Review of services for people living with HIV in New Zealand

perceived as formally (if implicitly) acknowledging a link between HIV and STIs and what might bethought of as ‘shameful behaviour’. Concerns were also reported about disclosing HIV vulnerabilityto persons who are from the same small community. It was suggested that such perceptions wouldact as an obstacle to engagement with HIV testing in that population.The question of how to engage African populations is especially challenging. It was reported that,among both Māori and African populations in Waikato, stigma is a pressing obstacle to serviceengagement. On a practical level, creative and service‐user‐acceptable solutions have been found insome areas, for example the use of Language Line in anonymous translation for African service users.SH services’ considerable emphasis on contact tracing, and testing, and routine ANC testing has beeninstitutionalised in WDHB. SH sees a narrow spectrum of heterosexuals – ANC sees a much widerspectrum.When individuals are identified as being infected with HIV, Waikato DHB staff may speak to apatient’s significant others and family members (with client consent). Waikato DHB described its useof ‘highly effective behavioural education’ focussed around HIV positive people, and its willingness toextend such activities anywhere they were needed – for example prisons, rest homes (where majorSTI outbreaks have been reported) and employers.Data for evidence‐based programming is wanting in a number of areas – for example, there is a lackof good data on condom use among the broad population. (Although there has been some researchcarried out: one school‐based study by the Adolescent Health Research Group (2008) found that,among adolescents, 64 percent used a condom the last time they had sexual intercourse.)In terms of recommendations for future investment, Waikato SH staff appreciatively emphasised thatthe Ministry of Health has been responsive to clinicians’ requests over the years, for example in theprovision of nevirapine, in addressing the issue of Zimbabwean refugees not being routinely testedand in the formation of the AIDS Medical and Technical Advisory Committee (AMTAC). The latter wasseen as a needed forum and a useful pathway for addressing issues.Waikato staff requested that acknowledgement be given to the fact that many community‐basedorganisations (CBOs) do not fit comfortably within business models. This observation wasparticularly made in reference to the closure of the NZAF office in Hamilton, which is still keenly feltin WDHB.Waikato’s wish‐list for future development included a perceived urgent need for enhanced training oftrainers, to ensure the adequacy of interventions in sexual health education (Education Review Office2007).Six children in Hamilton are infected with HIV, and they receive care from Auckland because there areno paediatricians with HIV expertise in Hamilton. Commenting on this, one interviewee noted:‘When the previous paediatrician left, we realised what it all meant for families – the widerimpact. That’s where [support provided by] NZAF was so important.’Accordingly, locally available paediatric ID specialist services are also on the wish‐list.REVIEW OF SERVICES FOR PLHA 15