Opinions amongst New Zealand delegates remain somewhat similar and yet also divided after today's AIDS 2014 conference presentations on the use of bio-medical intervention as a tool to halt the spread of HIV amongst gay and bisexual men. While the glamour event of the fourth day of the Melbourne conference was a rousing and optimistic speech by former USA President Bill Clinton, New Zealanders have been tackling the thorny subject of using drugs to minimise chances of HIV infection. But presentations on techniques of relying more on medicating people to ward off HIV infection were viewed differently by two HIV organisations in line with their differing constituencies and primary objectives. Bruce Kilmister "It must be accepted that safer sex is not completely covered by 'condoms for everyone,'" says Bruce Kilmister, the lead delegate from HIV-positive people's support and advocacy organisation Body Positive. "It has to be individualised," he says, "that is something we can learn for New Zealand. There will always be some people who do not, will not or cannot use condoms, therefore PrEP [pre-exposure prophylaxis, in which at-risk people are dosed with anti-HIV medications to lessen their risk of becoming infected] has its place... though probably not a large or significant place." Kilmister says this approach to HIV prevention is still not available in New Zealand but would be useful in some settings, "especially for our highly sexually active people, the risk-takers or those who for various reasons have little control over whether condoms are used in their sexual activity... PrEP should be available to them. There are situations where it would be very effective." However, the NZ AIDS Foundation delegates remain less optimistic about any reliance on bio-medical techniques after hearing reports of how 'treatment as prevention' works "in the real world." The NZAF does HIV support work but its primary task is halting the overall HIV epidemic amongst gay and bisexual men. "There is data coming in but it remains controversial," says NZAF boss Shaun Robinson, who is concerned that PrEP or 'treatment as prevention' - whereby those with HIV are identified and put on drug regimes which lower the level of virus in their body and thus their likelihood of passing on the virus. Robinson says field trials in Africa show a backlash emerging, "with expectations arising that people living with HIV should and must shoulder the load of HIV prevention by having undetectable viral loads. That onus on the already-infected is not what we want to see." "We've have a very successful social contract in that we in the New Zealand communities have accepted that we are all in this epidemic together, that we are mutually responsible," says Robinson. "We're seeing that the treatment as prevention approach breaks that up and starts to label people as 'goodies' and' baddies.'" Robinson was clearly concerned by presenters at the conference who dismissed this concern and would prefer to see everyone adopt drug treatments as the answer for prevention, preferring to "ramp it up and roll it out." The NZAF has long been an advocate of ensuring that condoms for anal sex are the main weapon against HIV's spread. Robinson says the NZAF has also been gathering material on methamphetamine use by men who have sex with men in London. "It's taken off in the last two years, particularly with people injecting meth as part of weekend-long sex parties. It's not just that they get too out of it but that sometimes they even pass out and wake up to find someone has had unsafe sex with them without their consent. There is often a total lack of inhibitions." "We're currently only seeing the tip of it in New Zealand," Robinson notes, "but it is also happening in Melbourne and Sydney and it is definitely starting to happen in New Zealand. It is one of the new challenges we face." Daisy Nakato In keeping with the overall "no one left behind" theme of the conference Kilmister says he was seriously impressed by "a tremendous African woman, Daisy Nakato of Uganda, talking about sex work. She said she does not want to be 'rehabilitated' and 'given a sewing machine', and that well-meaning HIV prevention workers should not try to change women like her. She enjoys her work and it pays well." Nakato says it is better for sex workers to be supported into keeping themselves free from HIV infection. Indigenous Australian aboriginal people talked of how they are very susceptible to HIV, being so low in all health statistics and their presence on the stage, says Kilmister, "helped humanise, as opposed to medicalise, HIV... in reinforces the view that to be more effective you have to put HIV awareness, prevention and support into terms that are acceptable and accessible to people." A highlight of the day for many was hearing Bill Clinton speak to a standing-room only crowd about how he feels the global goal of wiping out HIV may be achieved if prevention workers and vulnerable communities "step up the pace,"which is the tag line for this conference. Bill Clinton and PNG friends But for one New Zealander Clinton's presence became more personal. "Our Body Positive kaumatua was lucky enough to be one of the people selected to briefly meet and shake hands with Bill Clinton," says Kilmister. "It was a lovely thing to have happen and a wonderful moment for Michael." Only a few of the NZAF's delegates to the conference managed to get into the Clinton session, "and they report that he was very charismatic and seemed able to combine the personal faces of HIV with global trends," says Robinson. "It is great to have someone of his profile and calibre to advocate for HIV. He definitely has the 'wow' factor." Long and intense days are starting to take their toll on the delegates, particularly those already weakened by HIV infection. But HIV-positive people have respite access to a positive people's space "which is excellent," says an impressed Kilmister. "Instead of it being a perfunctory afterthought tacked on to the conference facilities as we have seen so often in the past, the Australians have done a wonderful job. It is peaceful, comfortable, with food and drink and massages and the chance to recharge and quietly chat." And this evening a small group from Body Positive used their free access to Melbourne's "fantastic public transport system" to travel out of the city centre to the foodie mecca of Lygon Street, "and treated ourselves to a lovely Italian meal."
Credit: GayNZ.com Daily News staff
First published: Wednesday, 23rd July 2014 - 11:43pm