Tuesday, October 26, 2004

State of AIDS in NZ

This also first appeared in REMIX - and once again you should buy this months issue.

Aaron found out he had HIV almost by mistake. About two and a half years after contracting the disease he was being tested for a blood condition, and after they narrowed down the likely causes it turned out to be HIV. He was diagnosed in January 2001 and was in his early thirties. The initial stages of infection – which often take the form of a flu-like illness – had gone unnoticed – so at 31 Aaron suddenly had to adjust to life as an HIV positive man.

Aaron had been active and out in his city’s gay scene since the late 80s. As a gay man he was aware of the risks and assiduously practiced safe-sex. At some point in the mid-90s Aaron says that he “became complacent and stopped practicing safe-sex and that led me to become HIV positive.”

Last year over 150 people in New Zealand received the news that they were infected with HIV, the precursor illness to AIDS. This is a larger number than any other year, and of that 154, more than a third were infected heterosexually. As the numbers are rising and the statistics starting to disprove any notion that AIDS is a homosexual affliction HIV/AIDS ought to be in the news. But instead AIDS education and reporting seems to be taking a lower profile than at any time since AIDS was first recognised as a problem in New Zealand in the 1980s. But what is the situation? Have we forgotten, or have we stopped taking AIDS seriously?

AIDS is still seen by some as a predominantly gay disease, but the numbers around the world do not bear this out. Internationally AIDS is 75% heterosexually transmitted. In NZ however it has traditionally been prevalently homosexually transmitted between men. This is still the case here with the majority of new cases arising as a result of unprotected sex between men, and the majority of these occurring domestically. In the heterosexual category 90% of the new transmissions in the past year were contracted overseas. Although this shows that the highest risk group remains as it has been – men having unprotected sex with men – it also suggests that as more heterosexual people carry the disease in New Zealand the likelihood of heterosexual transmission is rapidly rising. Although it will be some time until New Zealand has anything like three-out-of-four cases originating from heterosexual contact we are getting further along that road with every year. The real danger is that the entire pool of HIV positive people in New Zealand is increasing. This year saw the highest numbers of new cases ever. Also this is only reported cases. The New Zealand AIDS Foundation estimates that up to a third more people are infected without knowing it. As the pool increases so too does the risk to all sexually active people.

Why then as things are becoming more serious does the media not seem to make AIDS an issue? Steve Attwood of the New Zealand AIDS Foundation believes it is “more difficult to get mainstream media to pick up stories on domestic AIDS these days, they just do not seem to pick up on it unless there is a heterosexual angle.” So while it is still prevalently a minority concern it appears that is where it stays in terms of media coverage. No matter that if you are sexually active you are much more likely to contract HIV in any given year than you are to be murdered by a stranger. Stranger-danger rules the news while the more real and pressing dangers stay on the fringe.

Attempting to address the inequalities in coverage and to lift understanding of the situation we face with HIV/AIDS in New Zealand is Steve Attwood’s job. He hails from the NZ AIDS Foundation, a registered charity that is funded by the Ministry of Health but is also reliant on donations to continue their work. The Foundation grew out of a gay community organisation, originating out of gay men’s response to the illness. It now provides support, testing and care to anyone living with HIV/AIDS. But interestingly, considering the changing state of AIDS, they are only funded for gay specific campaigns for the prevention side of things – advertising risks, educating about the dangers and all other ambulance at the top of the cliff stuff. They are funded to target the biggest risk group, men who have sex with men, and no one else. The reason that the advertising is so narrowly focused is a simple case of best use of limited resources. Bang for your buck as Steve says “the biggest risks are to those having unprotected sex with many partners.” And to get across the message to these men “we focus on gay media because we are able to say things that we might not be able to say otherwise to people we might not otherwise reach.” Even considering what is a small pool population-wise a number of strategies are employed; packages at saunas or cruising clubs, print advertising, editorial contributions and brochure distribution. But on top of this Steve maintains that “it is important to be responsive – we are now coming up with ways to target Internet cruising and to get messages about safe sex out there in what is a relatively new high-risk activity”.Although no one is disputing the efficacy of targeting the most high-risk sector through these outlets it is also important not to leave the rest of the population without campaigns to publicise risks. “There is a role for mainstream media in this, and we are working towards this.”

But when this happens will depend on funding. Dr Doug Lush, Acting Director of Public Health is the man who oversees this funding. He is entirely supportive of the work the NZ AIDS Foundation is doing. “They are very effectively targeting where the burden of disease is.” But he also sees the importance of wider campaigns targeting other at-risk groups provided by specialist organisations. To this extent the Ministry of Health funds “the Prostitutes Collective, Migrant and Refugee Services and Family Planning among others.” The 13-18 year old group is also about to be addressed with a large campaign to try to cut down the overall rate of Sexually Transmitted Infections (STIs) and HIV/AIDS of course is targeted as part of this education and prevention campaign. Dr Lush and the Ministry are not taking AIDS lightly and reject any suggestion that HIV/AIDS are any less of a priority “it is of great concern, it is becoming of increasing priority and this is one of the reasons for the safe sex campaign that is coming up.” His concern especially rests with the increase of cases amongst older men who appear to be disregarding the safe sex message. He warns against a relaxing of vigilance against infection. “We have to be careful to retain these messages and avoid things like condom fatigue and viewing this as a less dread disease.”

The dread associated with AIDS in the 1980s has left the issue to a large extent. This benefits people living with the illness by reducing prejudice and stigma. But a lessening of the fear must not lead to a lessening in care taken regarding sexual activity. New Zealand has some of the worst rates of STIs like Chlamydia and Gonorrhea in the world and an increase in care taken needs to be seen across the board if we do not want to see AIDS become a more serious problem. Steve Attwood has noticed this relaxation in attitudes and his organisation has found that advertising risks in a way to capitalise on anxiety does not work. “We can not run fear based campaigns as fear can not be faced by people for long before it becomes normalised.”

Everyday is difficult when living with HIV. “It affects your whole life in many areas, mentally and physically.” For Aaron it involves taking 22 large pills a day. The added danger is that you have to take your medication on time every day or else your body can build a resistance and the medicine becomes useless. Even if you follow the proper regime you will develop a resistance over time. In New Zealand 13 medications are funded. And not all of these may be compatible with patients. If you run out of medicines you run out of options. Side-effects and toxicity of dosage are further concerns. Nausea, diarrhoea, vomiting are standard, diabetes is a common side-effect. “But there is no choice, you have to take the tablets if you want to remain well.”

New Zealand is lucky to be where it is. By dint of its geographical isolation we have managed to keep our overall numbers low. But as more and more cases come in from overseas we will see increasing rates of infection in all communities unless safe-sex messages get across. Steve Attwood sounds this warning “thanks to medical advances there may not be so many people dying of AIDS as there used to be but we haven’t cured this virus, we’re never likely to. It still is a very serious life length and life quality reducing illness. People live under the constant threat of discrimination, prejudice and the death threat of the medicine not working. People must not forget that.”

Aaron, in his early thirties, has no idea how the illness is going to affect him next, how many more medications he may go through or what science might turn up. One thing, however, is certain “my life is not the same as it was. My life is not as good as it was. I am not as well, I sometimes struggle to get around, I often feel weak. It is hard to live with every day.”


At 9:44 PM, Blogger Sarah said...

Great article Simon.

I found out recently that a friend of a friend was hiv+ recently and it's a huge waste. We forget too about the huge net of people who are affected one way or another. It's come directly into our community and will continue to come - we just hope that the pace lessens and the lessons are learnt.

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