.............................................................................
Contents
............................................................................. Snapshot of the Epidemic
www.lovecoverprotect.co.nz Committed to HIV education and support for New Zealand-based African communities.
01
What is Needed
02
HIV Explained
03
Fact & Fiction
04
HIV in New Zealand
06
Gay & Bisexual Men
09
Heterosexual Men & Women
11
HIV Prevention
13
The Impact of Treatment on HIV Prevention
15
Why Condoms are the Best Option
17
Testing
19
Treatment
21
The Cost of HIV
22
Role of the New Zealand AIDS Foundation
24
.............................................................................
Contents
............................................................................. Snapshot of the Epidemic
www.lovecoverprotect.co.nz Committed to HIV education and support for New Zealand-based African communities.
01
What is Needed
02
HIV Explained
03
Fact & Fiction
04
HIV in New Zealand
06
Gay & Bisexual Men
09
Heterosexual Men & Women
11
HIV Prevention
13
The Impact of Treatment on HIV Prevention
15
Why Condoms are the Best Option
17
Testing
19
Treatment
21
The Cost of HIV
22
Role of the New Zealand AIDS Foundation
24
Snapshot of the Epidemic ............................................................................. Since 2006 the HIV epidemic among heterosexuals in New Zealand has seen a steady decline. Among gay and bisexual men (the most at risk group), the epidemic has remained static for this period with the exception of a significant drop in diagnoses in 2011. While the total number of HIV diagnoses in 2012 was slightly higher than in 2011 it was lower than in every year in the period 2003-2010. Effective treatment has meant fewer deaths and therefore a larger pool of people living with HIV which increases the number of people who can pass it on.
What is needed
............................................................................. Adequate funding to maintain and improve New Zealand’s excellent record in containing the HIV epidemic. A continued focus on safe sex through condom use as the core component of evidence based HIV prevention. Smart and accessible HIV prevention programmes that promote condom and lube use to the population groups most at risk of HIV. An increase in national testing for HIV, with a strong focus on pre and post-test counselling which incorporates safe sex education.
Gay and bisexual men remain the population group most at risk of HIV in New Zealand, followed by heterosexual people in New Zealand-based African communities.
Improved access to antiretroviral (ARV) medications and support services to ensure people living with HIV receive the highest standards of care and support.
The cost of HIV treatment to New Zealand is $23 million per annum. This figure can be expected to increase as the epidemic continues.
An increase in HIV and sexual health research to ensure that New Zealand can effectively combat the HIV epidemic in the future. An integrated New Zealand HIV/AIDS strategy that incorporates wider issues of sexually transmitted diseases, sexual health and HIV related health issues such as cancers. Action to address the stigma and discrimination experienced by many people living with HIV. Early HIV treatment for people diagnosed with HIV in accordance with clinical guidelines.
Quick Fact: The best estimate of the number of people currently living with HIV in New Zealand is 2000.
Promotion of vaccinations against sexually transmitted infections (STIs) where available with an immediate focus on HPV and Hep A / Hep B.
01
02
Snapshot of the Epidemic ............................................................................. Since 2006 the HIV epidemic among heterosexuals in New Zealand has seen a steady decline. Among gay and bisexual men (the most at risk group), the epidemic has remained static for this period with the exception of a significant drop in diagnoses in 2011. While the total number of HIV diagnoses in 2012 was slightly higher than in 2011 it was lower than in every year in the period 2003-2010. Effective treatment has meant fewer deaths and therefore a larger pool of people living with HIV which increases the number of people who can pass it on.
What is needed
............................................................................. Adequate funding to maintain and improve New Zealand’s excellent record in containing the HIV epidemic. A continued focus on safe sex through condom use as the core component of evidence based HIV prevention. Smart and accessible HIV prevention programmes that promote condom and lube use to the population groups most at risk of HIV. An increase in national testing for HIV, with a strong focus on pre and post-test counselling which incorporates safe sex education.
Gay and bisexual men remain the population group most at risk of HIV in New Zealand, followed by heterosexual people in New Zealand-based African communities.
Improved access to antiretroviral (ARV) medications and support services to ensure people living with HIV receive the highest standards of care and support.
The cost of HIV treatment to New Zealand is $23 million per annum. This figure can be expected to increase as the epidemic continues.
An increase in HIV and sexual health research to ensure that New Zealand can effectively combat the HIV epidemic in the future. An integrated New Zealand HIV/AIDS strategy that incorporates wider issues of sexually transmitted diseases, sexual health and HIV related health issues such as cancers. Action to address the stigma and discrimination experienced by many people living with HIV. Early HIV treatment for people diagnosed with HIV in accordance with clinical guidelines.
Quick Fact: The best estimate of the number of people currently living with HIV in New Zealand is 2000.
Promotion of vaccinations against sexually transmitted infections (STIs) where available with an immediate focus on HPV and Hep A / Hep B.
01
02
HIV Explained
Fact & Fiction
.............................................................................
.............................................................................
HIV: Human Immunodeficiency Virus AIDS: Acquired Immune Deficiency Syndrome
Insertive vs. Receptive Anal Sex: “I’m never the receptive partner, so I’m not at risk, right?”
HIV is a virus that is transmitted through blood, semen, vaginal fluid, rectal mucous and breast milk. HIV cannot be transmitted through touching, kissing or sharing eating utensils. Once HIV is in a person’s bloodstream it begins to attack the immune system, killing healthy immune system cells that normally fight off infections and cancers. There is no cure for HIV so once it is in a person’s bloodstream, it is there for life. HIV can be treated with medication, known as antiretroviral drugs (ARVs). For more on ARVs see Treatment on page 21.
Wrong. Although unprotected receptive anal sex carries the highest risk, it is still possible to contract HIV if you are the insertive partner and you are not wearing a condom. HIV can enter the body through vulnerable skin cells under the head of the penis or possibly through the urethra.
