Review of services for people living with HIV in New Zealand

B. WAIKATO DISTRICT HEALTH BOARD (www.waikatodhb.govt.nz)Infectious diseasesHIV service provision in Waikato DHB, which covers geographical areas from Turangi to Bombay,including Gisborne and the Bay of Plenty, sees a reportedly seamless collaboration between theInfectious Diseases and Sexual Health services, and other services relevant to HIV management. IDrecorded 360 separate clinical contacts (clinic visits) for the approximately 160 HIV patients undertheir care during the 2009/2010 year. They report less than five inpatient events among the HIVinfectedpopulation in any year, causes for which would be made up of new AIDS diagnoses,treatment side effects and events in which HIV is incidental to presentation (for examplemicrovascular angina or coronary artery events).It was noted that an ID consultant was appointed in Tauranga in 2007 – 45 patients from Waikatotransferred there following that appointment.Waikato DHB moved its HIV services to a chronic disease model in 1996, and worked very closelywith the NZAF office in Hamilton until its closure at the end of 2009. The process of closure of thisoffice was described by Waikato clinicians as having begun five years earlier, when the NZAF soughtto instil more formal working processes than had been the norm in the collaboration with WaikatoDHB services – clinicians said that NZAF centrally did not endorse the flexible, multi‐tasking, multiserviceand multi‐sector Waikato model.This model had meant that patients in WDHB did not have to explain the story of their HIV statusmultiple times, because at the time of diagnosis there were often a number of health care workers(HCWs) from different but closely related services/departments present. There had been a sharing ofroles and responsibilities across departments and even sectors. NZAF were central in this,particularly in providing longer‐term social work or counselling backup for DHB services. For thesereasons, clinicians said that ‘the NZAF removal was a big jolt and shift for us’.In discussion of gaps in current service provision, ID identified:a major gap between knowledge and practice – condom use is down and going down further.Even highly educated and experienced gay men are saying ‘I don’t wear condoms’ – HIV is nolonger a death sentence ...It was also emphasised that the Waikato DHB was presently not adequately resourced to cover theneeds of PLHA in the Waikato. This reported inadequacy rested on there being:no funding recognition that service users have grown in numbers from 10 to 160 since the mid‐1990sno long‐term support of PLHA in the absence of NZAF, in terms of social work, mental health andother services. Counselling services are now under private sector short‐term contracts only, andthose providing counselling had, at the time of the Review, reportedly yet to be orientated to thespecific issues of HIV.Patients now have less frequent contact with clinical services (sometimes as few as once a year ifclinically stable, whereas previously three‐monthly visits were more common). Additionally, manyclients do not access primary health care – so specialist services are taking on this function by proxy.It was alleged that services were not reaching those at risk in terms of HIV and STIs. The need tofocus on links between HIV and STIs (in the provision of information, in discussion with service usersand in service delivery) was emphasised.REVIEW OF SERVICES FOR PLHA 13