Review of services for people living with HIV in New Zealand

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(FP) clinics, student and youth health clinics and laboratories. Improvements to the reporting oflaboratory surveillance data were made in 2009, enabling comprehensive regional and nationalpopulation estimates of STI incidence. The Institute of Environmental Science and Research (ESR)produces an Annual Surveillance Report (which quotes the AEG data on HIV/AIDS). Chlamydia wasthe most commonly reported STI in 2009. From 2005 to 2009, SHCs reported an increase in thenumber of cases and clinic visit rate of chlamydia (from 3.3 to 7.1 percent). These trends weresupported by laboratory data, which reported an 11.3 percent increase in the chlamydia restrictednational rate (based on nine DHBs) between 2006 and 2009. In SHCs, over 50 percent of cases werefrom non‐European ethnic groups (Māori, Pacific Peoples and Other).From 2005 to 2009, SHCs also reported an increase in the number of cases and clinic visit rate forgonorrhoea (from 17.5 to 21.7 percent). These trends were not reflected by laboratory data, whichreported a 22.0 percent decrease in the gonorrhoea restricted national rate (based on 10 DHBs)between 2006 and 2009. A national gonorrhoea rate (based on 18 DHBs) of 66 per 100,000population was reported from laboratory surveillance data. Over 60 percent of cases reported bySHCs and laboratories were in people aged less than 25 years.Syphilis statistics appear alarming, although case numbers are relatively low. Between 2008 and2009, the number of cases of syphilis reported by SHCs increased by 50.0 percent (from 92 to 138cases). SHCs reported higher numbers for individuals aged over 40 years and those of Europeanethnicity (44.9 percent and 55.8 percent respectively). Over the last five years the number of casesreported by SHCs has increased by 193.7 percent. These figures point to the need for a continualstrengthening of sexual health surveillance, not least because syphilis, for example, is mainlyoccurring in MSM and being transmitted within New Zealand: the links between ulcerative genitalconditions and HIV transmission are well accepted.As stated in the recent New Zealand UNGASS Country Progress Report (Ministry of Health 2010), theOttawa Charter for Health Promotion has formed the basis for operationalising approaches to HIVhealth promotion in this country, ensuring that responses are led by communities most at risk.Accordingly: ...the New Zealand AIDS Foundation (NZAF) delivers HIV prevention programmes that target themost at risk populations – MSM (predominately New Zealanders) and heterosexual Africanmigrants in New Zealand. It also provides community based HIV rapid testing services, sexualhealth clinics for men and care and support services for anyone affected by HIV. NZAF leads onnational advocacy and Pacific Region partnerships (including an NZAF International DevelopmentUnit), policy advice and coordination of the National HIV and AIDS Forum. Within the NZAF’sprevention programmes is a specific social marketing team that uses new technologies and socialnetworking sites to build a pro‐condom social movement. Community Engagement programmesthat work with community volunteers include work stream teams led by gay non‐Māori, gay andfa’afafine Pacific People and African heterosexual migrants to New Zealand.Peer support organisations (Body Positive Inc, the Māori, Indigenous & South Pacific HIV/AIDSFoundation (known as INA), Positive Women Inc, Absolutely Positively Positive) provide supportand advocacy for people living with HIV and AIDS (and their families). Body Positive Inc alsoprovides rapid HIV testing and other clinical services. Positive Women Inc promotes awareness ofHIV and AIDS in the community through educational programmes with a focus on prevention andde‐stigmatisation. INA organised an HIV positive Māori, Indigenous and Pasifika Conference, heldfrom 28 January to 1 February 2009 where participants were encouraged to discuss the impact ofHIV and AIDS on Māori, Indigenous and Pasifika people. Despite presently not receiving anyfinancial assistance from Government, these organisations are involved in HIV awareness, selfesteem development, and challenging stigma and discrimination at a number of levels.4 REVIEW OF SERVICES FOR PLHA
Family Planning is a not‐for‐profit organisation which provides quality sexual and reproductivehealth services for all New Zealanders. Family Planning seeks to expand access and reduce thebarriers to achieving improved sexual and reproductive health and reproductive rights. There are30 clinics with 180,000 visits per annum, nationally. HIV is integrated into all areas of healthpromotion, education, clinical and professional development work. Family Planning acts as astrong advocate and lobby group for the empowerment of women and girls, particularly withrespect to sexual and reproductive health issues such as HIV.Other programmes and clinical services are delivered via District Health Boards, in sexual healthclinics and sexual health promotion services. The services offer free, confidential, specialist sexualhealth care services including diagnosis and treatment of sexually transmitted infections,telephone information and advice, testing and treatment of HIV/AIDS, sexual