Review of services for people living with HIV in New Zealand

(It is noteworthy that data specific to the Counties Manukau district is not separately reported to orby ESR – only Auckland SH data as a whole is reported.) A recent survey in South Auckland revealedthat many MPI are electing not to have tests for HIV or other STIs (McAllister et al 2008).While SH services participating in the review from other regions noted as a continual obstacle toprevention the unquantified though reportedly significant population of MSM who do not selfidentifyas gay or bisexual, this is reportedly much less of a problem in Auckland. However, peergroupcoherence does not appear to necessarily correlate to behavioural prevention: One physicianin ADHB noted that:Of those who are aware [of HIV as a risk], many are more blasé. Traditional approaches toprevention aren’t working. There is a sense that the amount of risk [behaviour] is going up.It should be noted that HIV is now a chronic disease, rather than the ‘death sentence’ it once was,thanks to extraordinary developments in highly active anti‐retroviral therapy (HAART). This may becontributing towards ‘blasé’ attitudes, along with a further potential spanner in the spokes ofprevention: the availability of non‐occupational post‐exposure prophylaxis (nPEP). In somecountries, this has come to be perceived by some as a ‘morning‐after pill’ following high‐risk sexualepisodes. At the time of this review, the issue of having nPEP funded by Pharmac (with tighteligibility criteria was under discussion. nPEP carries significant costs – expected to be about $1500for a full course.SH identified the following issues in current service provision:the need for greatly strengthened STI surveillance nationally – data is only collected voluntarily byspecific clinical sites at present, although 40 laboratories report on chlamydia and 35 report ongonorrhoea nationally (importantly, there is no laboratory data collection on syphilis)the lack of sexual health behavioural data – the available MSM data comes from NZAF only. SHare currently making a submission to be included in the national health survey, so regularinformation can be collected to inform future control strategies for STIs and HIV.Future investmentCatchments of concern in many developed and developing countries, such as injecting drug users andprisoners, only rarely came up in discussion during the course of this brief review. With respect tothe former, SH and ID services reported little active interaction with methadone programmes andother drug treatment services (reflecting the current epidemiology showing a low rate of HIVinfection in the IDU population). Prisons were described as ‘an unknown area’, although somepatients do come from this context, having reportedly acquired HIV through tattoos, for example.Unfortunately, the review did not have the opportunity to discuss aspects of HIV service need withADHB IDU services.As in other DHBs, liaison psychiatry coverage was seen to be an issue in ADHB. Despite close liaisonwith the ID team, psychiatrists and mental health colleagues were perceived as working in verydefined catchments, making acute engagement or referral more trouble than it is worth in terms ofclinical requirement. SH cannot access liaison psychiatry because SH is an outpatient‐only service; SHphysicians therefore sometimes find themselves clinically managing mood disorders in HIVoutpatients. SH noted that they prefer to enable referrals through primary care services, or liaisewith community psychiatric services.12 REVIEW OF SERVICES FOR PLHA