The continuing evolution of the HIV epidemic in New Zealand, which occurs primarily amongst gay and bisexual men, has led to it again getting out of control with the highest ever annual rates of newly-identified cases of HIV now an undeniable reality.
The causes are fairly clear and include changing patterns of sexual behaviour facilitated by the digital communications revolution; too many people having the virus without knowing it and unknowingly passing it on to others; a lowered 'fear' of HIV now that it is a largely manageable disease; increasingly complex patterns of sexual interaction; the HIV epidemic's overlap with the methamphetamine epidemic; chronic government under-funding of important HIV prevention tools such as PrEP, HIV testing, treatment on diagnosis and research such as GAPSS/GOSS; and the slow year by year financial strangulation of the NZ AIDS Foundation, our only organisation with the expertise and clear mandate to stop HIV in its tracks.
In 2015, the latest period for which figures are available â€“ 2016 figures are due soon â€“ 224 people, mostly gay and bisexual men, were newly-diagnosed with HIV, an increase on 2014 figures which were an increase on 2013, etc.
The government, tasked by New Zealanders with funding the fight against the spread of HIV, now spends $32 million a year, and rapidly rising, on medical treatment and support for people with HIV. And yet it only spends $4.5 million per year on prevention programmes.
Despite inflation and warnings by health researchers and HIV prevention experts that getting HIV back under control is harder now than it ever has been funding for prevention has not changed in any meaningful way since 2009. In the last three years while pleading for more financial resources and at the same time trying to keep its work going the NZAF has gone into hock to the tune of $500,000.
That mounting debt is clearly unsustainable and the Foundation has announced that it is cutting back on staff.
And yet the government, last month, in the persons of Prime Minister Bill English, deputy PM Paula Bennett and Auckland Central MP Nicki Kaye, expressed its total support and commitment to the NZAF's determination to somehow end the incidence of new HIV infections within New Zealand within eight years. A now-available and proven-effective mix of tools and techniques such as condom use, PrEP, early treatment, fast HIV testing, and highly competent research and prevention programme expertise give rise to optimism that, properly rolled out and reinforced, this goal can be substantially met.
All those elements cost money and yet the government, primarily through the Ministry of Health, is standing in the way of adequate funding of that roll out and reinforcement. With the culling of staff expertise at the NZAF and the blinding of the Foundation through denial of monitoring study funding we are now officially and undeniably moving backwards when the government itself tells us we should be going forwards.
How can this be?
Prime Minister English gave us a pointer when GayNZ.com Daily News questioned him at the Big Gay Out last month. Asked, among other HIV-related questions, whether the skyrocketing cost of HIV treatments and the worst new HIV diagnosis rates in thirty years was not sufficient reason to increase HIV prevention and research funding regardless of what's happening in other areas of Government health spending that have seen HIV effectively de-prioritised, English said it's "a very good reason to be asking all those questions. If we saw some significant uplift in some debilitating health problems then I would expect the Minister of Health and the ministry to answer questions about what action should be taken."
Well, we are seeing soaring HIV diagnoses of newly-contracted HIV amongst gay and bisexual men. We are seeing a resurgence in other STDs such as syphilis amongst gay and bisexual men.
And, while we're at it, we are still seeing a shocking and disproportionately high suicide rate amongst glbti youth and many trans people are suffering deeply from the total lack of gender reassignment surgery in this country, and the lingering effects of its chronic under-funding for years.
So, with the clear expectations of the Prime Minister, and the preamble above, in mind we have sent these questions to Minister of Health Dr. Jonathan Colman. And like the PM we expect answers...
Is the government fully or sufficiently informed regarding the current state of the HIV epidemic in New Zealand and the measures which now need, and can, be taken to address it?
What is your position on so many gay and bisexual men continuing, for a variety of reasons, to contract HIV?
What is your position on the surging rate of new infections, the years-long freeze on prevention funding and the rapidly rising annual cost of supplying medical support, primarily HIV medications, to people with HIV?
The PM and other government MPs including the deputy PM have voiced their total commitment to the â€śEnding HIVâ€ť objectives. What do you see as the government's role in achieving this objective and what will this mean in practical terms now and over the coming years?
What has been your rationale for allowing the freezing of the NZAF's funding to continue for so long?
With negotiations underway for the next round of funding for the NZAF how do you plan to better support them as they tackle the rising annual HIV diagnoses rate?
Why do you believe PrEP is still not funded and is this acceptable in the current circumstances?
Why do you believe that treatment on diagnosis is still not funded and is this acceptable in the current circumstances?
What can and/or will you do to address the continuing delay in addressing the funding issues specifically underlying PrEP and early treatment not yet being properly addressed?
What do you believe is an appropriate level of funding for HIV testing?
The government has been criticised for dropping the ball on HIV and has been urged to 're-engage.' (The immediate-past NZAF Executive Director last year repeatedly expressed a high degree of frustration.) What is your position on this?
For some years the government has been criticised for not being sufficiently concerned about the sexual health in particular and health in general of gay and bisexual men? What is your position on this?
What is your position on the government denying funding to, thereby effectively stopping, the GAPSS/GOSS study this year?
What is your position on the NZAF being denied up to date behavioural and epidemiological data on the HIV epidemic at this juncture?
What is the government's role in ensuring HIV-positive people's advocacy and support organisation Body Positive is adequately funded, with particular reference to its role in helping stem the HIV epidemic?
Do you believe the NZAF has been, and is, sufficiently funded?
Do you believe the NZAF can play its expected role in turning back the HIV epidemic given its current, and historical, funding level?
Do you have confidence in the expertise of the NZAF and its advice to the Ministry of Health?
Thank you for reading this Dr Colman, we all await your answers with interest. Please feel free to address not just our specific questions but any and all of the issues included in and implied by the preamble to our questions.
- Jay Bennie