Review of services for people living with HIV in New Zealand

More documents

Recommendations

Info

clinics are men). It is a specialist service for addressing these issues, offering a viable alternative toDHB primary care services. HIV is integrated into all aspects of FP’s work, for example by theprovision of HIV testing in clinics, as well as in the organisation’s education, health promotion,advocacy and professional development work. Emphasis is given to sexual and reproductive healthrights, and empowerment of women and girls in relation to these, including through HIV education.60 percent of FP’s health promotion activities target young people – through direct campaigns inschools, youth groups and outreach events, together with consultancy work in schools and theprovision of professional training, for example of teachers. FP’s adult health promotion oftenengages parents, making significant use of media, events and expos. FP has recently applied toprovide medical TOP services.Nationally, FP has 33 clinics, with 280 staff, 22 of whom are full‐time health promoters. 80 percent ofFP funding ($12–13 million) is from Government – approximately two‐thirds is for clinical work, andone‐third for health promotion. FP charges a co‐payment for some service‐users – services are freefor those under 22 years, $5 for Community Services Card holders and $22.50 for all others.Although FP offers diagnostic HIV testing as part of general STI screening in its clinics (and isparticipating in a pilot project on antenatal HIV screening in Hamilton), and promotes and distributescondoms as part of its general sexual health programme, it does not provide clinical care for PLHA;nor does it use rapid tests for HIV. When blood samples are taken for ‘conventional’ STI screening,clients are asked if they want to be tested for HIV also (the ‘opt‐in’ model); if they do, they are sent tohave their blood taken at the local laboratory. Occasionally, FP clinicians may refer a person to thelocal DHB SH service for T&C, though this is not the normal practice. Where people are found to haveHIV infection, they are referred to the local hospital ID department for clinical follow‐up.During 2008–2009, FP recorded 180,000 client visits to its clinics, 95 percent of which were byfemales. Approximately 50 percent of those attending were under 22 years, and the most commonlycited reason for attendance was ‘contraception’; STI testing/treatment was the second most‐citedreason, accounting for 17.4 percent of visits (see Figure 2). In the same period, FP reported 60,000health promotion contacts. According to FP data, ‘Maori make up around 14 per cent of our totalclient numbers, Pacific Island people 5 per cent, and Asian people around 5.6 per cent.’ The rest selfidentifiedas European. FP uses the Office of Ethnic Affairs’ Language Line translation service to assistclients who speak English as a second language: telephone translators protect client confidentiality(Family Planning 2009, p. 7). Given the pressure on services, clinic visits are much like those ofprimary medical care services – 10‐minute encounters are the norm.In discussing current gaps in services for PLHA in New Zealand, FP acknowledged that beyond thescope of services it provides, it could refer clients to further treatment and support services (albeitwith limitations in some geographical areas). However, it expressed a clinically based concern aboutthe lack of targeted and effective prevention for migrant communities, and for MSM.28 REVIEW OF SERVICES FOR PLHA
Figure 2: Reasons for FP clinic attendance 2008–2009C. POSITIVE WOMEN INC (www.positivewomen.co.nz)Positive Women Inc (PW) is a community service for women and families living with HIV. It started in1990, when a group of five women felt the need to assert a specifically female HIV identity ratherthan being subsumed under the umbrella of Body Positive, which, at the time, had a particularly gaymale identity. Initially, it began as a series of peer‐support unstructured coffee mornings, beforeeventually becoming an incorporated society in 2000. Currently, PW works with 140 HIV positivewomen, in addition to providing support to the children and families of women with HIV. Itacknowledges that there is some membership overlap with Body Positive, and to a lesser extent withthe NZAF, but it sees this as providing advantages from a service‐users’ perspective: ‘We alwaysrecommend members to go to NZAF outside Auckland.’ On the other hand, it is acknowledged thatthe relatively small number of PW’s service users means they tend to struggle to obtain centralfunding support.PW’s aim is to provide support for women and families living with HIV, and ‘to identify ways toempower women to go forward’. In fulfilling its mission, it has one full‐time staff member, and isengaged in the following activities: support – psychosocial and informational, practical, accompanying, social work an annual women’s retreat a biannual family retreat a regular newsletter a 24‐hour 0800 number for information and advice a one‐on‐one support service –PW did not call this service ‘counselling’, but in a similar fashion tocounselling it offers practical counsel and solidarity for women facing HIV‐related concerns.In effect, PW offers a broad range of individual and community support. The retreats were describedby service‐users as ‘a huge thing’ in the way that they enabled women with HIV to obtain immediateadvice, mentoring, support and acceptance in an atmosphere of normalcy and confidentiality.Women interviewed saw this as especially significant because, in the context of a national epidemicwith an overwhelmingly gay male face, ‘Being a minority in a country of low prevalence is veryisolating.’ The downside of PW’s operation as a small NGO with a national identity is that it can veryquickly become consumed with day‐to‐day issues: capacity for crisis management or administrativeresponse may become strained very quickly.REVIEW OF SERVICES FOR PLHA 29
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 and 12: The available data show that in the
Page 13 and 14: Family Planning is a not‐for‐pr
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: As indicated above, there is a stro
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 -

Review of services for people living with HIV in New Zealand

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?