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Changing tactics for changing times

Posted in: Health & HIV, Features
By Jay Bennie - 18th October 2016

In one of the biggest HIV prevention changes in almost a decade the NZAF is about to move away from its Love Your Condom campaign to a core message embracing condom alternatives it has in the past been reticent to publicly countenance.

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On February 1st, timed to coincide with the Auckland Pride Festival, the Foundation will go public with its new Ending HIV campaign which sets a target of ending HIV transmissions in New Zealand by 2025.

“Changing to the new messaging is the culmination of extensive analysis of new science and real-world implementation of the additional prevention tools which have emerged in recent years,” says Jason Myers, the new Executive Director of the NZAF. “We've learned more about using PrEP in a structured way and about the effectiveness of Treatment as Prevention... and now we feel confident adding them to the 'use condoms' messaging.”

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He says the blending of primary condom use, backed up by PrEP, whereby those for whom condom use is proven to be unfeasible are put onto preemptive HIV medication regimes, and Treatment as Prevention - which is the cumulative effect whereby if all, or nearly all, individuals with HIV are on medication the lowered level of active HIV amongst MSM lowers chances of HIV transmission - “could see us ending HIV transmission in New Zealand.”

Just over two years ago the Australian HIV prevention sector was criticised by some, including by the NZAF, for its almost nation-wide embracing reliance on PrEP and Treatment as Prevention as parts of its core HIV prevention strategy. It was suggested at the time that the strategy was not applicable to New Zealand – and even some Australian states – where epidemic pattern and drivers are different from centres where HIV infection rates were still running out of control such as Sydney and Melbourne. It was also suggested that in this context there was insufficient 'good science' behind more actively embracing PrEP and Treatment as Prevention and that the Australian states embracing the techniques were panicking in the face of infection, and therefore health budget, blowouts and unseemly state and federal political pressure to try something, anything, new.

“The NZAF was part of the concerned commentary at that time,” acknowledges Myers, who became the organisation's boss just four months ago. “We have waited until the science is more conclusive, until we have seen sufficient research about the role of PrEP in real-world settings... Some of the criticism of ACON,” the AIDS Council of New South Wales which was an early and strong adopter of the new way of thinking, “was based on not having the information we needed to properly assess it.”

The new Ending HIV campaign will actually, for a transition period, blend the existing LYC messaging and branding with the new campaign material which, and Myers admits the irony, has been sourced from ACON.

“We feel the ACON campaign imagery reflects what we want to say in a powerful way,” he says, “and they have made it available to us at no cost.”

The campaign change represents a major shift in strategy for the NZAF which had long feared that New Zealand's comparatively low incidence of HIV, low in numbers and low in cost - at least when compared to most epidemics amongst men who have sex with men in comparable western nations, would be compromised if high adherence to condom use became compromised by at-risk men choosing what they felt were 'easier options' to maintaining condom use.

The new strategy will be rolled out progressively. “We'll launch with a big bang with the aim of getting people on board and making sure people understand that we now believe the end of HIV is now possible,” says Myers. Then, “over a number of years” the NZAF will introduce “multiple messages” which will be added to the condom use core message.

“The first phase message is 'stay safe, use condoms and if you can't use condoms then there are other options. The second phase is about testing. To make sure men are testing, because if you know then we can get you on treatments which will have benefits for your health and will also assist with preventing you passing on HIV to others.”

In essence phase two is about ensuring men diagnosed with HIV infection can get onto treatment regimes as early as possible, that they maintain good health with a low viral load and that this has consequent advantages for the effort to halt the now seemingly inexorable rise, evident over the past three years, in the number of new HIV diagnoses amongst gay and bisexual men.

Myers says he sees the transition into a new campaign as “exciting” but it's worth noting that two government agencies which should be actively supporting the Foundation's effort to get the HIV epidemic back under control are lagging behind in making key components of this new strategy available.

The government's drug-funding agency has yet to fund HIV medications to be available immediately a person gets an HIV diagnosis, meaning some of those with new infections are unnecessarily able to pass on their HIV to others, thus still undermining the Treatment as Prevention component of 'ending HIV.'

Government enthusiasm for PrEP has been luke-warm at least with sexual health agencies having to cobble together a research programme to prove locally what experts around the world – including across the Tasman - have been saying for years: that appropriately-delivered PrEP is a viable and cost-effective HIV prevention tool.

And the Ministry of Health has advised HIV-focused health organisations, such as the NZAF and Auckland University's gay men's health research unit, that it will not be funding next year's hoped-for periodic research into the factors underlying NZ's HIV epidemic, thus leaving them to rely on information which is already three years out of date while the HIV epidemic has soared to its highest rate in thirty years and continues to trend upwards against a background of fast-changing contributory factors.

Myers reflects the view of many involved in HIV work amongst men who have sex with men when he says HIV prevention work is being progressively undermined by a “government that doesn't have HIV as a priority, doesn't have sexual health as a priority.”




Jay Bennie - 18th October 2016

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