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Rachael's Way : The NZAF and a complex epidemic

Mon 10 Jan 2005 In: HIV

Rachael le Mesurier It's been a challenging first year for AIDS Foundation executive director Rachael LeMesurier. She's faced the worst rate of HIV infections in a decade, lost some key staff, fought a continuing battle against Government drug agency Pharmac for access to new HIV treatments, and had the Foundation's Enough is Enough campaign slogan stolen by the Destiny Church. But she's also – to slip into the vernacular briefly – kicked arse with respect to ramping up the volume on the HIV message in an increasingly complacent community. How has she coped with the bumpy ride in her first year at the helm? "Some of the things have been a surprise to us all, not just myself,” she says. "I had expected a great organisation with some remarkable individuals working within it, and I have been absolutely affirmed on that. I think the people that work for the AIDS Foundation are wonderful. I'm also aware that volunteers and members are really significant people, and we may not have always affirmed that in the past as much as we should.” The Foundation's strategic plan for the next five years has a big vision. It wants nothing less than a world without HIV and AIDS, despite how insurmountable such a vision may seem. More tangibly, it wants the infection rates of 2003 to be halved. “I have been hugely heartened by the process with the strategic plan and staff involvement in that, and I have a lot of faith that in the next five years we can meet most of those goals.” There have been some significant personnel changes at the Foundation this year, for varying reasons. Kerry Price, the Gay Men's Health Manager, left to work elsewhere in the health sector. Positive Health Manager Kevin Baker is off to Europe at the end of this month. Health promoter David Morris left for his OE. And most sadly, Positive Men's Health Promoter Matt Whyte was forced to retire when AIDS-related ill health got the better of him. He passed away in October. But change is inevitable, says LeMesurier. “The role of an NGO is to make sure that people learn what they can within the organisation, but there's only so much we can do. We don't pay great salaries. We wouldn't expect people to stay with us for 20-30 years, unless there was something unique we could offer. I think we've got a relatively reasonable level of staff turnover, and people are going onto better jobs. If they were leaving us to go onto something worse, I'd be deeply worried.” As promised when she took the helm last year, LeMesurier has taken the opportunity to do some restructuring within the organisation. Price's departure saw the formation of a national health promotions team, consolidating resources in that area. But perhaps the most significant weapon added to LeMesurier's arsenal has been the creation of a national communications co-ordinator, a position taken by former South Island health promotions manager Steve Attwood. The result has been visible throughout the country. Coverage of HIV issues in all forms of media is well and truly back on the map. Quick turnaround responses from the Foundation were to be seen everywhere from television news to letters columns in suburban newspapers. “When communications were sitting with the executive director, it was going to be inevitable that the majority of the time I wasn't going to be available,” LeMesurier says. “We're getting far more coverage now. At one point we managed to be on TV One News four weeks in a row, on four different things.” Not only is the Foundation effectively able to fight media fires, it can now be on the offensive once more. In March, before the creation of Attwood's position, the Foundation was thrown to the wolves when media got hold of a story involving one of the Foundation's speakers being banned from Northcote College after a parent complained about the contents of a sex education lecture. Kerry Price found himself under seige, with everyone from Newstalk ZB to gay-soy theorist Ian Wishart baying for blood. By year's end, the Foundation was leading the charge, defending the gay community on all sorts of issues. It even provided a timely riposte to the Hubbard letter, in which Auckland's mayor co-signed a letter alleging gay parents were more likely to abuse and murder their children. The Foundation politely but firmly rubbished the claims, and offered to meet with Hubbard and help him out with some real research. Previously criticised for slipping out of touch with the community, the Foundation spent a good portion of the year raising profile. “I think we've had some great successes this year with Queen Of The Whole Pacific and Big Gay Out, two events that were really clear about our role and our place within the community, and ensuring that in the midst of the fight against HIV/AIDS we also affirm the great stuff, the great relationships, the good sexual health, the good behaviour that is out there – and have fun while we're doing it. The AIDS Foundation is as strong as it ever has been in being able to do that.” The big cloud hanging over LeMesurier's head has been the whopping increase in new HIV infections. When she came on board late last year, the first set of disturbing figures, showing the highest rate of infections among MSM since 1991, had just been released. 