Maggie Barry 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 part two of an edited transcript of that programme. Maggie Barry: Let's take another phone call. Good evening Victor. Victor: Good evening Maggie. Five or six years ago New Zealand was one of only one or two countries in the world with a declining annual HIV infection rate. So clearly New Zealand was doing something right. I guess my question is what do we need to do to return to that positive public health outcome. Barry: Dr Douglas Lush, Acting Director of Public Health for the Ministry of Health, would you like to pick up on that, about the overall strategy for turning the statistics around? Dr Douglas Lush: We certainly have done well to date and even the rates that we have at the moment, 188 makes us quite small in comparison to other countries. But every infection is preventable and every infection is a disaster for the individual concerned. As far as turning it around, the virus hasn't changed and the messages to prevent it are the same. It's really the safer-sex message that's the one and letting the risk groups know about how it's spread and reminding them about how to prevent infection. Barry: Do we need more public education campaigns? Victor, is that something you feel might... Victor: I'm wondering if it's the approach of the campaigns or the resourcing of them or a bit of both. But what I'm really saying is that in the face of an international trend of increasing HIV rates, we had halted it, and we stood out against other countries in terms of our approach and our success. I'm not dishing out criticism on those people trying to do good work now but clearly a change of emphasis is at least a prospect. Barry: Do you agree with that Kevin Baker [Positive Health manager for the NZ AIDS Foundation]? Kevin Baker: Yes, I very much agree. I think that people think that it's someone else's problem still. Maybe it's: “the AIDS Foundation that are the ones concerned about AIDS but it's certainly not important in my life and I don't know anyone with HIV and therefore it's not an issue, so therefore it's background and less of a problem... so I don't have to worry about it.” A lot of AIDS organisations including ours are talking about how do we re-invigorate the messages that are very much consistent from the beginning of the epidemic. How do we make them relevant again. How do we capture people's attention and make sure that they get the message clearly, how do we skill them and how do we talk to partners about safe sex and make it a normal thing and how to make condoms a normal part of what you do... so you don't have to think twice about it. And also trying to re-engage the community in the full sense of the word. Because in the beginning of this epidemic it was driven by a community initiative and that's how the NZ AIDS Foundation started. I think that community has just sailed on, they sort of know about us but we're not the main part of their lives. So they are less interested in the whole deal. That's what it's about. Barry: Where does the stigma fit in amongst all of this... the stigma of being HIV positive, where is that at the moment? Baker: I think that it's just as huge as it ever was because. Positive people are very much keeping a low profile these days... there's fewer positive people that want to put their head up and say “I'm a person living with HIV, I'm a person living with AIDS and you need to take notice.” We had a lot of those people who did incredibly powerful public education in the early days. Fewer people want to do that because they just want to have an ordinary life. They don't want to be stood out and identified as someone with the virus. They really want that to be known only by themselves and their doctor and a few close friends and just get on with their life. In some respects they've been able to do that because of the effectiveness of treatments which are keeping people a lot healthier for longer. Barry: Do you think that the stigma about HIV and AIDS is a natural extension of the homophobia that's plagued this nation for such a long time? Kevin Baker: Probably yes, in some ways. But I think it also stems down to that basic fear that people have to get past when they are confronted by HIV in their personal life or with someone who's close to them. Everyone has to come to terms with that. People who get newly diagnosed have to come to terms with that reality in their own way, and I think we've got all of that adding to the stigma. So, it's basically fear of HIV. Barry: Dr Lush, in terms of the stigma, do you have any ideas about how to reach these at risk men? Do we need young men leading the campaign, being the public face of HIV positive for future campaigns. Dr Douglas Lush: We need to explore all possible options. And speaking to youth and young men we need to get role models and people who are likely to get that message across. So the Ministry's looked at the evidence of what's worked and what doesn't work, and it's working with other Ministries, the Ministry of Education and Youth Development to look at campaigns that will work. The other thing that we are doing this year is mounting a safe sex campaign... $1.8m has been set aside for this safe-sex campaign and we're going to work with the other agencies such as the AIDS Foundation to ensure that we are getting that message across through the groups and networks that work to get that message through to where it goes. We need to be very innovative and look at any option to get that information across to the people who are at risk. Barry: Is there anything to be learned from the road safety advertisements, particularly the hard-hitting ones for drink driving with the grim reaper, that sort of thing, should we lose some of the subtlety that we've had in former campaigns do you think? Lush: I think we've moved on from there and I don't think that would be appropriate. If people want to know how bad HIV/AIDS is they can look at what's happening internationally with 40 million HIV infections thought to exist in the world, 3 million people a year dying from HIV/AIDS. If you look at developing countries where they don't have the advantage of treatment you can see the absolute disaster that this disease causes and I think that's a good example. We don't need to look here, we can look overseas and see just how devastating this disease is. Barry: I agree that those facts and figures are shocking but are they the sort of facts and figures that are going to be reaching the people who are increasingly at risk and becoming HIV positive? It's not enough any more is it to say “look overseas, it's in black and white... we really need to get serious about this.” Those sort of messages appear to be falling on deaf ears. Lush: I think that's an important reminder. I think it's also important to hear people who are HIV positive and the problems that they're having with the treatment. And this is an avoidable infection so if you can avoid getting it then you are much better off than if you get it. If you get it then there's many years of taking anti-retrovirals, you're unsure about the future, whether you're going to get resistance and all the problems of being HIV positive. So I think that we can look at what's happening to people who are HIV positive, both in New Zealand and internationally and they are I think strong enough messages without going for anything more