Review of services for people living with HIV in New Zealand

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Overall, then, given the reported ubiquity of stigma as a public health issue associated with HIV, itwould seem a useful exercise to explore its parameters and the means of its maintenance in HIVmanagement. A national conversation on stigma in health would enable a broad understanding ofwhat it is, how it works and how it can be addressed. An action agenda can then be initiated tosystematically take evidence‐based experimental approaches with populations concerned. Unlessstigma is addressed in a mature manner in the management of HIV, diagnostic, preventive, treatmentand care initiatives and interventions will always be playing ‘catch‐up’ as stigma effects aresubsequently revealed.In the course of this review, many comments were made regarding challenges for HIV prevention.This review was not asked to examine or assess the nature of HIV prevention services or activities inNew Zealand, in terms of sexual, drug injecting or other potential risk behaviour. Nevertheless,because HIV prevention is inevitably linked to HIV care and support, and to stigma, education,gender, ethnicity, service provision and the Ottawa charter; because prevention was continuouslyraised in the context of this review; and because the contexts and outcomes of HIV preventionappear to be continually evolving, it would seem reasonable to consider a review of HIV preventionservices in New Zealand in the future.Although established research groups provide regular compilations of statistics and analysis relatingto both HIV/AIDS and STIs (e.g., AEG, ESR, NZAF), New Zealand has no coordinated or comprehensiveresearch agenda linked to HIV/AIDS or STIs. This means that there is a continual and pressingabsence of data for policy and programme refinement, for example in relation to the almost mythicissue of the impact of stigma on HIV service engagement, or in relation to geographical anddemographic differences in the availability, structure and effect of HIV services in New Zealand.Development of such an agenda with Ministry of Health backing would strengthen service deliveryand the evidence base for service development. In addition, as part of the development of a nationalresearch agenda, a framework for external quality audits of PLHA services is needed – for both DHBand NGO PLHA services. Reviews of the quality of service processes and impacts are well overdue. Itwould seem timely to consider external standards as a foundation for the next generation of PLHAservice delivery.42 REVIEW OF SERVICES FOR PLHA
CONCLUSIONSFrom the foregoing, some conclusions recommend themselves as a natural outcome of this briefreview.First, the Ministry of Health HIV/AIDS Action Plan (2003) is out of date and needs revision. Theoperational content of the plan needs to be strengthened and the activities it covers need greaterdefinition, to enable greater specificity in benchmarking of performance against objectives.In addition to this is the need for an action plan linked to the Sexual and Reproductive HealthStrategy. Given the obvious and often‐remarked link between STIs and HIV transmission, and theconcerning increases in STI rates around the country, development of such a plan is a necessarycomponent in terms of future HIV prevention and management. It would also provide an excellentopportunity for a coordinated process of reflection on prevention approaches and how they can besupported in this new decade, as a counter to the apparent behavioural complacency linked tocommunity perception of HIV treatment successes.Second, there is currently no coordinated strategy in place for research for policy and programmerefinement in HIV/AIDS in New Zealand – this means that any research undertaken is opportunisticand incidental. The development of a national agenda for operational research for policy andprogrammatic strengthening should be a priority. Furthermore, evaluation of service delivery qualityis absent across sectors. A framework for external audits is needed as a complement to existingfinancial and governance auditing mechanisms and self‐report measures, and should be developed aspart of a broader research agenda for HIV in New Zealand.Third, repeatedly expressed concerns over levels of mental health coverage for outpatient PLHAhighlight the need to establish benchmarks in this area linked to ID and SH services in particular, andto explore and identify options for increasing access to quality MH services and personnel amongPLHA.PLHA (particularly those with young families) often cited cost as an obstacle to accessing primary careservices for many PLHA. In this regard, a review of primary care fee costs for PLHA is advisable. Areview could have a significant effect on resources within outpatient ID and SH services for PLHA,since many PLHA currently use such services as a proxy for expensive primary care services. PLHAalso made adverse comments about the quality of some primary care services: it is timely to reviewthe reach and depth of core primary care staff training in HIV.There are significant variations in HIV testing processes within and across sectors in New Zealand.Although New Zealand has its own national protocols for HIV T&C, these are not well known (at leastto the majority of participants in this review). New Zealand is also a national participant indevelopment and ratification of the standards and rights‐based guidance published by WHO andUNAIDS. WHO and the Regional Office for the Western Pacific published updated guidance on HIVT&C last year, but the existence and content of this guidance was unknown to the majority of thoseinterviewed for this review. A national discussion on standards in HIV T&C appears necessary. Such adiscussion could also cover necessary training in administration of tests, protocols for pre‐ and posttestcounselling and service backup, and compatibility with established national and internationalbenchmarks for HIV T&C.REVIEW OF SERVICES FOR PLHA 43
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 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: It is evident that stigma is the el
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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