Review of services for people living with HIV in New Zealand

DISCUSSIONA review of this nature (and indeed, the terms of reference for this review) inevitably focuses ongaps, rather than successes. Nevertheless, this review has identified that services for PLHA in NewZealand are successfully reaching those for whom they are designed. It is acknowledged that themajority of PLHA services are in Auckland, the region hardest hit by HIV. However, there are gaps inthe administration, monitoring and evaluation of PLHA services in Auckland, as there are elsewhere.One way to address current service provision for PLHA in New Zealand is to ask whether it isnecessary and sufficient to address current needs. The answer, for now, is: Necessary, yes; sufficient,not yet. Aside from the obvious tensions associated with increases in STI rates in many parts of NewZealand, and with the reported current absence of a condom culture in those groups where HIV hashit hardest, this review has raised other issues.Support means different things for different people. For PLHA, life with HIV is a continuum, andsupport needs vary according to the stage they have reached on that continuum. Absence of viralload or symptoms does not necessarily mean an absence of problems. It was evident that somePLHA groups had specific issues that they felt current service structures were unable to meet.One of the main gaps in service provision for PLHA identified by DHB and NGO staff and service usersrelates to mental health coverage, particularly for those with longer‐term psychiatric andpsychological issues. A review of benchmarks for minimum MH service coverage in ID and SHservices would be timely, as would an exploration of potential alternatives for MH service access forPLHA outpatients with chronic conditions, including dual diagnoses and pre‐existing conditions.Additionally, many health workers and NGO staff and service users identified primary care servicefees as a major obstacle to PLHA making use of primary care services for HIV‐related managementnot necessitating specialist secondary or tertiary services. In practice, PLHA are using DHB and NGOservices as a proxy for primary care services, as a way of receiving free treatment. This couldpotentially cause a significant knock‐on effect in clinic waiting times and resources. It would seem asignificant and inexpensive solution to downsize primary health care fees for PLHA and perhaps theirfamilies, particularly those with young children.All findings lead towards the suggestion that a national discussion about national guidelines andstandards for HIV T&C is necessary, in the light of developments in HIV testing technology and therecent availability of testing outside of routine clinical settings. An aim of such a conversation wouldbe to ensure that agreed standards are observed in all settings without diminishing the efficacy andoutcomes of current efforts. Much discussion of rapid testing outside of New Zealand has beencentred on concern over appropriate levels of training and capacity for administering tests, as well aspre‐ and post‐test counselling and psychosocial support. This review could encompass suchstandards, alongside compatibility with established national and international benchmarks for HIVT&C.Stigma was repeatedly mentioned as a major issue in the context of HIV in New Zealand. Stigma canbe the cause of: reluctance to test for HIV among certain populations (including Māori in particular) reluctance of Africans to disclose their HIV status, particularly within their own communities reluctance of MSM to use community‐based NGO services reluctance of PLHA to attend SH services reluctance to access primary care surgeries for HIV testing reluctance to use condoms reluctance to identify as gay or bisexual.40 REVIEW OF SERVICES FOR PLHA