Unprotected receptive anal sex carries by far the highest risk of sexual HIV transmission. Approximately 70 per cent of immune system cells are located in the gut and HIV has very rapid and substantial effects on these cells from soon after infection. The inside of the rectum is also like a sponge; designed to absorb nutrients into the bloodstream from food passing through, meaning it can also easily absorb HIV from semen.
Oral Sex: “If I have unprotected oral sex with an HIV positive person, am I at risk?” The risk of HIV transmission via oral sex is extremely low. The enzymes in saliva act as a natural defence to HIV. The risk of contracting HIV increases if there are open sores or cuts in the mouth. Unprotected oral sex does expose you to the risk of other sexually transmitted infections (STIs).
Unprotected receptive vaginal sex carries the second highest risk of sexual HIV transmission. The cells that make up the vagina are less absorbent than those in the rectum; however they are still capable of allowing HIV to pass into the bloodstream.
Touching & Rubbing: “I received a full body massage from a sex worker. Am I at risk of HIV?”
Due to these differences receptive anal sex is 18 times more risky than vaginal sex.
No. HIV cannot be transmitted via skin to skin contact.
A person is most infectious in the three months immediately after acquiring HIV. HIV multiplies much faster than the time it takes for the body to produce a strong antibody response. Antibodies to HIV can take up to three months to appear in detectable levels in the bloodstream which can make it difficult to detect HIV through tests during this period. For more on HIV testing, see Testing on page 19.
STIs: “If I contract another STI does my risk of getting HIV increase?”
The deterioration and destruction of immune function can lead to AIDS, the final stage of HIV infection. 03
Yes. The presence of another sexually transmitted infection (STI) substantially increases the risk of contracting HIV. This is because the immune system is already considerably compromised in the presence of an existing STI therefore making a person more vulnerable to HIV transmission. 04
HIV Explained
Fact & Fiction
.............................................................................
.............................................................................
HIV: Human Immunodeficiency Virus AIDS: Acquired Immune Deficiency Syndrome
Insertive vs. Receptive Anal Sex: “I’m never the receptive partner, so I’m not at risk, right?”
HIV is a virus that is transmitted through blood, semen, vaginal fluid, rectal mucous and breast milk. HIV cannot be transmitted through touching, kissing or sharing eating utensils. Once HIV is in a person’s bloodstream it begins to attack the immune system, killing healthy immune system cells that normally fight off infections and cancers. There is no cure for HIV so once it is in a person’s bloodstream, it is there for life. HIV can be treated with medication, known as antiretroviral drugs (ARVs). For more on ARVs see Treatment on page 21.
Wrong. Although unprotected receptive anal sex carries the highest risk, it is still possible to contract HIV if you are the insertive partner and you are not wearing a condom. HIV can enter the body through vulnerable skin cells under the head of the penis or possibly through the urethra.
Unprotected receptive anal sex carries by far the highest risk of sexual HIV transmission. Approximately 70 per cent of immune system cells are located in the gut and HIV has very rapid and substantial effects on these cells from soon after infection. The inside of the rectum is also like a sponge; designed to absorb nutrients into the bloodstream from food passing through, meaning it can also easily absorb HIV from semen.
Oral Sex: “If I have unprotected oral sex with an HIV positive person, am I at risk?” The risk of HIV transmission via oral sex is extremely low. The enzymes in saliva act as a natural defence to HIV. The risk of contracting HIV increases if there are open sores or cuts in the mouth. Unprotected oral sex does expose you to the risk of other sexually transmitted infections (STIs).
Unprotected receptive vaginal sex carries the second highest risk of sexual HIV transmission. The cells that make up the vagina are less absorbent than those in the rectum; however they are still capable of allowing HIV to pass into the bloodstream.
Touching & Rubbing: “I received a full body massage from a sex worker. Am I at risk of HIV?”
Due to these differences receptive anal sex is 18 times more risky than vaginal sex.
No. HIV cannot be transmitted via skin to skin contact.
A person is most infectious in the three months immediately after acquiring HIV. HIV multiplies much faster than the time it takes for the body to produce a strong antibody response. Antibodies to HIV can take up to three months to appear in detectable levels in the bloodstream which can make it difficult to detect HIV through tests during this period. For more on HIV testing, see Testing on page 19.
STIs: “If I contract another STI does my risk of getting HIV increase?”
The deterioration and destruction of immune function can lead to AIDS, the final stage of HIV infection. 03
Yes. The presence of another sexually transmitted infection (STI) substantially increases the risk of contracting HIV. This is because the immune system is already considerably compromised in the presence of an existing STI therefore making a person more vulnerable to HIV transmission. 04
HIV in New Zealand
............................................................................. In 2012, 170 people were diagnosed with HIV in New Zealand; 124 through antibody tests and a further 46 through viral load testing. Last year’s NZAF HIV Update recorded a total of 109 HIV diagnoses for 2011, so why the jump to 170? Until now, the Otago University AIDS Epidemiology Group (AEG) has reported HIV diagnoses via antibody testing only. Viral load test figures have been collected by Otago AEG since 2002 but are being included for the first time this year, hence the increase. It’s important to note that while the total annual diagnoses has increased due to the inclusion of viral load test results, the overall trend of annual diagnoses has not changed. This is illustrated in the graphs on page 7 & 8 (note that the relative heights of the bars are unchanged).
Quick Fact: The best estimate of the number of people currently living with HIV in New Zealand is 2000. Sexual transmission accounts for the vast majority of new HIV diagnoses in New Zealand. Gay and bisexual men are the population group most at risk by a large margin; however it is encouraging that HIV diagnoses for this group have reduced by 12 per cent since 2010. Overall, HIV diagnoses among heterosexual New Zealanders have continued a steady downward trend since 2006. For the first time in New Zealand, research conducted by Otago AEG in 2011 measured undiagnosed HIV among Auckland’s gay and bisexual men. Of the men who took part and were living with HIV, 1 in 5 (21 per cent) did not know they had it. The study estimated that 1 in 15 (6.5 per cent of) gay or bisexual men in Auckland is now living with HIV.
