The announcement by the NZ AIDS Foundation that it is to tender out the production of a website to replace the HIV positive people's magazine Collective Thinking has spurred a call for it to abandon such support services and to concentrate on preventing the further spread of the debilitating virus. As reported just over a week ago in GayNZ.com Daily News, long-time HIV activist and positive man Ray Taylor has joined the nation's largest peer support group, Body Positive Auckland, in questioning whether the Foundation should have control over what was initially an independent voice for and by HIV Positive people. Collective Thinking started as an initiative by and for gay men with HIV - with funding from the Ministry - hence the 'Collective' of its title. AIDS Foundation Executive Director Rachael Le Mesurier says the NZAF "was asked to take over the delivery of the quarterly magazine in the late 1990s and did so." Rachael Le Mesurier - NZAF It now therefore administers the funding for the publication. And just days ago the Foundation said recent feedback from HIV peer support groups expressed support for Collective Thinking being under the NZAF's wing. But "it makes no sense for the NZAF to retain any control of Collective Thinking," says Taylor, "although I do like the online idea as this would provide a much needed avenue of contact for positive people in remote areas of NZ." However, he believes there is a a bigger issue at stake. "Is it appropriate for the NZAF to suggest that it provides support for positive people." Collective Thinking, Taylor believes, is just a part of this broader question. In Taylor's view the current model for provision of support is outmoded. Indeed, the Ministry of Health has commissioned a report on HIV services which is due out as early as the end of this week and may shed further light on this area. "As one of the instigators of the current support system back in the 1980s, I am amazed that it is still being used today," says Taylor. "Back in the early days, pre- law reform, the current system was set up to meet the need of a radically different epidemic in a radically different environment. The support facilities were primarily established to provide HIV testing and then to provide ongoing counselling to positive people who were facing an indefinite future. So in reality the testing facilities were and have remained a key component in the prevention of HIV rather than the ongoing ‘support’ of positive people." A factor which is influencing Taylor's view is that HIV is now a largely manageable disease. "As the disease has changed from terminal to treatable there is a need for different support services and while the NZAF are providing assistance - usually financial - to local initiatives, they are not the ones actually doing the work," he believes. POWER AND INFLUENCE Taylor observes that there is an uncomfortable overlap between some of the services being provided by the NZAF and by some of the peer support groups. "The larger peer support organisations like Body Positive in Auckland expanded their vision and have in some areas ended up in competition with the NZAF. In this day of dwindling funds maybe the NZAF needs to concentrate on prevention, keeping their testing facilities and allowing the peer groups to actually do the support." Taylor and others believe the habit of the Ministry of Health of spending its HIV support budget at the NZAF's 'One Stop Shop' places restrictions on the other organisations and gives the NZAF too much power and influence which disadvantages the needs of people living with the virus. "While the NZAF remains fixed to this idea that they are providing support to positive people, outside of a bit of counselling here and there, the other organisations are not really able to apply to the Ministry of Health and other sources for support funds - and positive people loose out," Taylor says. This unease has been muttered about in HIV circles for some time but Taylor says he is only now a convert to the view that the provision of government-funded HIV services should not be left solely with the NZAF and those contractors or organisations it chooses and therefore controls. "Unfortunately in years past other positive people saw this conflict... and I did not fully support their initiatives at the time," says Taylor. "I was wrong and I hope that the NZAF can move into the 21st century and make the necessary changes to the organisational structure that is required to free up the way for others to provide much needed, ongoing support to all positive people wherever they are in NZ. DRAWING THE LINE For its part the NZAF points out that it provides "a national professional counselling and psychotherapy service for people newly diagnosed with HIV." In the context of its vital prevention work the Foundation works to help those it diagnoses as HIV positive deal with the issues surrounding the diagnosis and to move on with their lives without spreading the virus to others. But, how or where to draw the line between the support associated with an HIV positive diagnosis and the ongoing needs of HIV positive people is an issue for the NZAF. "It's very difficult to say that certain services are for newly diagnosed people and that other services are not," says Le Mesurier. "For example, a person who has been living with HIV for a very long time but may come to the Burnett Centre with his new boyfriend, who is HIV negative, because his boyfriend has a strong aversion to using condoms for anal sex." The same situation could occur for a person who is newly diagnosed, she says, "or one who has been living with HIV for a medium length of time." And there's the issue of geographical spread and physical accessibility. Currently there are HIV peer support organisations located in Central Auckland, Hamilton, Gisborne, Wellington and a small informal grouping in Christchurch. By contrast, the NZAF has bases in Auckland, Wellington and Christchurch with