health counsellingand free condoms. District Health Boards also fund Primary Care Organisations which are a firstpoint of contact for people with sexual health concerns and offer testing and treatment ofcommon STIs.There is access to a range of sites for HIV testing. The greatest proportion of people diagnosedwith HIV infection is in primary care (pp. 4–5).This report goes on to state:Testing, treatment and care are provided in a number of health settings, including generalpractice, sexual health centres, community based centres, specialist units based in majorhospitals, and hospices. Patient centred integrated care is a particular feature of HIV and AIDSservices, for example, enabling patients to care for themselves at home (p. 5).Data from the extensive survey of PLHA in New Zealand HIV Futures New Zealand 2 (Grierson et al2008) indicates good use of available services by PLHA. For HIV‐specific treatment, most respondentsto this survey (80 percent; n=209) went to HIV specialists as their primary provider; 7 percent sawsexual health centre physicians for this purpose. For general health care, 52 percent saw primarycare staff, 21 percent saw primary care staff with a high HIV caseload and 18 percent saw an HIVspecialist at an outpatient clinic. In the six months prior to the survey, 79 percent had seen an HIVspecialist in an outpatient clinic, 56 percent had seen a primary care physician, 22 percent had seen adentist and 20 percent had seen a primary care physician with a high HIV caseload. NGO services alsoprovided vital services for PLHA responding to the survey – 34 percent had received treatment advicefrom an NGO, 31 percent had received counselling, 20 percent had received social contact and peersupport, 12 percent had received complementary therapies and 15 percent had received treatmentinformation. The Futures 2 survey showed that a little less than two‐thirds (62 percent) of thosesurveyed had some contact with HIV/AIDS organisations, the majority receiving a newsletter or someof the services they provided.Against this background, the author of the present document was competitively selected toundertake a review of selected services for people with HIV infection, with the expressed aim ofidentifying possible gaps in services and areas for potential future investment. The Ministry of Healthspecified services to be included in the review, although the discussions against which informationwas received and analyses undertaken included other organisations’ representatives as well. Thereview was commissioned by the Public Health Group of the Health and Disability National ServicesDirectorate of the Ministry of Health (the Terms of Reference are in Appendix 1).Structure of this reportThe Introduction to this review has presented its background. Subsequent sections describe thereview’s methodology and the results of the review process: first the results of discussions with DHBstaff in the main centres, and then the results of discussions with the NGOs recommended asREVIEW OF SERVICES FOR PLHA 5
Page 1 and 2: REVIEW OF SERVICES FORPEOPLE LIVING
Page 3 and 4: ACRONYMSAEGAMTACANCAPPARVBPCBOCSWDH
Page 5 and 6: CONTENTSACRONYMSACKNOWLEDGEMENTSEXE
Page 7 and 8: EXECUTIVE SUMMARYThis review has id
Page 9 and 10: INTRODUCTIONThe national clinical a
Page 11: The available data show that in the
Page 15 and 16: METHODOLOGYThis review effectively
Page 17 and 18: * This does not include all DHB ser
Page 19 and 20: an adult sexual assault unit - SH r
Page 21 and 22: B. WAIKATO DISTRICT HEALTH BOARD (w
Page 23 and 24: perceived as formally (if implicitl
Page 25 and 26: The discussions in Wellington also
Page 27 and 28: informally arranged with SH colleag
Page 29 and 30: Ongoing close collaboration between
Page 31 and 32: The NZAF is the only national NGO r
Page 33 and 34: Auckland - Burnett CentreAuckland h
Page 35 and 36: As indicated above, there is a stro
Page 37 and 38: Figure 2: Reasons for FP clinic att
Page 39 and 40: As part of this review a focus grou
Page 41 and 42: Christmas dinner serving 100 or mor
Page 43 and 44: Despite INA’s development constra
Page 45 and 46: Difficulties in maintaining quality
Page 47 and 48: 6. The need for consistent targeted
Page 49 and 50: It is evident that stigma is the el
Page 51 and 52: CONCLUSIONSFrom the foregoing, some
Page 53 and 54: APPENDIX 1: TERMS OF REFERENCEREVIE
Page 55 and 56: Modes and frequency of communicatio
Page 57 and 58: LOCATION NAME ORGANISATIONHamiltonT
Page 59 and 60: Institute of Environmental Science
Page 61 and 62: APPENDIX 5: HIV NGO WEBSITE DATAOrg
Page 63 and 64:
InquiryResponseResearch, analysis,
Page 65 and 66:
InquiryResponseFrequency and regula
Page 67 and 68:
Inquiry5. By what criteria are need
Page 69 and 70:
Inquiry9. How is impact,effectivene
Page 71 and 72:
B. BODY POSITIVE INC.Inquiry1. Is t
Page 73 and 74:
C. INA FOUNDATION CHARITABLE TRUSTI
Page 75 and 76:
Inquiry6. What makes the service ef
Page 77 and 78:
Inquiry9. How is impact, effectiven
Page 79 and 80:
InquiryResponse2. Personal knowledg
Page 81 and 82:
InquiryResponseMF is 26 and has ove
Page 83 and 84:
InquiryResponse7. What obstacles -
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Review of services for people living with HIV in New Zealand

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