Quick Fact: Gay and bisexual men are the group most at risk of HIV in New Zealand.
The undiagnosed HIV figures highlight the importance of regular HIV testing for highly sexually active people, in particular those most at risk of HIV in New Zealand, gay and bisexual men.
06
HIV in New Zealand
............................................................................. In 2012, 170 people were diagnosed with HIV in New Zealand; 124 through antibody tests and a further 46 through viral load testing. Last year’s NZAF HIV Update recorded a total of 109 HIV diagnoses for 2011, so why the jump to 170? Until now, the Otago University AIDS Epidemiology Group (AEG) has reported HIV diagnoses via antibody testing only. Viral load test figures have been collected by Otago AEG since 2002 but are being included for the first time this year, hence the increase. It’s important to note that while the total annual diagnoses has increased due to the inclusion of viral load test results, the overall trend of annual diagnoses has not changed. This is illustrated in the graphs on page 7 & 8 (note that the relative heights of the bars are unchanged).
Quick Fact: The best estimate of the number of people currently living with HIV in New Zealand is 2000. Sexual transmission accounts for the vast majority of new HIV diagnoses in New Zealand. Gay and bisexual men are the population group most at risk by a large margin; however it is encouraging that HIV diagnoses for this group have reduced by 12 per cent since 2010. Overall, HIV diagnoses among heterosexual New Zealanders have continued a steady downward trend since 2006. For the first time in New Zealand, research conducted by Otago AEG in 2011 measured undiagnosed HIV among Auckland’s gay and bisexual men. Of the men who took part and were living with HIV, 1 in 5 (21 per cent) did not know they had it. The study estimated that 1 in 15 (6.5 per cent of) gay or bisexual men in Auckland is now living with HIV.
Quick Fact: Gay and bisexual men are the group most at risk of HIV in New Zealand.
The undiagnosed HIV figures highlight the importance of regular HIV testing for highly sexually active people, in particular those most at risk of HIV in New Zealand, gay and bisexual men.
06
Overall, New Zealand has done very well in controlling HIV and continues to have one of the lowest HIV prevalence rates in the world. This is largely due to the consistent promotion, since 1987, of condom and lube use for anal sex between men. A robust legislative environment based on strong human rights approaches is also a key reason for this success. A low number of injecting drug users and the successful operation of an effective national needle exchange programme since 1988 have meant that injecting drug use accounts for very few HIV infections in New Zealand. Similarly, the widespread adoption of condom use among New Zealand sex workers has resulted in a low rate of HIV transmission in the New Zealand sex industry. Wide spread pregnancy screening and effective treatment for pregnant women means that the transmission of HIV from mothers to babies is at very low levels. These results are considered highly successful worldwide.
Annual HIV diagnoses in gay & bisexual men by antibody & viral load testing in New Zealand, 2002-2012
Unknown
Info-Graphic Key
New Zealand
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
Annual HIV diagnoses in heterosexual men & women by antibody & viral load testing in New Zealand, 2002-2012
110
110
100
100
90
90
25 26
80
80
23
21 16
18
70 25
60
Overseas
70
19
20
60
16
50
50
72
22 40 62
30 49
40
75
68 53
69
66
65
56
45
66 64
52
47
30
52
20
20
34 10
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
07
19
27
29
18
10
2002
33
07
09
2002
2003
04 2004
08 2005
13
2006
21
17 09
2007
2008
2009
17 10
10
2010
2011
2012
08
Overall, New Zealand has done very well in controlling HIV and continues to have one of the lowest HIV prevalence rates in the world. This is largely due to the consistent promotion, since 1987, of condom and lube use for anal sex between men. A robust legislative environment based on strong human rights approaches is also a key reason for this success. A low number of injecting drug users and the successful operation of an effective national needle exchange programme since 1988 have meant that injecting drug use accounts for very few HIV infections in New Zealand. Similarly, the widespread adoption of condom use among New Zealand sex workers has resulted in a low rate of HIV transmission in the New Zealand sex industry. Wide spread pregnancy screening and effective treatment for pregnant women means that the transmission of HIV from mothers to babies is at very low levels. These results are considered highly successful worldwide.
Annual HIV diagnoses in gay & bisexual men by antibody & viral load testing in New Zealand, 2002-2012
Unknown
Info-Graphic Key
New Zealand
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
Annual HIV diagnoses in heterosexual men & women by antibody & viral load testing in New Zealand, 2002-2012
110
110
100
100
90
90
25 26
80
80
23
21 16
18
70 25
60
Overseas
70
19
20
60
16
50
50
72
22 40 62
30 49
40
75
68 53
69
66
65
56
45
66 64
52
47
30
52
20
20
34 10
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
07
19
27
29
18
10
2002
33
07
09
2002
2003
04 2004
08 2005
13
2006
21
17 09
2007
2008
2009
17 10
10
2010
2011
2012
08
Gay & Bisexual Men Most at Risk ............................................................................. Gay & bisexual men are overwhelmingly the population group most at risk of HIV in New Zealand. There are several reasons for this: 01
Gay and bisexual men have anal sex at higher rates than any other group and rectal cells are more susceptible to HIV infection than vaginal cells.
02
Semen and rectal mucous carry more HIV than vaginal fluid.
03
The prevalence of HIV is already far higher among gay and bisexual men than in the rest of the population, making the risk of exposure greater.
Of the 170 people diagnosed with HIV in New Zealand in 2012, 87 were men who were infected through sex with other men. At the time of publication there were a further 19 men for whom the mode of transmission was unknown. It is highly likely that some of them will also have been infected through sex with other men. Trends over the last ten years show consistently that the majority of gay and bisexual men contract HIV in New Zealand. In 2012, 66 (76 per cent) of the 87 gay and bisexual men diagnosed with HIV were reported to have contracted HIV here. In 2012, most gay and bisexual men diagnosed with HIV were of European ethnicity; this is consistent with figures over the last ten years.
