New Zealand AIDS Foundation Executive Director Shaun Robinson has passed the six month mark in a role leading an organisation which is crucial for the health of the gay community. We catch up on how he feels he has done so far and what he's focused on heading into the future. Shaun Robinson came into the job with three clear goals; the first was to settle the organisation down and improve its teamwork, while the second was to settle some of its external relationships down by improving communication and addressing concerns so the community was more supportive of the NZAF. The third is of course to ultimately bring the rate of infection down – he arrived at his new office on Auckland's College Hill just before figures were released showing HIV infection rates for gay and bi men had surged higher than ever, making 2010 the worst year on record for HIV diagnoses. Robinson tells us he believes he has made some inroads on his first two goals, and is determined to see the third and hardest task of bringing the infection rate down come to fruition. Here is a part two of a series, Six Months In, which looks at Robinson's third goal and some of the key current and ongoing issues facing the NZAF. Bringing the infection rate down "We're doing the right things. It's just about doing them better," is the key statement that sums up his priorities as he pushes towards his ultimate goal of bringing HIV infection rates down. "I haven't had to come in as a leader and say 'we're moving in completely the wrong direction, let's do something different'," he says. "There have been and there are very talented people here. I think it's been more about coordination, collaboration and making sure those good things are done as well as possible because with the range of things that the organisation does, sometimes it's easy to try and do too much." Robinson says underlining the seriousness of the situation is the knowledge that at the moment a gay man is contracting HIV once every four days in New Zealand. "That's sobering for the mind. That's what we're up against, that's what we're trying to turn around, that's what we're trying to stop, that's the real challenge. I think we're doing a lot of really good stuff but we always need to refine it, we always need to be open to feedback." Community buy-in Robinson says if the NZAF tried to please everybody it would be torn into a million pieces. But he believes the Foundation needs cooperation and buy-in from the gay community, as well as a basic acceptance that it's genuinely doing the best it can. "It's not that anybody won't make mistakes in trying to deal with an epidemic like this. There isn't a magic formula. So I'm sure there are going to be things we do that don't work out." He hopes that over time people will respond with understanding that although some things didn't work, it doesn't mean they need to put the boot in, something he says starts to undermine people's confidence in the organisation full stop. "And that means then that anything we do has much less chance of being effective because people say 'oh it's just the NZAF, they're crap, we won't listen to them'." Testing One area where Robinson wants clarity is in the realm of testing. "The Miller Report pointed out as one of its key findings that there's real confusion around HIV testing in New Zealand and there's a lack of consistency of approach," Robinson says. "And the Otago AIDS Epidemiology Group recently in an article was saying that 50 per cent of the HIV diagnoses in the last ten years, people have been diagnosed late, so their HIV is already progressed further than would be optimal. That's probably getting less over that period, but still in 2010 the epidemiology stats had a number of men that had progressed to the beginning of the AIDS phase. Now that shouldn't be happening, not in 2011." Robinson says while in the past six months alone the NZAF's HIV testing has increased seven per cent (a figure which sits at 20 per cent when Christchurch is excluded, as the quake obviously had an impact on the availability of services) there is still an issue about accessible and responsive testing services throughout New Zealand. "The AIDS Foundation has really played the role of being a catalyst in bringing in the rapid testing technology, which is far more responsive. We've seen an over 600 per cent increase in our testing since it came in ... so clearly being able to get your results rapidly is a real benefit." He says the questions now are how the NZAF can encourage a New Zealand-wide approach to HIV testing and how that would work, for example whether sexual health services may be the next location where rapid testing is used. "Ultimately it would be great if we could get to the point where if you go to your local GP, you could get a rapid test." Condoms In tune with the 'condoms, condoms, condoms' song the NZAF has forever sung, Robinson still sees condom use as far and away the most vital aspect of responding to HIV. "In the last six months we have counselled a hundred positive men. A lot of that is around 'how do you keep yourself healthy and safe into the future?' Had those men been using condoms a hundred per cent of the time they wouldn't be positive. That's the bottom line," he says. "Throughout the history of the