shocking than that. The evidence that we have already is shocking enough. Barry: The international trends, that's something that our next caller wants to talk about. Todd: Hi Maggie. First I'd like to commend you on convening this panel tonight. My name is Todd Andrews and I'm a trustee of the Circle of Friends which was established three years ago in the Kanuka Grove at Western Springs Park in Grey Lynn as a memorial garden built to remember and celebrate those we've lost and those who have been touched by AIDS. I lost my brother back in 1986 in San Francisco and back then AIDS didn't even have a name. It was before Rock Hudson, it was before Liz Taylor and Elton John had started their fine work fundraising and promoting awareness. But the stigma was all-pervading and it is still all-pervading. And I feel that after the surge of awareness in the late '80s and early '90s of safe sex in the homosexual community and heterosexual community we've lost the momentum. So that concerns me. Barry: Why do you think we have lost the momentum, have you any theories on that? Todd: I don't know. I was quite heartened because New Zealand's numbers were declining a few years back... and now to be hearing the alarming statistics of them being up, I'm surprised and disturbed. Barry: I'm wondering if there is anything that can be gleaned from these experiences. Do you, Todd, see that what happened to you and your family in the 80s can have relevance still today? Todd: Well I hope so. I mean, I echo the voice of the panel in exhorting all of us to remember. I was at Government House when Her Excellency Dame Sylvia Cartwright honoured the kaumatua of the AIDS Foundation Henare Te Ua for his 20 years of work... and he had a good stern reminder to all of us that we can't relax, we must stay vigilant. To quote Dr. Lush, AIDS is preventable. Barry: Kevin Baker, do you think that part of the programme could be perhaps to talk about the positive side of things, the people who've made such a wonderful contribution to education and to AIDS and HIV awareness in this country... to do it that way rather than the “punishment” method. Baker: We certainly wouldn't want to do the “punishment” method. But I agree with the idea of putting a face to the epidemic and that's something that we're working on, with this year's campaigns very much coming out of the new statistics and putting different approaches or a stronger approach to our prevention programmes through the AIDS Foundation. We've done a number of programmes consistently around safe-sex and I think that the real issue is about reinforcing that. It is a consistent safe-sex message and it applies to everyone, not only men who have sex with men but to the wider heterosexual community. HIV isn't a big problem for the wider heterosexual community at the moment, and we're lucky that it's been kept at very low levels. But that doesn't mean that it will stay like that and it certainly won't stay like that. The biggest other risk of sexually transmitted infections is more of a problem for heterosexuals but HIV fortunately is not. A small numbers of heterosexual New Zealanders get infected in this country every year and the majority of our heterosexual infections are people who have acquired it overseas and are now living in New Zealand. Barry: Last year 52 heterosexual people were diagnosed, 28 men and 24 women. What do you see as the significance of the trend? Baker: The significance seems to be in the proportion. The rise has been a 39% increase in men who have sex with men and about a 36% increase for the wider heterosexual group. We've always said that there is a number of sub-epidemics and New Zealand is impacted by the fact the globally HIV is a big problem. We've managed it the best we can and we continue to do that but we can't protect ourselves from HIV coming in our door. It's already here. We also have to be cognisant, and we are cognisant, that people from other countries coming here, visiting, seeking residence, some of those people will have HIV, that's just a reality. Barry: Dr Mark Thomas [an infectious diseases physician from Auckland University's Department of Molecular Medicine and Pathology], do you believe that this message of safe sex should be delivered differently for gay people and heterosexuals or do you agree with Kevin that ‘the song remains the same'? Mark Thomas: I think the intensity of the message has to be greater for gay men because I think there is a much greater risk of HIV infection in gay men. So I think that message needs to be hammered again to gay men that HIV infection is not a banal infection. It is not something that anybody gets and thinks: “Oh, I've got HIV infection, well life goes on.” It does not. Life changes dramatically in all sorts of unpleasant ways as a result of having HIV infection. Your first caller [See Part One -Ed.] talked about some of those and, despite what was said earlier this evening, there are people around this city who are dying at the moment and who will be dying. There are not as many as there used to be but they are out there in small numbers and we will see increasing numbers in the years to come. So this is not some banal infection that we can all be blase about. With regard to heterosexual people I think there needs to be a wake-up call to heterosexual New Zealanders to remind them that there is an awful lot of HIV infection in people living in third world countries. This is an infection that is a big deal in Africa, this is a big deal in parts of South East Asia and if you go to Africa or South East Asia and have sex with somebody who lives there you are placing yourself at risk of HIV infection. Likewise, if you choose to have sex with somebody who's come from one of those countries to New Zealand then you are placing yourself at risk of HIV infection from having sex with those people as well. And that is the hard, cold reality of it and people need to be aware of it. And I think that there is a neglect of that fact at present and people need to wake up to it. Barry: What are the other countries that are the most at risk Kevin Baker? What are the places apart from Africa... Kevin Baker: Well, as I said before, really HIV is a global problem. I'm not saying that is one country, every country has got a problem and every country has to deal with it in their own way. Some countries are doing well by international standards, others haven't really even started. HIV just takes off in a community and the ways that it moves, we know that it is through unprotected sexual intercourse, vaginal and anal, or through sharing needles or blood equipment and from mother to baby. So we know those are the ways and we know that all of those ways are very preventable. We have to come back to the fact that the condom has definitely been scientifically proven to work. If you use it consistently it is an easy tool to use... 100% effective. Why people would think that this wasn't a good thing to do defies logic doesn't it. So we need to just keep on reinforcing the fact that everyone has to think about their risk, that if they want to prevent themselves getting HIV they can do so. END OF PART TWO GayNZ.com will publish Part Three of this National Radio panel discussion next week, with subjects covered including effectiveness of campaigns, overseas travellers, and drug resistance and availability. GayNZ.com/RadioNZ - 24th April 2004