Review of services for people living with HIV in New Zealand

traditional whānau acceptance without shame of takatāpui).communication, 21 April 2010):Additionally (M Pala, emailINA believes that the medical care of HIV positive Māori must stay with the current InfectiousDisease Specialist, maintaining confidentiality, health care etc. The whare tapa wha (MasonDurie) approach includes Whānau family, Hinengaro mind/mental, Tinana physical/medicaland Wairua spiritual/sustenance. ID Specialists are key to the tinana physical/medical.Whereas whānau, wairua and hinengaro are not culturally catered for appropriately by non‐Māori service providers. INA can help refer someone to mental/psychological support, andprovide listening support, INA can help with providing information about HIV to whānau, hapūand iwi, as well as support the whānau affected by HIV and INA can help refer and directPLWHA to where best suits their spiritual needs, i.e., tohunga, kaumātua, priest, pastor, rongoamāori ...INA is developing a process called ‘ohu mahi’ – a cellular approach of training satellite educators whowill engage with their targeted constituents nationally. At the time of this review, INA stated thatthey ‘have people ready to go in the South Island, Wellington, Lower Hutt, Porirua, Tauranga, Taupo,Opotiki and Whanganui’. Within the network, HIV and STIs are addressed as a package: the topic ofHIV is brought up as a means of getting ‘a foot in the door’; INA educators then aim to normalise HIVas an issue for discussion by increasing understanding, providing testing and facilitating access totreatment among the constituent community.This approach (which is currently lacking the testing and post‐test components) is being employedwithin gangs, prison populations, and alcohol and drug users. Where necessary, ohumahi includesbringing in health staff from the Pacific Islands. INA wants to work with DHBs in partnership, ‘as anequal partner in facilitating MPI HIV engagement’.F. SUMMARY OF ISSUES EMERGING FROM THE REVIEW OF NON‐GOVERNMENTORGANISATION SERVICES FOR PLHAStigma and the Ottawa CharterHow can NGO services best engage with communities at risk to educate about prevention, whenstigma and fear of disclosure seems so effective in keeping them away? Like DHBs, NGOs reportedoften observing great reluctance to engage with services, even when need was pressing. This issue israised in detail in the conclusions below.Varying approaches to HIV testingIt is interesting that rapid testing for HIV appears to be the province of NGOs in New Zealand (otherthan, occasionally, in ANC). Of course, in most settings, HIV is tested for in the context of broader SHscreening, so a group of test samples is sent to a laboratory for assessment in the same package.Nevertheless, broad DHB/NGO division in the use of HIV test technologies; the differing nature ofinformation and counselling available alongside testing; and the fact that contract counsellors may, inthe future, be administering tests in areas distant from HIV experienced medical or social supportfacilities or personnel all point to the absence of a nationally coherent approach to HIV testingprocesses.The Futures 2 survey of 2008 indicated that of people who had tested positive in the prior two years,only 22 percent had received pre‐test counselling, although 80 percent had received post‐testcounselling – 36 percent from a physician, 26 percent from NGO staff, 17 percent from a counsellorand 7 percent from a nurse.36 REVIEW OF SERVICES FOR PLHA