Appearance: “He looks healthy so he can’t have HIV.” Wrong. It is not possible to tell if someone has HIV simply by their appearance. In its early stages HIV often has no visible symptoms. Highly effective HIV medication is now available and means that people living with HIV can lead healthy, normal lives with often no visual symptoms.
Of the 87 gay and bisexual men diagnosed with HIV in 2012:
22% Asian
11% Other
62% European
5% Maori
The age at diagnosis was evenly spread across all age groups for men who were infected through sex with other men, with the ages ranging from 19 to 74 years. A person can be living with HIV for months or even years before diagnosis so it is not possible to determine age at the time of infection. 07
09
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
10
Gay & Bisexual Men Most at Risk ............................................................................. Gay & bisexual men are overwhelmingly the population group most at risk of HIV in New Zealand. There are several reasons for this: 01
Gay and bisexual men have anal sex at higher rates than any other group and rectal cells are more susceptible to HIV infection than vaginal cells.
02
Semen and rectal mucous carry more HIV than vaginal fluid.
03
The prevalence of HIV is already far higher among gay and bisexual men than in the rest of the population, making the risk of exposure greater.
Of the 170 people diagnosed with HIV in New Zealand in 2012, 87 were men who were infected through sex with other men. At the time of publication there were a further 19 men for whom the mode of transmission was unknown. It is highly likely that some of them will also have been infected through sex with other men. Trends over the last ten years show consistently that the majority of gay and bisexual men contract HIV in New Zealand. In 2012, 66 (76 per cent) of the 87 gay and bisexual men diagnosed with HIV were reported to have contracted HIV here. In 2012, most gay and bisexual men diagnosed with HIV were of European ethnicity; this is consistent with figures over the last ten years.
Appearance: “He looks healthy so he can’t have HIV.” Wrong. It is not possible to tell if someone has HIV simply by their appearance. In its early stages HIV often has no visible symptoms. Highly effective HIV medication is now available and means that people living with HIV can lead healthy, normal lives with often no visual symptoms.
Of the 87 gay and bisexual men diagnosed with HIV in 2012:
22% Asian
11% Other
62% European
5% Maori
The age at diagnosis was evenly spread across all age groups for men who were infected through sex with other men, with the ages ranging from 19 to 74 years. A person can be living with HIV for months or even years before diagnosis so it is not possible to determine age at the time of infection. 07
09
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
10
Heterosexual Men & Women
............................................................................. Of the 170 people diagnosed with HIV in New Zealand in 2012, 38 were infected through heterosexual sex. HIV diagnoses among heterosexual people increased sharply from 2002 to 2006. This corresponds with a large increase in immigrants and refugees between 2002 and 2004 from countries with a high prevalence of HIV. During this period HIV screening was not a compulsory part of the immigration process in New Zealand. Heterosexual diagnoses began to decline from 2007 due to immigration policy changes in late 2005 which introduced mandatory HIV testing for residency applicants and people applying for visas for longer than 12 months.
Among heterosexuals in New Zealand, Africans remain the only ethnicity significantly and consistently overrepresented in HIV diagnoses. In 2012, Asian heterosexual men and women appear to be overrepresented however there is no upward trend for this ethnic group over the past 10 years. The age at diagnosis was widely spread across all age groups for those infected through heterosexual sex in 2012, with ages ranging from 22 to 65 years. A person can be living with HIV for months or even years before diagnosis so it is not possible to determine age at the time of infection.
............................................................................ Of the 38 heterosexual people diagnosed with HIV in 2012:
Only 45%
..........................................................
of the 38 heterosexual men & women diagnosed with HIV in 2012
26% European
were infected in New Zealand
34% Asian 3% Other 8% Maori
............................................................................
Despite policy changes, trends over the last 10 years show consistently that the majority of heterosexual people who are diagnosed in New Zealand still contract HIV overseas rather than in New Zealand.
8% Pacific
21% African 11
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
12
Heterosexual Men & Women
............................................................................. Of the 170 people diagnosed with HIV in New Zealand in 2012, 38 were infected through heterosexual sex. HIV diagnoses among heterosexual people increased sharply from 2002 to 2006. This corresponds with a large increase in immigrants and refugees between 2002 and 2004 from countries with a high prevalence of HIV. During this period HIV screening was not a compulsory part of the immigration process in New Zealand. Heterosexual diagnoses began to decline from 2007 due to immigration policy changes in late 2005 which introduced mandatory HIV testing for residency applicants and people applying for visas for longer than 12 months.
Among heterosexuals in New Zealand, Africans remain the only ethnicity significantly and consistently overrepresented in HIV diagnoses. In 2012, Asian heterosexual men and women appear to be overrepresented however there is no upward trend for this ethnic group over the past 10 years. The age at diagnosis was widely spread across all age groups for those infected through heterosexual sex in 2012, with ages ranging from 22 to 65 years. A person can be living with HIV for months or even years before diagnosis so it is not possible to determine age at the time of infection.
............................................................................ Of the 38 heterosexual people diagnosed with HIV in 2012:
Only 45%
..........................................................
of the 38 heterosexual men & women diagnosed with HIV in 2012
26% European
were infected in New Zealand
34% Asian 3% Other 8% Maori
............................................................................
Despite policy changes, trends over the last 10 years show consistently that the majority of heterosexual people who are diagnosed in New Zealand still contract HIV overseas rather than in New Zealand.
8% Pacific
21% African 11
Source: AIDS NZ, Issue 71, March 2013, Otago University AIDS Epidemiology Group (AEG), Department of Preventive and Social Medicine.
12
HIV Prevention
............................................................................. One thing we know for certain is that the sexual networking environments people engage in today are very different from those 20 or even 10 years ago. This requires us to rethink how we reach and engage with those most at risk of HIV in New Zealand; gay and bisexual men and New Zealand-based Africans. The NZAF’s response has been to move from a traditional education-based HIV prevention programme to a social marketing programme that works with the communities most at risk of HIV to encourage positive behaviour change. The Get it On! social marketing programme aimed at gay and bisexual men was launched in 2009 followed by Get it On! Love Cover Protect, aimed at New Zealand-based Africans, in 2011.