trained contractors available in Dunedin, Greymouth, Palmerston North, Wanganui, Napier, Rotorua, Tauranga and Whangarei. "There are many people living with HIV who are not connected with HIV peer support organisations either by choice or circumstance - such as living in an isolated area or speaking English as a second language - who may choose to use NZAF Positive Health Services." "A person newly-diagnosed with HIV may go to NZAF South/Te Toka because he has started a new job and would like to know what his rights and obligations are," pojnts out Le Mesurier. "However, a person who has been living with HIV for ten years may go to the NZAF Awhina Centre also wanting to know what his rights and obligations for employment are because he is moving to a new job after a long time at his previous place of employment. Still other people may access NZAF Positive Health Services when they are newly diagnosed and then check in from time to time as issues arise for them." Michael Stevens - researcher This view is reflected by HIV positive health researcher and past-NBZAF Chair, Michael Stevens in his most recent GayNZ.com blog. He went so far as to suggest that for an increasing number of HIV positive gay men in New Zealand peer support groups are becoming irrelevant to the way they deal with their infection and plan their lives. THE DIVIDING LINE For some time an uneasy truce prevailed. "Since the mid 1990s, the NZAF has followed an unwritten agreement with HIV peer support organisations that peer-based support would not be provided by the NZAF," says Le Mesurier. "Nor is the NZAF contracted [by any funding body such as the Ministry] to provide these services. The NZAF will provide staff to support the various hui and retreats for people living with HIV, specific support groups, etc. when asked to do so but does not initiate these events." There was, not surprisingly, a quid pro quo in that unwritten agreement. "In return," according to Le Mesurier, "HIV peer support organisations were to focus on supporting the needs of people living with HIV but not on prevention services such as HIV testing as the majority of those who benefit from these services are HIV negative." Bruce Kilmister - Body Positive Body Positive Auckland recently secured funding to run a rapid HIV test programme in Auckland sex on site venues, an extension of its ongoing testing services based on two sites on Karangahape Road, New Zealand's gayest street. "A small amount of funding was available, we have the testing expertise and if we can identify people with HIV to be able provide ongoing support for them then for us testing is just one way of reaching out to people with HIV,' says BP's Bruce Kilmister. Body Positive Auckland also justifies its testing programme on its location. Its own offices are half a block from Karangahape Road - gay party central - and it operates a more discrete service from the K Rd Clinic amongst the glbt venues right on K Rd. It's an area vacated by the NZAF when it consolidated its Auckland offices and services a couple of kilometers away in College Hill It's worth noting that the NZAF has never had a exclusivity over HIV testing. GPs, sexual health clinics and hospitals throughout the country also provide HIV testing and associated pre- and post-test counselling funded to varying degrees by the Ministry of Health. TENSION OVER TERRITORY But lets return our focus to peer support which has become the first publicly debated aspect of the turf war. While Taylor and Body Positive Auckland argue for more government funding and less NZAF involvement in support services their approach may not be to everyone's taste. "The NZAF has been repeatedly asked to provide HIV peer support groups by those not so enamoured with the current HIV peer support organisations," counters Le Mesurier, "but we have declined as per the agreement." It's worth noting that, by its own Trust Deed which was only recently re-ratified, the NZAF is required by its members to undertake "provision of medical and psychological treatment, counselling, emotional and religious support and the relief of poverty of persons affected by HIV..." and to "wherever possible... understand the special health needs of, and work with sensitivity specific to the special health needs of those living with HIV." Another complication in this positioning for territory is that the Ministry of Health funds the AIDS Foundation through its Public Health funding stream. The NZAF utilises some of this money to provide its positive people's health services on the basis that "a core focus on providing professional care and support services [is] to enable and empower both HIV positive and HIV negative people to maintain safe sex behaviours – even our STI clinics are based on increasing safe sex behaviour and reducing STIs in the ‘most at risk’ populations." By way of comparison, organisations which represent medical problems such as diabetes, cerebral palsy, and Hepatitis C are not Ministry-funded because they focus on providing support and care for individuals. The Ministry's Personal Health funding tends to be channeled to GPs and other clinical services, says the NZAF. So the funding and provision of HIV services in New Zealand has become subject to a turf war due to the complex and various philosophical approaches to prevention, testing, counselling, on-going support and advocacy. "We recognise that there is a lot of tension at present, as there has been in patches in our 25-year history," says the Le Mesurier. "The NZAF is committed to staying engaged with HIV peer support organisations. What is key for all of us is focusing on the needs of all people living with HIV." Of course, in the background to all this is the unsettling fact that, with a radically lowered death rate and increasing availability of sophisticated drug regimes, there are now more people than ever before living with the virus and most of them are gay and bi men. Jay Bennie - 26th April 2010