epidemic there have been a lot of changes and alternatives. And we're seeing changes in treatment and the use of treatment coming through in a lot of clinical trials now. And this year's been pretty significant for some early trials coming through showing very high effectiveness of early treatment in reducing the ability to pass on the infection. "Now that's really exciting, but it doesn't to me override the one hundred per cent effectiveness of a high condom culture. And there's a reason why New Zealand has one of the best results in terms of control of HIV in the world; because we have a very good high condom culture." PrEP The NZAF is still in the process of researching as it works on deciding on a stance about Pre-Exposure Prophylaxis (PrEP), which is where HIV negative people take antiretroviral medication daily to try to lower their chances of becoming infected if they are exposed to HIV. Robinson says the NZAF is looking at PrEP thoroughly, as it's not a simple issue and there's been a multitude of trials. He points out there are also a lot of vested interests around the science of HIV, such as the obvious in drug companies. "I mean the best way for drug companies to make hugely more profits is to be able to sell drugs to well people. At the moment they can only sell them to sick people. If they can get them to well people to buy them or be subsidised to take them, wow, that's fantastic for them. Now that's at the most cynical end of the spectrum, but you do have to realise there's a lot of that money and promotion behind these developments. And they're at very early stages." He says the NZAF is simply being responsibly conservative about PrEP, as there is a big jump from clinical trials to the real world, given how quickly HIV can take off, "I always think of it like a tiger that we've got by the tail. You know, you let go for a minute and it will turn around and maul you." At the moment the NZAF is working through a 50 page summary of complex research which was commissioned by an HIV organisation in Britain. "It will take us some time to do justice to that information," Robinson says. "We're trying to say things to the public that are reasonable, but at the same time we don't want to jump on bandwagons. We want to be rational and responsible." Policy "There are things that politicians can be doing to make our job easier. One of them is to make HIV a notifiable disease so that we can have much better information about what is happening," Robinson says. "The other is to actually get behind having a strategy. We really have no strategies. There's a bit of a void in terms of a national strategy in dealing with HIV and STIs at the moment. And a lot of the advances that the NZAF has made over the last 25 years have been about effecting Government action, so that's still part of our response." Collaboration Robinson sees working collaboratively to support people with HIV and at risk of HIV is another area that is important. "As our sector has changed we have positive support groups. We have Rainbow Youth, the Aotearoa Rainbow Alliance, we've got OUTLine. Things have changed from when perhaps NZAF was pretty much it for supporting people. So it's about 'how do we play the best possible role to collaboratively be a catalyst to that total body of concerned people, having the best possible effect on people living with HIV and people at risk of HIV?' There's a lot of relationship work there." Overall All in all Robinson has a military analogy he likes to use to explain the fight, where HIV is a cunning foe that will use new social terrain to its advantage. While he is prepared to be bold in his targets, Robinson is realistic in stating he does not believe the epidemic will be turned around in the short term. "There are a lot of drivers with a lot of momentum around them. If in three years time we start to see the infection rates dropping, I think we will have done really well. And then it will be a matter of trying to keep a sustained pattern of that rate dropping." As gathering data on HIV and discovering patterns is an ongoing process, Robinson believes there needs to be a mixture of strategy and research. "You have to do your best thinking that you possibly can with the information you've got. Do the best analysis you can. "If it was entirely up to me, I think you should be worried. But when you've got the likes of Tony Hughes, Simon Harger-Forde, Eamonn Smythe; talented people with a lot of depth in this area who have done some really solid thinking. So I'm smart enough to see good thinking when I see it. I think I'm also a good enough conductor of the orchestra to try to enhance that. "But I also think we do have to say, if strategically that's the best, the best response we can come up with, with all the information that we've got, then we have to back ourselves." Robinson says one of the challenges is trying to communicate to the community, which may want to see more instant results. He says next year's results may show a higher rate infections and the very easy response for people will be to say the NZAF has failed. "Part of our job is then to say 'no we don't think we've failed. We're not happy with this, but we do believe that we will have this effect over time'." Jacqui Stanford - 12th August 2011