Review of services for people living with HIV in New Zealand

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supporting engagement with appropriate health and social services. BP reported identifying as manyPLHA ‘on‐site’ as NZAF has done nationally. It sees its accompanying/facilitative role for those foundto be HIV positive through its own channels to be a crucial one – indeed, the spectrum of supportservices BP offers directly matches the needs that PLHA themselves express.BP is a national service, but has a physical base only in Auckland. Its main national initiatives are thedissemination of information, the annual HIV+ Men’s Retreat, the HIV Treatment Update (a dayseminar) and its national 0800 helpline. There were no funds available for the establishment ofbranches elsewhere in New Zealand at the time of this review.As a relatively small NGO with a very limited budget, BP reports being ‘consumed with individualissues – it is difficult to take a step back to policy level’. Lack of resources impacts social work andcounselling in particular.All BP’s activities and services are subject to internal evaluation and, in the case of the social workercurrently employed, external professional supervision. Counsellors’ protocols are peer‐reviewedannually. All clinics and events offer evaluation forms.GapsBP expressed the need for renewed support for the following:1. outreach clinics for sex workers, immigration overstayers, Māori and others with HIV who willnot engage with ID or SH, for whatever reason2. treatment and funding support for treatment of lipodystrophy using Aquamid – BP report 200of its members who need treatment (78 have been treated to date).E. INA HIV/AIDS FOUNDATION CHARITABLE TRUST (www.ina.maori.nz)INA was incorporated as a charitable trust in 2008, as a reaction to what the organisers saw as an lackof engagement of the NZAF with Māori men and women affected by HIV/AIDS. Based in Tirau, INAoutlines its purpose in this way (INA 2009):... to improve the quality of life for people living with HIV/AIDS Māori, indigenous and SouthPacific and the quality of information about HIV/AIDS to the Māori, indigenous and SouthPacific communities in Aotearoa. In particular, the [INA] Trust will:1. ... establish programmes and prevention and intervention strategies specific to Māori,indigenous and South Pacific people;2. ... establish effective support services for Māori, indigenous and South Pacific people livingwith HIV/AIDS, with culturally specific, culturally designed and sensitive programmes/projects.INA is still in its development phase. There is one staff member paid on a part‐time basis (but inpractical terms working full‐time) and a board that meets twice annually (and more frequentlythrough Skype and the telephone). Experienced colleagues, volunteers and board members makethemselves available when required by service‐users. INA’s capacity to develop has been dictated byavailable public funding and donations – lack of funding for national development remains its mainoperational obstacle. To date, INA has secured three grants totalling $75,000 to fund its first years ofoperations, and has recently developed strategic performance indicators and operational documents(including a comprehensive business plan).34 REVIEW OF SERVICES FOR PLHA
Despite INA’s development constraints, it has already established a national presence, obtaining aplace at the table at national forums and representation at national and international meetings. In its2008–2009 Annual Report, INA reports having participated in the following consultation groups andconferences: Indigenous HIV/AIDS pre‐Conference 2006 International AIDS Conference 2006 Indigenous HIV/AIDS pre‐Conference 2008 International AIDS Conference 2008International Indigenous HIV/AIDS Working GroupInternational Indigenous HIV/AIDS dialogue advisory group to UNAIDS and Health CanadaInternational Collaborative Indigenous Health Research Partnership advisory group Ngā Pae o teMāramatangaPacific Alliance of NGOs and AIDS AmbassadorsHealthcare AotearoaNational HIV/AIDS ForumBehavioural Blood Donor Reviewvarious research projects.The Foundation has also been on the advisory committee of the NGO committee on the InternationalDecade of the World’s Indigenous Peoples.INA hosted a training conference in 2009 – the first HIV Positive Māori, Indigenous and PasifikaConference, which attracted 30 PLHA and whānau – and reported delivering HIV awareness wānangato over 2000 whānau, hapū and iwi on 15 marae in the North Island in 2008–2009. It reports training19 Māori PLHA as volunteers and providing support for over 80 PLHA and their whānau over thesame time period. INA has worked to raise awareness through participation in documentaries,television and radio interviews and magazine and newspaper publications.A core tenet of INA is its aim to change the prevention and support focus from ‘those at risk’ to ‘thecommunity’. In particular, it notes (INA 2009):... the trend [in demographics of HIV/AIDS] is leaning towards a disproportionally higher rateof [HIV] infection [among indigenous populations than among] non‐Indigenous people. Thesocio‐economic cultural factors place these populations at increased risk of HIV/AIDS infection.Accordingly, INA asserts the need for Māori and Pacific Island (MPI)‐focussed services which MPI willrelate to and attend, for MPI‐focussed literature and, in particular, for a sustained approach to MPIthat is whānau‐based. The contention of INA is that as long as services are perceived as being ‘gay’,‘white’ and ‘in Auckland’, most MPI will remain un‐engaged. With STI rates among MPI currentlycausing serious concern, and with ‘stigma keeping Māori away from health services’, the INA assertsthat the need for developing specific approaches for MPI is stronger than ever.One key issue when considering the relevance and impact of various HIV services in New Zealand iswhether a ‘by Māori for Māori’ approach to HIV will yield greater results than the status quo ofdeterminedly bi‐cultural services staffed with essentially non‐Māori‐speaking staff.INA state that NZAF and other community‐based services ‘do not engage gay/bisexual Māori menand women, because the outreach and education programmes employed are not based on whanau’.The INA approach is a focus on Māori‐speaking kaumātua. Emphasising the purpose of whakapapaprotection from HIV and STIs, they assert, will foster whānau/community solidarity (including theREVIEW OF SERVICES FOR PLHA 35
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 and 36: As indicated above, there is a stro
Page 37 and 38: Figure 2: Reasons for FP clinic att
Page 39 and 40: As part of this review a focus grou
Page 41: Christmas dinner serving 100 or mor
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

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