to make the decision with Kaletra [a newly-available HIV drug which is not yet fully funded by health authorities in NZ - Ed.] I really had only one other drug regime that I could go on to which would have been funded. However, the side-effects of that regime have been so horrific that there would have probably been an inability for me to work and I would have been reliant on welfare. So I took the avenue of going on to Kaletra, paying for it myself, in order to be able to continue on working. So, at the moment the number of drugs available to me is very limited. Barry: How important was it to you to keep on working, to not go down the track of the drugs that would have dire side effects? Smith: 100 per cent. Because being able to work and being self-employed is part of my self-esteem, my self-worth. Not having to be reliant on welfare from the state was a major issue for me and that was one of the major reasons I decided to self-fund my drugs. Barry: Pharmac is the government drug agency, Kevin Baker what are the challenges for them as you see it? Kevin Baker: Pharmac have to manage the whole range of pharmaceutical options in New Zealand and that is what they were instructed to do. We don't know at this stage how big their budget increase is and whether that will extend to other essential retrovirals that may come on to the market in the next year or two. So we don't know how far it extends. Pharmac have still got a challenge to look at how they anticipate the need and the growing demand for those people at the edge of the treatment precipice. Barry: Are people in New Zealand with HIV going to Australia for treatment? Baker: Very few. In the past people could go to Australia and get treatment there... it was easy to get across the Tasman, they could access those treatments that we didn't have available in New Zealand. Those loopholes have been very steadily closed over the past couple of years and it's almost impossible to just go over there and go on welfare. Certainly if you can go over to Australia and you are well and you can become employed you can then get a Medicare card then you are entitled to health and medical treatment in Australia. But that again is for those who are well. For those who are unwell you certainly couldn't cross the Tasman at this point in time. Maggie Barry: I'd like to thank you all very much for your time on the panel to discuss HIV, the latest trends and statistics. RadioNZ, GayNZ.com - 10th May 2004    

Credit: RadioNZ, GayNZ.com

First published: Monday, 10th May 2004 - 12:00pm

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