Thu 11 Jun 2015 In: Health and HIV View at Wayback View at NDHA
The West Australian AIDS Council last Friday offered its own critique of a GayNZ.com comment piece in which Michael Stevens criticised the NZ AIDS Foundation's on-going safe sex promotion message. GayNZ.com publishes it here as part of the on-going debate on this sensitive but important issue regarding our HIV epidemic amongst gay and bi men. Andrew Burry, Chief Executive Officer, WA AIDS Council RECORD HIV NOTIFICATIONS RATES NOT NECESSARILY A PUBLIC HEALTH FAILURE The New Zealand AIDS Epidemiology Group has released statistics that 217 people were newly diagnosed with HIV in New Zealand in 2014. The bulk of the new infections were again amongst men who have sex with men – 86 men infected compared to 69 the previous year – and show a three year upward trend. The New Zealand AIDS Foundation has labelled this ‘seriously concerning’, while commentators have been quick to label the prevention efforts of the NZAF as ‘ineffective’. GayNZ.com reported NZAF Executive Director Shaun Robinson as saying ‘some gay and bisexual men are simply not responding to the messages to use condoms and lubricant… while 80% of gay men are high condom users, 20% are not’. Internationally, this is hardly a statistic to be ashamed of; rather, it conclusively demonstrates that while condom use continues to decline internationally, gay men in New Zealand have maintained a steady culture of condom use as the norm in their networks, particularly for casual partners. This percentage has not appeared to have significantly changed over the last few years, potentially signalling a successful condom promotion and reinforcement campaign. In Western Australia 2014 delivered record rates of HIV notifications – an increase of 27% amongst gay men over the last year, and the highest number since 1991. A headline in the West Australian newspaper read: ‘HIV increase points to safe sex decline’, a quote attributed to a health department official. The WA AIDS Council was able to successfully show that the rise in HIV infection rates was not able to be attributed to any discernible drop in safe sex behaviour; rather the increase in testing by gay man as a result of a successful testing campaign and the introduction of rapid HIV testing (accompanied by a positive change in testing patterns) were far more likely to be the driver of new notifications. Put simply, the rise was a case of detection rather than infection. Increased testing rates that result in new diagnoses reduce the level of undiagnosed HIV in the community. This produces three significant benefits – those of reducing the likelihood of onward transmission by those who did not know they had a positive status, of enabling the individual to access medications far more quickly leading to improved health outcomes, and reducing community viral load. A further potential benefit is that wider individual status knowledge improves the effectiveness of alternative or complementary risk reduction strategies, such as sero-sorting. A couple of years ago, the NZAF released the information that approximately 20% of gay men who had HIV did not know they had it. From where we’re sitting, an increase of HIV infections, viewed alongside an apparently non-declining rate of condom use in New Zealand does not look like a failure of what is an internationally acclaimed long-term social marketing campaign. The comments by commentator Michael Stevens on gaynz.com describing the work of the NZAF as ‘ineffectual’, and as having ‘a blind spot’, and mentioning ‘congratulatory back-slapping’ is at best unhelpful. At worst, it demonstrates the limited ability of simple epidemiology to explain the full story of HIV prevention and is therefore a somewhat lazy response. In essence, this is a failure in distinguishing the key difference between notifications of HIV infection and new infections themselves. It is nothing but common sense to say that once notifications occur at a rate that is greater than new infections, the tide will be turning. Success in encouraging gay men to test more frequently can really only be measured by an increase in diagnoses. Were that not to occur, it could be concluded that the testing strategy is poorly targeted. A further positive indicator is the proportion of new diagnoses that are of recent infection. From the evidence available to us, we believe that the approach taken by the NZAF is very likely effective, and we will continue to adopt and adapt similar strategies here in Western Australia. We have seen before the negative consequences of somewhat knee-jerk reactions to simplistic epidemiological interpretations, and sincerely hope that this will not be the case in New Zealand. - Andrew Burry, Chief Executive Officer, WA AIDS Council Andrew Burry - 11th June 2015