The Get it On! message for 2012-13 is Love Your Condom (LYC), and is being promoted through multiple channels including outdoor (billboards and bus shelter ads), ambient (wall projections), posters, online and through social media and event sponsorship. The creative concept behind LYC encourages gay and bisexual men to take condom use to the next level and form a social movement, reinforcing the core tenet of the NZAF’s HIV prevention programme which is the creation of a condom culture where condom use is the norm. Results from the Gay Auckland Periodic Sex Survey (GAPSS) and the Gay Online Sex Survey (GOSS) released in 2012 show that 80 per cent of gay and bisexual men in this country always or almost always use condoms for anal sex with casual male partners. Check out www.getiton.co.nz for more info.
Quick Fact: The NZAF’s Get it On! programme distributed over 550,000 condoms in 2012. As well as mainstream media channels, both programmes specifically target environments where people engage, be they popular hang-out spots, social venues or virtual networking spaces. The messaging is always designed to speak to their current condom use behaviour and encourage increased condom use through positive messages that endorse condoms as a normalised part of great sex. Research shows that gay and bisexual men in particular are engaging in internet and mobile-based sexual networking at very high rates, therefore a key component of Get it On! is its online and smartphone app presence. The Get it On! website is currently receiving an impressive 90,000 visits per month on average. The NZAF Community Engagement teams play a crucial role in both programmes; interacting with respective audiences on an individual and collective basis in venues, clubs and at events. As well as sponsoring numerous community events, Get it On! initiated and ran many events in 2012, the largest being the annual Get it On! Big Gay Out in Auckland which attracted around 15,000 people. 13
14
HIV Prevention
............................................................................. One thing we know for certain is that the sexual networking environments people engage in today are very different from those 20 or even 10 years ago. This requires us to rethink how we reach and engage with those most at risk of HIV in New Zealand; gay and bisexual men and New Zealand-based Africans. The NZAF’s response has been to move from a traditional education-based HIV prevention programme to a social marketing programme that works with the communities most at risk of HIV to encourage positive behaviour change. The Get it On! social marketing programme aimed at gay and bisexual men was launched in 2009 followed by Get it On! Love Cover Protect, aimed at New Zealand-based Africans, in 2011.
The Get it On! message for 2012-13 is Love Your Condom (LYC), and is being promoted through multiple channels including outdoor (billboards and bus shelter ads), ambient (wall projections), posters, online and through social media and event sponsorship. The creative concept behind LYC encourages gay and bisexual men to take condom use to the next level and form a social movement, reinforcing the core tenet of the NZAF’s HIV prevention programme which is the creation of a condom culture where condom use is the norm. Results from the Gay Auckland Periodic Sex Survey (GAPSS) and the Gay Online Sex Survey (GOSS) released in 2012 show that 80 per cent of gay and bisexual men in this country always or almost always use condoms for anal sex with casual male partners. Check out www.getiton.co.nz for more info.
Quick Fact: The NZAF’s Get it On! programme distributed over 550,000 condoms in 2012. As well as mainstream media channels, both programmes specifically target environments where people engage, be they popular hang-out spots, social venues or virtual networking spaces. The messaging is always designed to speak to their current condom use behaviour and encourage increased condom use through positive messages that endorse condoms as a normalised part of great sex. Research shows that gay and bisexual men in particular are engaging in internet and mobile-based sexual networking at very high rates, therefore a key component of Get it On! is its online and smartphone app presence. The Get it On! website is currently receiving an impressive 90,000 visits per month on average. The NZAF Community Engagement teams play a crucial role in both programmes; interacting with respective audiences on an individual and collective basis in venues, clubs and at events. As well as sponsoring numerous community events, Get it On! initiated and ran many events in 2012, the largest being the annual Get it On! Big Gay Out in Auckland which attracted around 15,000 people. 13
14
The Impact of Treatment on HIV Prevention ............................................................................. In May 2011 the results of an international study known as HPTN 052 concluded that HIV medication was 96 per cent effective in reducing sexual transmission of HIV among heterosexual couples where one partner was HIV positive and the other HIV negative. This one study garnered widespread support for the idea of ‘treatment as prevention’; a secondary prevention intervention where everybody diagnosed with HIV is subsequently treated with antiretroviral therapy to levels where their HIV viral load is undetectable. The HPTN 052 study concluded that this method can drastically reduce infectivity. The NZAF is concerned that this is overly-simplistic and could be providing people with an excuse to risk unsafe sex, with catastrophic consequences. It’s important to note that this study was conducted mostly among heterosexual couples. Most couples were married and all received counselling on sexual behaviour modification and condom use. When we consider that the risk of HIV transmission through unprotected anal sex between men is 18 times higher than unprotected vaginal sex, we see that the HPTN 052 results cannot be used to conclude that treatment will be equally effective as an HIV preventative for men who have sex with men. One inescapable limitation of using treatment to prevent HIV is that an individual must know they have HIV to be treated. Research tells us that HIV is not primarily passed on by people who know they’ve got it – it’s mainly passed on by people who don’t know. Acute HIV infection is a major consideration. Studies show that around 50 per cent of transmission occurs within the three month window period when a person is most infectious and before HIV can be easily detected in a test. For more information see Testing on page 19. A further limitation of a drug-based prevention model, in this context, is that it puts the responsibility for HIV prevention primarily on people living with HIV. Condoms, conversely, share the responsibility equally between those who want to protect themselves from getting HIV and those who want to prevent themselves from passing it on. 15
Medication adherence and STIs are yet further limitations. If an HIV positive person has a lapse in HIV medication or contracts an STI, in both circumstances this can cause a significant rise in HIV viral load and increase the chance of passing HIV on through unprotected anal or vaginal sex. While it must be acknowledged that treatment is essential for the well-being of people living with HIV and that it has some impact on reducing infectiousness, it must also be understood that HIV treatment is not a replacement for condoms.
