Review of services for people living with HIV in New Zealand

Ongoing close collaboration between SH and ID occurs in the form of shared clinical management (forexample, ID sees pregnant women with complications arising from HIV), and the services are linkedthrough a weekly journal club in which HIV patient management is regularly discussed.CDHB staff reported that HIV impacts on the ability of SH services to fulfil their mandate, because ittakes up a significant proportion of staff time and resources. No service stock‐taking has beenundertaken to quantify this (although individual patient audits are a regular feature). In addition topatients’ clinical status being routinely monitored through assessment of clinical indicators and viralload assessments, the Centre also carries out regular patient satisfaction surveys, eliciting patients’views on whether they were seen in a timely fashion, ratings of service quality, recommendationsand feedback, and suggestions for service development. The Centre employs standardised patientdata capture processes (using MedTech).On a clinical level, the added value of providing testing through outreach programmes was reportedlyunclear.The following issues were reported as gaps or obstacles in service provision: dedicated ancillary services, such as psychology and psychometric testing resources – clinics are currently running at maximum operating levels responsiveness to cultural issues – for example for African patients stigma at community level, especially among refugees and recent immigrant populations the physical distance of SH services from other hospital services, including ID.In terms of reaching all available populations, particularly in terms of HIV prevention, testing andfollow‐up, CDHB stressed the importance of focusing on Māori and Pacific Islands populations. Thereis a relative absence of statistical data on SH in these populations, but the importance of engagingthem on sexual health issues is borne out by the recent substantial, dramatic increase in STIs amongthose demographics. The SH Centre has one staff member dedicated to Māori sexual health. Oneclinical question is whether the role is having a beneficial impact, or whether – as is the caseelsewhere – stigma acts as an obstacle to effective implementation. It was reported that presentlythere is no budget or staff dedicated to health promotion in the SH service.The SH Centre identified current and future needs as including:ensuring easier access to condoms – a prescription is currently needed to pay for subsidisedcondoms (144 per person for three months – no free samples are available for health promotion)a budget for health promotionsocial work supporta clinical nurse specialist for hospital and community liaison in case management.E. SUMMARY OF ISSUES EMERGING FROM THE REVIEW OF DHB SERVICES FOR PLHAKey issues emerging from discussions with DHB staff in this review included the following.Stigma in specific populations may be acting as an obstacle to testing for HIV, particularly in someAfrican populations, and also to having populations engage in clinic and even NGO‐based sexualhealth discussion. Interviewees made repeated reference to the crippling effects of stigma inindigenous and immigrant populations, and to the broader argument of how best to engage minoritypopulations (including deciding which service provider is best able to do this). This issue appears todirectly challenge the tenets of the Ottawa Charter, and was raised with such consistency that it mayREVIEW OF SERVICES FOR PLHA 21