Review of services for people living with HIV in New Zealand

dealing with the MSM population, and Family Planning would undertake HIVprevention in the heterosexual world.MSM make up by far the majority of all HIV infections, and most of them happen inAuckland. Which brings us back to the problem of a small population spread over along narrow piece of land. How does one provide a full suite of services to HIV+people in Temuka or Kaitaia? How do you deal with their expectations? Obviously itcan’t be done under current financial constraints, but people resent this, and blameNZAF for not being there for them.Others bemoaned a supposed lack of understanding that appeared to diminish options forservices focusing on their own constituencies: a typical view was that ‘We need much more[practical] support, materials and information for women and for children.’2. A desire for a national PLHA forum, with paid staff coordinating activities for PLHA from allconstituencies: A forum of this nature would support PLHA meeting regionally, among otherinitiatives (possibly including administration of the Wellness Fund, led by and for PLHA). (Theestablishment of such a forum was announced during the preparation of this report.)3. The ubiquity of stigma about HIV: Stigma has wide effects: in society in general, in groupsmost affected and at risk, and in groups of those infected. To provide one example, oneinterviewee commented that: ‘It is very unsafe to say “I’m HIV+” in the gay community – you’llbe ostracised and isolated [here] and outside.’Many others mentioned the judgementalism of the communities they were a part of, makingthe perceived risks of disclosure too great, particularly if they were facing additional issues,such as decisions about their immigration status.A large proportion of discussion about stigma concerned the challenge of disclosing HIV statusto members of one’s own community. African PLHA often said that they would not tell anyfellow Africans their status, and would avoid being seen in any HIV‐related group or services towhich fellow Africans belonged or attended. According to interviewees, the impact offundamentalist religion, the lack of integration of gay Māori within traditional gay frameworks,geographic specificity in prevention and support strategies and the pressure of socialframeworks in small towns all also act as obstacles to overcoming stigma and effectiveengagement in community behavioural change. This prevented many people from regularlyengaging with services they knew would be of benefit. One person commented: ‘I don’t tellanyone [about having HIV] in the rest of my life.’ Another, by way of addressing the public,pleaded ‘Make it okay for us to be visible!’ Interviewees suggested HIV champions, HIV positiveheterosexual characters on television soaps, and television advertisements, among otherideas, as ways of discouraging the association of HIV with MSM and ensuring a broad publicawareness of behavioural risk.4. Praise for the quality of DHB‐provided HIV treatment, care and support services: Commentsincluded ‘brilliant’, ‘very impressed – absolutely fantastic, though administration is not alwaysso good at maintaining appointment times’ and ‘[in DHB services] we feel no stigma at all’.5. Praise and gratitude for NGO support services: PLHA gave free and often emphatic praise toNGO services. In particular, they were enthusiastic about services that were able to addresstheir issues quickly and facilitate ease of access. This appreciation was usually couched in thecontext of recognition that services cannot be ‘all things to all people’, and of the obviousgeographic weighting given to PLHA in Auckland.38 REVIEW OF SERVICES FOR PLHA