Question: “Some people say that if they are on HIV medication & have an undetectable viral load, it’s safe for them to have unprotected sex. Is this correct?”
Answer: This is incorrect. Even if a person has a low viral load through treatment, it is still possible for HIV transmission to occur. A viral load test is usually a measure of HIV in blood rather than sexual or rectal fluids. While treatment can also lower viral load in sexual fluids, a viral load test does not directly measure this. A person’s viral load can also fluctuate and can increase significantly in the presence of another STI. Using condoms and lube for sex every time remains the most effective way to prevent sexual transmission of HIV. 16
The Impact of Treatment on HIV Prevention ............................................................................. In May 2011 the results of an international study known as HPTN 052 concluded that HIV medication was 96 per cent effective in reducing sexual transmission of HIV among heterosexual couples where one partner was HIV positive and the other HIV negative. This one study garnered widespread support for the idea of ‘treatment as prevention’; a secondary prevention intervention where everybody diagnosed with HIV is subsequently treated with antiretroviral therapy to levels where their HIV viral load is undetectable. The HPTN 052 study concluded that this method can drastically reduce infectivity. The NZAF is concerned that this is overly-simplistic and could be providing people with an excuse to risk unsafe sex, with catastrophic consequences. It’s important to note that this study was conducted mostly among heterosexual couples. Most couples were married and all received counselling on sexual behaviour modification and condom use. When we consider that the risk of HIV transmission through unprotected anal sex between men is 18 times higher than unprotected vaginal sex, we see that the HPTN 052 results cannot be used to conclude that treatment will be equally effective as an HIV preventative for men who have sex with men. One inescapable limitation of using treatment to prevent HIV is that an individual must know they have HIV to be treated. Research tells us that HIV is not primarily passed on by people who know they’ve got it – it’s mainly passed on by people who don’t know. Acute HIV infection is a major consideration. Studies show that around 50 per cent of transmission occurs within the three month window period when a person is most infectious and before HIV can be easily detected in a test. For more information see Testing on page 19. A further limitation of a drug-based prevention model, in this context, is that it puts the responsibility for HIV prevention primarily on people living with HIV. Condoms, conversely, share the responsibility equally between those who want to protect themselves from getting HIV and those who want to prevent themselves from passing it on. 15
Medication adherence and STIs are yet further limitations. If an HIV positive person has a lapse in HIV medication or contracts an STI, in both circumstances this can cause a significant rise in HIV viral load and increase the chance of passing HIV on through unprotected anal or vaginal sex. While it must be acknowledged that treatment is essential for the well-being of people living with HIV and that it has some impact on reducing infectiousness, it must also be understood that HIV treatment is not a replacement for condoms.
Question: “Some people say that if they are on HIV medication & have an undetectable viral load, it’s safe for them to have unprotected sex. Is this correct?”
Answer: This is incorrect. Even if a person has a low viral load through treatment, it is still possible for HIV transmission to occur. A viral load test is usually a measure of HIV in blood rather than sexual or rectal fluids. While treatment can also lower viral load in sexual fluids, a viral load test does not directly measure this. A person’s viral load can also fluctuate and can increase significantly in the presence of another STI. Using condoms and lube for sex every time remains the most effective way to prevent sexual transmission of HIV. 16
Why Condoms are the Best Option
............................................................................. The NZAF’s response to the HIV epidemic over the last 25 years has been centred on the promotion of condoms and lube for anal sex every time.
Answer:
Some countries are promoting the choice to negotiate condoms out of the mix if partners feel they can trust each other’s HIV status. Others are positioning HIV drugs as a pill that HIV negative people can take to prevent infection (known as Pre-Exposure Prophylaxis or PrEP), and others still are touting HIV treatment and undetectable viral load as a valid reason to de-emphasise condoms. All of these strategies rely completely on an individual’s accurate knowledge of their HIV status and also trust, based on honest conversation and a sense of responsibility for themselves and their sexual partner. While this is certainly the ideal, it simply isn’t a reality in many situations. Casual sex engaged in bars under the influence of alcohol or drugs, through online sexual networking websites or at sex-on-site venues, often isn’t conducive to open conversations about HIV status. Condoms by comparison are tangible. They need no prior discussion about HIV status and they are an immediate physical guarantee of maximum protection against HIV for both partners. There is no guess-work with condoms. They are also affordable and easily accessible. The Centre for Disease Control and Prevention (CDC), a global leader in infectious disease research, confirms that ‘latex condoms provide an essentially impermeable barrier to particles the size of HIV’. Condoms have a proven 95 per cent efficacy in preventing HIV transmission when used correctly and consistently, making them the single most effective HIV prevention tool available.
17
Question:“I’ve heard I can take a pill to prevent getting HIV, so I don’t have to worry about using condoms as much now, right?”
17
Wrong. There has been a lot of discussion in the last 18 months around the use of HIV medication by HIV negative people to prevent transmission of the virus. This is known as Pre-Exposure Prophylaxis or PrEP. Evidence to date suggests that PrEP is only 42 per cent effective at preventing the transmission of HIV between men who have sex with men (75 per cent effective between heterosexuals) when used correctly and consistently*. PrEP is not supported by PHARMAC. Most HIV specialists recommend that condoms should continue to be used in conjunction with HIV medication. * http://www.cdc.gov/condomeffectiveness/latex.htm
............................................................................
91%
of gay men at the 2011 Get it On! Big Gay Out Auckland said that they
............................................................................
support condom use
............................................................................
Source: Gay Auckland Periodic Sex Survey (GAPSS) 2011.
18
Why Condoms are the Best Option
............................................................................. The NZAF’s response to the HIV epidemic over the last 25 years has been centred on the promotion of condoms and lube for anal sex every time.
