Review of services for people living with HIV in New Zealand

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initiated to systematically take evidence‐based experimental approaches with populationsconcerned. Unless stigma is addressed in a mature manner in the management of HIV, diagnostic,preventive, treatment and care initiatives and interventions will always be playing ‘catch‐up’ asstigma effects are subsequently revealed.New Zealand has no coordinated or comprehensive research agenda linked to HIV/AIDS or sexuallytransmitted infections (STIs). This means that there is a continual and pressing absence of data forpolicy and programme refinement, for example in relation to the almost mythic issue of the impact ofstigma on HIV service engagement, and in relation to the impact of geography and demographics onthe availability, structure, and functioning of HIV services in New Zealand. Development of such anagenda with Ministry of Health backing would strengthen service delivery and the evidence base forservice development. In addition, as part of the development of a national research agenda, aframework for external quality audits of PLHA services is needed – for both DHB and NGO PLHAservices. Reviews of the quality of service processes and impacts are well overdue.Finally, smaller NGOs with demonstrated records of service provision and defined constituencies arehaving difficulty coping. Even though their constituencies may be well defined and relatively small, thedemands of those constituencies are significant and growing, in terms of both practical and emotionalneeds. These NGOs need and deserve help. The Ministry of Health should consider core funding ineach case to support sustainable, outcomes‐based activities so these NGOs are not constantly distractedfrom their primary missions by the need to find funding for survival. Possible benchmarks could beimplemented for providing funds to smaller community‐based HIV support services.SUMMARY OF RECOMMENDED RESPONSES TO ISSUES IDENTIFIEDISSUEMinistry of Health HIV/AIDS Action Plan (2003) isout of date and needs revision; there is no Sexualand Reproductive Health Strategy action planThere is no national HIV research strategy;evaluation of quality of service delivery acrosssectors is absentMental health coverage for PLHA – particularlylonger‐term mental health support – is difficultto access in most areasCost is an obstacle to accessing primary care formany PLHA; DHB and NGO HIV services are aproxy for primary care servicesThere are variations in T&C for HIV according tosector and serviceStigma, particularly in minority populations,creates obstacles to HIV service engagementNGOs are experiencing difficulties in coping withdemandRECOMMENDED RESPONSEReview and update the HIV/AIDS Action Plan; develop a Sexual andReproductive Health Strategy action planDevelop a national HIV research agenda; develop a framework forexternal evaluation of HIV service qualityEstablish benchmarks for MH coverage for PLHA; explore new pathwaysfor access to qualified MH servicesReview primary care fee costs for PLHA; review core primary care stafftraining in HIVInitiate a national conversation on standards and guidance for T&Cprovision, training and monitoringInitiate a national conversation on stigma in health – examiningexperiences to date from a variety of perspectives; develop an actionagendaIdentify possibilities for core funding of sustainable, outcomes‐basedactivities to enable NGOs to survive without being distracted from theirprimary mission; explore implementation of benchmarks for fundingsmaller support servicesviiiREVIEW OF SERVICES FOR PLHA
INTRODUCTIONThe national clinical and policy response to HIV is a New Zealand success story. Being a small countrywith an extremely mobile commercial and recreational population, and a South Pacific hub fortourism, New Zealand’s spread of HIV might have been considerably greater. HIV infections haveremained at a low level annually, and despite well‐founded concerns about the need for preventionand education, there has been no cross‐over of HIV from communities most at risk to the wider NewZealand population. Legislation to decriminalise homosexuality and prostitution; coordinatedepidemiological surveillance coupled with advanced medical diagnostic and treatment services;continual funding of creative, targeted prevention campaigns; reliance on evidence‐based action; anda flexible and committed DHB and NGO workforce in the management of HIV/AIDS have allcontributed to New Zealand’s continuing low incidence of HIV.The structure and functioning of HIV support services in New Zealand are very much determined bythe physical characteristics of the country and its people – its small population size, its geography, itsdisparate demographics, its restricted institutional capacity, and the concentration of men having sexwith men (MSM) in Auckland. New Zealand’s whole population is less than that of cities in otherdeveloped countries, where HIV has become a major health burden.There are estimated to be up to 2000 people living with HIV/AIDS in New Zealand. In 2009,151 people were diagnosed with HIV through HIV antibody testing, and 28 people were notified withAIDS. A further 48 people with HIV infection who had not been tested in NZ had a first viral load testin 2009 – the majority had previously been diagnosed overseas. Of those diagnosed with HIV here,73 were men infected through sex with other men, 50 through heterosexual sexual contact (24 men,26 women), 5 (all men) through injecting drug use, three through mother‐to‐child transmission andtwo through possible nosocomial transmission overseas. For 18, the means of infection wasunknown.There is a network of linked HIV treatment professionals in DHB services providing care and supportfor this population. It has, in the context of this review, won universal praise from PLHA. Operationalcollaboration between these services and community‐based support services appears verysuccessful; DHB and NGO services meet regularly in what appears to be a constructive forum for adiscussion of policy and operational responses to emerging crises and issues.The policy structure upon which national responses to HIV/AIDS are exercised is the HIV/AIDS ActionPlan. Published by the Ministry of Health in 2003, this plan identifies recommended action pointsunder objectives deriving from the following:1. societal attitudes, values and behaviour2. personal knowledge, skills and behaviour3. programmes and services4. information.Many of the actions and their operational interpretations are what would be expected of anevidence‐based plan for HIV management within a nation signatory to the United Nations GeneralAssembly Special Session on AIDS (UNGASS) and other international agreements. The actioninterpretations in the Plan tend to be reflective of the then current levels of activity; they arefrequently non‐directive and aspirational.REVIEW OF SERVICES FOR PLHA 1
Page 1 and 2: REVIEW OF SERVICES FORPEOPLE LIVING
Page 3 and 4: ACRONYMSAEGAMTACANCAPPARVBPCBOCSWDH
Page 5 and 6: CONTENTSACRONYMSACKNOWLEDGEMENTSEXE
Page 7: EXECUTIVE SUMMARYThis review has id
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
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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
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Page 43 and 44: Despite INA’s development constra
Page 45 and 46: Difficulties in maintaining quality
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Page 51 and 52: CONCLUSIONSFrom the foregoing, some
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Institute of Environmental Science
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APPENDIX 5: HIV NGO WEBSITE DATAOrg
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InquiryResponseResearch, analysis,
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InquiryResponseFrequency and regula
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Inquiry5. By what criteria are need
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Inquiry9. How is impact,effectivene
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B. BODY POSITIVE INC.Inquiry1. Is t
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C. INA FOUNDATION CHARITABLE TRUSTI
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Inquiry6. What makes the service ef
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Inquiry9. How is impact, effectiven
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InquiryResponse2. Personal knowledg
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InquiryResponseMF is 26 and has ove
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InquiryResponse7. What obstacles -
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