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Shaun Robinson
Executive Director NZAF
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NZ an Epidemic under Control but not in Decline
Incidence Below the Prevalence Trend
MSM Incidence Below Prevalence Trend
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NZ an Epidemic under Control but not in Decline
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Success Story for Māori Health
Testing rates lower but increasing
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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
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Strategy
Condoms
Test
PrEP
Sexual Health Context
Support for PLHIV/ Stigma Elimination
Cultural Responsiveness
Legal and Human Rights
Treat
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NZ an Epidemic under Control but not in Decline
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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.
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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
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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
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NZ an Epidemic under Control but not in Decline
Testing TacticsHome Testing pilot
Exploring other models
Working towards national strategy
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New Zealand 30 Years into the Epidemic…
A Lot to Loose …
Low Prevalence
A Lot to Gain …
Persistent Incidence
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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
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New Science New Opportunities
PARTNER Study - TASP
PROUD and IPERGAY - PrEP
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No one uses
Condoms
Most people use Condoms
A new medication
Day to Day Focus Can Pull Us Apart
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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
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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
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Clinical and Community Collaboration