Answer:
Some countries are promoting the choice to negotiate condoms out of the mix if partners feel they can trust each other’s HIV status. Others are positioning HIV drugs as a pill that HIV negative people can take to prevent infection (known as Pre-Exposure Prophylaxis or PrEP), and others still are touting HIV treatment and undetectable viral load as a valid reason to de-emphasise condoms. All of these strategies rely completely on an individual’s accurate knowledge of their HIV status and also trust, based on honest conversation and a sense of responsibility for themselves and their sexual partner. While this is certainly the ideal, it simply isn’t a reality in many situations. Casual sex engaged in bars under the influence of alcohol or drugs, through online sexual networking websites or at sex-on-site venues, often isn’t conducive to open conversations about HIV status. Condoms by comparison are tangible. They need no prior discussion about HIV status and they are an immediate physical guarantee of maximum protection against HIV for both partners. There is no guess-work with condoms. They are also affordable and easily accessible. The Centre for Disease Control and Prevention (CDC), a global leader in infectious disease research, confirms that ‘latex condoms provide an essentially impermeable barrier to particles the size of HIV’. Condoms have a proven 95 per cent efficacy in preventing HIV transmission when used correctly and consistently, making them the single most effective HIV prevention tool available.
17
Question:“I’ve heard I can take a pill to prevent getting HIV, so I don’t have to worry about using condoms as much now, right?”
17
Wrong. There has been a lot of discussion in the last 18 months around the use of HIV medication by HIV negative people to prevent transmission of the virus. This is known as Pre-Exposure Prophylaxis or PrEP. Evidence to date suggests that PrEP is only 42 per cent effective at preventing the transmission of HIV between men who have sex with men (75 per cent effective between heterosexuals) when used correctly and consistently*. PrEP is not supported by PHARMAC. Most HIV specialists recommend that condoms should continue to be used in conjunction with HIV medication. * http://www.cdc.gov/condomeffectiveness/latex.htm
............................................................................
91%
of gay men at the 2011 Get it On! Big Gay Out Auckland said that they
............................................................................
support condom use
............................................................................
Source: Gay Auckland Periodic Sex Survey (GAPSS) 2011.
18
Testing
............................................................................. Quick Fact: Visit www.nzaf.org.nz for free and confidential HIV, syphilis & Hepatitis C rapid tests with results in just 20 minutes. If you’re a sexually active person, you should consider having a full STI screening at least once a year. If you have more than 10 sexual partners in a three month period, aim for a full STI screening every three to six months. In either case this includes having an HIV test. Even if you’re sure you’ve been safe, knowing your HIV status is an important part of keeping yourself and your sexual partner(s) healthy. If you think you might have been exposed to HIV, when should you test? Unfortunately it’s not possible to find out if a person has HIV immediately after suspected exposure. It can take several weeks for a person’s immune system to react to the presence of HIV and for signs of HIV to appear in the most frequently used blood test.
that are detectable much sooner than antibodies. The combined antibody/antigen HIV test therefore has the potential to diagnose HIV sooner than if antibody testing was used alone. The NZAF rapid test for HIV, called ‘FAST test’, gives accurate results in just 20 minutes. FAST test involves a quick and almost painless finger-prick to produce a single drop of blood which is placed in the testing device. An accurate result is confirmed while you wait. NZAF FAST tests are available at no cost through NZAF regional centres in Auckland, Wellington and Christchurch, and through NZAF
The most common test for HIV is an ‘antibody’ test. When HIV enters the bloodstream, the body produces antibodies to HIV to try and fight the virus off. The time between acquiring HIV and the development of detectable levels of antibodies in the bloodstream can be up to three months. This is referred to as the ‘window period’. If an antibody test is taken before the three month period has passed, a false-negative test result may occur as antibodies may have not yet developed.
Question: “I get tested regularly so I don’t have to use condoms every time, right?”
Once HIV is in a person’s bloodstream it multiplies very rapidly - before the immune system begins to develop antibodies. This means that a person who has recently contracted HIV is most infectious during the first three to six months after infection. The NZAF has recently completed trials of a fourth generation rapid HIV test which tests for both antibodies and ‘antigens’ to HIV. Antigens are proteins found in HIV
Wrong. You could test negative for HIV and contract HIV through unprotected sex later the same day. HIV also has a window period of three months before it will show up in a test.
19
20
19
Answer:
20
Testing
............................................................................. Quick Fact: Visit www.nzaf.org.nz for free and confidential HIV, syphilis & Hepatitis C rapid tests with results in just 20 minutes. If you’re a sexually active person, you should consider having a full STI screening at least once a year. If you have more than 10 sexual partners in a three month period, aim for a full STI screening every three to six months. In either case this includes having an HIV test. Even if you’re sure you’ve been safe, knowing your HIV status is an important part of keeping yourself and your sexual partner(s) healthy. If you think you might have been exposed to HIV, when should you test? Unfortunately it’s not possible to find out if a person has HIV immediately after suspected exposure. It can take several weeks for a person’s immune system to react to the presence of HIV and for signs of HIV to appear in the most frequently used blood test.
that are detectable much sooner than antibodies. The combined antibody/antigen HIV test therefore has the potential to diagnose HIV sooner than if antibody testing was used alone. The NZAF rapid test for HIV, called ‘FAST test’, gives accurate results in just 20 minutes. FAST test involves a quick and almost painless finger-prick to produce a single drop of blood which is placed in the testing device. An accurate result is confirmed while you wait. NZAF FAST tests are available at no cost through NZAF regional centres in Auckland, Wellington and Christchurch, and through NZAF
The most common test for HIV is an ‘antibody’ test. When HIV enters the bloodstream, the body produces antibodies to HIV to try and fight the virus off. The time between acquiring HIV and the development of detectable levels of antibodies in the bloodstream can be up to three months. This is referred to as the ‘window period’. If an antibody test is taken before the three month period has passed, a false-negative test result may occur as antibodies may have not yet developed.
Question: “I get tested regularly so I don’t have to use condoms every time, right?”
Once HIV is in a person’s bloodstream it multiplies very rapidly - before the immune system begins to develop antibodies. This means that a person who has recently contracted HIV is most infectious during the first three to six months after infection. The NZAF has recently completed trials of a fourth generation rapid HIV test which tests for both antibodies and ‘antigens’ to HIV. Antigens are proteins found in HIV
Wrong. You could test negative for HIV and contract HIV through unprotected sex later the same day. HIV also has a window period of three months before it will show up in a test.
