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The enormity of AIDS

Sun 3 Aug 2003 In: HIV

Kevin Hague was a political activist since his student days, but it was the enormity of the AIDS epidemic and an opportunity to help the gay community that brought him to the New Zealand AIDS Foundation, which he leaves on 12 September after five years as Executive Director and a further five years prior to that as a research officer. During that time, New Zealand has been arguably the star performer in the developed world in terms of managing the AIDS epidemic, but Hague says it's still early days. "In the five years I've been here, the epidemic hasn't changed substantially. The biggest single thing that has changed since the late eighties is the introduction of protease inhibitors, which have allowed HIV+ people to live well, get better and go back to work. In the eighties, people were dying every day." But recent times have brought new challenges. Unlike the eighties, people are now aware of the disease and how it is transmitted - yet unsafe sex practices and new HIV infections continue, despite the proliferance of information. Surveys conducted by the Foundation in the late eighties showed that low self-esteem and discrimination that discouraged openness about sexuality (ie. men having sex with other men that didn't identify as "gay", so therefore didn't think the safe sex message applied) have always been contributing factors, but these aren't the only theories. Some people mistakenly believe that the advancement of HIV drugs means that AIDS can be cured, and then there's the younger generation who haven't seen first-hand the effects of the disease through having friends sick and dying. For some it is a case of fatigue - they made a fundamental change to their lifestyle at the start of the epidemic, believing it would only last for a limited time, and are now throwing caution to the wind. During Hague's tenure, the AIDS Foundation has launched a number of campaigns to target each of these attitudes, most of which Hague says have met with positive responses. "Every resource we've put out, I've had people contacting me and saying this is the best thing the AIDS Foundation have done...the "Loved Up" campaign, the Tool Box, the commercial we made that was played at the Out Takes festival..." The Boyfriends and Fuck Buddies campaign? "Some people in the gay community have been scared by the use of term 'fuck buddy'. However, we didn't dream it up. It came from a number of men responding to the Gay Auckland Periodic Sex Survey, so it's a term that clearly means something to a significant number of men who have sex with men." Trying to connect with people on a friendly level whilst always retaining the safe sex and condom use messages has been a big part of all the campaigns. Hague is critical of international campaigns that have used shock tactics. "In the early days of the epidemic, Australia sought to motivate safe sex behaviour through a fear-based Grim Reaper campaign. Evidence suggests that that style of campaigning has a big short term effect but it doesn't last." Other international campaigns have sent out confusing messages about unsafe sex by inventing terms like "negotiated safety", in which two men in a relationship only use condoms for outside sex, and "strategic positioning", which suggests that if you don't want to use condoms you should always be the insertive partner because there is less HIV risk. "It's a very complex message, and you can't niche market something like that. All gay men see these campaigns, and the take-out message is that you don't have to use condoms every time." Unlike other counties, New Zealand has managed to keep the rate of new HIV infections at more or less the same rate, which Hague attributes to the Foundation getting better and better at reducing unsafe sex. There is the potential that New Zealand can lead the world in HIV prevention and research, and there have already been approaches from the United Nations in regard to this. "They were particularly interested in whether we could contribute more internationally, and of course we are, but someone has to pay for that. Anything more we do internationally takes resources away from what we're doing here." There are a number of challenges that Hague believes his successor will face in continuing to manage the epidemic and those living with the disease in New Zealand. "Resistance to the disease is beginning to outstrip our ability to deploy new treatments. Treatment options for people who are newly infected are becoming more limited." And it's not only an issue of resistance - all of the newest HIV treatments are at present too costly to be covered under our public health system, meaning that private health care for HIV patients could become essential. The Foundation has been trying, with limited success, to remedy the situation with Pharmac. "The amount of people living with HIV has trebled in the last decade. That means you will have three times as many people that will have to be helped when that develops into serious illness. That's a scary prospect and that will be heightened if we're not able to change the way that treatments are funded." Despite these warning signs of things to come, Hague says he is not leaving the job because of burnout. "I don't think this job burns people out, particularly. I think we've learnt the lesson of sustainability. Throughout this organisation there are people who have been here a long time, upwards of ten to fifteen years, and I don't think that's the case in many of the organisations overseas. At international conferences I've been to, I don't recognise many of the faces from year to year." Hague will take up a management position with the West Coast District Health Board in September, which will see him move to the rural South Island. "I dont consider that my time on HIV has ended. I expect that at some point in the future I'll be involved with the AIDS Foundation again in some capacity." Chris Banks - 3rd August 2003    

Credit: Chris Banks

First published: Sunday, 3rd August 2003 - 12:00pm

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