biomedical prevention: testing - the nz strategic context

Shaun Robinson

Executive Director NZAF

NZ an Epidemic under Control but not in Decline

Incidence Below the Prevalence Trend

MSM Incidence Below Prevalence Trend

NZ an Epidemic under Control but not in Decline

Success Story for Māori Health

Testing rates lower but increasing

Challenges in Prevention

New Biomedical Tools – TASP and PrEP

+Long Standing Public Health Tools – Condoms, Needle Exchange

How do they Fit together in the NZ Context?

Need clinical and community collaboration and co-ordination

Need a National Strategy

Strategy please

Strategy

Condoms

Test

PrEP

Sexual Health Context

Support for PLHIV/ Stigma Elimination

Cultural Responsiveness

Legal and Human Rights

Treat

NZ an Epidemic under Control but not in Decline

NZ an Epidemic under Control but not in Decline

Testing /Clinical Challenge

20% of MSM and of Africans in NZ who have HIV are undiagnosed

50% of all HIV diagnoses are late

200? People Diagnosed but lost to Care since 2005.

NZ an Epidemic under Control but not in Decline

Testing Challenge

Rapid testing at NZAF since 2006

Increased from 250 pa – 2500 pa

No policy or national consistency

Health system has not adopted rapid testing

NZ an Epidemic under Control but not in Decline

Testing TacticsOutreach to :

• Venues• Events• Suburbs

Partnering with others to support rapid testing• Marae• GPs• Body positive• Asian• Pacific

NZ an Epidemic under Control but not in Decline

Testing TacticsHome Testing pilot

Exploring other models

Working towards national strategy

New Zealand 30 Years into the Epidemic…

A Lot to Loose …

Low Prevalence

A Lot to Gain …

Persistent Incidence

NZ an Epidemic under Control but not in Decline

Condom Use Challenges

95% positive attitudes to condom use (GAPSS GOSS research)

Close the GAP

80% high condom use

New Science New Opportunities

PARTNER Study - TASP

PROUD and IPERGAY - PrEP

No one uses

Condoms

Most people use Condoms

A new medication

Day to Day Focus Can Pull Us Apart

PrEP

A small targeted role

For people who resist condom use and are able to manage adherence

Requires Clinical Oversight – HIV testing, STI testing, Adherence monitoring, Condom promotion, Support

Best managed by sexual health physicians as people using PrEP will definitely risk repeated STI infections

PrEP Project New Zealand

No funding

Voluntary project being developed with Auckland Sexual Health

Need to put definition around PrEP in NZ• Access Criteria• Clinical Protocols/ Guidelines

Test demand and effectiveness in real world in NZ

Gain experience which will guide future developments

Clinical and Community Collaboration