19
20
19
Answer:
20
Treatment
The Cost of HIV
.............................................................................
.............................................................................
Government-subsidised and effective treatments for HIV called antiretroviral drugs (ARVs) were introduced in New Zealand in 1997 and significantly impacted the HIV epidemic in New Zealand. A direct result of the introduction of ARVs is that the death rate for people diagnosed with AIDS has decreased dramatically since 1997; there have been eight or fewer AIDS-related deaths per year for most of the 2000’s.
In 2012, PHARMAC data showed that 1616 people living with HIV in New Zealand received funded ARV treatment. The average cost of ARVs per person was $14,255 per annum, making the total cost of ARVs in 2012 approximately $23 million.
While ARVs are an effective treatment, there is still no cure for HIV. ARVs have meant that people living with HIV are generally healthier and have much greater life expectancy, however they can have serious side effects such as kidney or liver failure for some people and it is possible to become resistant to ARVs. ARVs are subsidised by PHARMAC and are available at little or no cost to New Zealand residents.
If we assume that the numbers of new diagnoses per year continue at rates shown over the last ten years, the cost of ARVs alone could increase by approximately $2 million per annum (if 80 per cent of people start ARVs immediately). In addition, the clinical threshold for placing someone on ARV treatment is expected to be lowered in 2013. This would indicate a likely increase in the number of people accessing ARVs and therefore a rise in the fiscal cost of treatment. Every HIV diagnosis that is prevented eliminates a cost of at least of $14,255 per year in HIV related health care and leads to a healthier community.
Quick Fact: Around 80% of people living with HIV in New Zealand are on ARVs.
Quick Fact: The total cost of ARVs in 2012 was approximately $23 million.
21
22
Treatment
The Cost of HIV
.............................................................................
.............................................................................
Government-subsidised and effective treatments for HIV called antiretroviral drugs (ARVs) were introduced in New Zealand in 1997 and significantly impacted the HIV epidemic in New Zealand. A direct result of the introduction of ARVs is that the death rate for people diagnosed with AIDS has decreased dramatically since 1997; there have been eight or fewer AIDS-related deaths per year for most of the 2000’s.
In 2012, PHARMAC data showed that 1616 people living with HIV in New Zealand received funded ARV treatment. The average cost of ARVs per person was $14,255 per annum, making the total cost of ARVs in 2012 approximately $23 million.
While ARVs are an effective treatment, there is still no cure for HIV. ARVs have meant that people living with HIV are generally healthier and have much greater life expectancy, however they can have serious side effects such as kidney or liver failure for some people and it is possible to become resistant to ARVs. ARVs are subsidised by PHARMAC and are available at little or no cost to New Zealand residents.
If we assume that the numbers of new diagnoses per year continue at rates shown over the last ten years, the cost of ARVs alone could increase by approximately $2 million per annum (if 80 per cent of people start ARVs immediately). In addition, the clinical threshold for placing someone on ARV treatment is expected to be lowered in 2013. This would indicate a likely increase in the number of people accessing ARVs and therefore a rise in the fiscal cost of treatment. Every HIV diagnosis that is prevented eliminates a cost of at least of $14,255 per year in HIV related health care and leads to a healthier community.
Quick Fact: Around 80% of people living with HIV in New Zealand are on ARVs.
Quick Fact: The total cost of ARVs in 2012 was approximately $23 million.
21
22
Role of the New Zealand AIDS Foundation. ............................................................................. The NZAF is New Zealand’s national HIV prevention and health services organisation. The work of the NZAF includes HIV prevention and community engagement, testing and health services, science and advocacy and is funded primarily by the New Zealand Ministry of Health. The NZAF is a registered charity that grew out of gay community initiatives in the 1980s and today brings history, passion, commitment, expertise and diversity to meet the emerging trends of the HIV epidemic and the changing needs of the communities it serves.
NZAF National Office phone
09 303 3124
phone
09 309 5560
contact@nzaf.org.nz
contact.burnett@nzaf.org.nz
location
31 Hargreaves Street St Mary’s Bay Auckland, 1011
location
35 Hargreaves Street St Mary’s Bay Auckland, 1011
NZAF Awhina Centre
NZAF Mission: To prevent the transmission of HIV and provide support for people living with HIV, their whānau and families.
NZAF Burnett Centre
NZAF Te Toka Centre
phone
04 381 6640
phone
03 379 1953
contact.awhina@nzaf.org.nz
contact.tetoka@nzaf.org.nz
location
Level 1, 187 Willis Street Wellington, 6011
location
253 Cashel Street Christchurch, 8011
24
Role of the New Zealand AIDS Foundation. ............................................................................. The NZAF is New Zealand’s national HIV prevention and health services organisation. The work of the NZAF includes HIV prevention and community engagement, testing and health services, science and advocacy and is funded primarily by the New Zealand Ministry of Health. The NZAF is a registered charity that grew out of gay community initiatives in the 1980s and today brings history, passion, commitment, expertise and diversity to meet the emerging trends of the HIV epidemic and the changing needs of the communities it serves.
NZAF National Office phone
09 303 3124
phone
09 309 5560
contact@nzaf.org.nz
contact.burnett@nzaf.org.nz
location
31 Hargreaves Street St Mary’s Bay Auckland, 1011
location
35 Hargreaves Street St Mary’s Bay Auckland, 1011
NZAF Awhina Centre
NZAF Mission: To prevent the transmission of HIV and provide support for people living with HIV, their whānau and families.
NZAF Burnett Centre
NZAF Te Toka Centre
phone
04 381 6640
phone
03 379 1953
contact.awhina@nzaf.org.nz
contact.tetoka@nzaf.org.nz
location
Level 1, 187 Willis Street Wellington, 6011
location
253 Cashel Street Christchurch, 8011
24