Review of services for people living with HIV in New Zealand

EXECUTIVE SUMMARYThis review has identified that services for people living with HIV/AIDS (PLHA) in New Zealand arereaching and being appreciated by those for whom they are designed. PLHA in New Zealandcontacted and interviewed in this review spoke unanimously and extremely enthusiastically aboutthe quality of care they receive from District Health Board (DHB) services providing HIV‐relateddiagnostic, treatment and support services. There appears to be excellent collaboration and peersupport between physicians providing diagnostic and treatment services for PLHA in New Zealandand moreover, close and fruitful collaborations between departments of infectious diseases andsexual health services in each of the DHBs reviewed.Additionally, there was overwhelming appreciation for the community‐based NGO support servicesbeing provided for PLHA in the main centres where such services exist.In addressing current service provision for PLHA in New Zealand, we might usefully ask whether it isboth necessary and sufficient to fully address the needs of PLHA. The general answer appears to be:Necessary, yes; sufficient, not yet.In terms of community‐based support services, Auckland is something of a city‐state – three of themajor HIV support NGOs are there; two have no physical infrastructure outside Auckland beyondtelephone and internet links. NGO groups and PLHA outside that city expressed significantdisenchantment with the weighting of support services in Auckland, despite recognition of theepidemiological basis for it.A main and consistently cited gap in service provision for PLHA identified by DHB and NGO staff andservice users relates to mental health (MH) coverage, particularly for those with longer‐termpsychiatric and psychological issues. A review of benchmarks for minimum MH service coverage ininfectious diseases (ID) and sexual health (SH) services would be timely, as would an exploration ofpotential alternatives for MH service access for PLHA outpatients with chronic conditions, includingdual 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 health care services, as a way of receiving free treatment.A national review of guidelines and standards for HIV testing and counselling (T&C) appears to benecessary, in the light of developments in HIV testing technology and the recent availability of testingoutside of routine clinical settings. The newly defined standards would need to be initiated in allsettings without diminishing the efficacy of current efforts. This review could include standards as tothe degree of training and competency necessary prior to administering and interpreting HIV tests,the level of pre‐ and post‐test counselling and service backup required wherever rapid testing isprovided, and compatibility with established national and international benchmarks for HIV T&C.Stigma was repeatedly mentioned as a major issue in the context of HIV in New Zealand. It is evidentthat stigma is the elephant in the waiting room of HIV public health responses – often invoked as thecause of sub‐optimal population responses to prevention and support activities, yet hard to quantifyor isolate by region or population. Operationally, it is of major concern particularly among bothAfrican and Māori communities. Given the reported ubiquity of stigma as a public health issueassociated with HIV, it would seem a useful exercise to explore its parameters and the means of itsmaintenance in HIV management. A national conversation on stigma in health would enable a broadunderstanding of what it is, how it works and how it can be addressed. An action agenda can then beREVIEW OF SERVICES FOR PLHAvii