2004 continued this trend. It was time for action, not just in the area of research, but in grass-roots community connections. Shaky bridges with Body Positive were mended, with the Foundation working in partnership with that organisation to host a series of community forums around the country to get answers surrounding the increase in HIV infections. Analysis of data from the second Gay Auckland Periodic Sex Survey was fast-tracked. Resources were pooled across the board, both inside and outside the Foundation. “The HIV/AIDS sector is rallying together and becoming stronger because of this challenge. It's about broadening the platform,” says LeMesurier. “It's not just the AIDS Foundation that's dealing with HIV and AIDS, and it cannot be just us. One of the most exciting things that has come out of this year is the National HIV/AIDS Council which met for the first time on 1st December, World AIDS Day. That was the first time the key players had been round a table since 1991, and what that group can do is have a united voice in response to Pharmac, to HIV/AIDS strategy, immigration, and all the things that come through.” Although messages about HIV in the mainstream media have increased significantly over the last year, a key challenge in 2005 is still reaching those men who aren't getting the message about safe sex, and regular HIV testing. The average age of new infections for gay men was 39, and half those infected in 2003 had never had an HIV test. “That particular group is another area that we're aware of that we need to do something about – those who don't necessarily test,” she says. “At that age group, it suggests to us that they're highly likely not to have been in touch with the gay community. If they've not tested ever before, they're far more likely not to identify as gay or bisexual, and be sitting out there in the heterosexual community.” With the growing tolerance and acceptance of homosexuality in our society, there's also less of a need for some men to identify specifically with the gay community, and LeMesurier is aware that the Foundation will need to devise new ways to ensure these men are reached. “Also, in the men who go to the sex-on-site venues, the bars, while I'm aware that we are reaching them with our current resources, we may not be engaging them. What we're aware of is those average-age-39 men are individuals, they have very specific reasons for why they may not be being reached. We have to speak more with them about what they think will have an impact.” Gay Men's Health team co-ordinator Douglas Jenkin's work in building up the Foundation's focus groups will be key to ensuring that connections to the community stay strong. These focus groups are already used to test the Foundation's campaigns before they're unleashed into the public domain. With the nature of the HIV epidemic changing, with the gay community fragmenting and social and sexual attitude changes in NZ as a whole becoming both more subtle and more up front, treatment advances and generational changes there's one word which sums up the environment the NZAF must now come to terms with. “Complexity,” says LeMesurier, in summary of the modern HIV epidemic. “It's clear that treatments themselves have had an impact on people's assumptions. People are misunderstanding what HIV realities are, hence some of the campaigns we've done this year to address that. We're also aware that there are different ways in which people are accessing sex, and some of this is through the internet. It's difficult to get prevention messages out to that group, as a lot of these hook-up sites are based overseas, so it's impossible to get a banner ad in there because of cost.” With more people in New Zealand living with HIV than ever before, it is becoming increasingly important for the Foundation to stay in touch with the needs of the positive community. Matt Whyte's death in October highlighted the increasing numbers of men for whom HIV treatment options in New Zealand were running out. “It is unacceptable that people who are HIV+ are facing increasing ill health that would not occur if they had right of residency in almost any other developed country,” commented LeMesurier in her annual report. The Foundation's advocacy in this area resulted in Kaletra being made partially available in July. “However, the whole experience underlined the difficulties in the funding formula used by Pharmac and the need to plan for funding for new [drug therapies] as they come available.” Keeping the safe sex message fresh twenty years on into an epidemic is a challenge that never goes away, but LeMesurier thinks New Zealand's success in keeping HIV infection rates relatively low compared to the rest of the world can set an example for anyone pushing a health promotion message. “We have been selling this message for twenty years. That means we have been asking men, particularly men who are HIV+, to wear a condom for every act of anal intercourse – every single time for twenty years. Now to sustain that level of compliance is both an incredible achievement, but also very very challenging. How do we sustain the same message for 20 years and still make it interesting, still make it something people believe in, and something they'll actually agree with?” LeMesurier says the Foundation is in good heart to meet the challenge, and one year on, she's still loving it. Her exuberance and enthusiasm is present everywhere from office corridors to community gatherings at which the Foundation's presence now seems ubiquitous. “I am so lucky. I see myself incredibly lucky, and I'm very appreciative of the position I've been given,” she says. “Of all the NGO's I've been involved with, this one has the best events. We do the best glamour, we do the best fun, we can manage to challenge whilst also ensuring that its enjoyable, and I've not seen that happen in any of the other organisations I've been part of.” Chris Banks - 10th January 2005    

Credit: Chris Banks

First published: Monday, 10th January 2005 - 12:00pm

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