Having one of the lowest adult HIV prevalence rates in the world is a significant public health success story, explained Jason Myers, PhD, CEO of the New Zealand AIDS Foundation.
Having one of the lowest adult HIV prevalence rates in the world is a significant public health success story, and that is due to several factors: decriminalization of behavior on several fronts, not permitting people with HIV to take permanent residence in New Zealand, and incorporating treatment and prevention into the strategic approach, explained Jason Myers, PhD, CEO of the New Zealand AIDS Foundation.
What precipitated the founding of the New Zealand AIDS Foundation?
The New Zealand AIDS Foundation has a proud and rich history. We were formed right back at the start of the global HIV and AIDS epidemic when a wonderful man by the name of Bruce Burnett returned to New Zealand from San Francisco, where he was seeing his friends and his people succumb to—at that time—this unknown illness. A number of conversations started in lounge rooms across New Zealand where Bruce was sharing this experience and saying, “Look, this is going to come and we need to be ready for it.” Really, that was the beginning of a big and proud history—the start of a community movement and an organization really started by and for those people who are most impacted by HIV in New Zealand.
For more than 35 years now, the organization's been at the forefront of New Zealand's HIV/AIDS response, particularly the community-based response. Today, we're still going strong with our international office in Auckland and 2 remote offices in Wellington and Christchurch, doing everything we can to support the prevention of HIV transmission and the support of people living with HIV. That work looks like social marketing programs for behavior change, targeted at those most impacted; testing services for HIV and other STIs [sexually transmitted infections]; and counseling and other support for people living with and affected by HIV.
Can you tell us about the history of HIV and AIDS in New Zealand?
Probably the first thing to say is really this has been one of our biggest public health success stories. New Zealand has one of the lowest adult HIV prevalence rates in the world. There's a few things I'd say at a high level that I think characterize the response and have led to that result.
The first is the legislative environment that governments, very early on in the days of HIV and AIDS, enacted from the principles of both human rights and public health. We're talking about things like decriminalization of sex between men; decriminalization of sex work; the decriminalization of possession of needles and syringes, so that people injecting drugs had access to clean equipment; the inclusion of sexual orientation in the Human Rights Act. What all of this did essentially was mean that organizations like ours, the New Zealand AIDS Foundation, could very easily reach the communities who were either most impacted or had the opportunity or the risk of being most impacted.
What that has done over time has been that we have been able to control the HIV epidemic in populations that are traditionally and elsewhere significantly impacted. We have virtually no epidemic among people who inject drugs, virtually no epidemic among sex workers, for example. The epidemic is concentrated among men who have sex with men [MSM]. To give that a bit of color, we know that every year around 80% of our locally acquired infections—so that's infections acquired in New Zealand—are among MSM. They are really carrying this significantly disproportionate burden of the impact.
When we have a look at the heterosexual epidemic in New Zealand, that's quite a different picture. Historically, what that has looked like is that the majority of MSM infections have acquired those infections in New Zealand, whereas the majority of heterosexual infections have acquired those infections overseas. For the most part, early on in particular, those were individuals who were migrating to New Zealand from sub-Saharan Africa. The thing that's changed that picture was a reset to immigration settings around the mid-2000s, which essentially led to an exclusion of people living with HIV taking permanent residence in New Zealand, on the basis of a significant public health cost that that would pose to the New Zealand government.
So while it's been a success story, we have obviously been impacted by HIV and AIDS in New Zealand. When we think about HIV, first of all, the numbers have gone sort of up and down steadily over the years, to reach an all-time peak in 2016, which was a really concerning time for us. Usefully, around that time, we also saw this global revolution in the potential that HIV treatments can play in prevention. Here I'm talking about preexposure prophylaxis for people not living with HIV who ought to prevent acquiring it, and I'm talking about the role of successful HIV treatment for those living with HIV and what we know now about how that can prevent onward transmission.
What New Zealand did at that time was really move from a strategic approach that had essentially relied on the single tool of condoms—and very successfully for the entire duration of the epidemic—to integrate the potential of treatment and prevention into our strategic approach. We're really excited that since 2016, we have seen significant reductions in the number of HIV transmissions year-on-year. Last year, 2020, for example, we saw numbers of locally acquired transmission among MSM as low as we've seen them for a decade. We do think we are on track to reach the ambitious goal of eliminating locally acquired transmissions within the coming years.