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Monday 08 November 2010

25 Years: the watershed period

Posted in: HIV, Features
By Jacqui Stanford - 17th September 2010


You'd be hard pressed to find many people, these days anyway, who have remained in the same job or with the same company for 25 years. Tony Hughes has been with the New Zealand AIDS Foundation since its inception and remains there today as its Research Director, based in Auckland.

His role in the initial response to HIV/AIDS was outlined in our earlier feature, which looked at the various strands which were pulled together to form the NZAF in 1985.

Hughes now tells about the watershed period, from the NZAF's inception in 1985, to Homosexual Law Reform in 1986, to divergence with the USA in 1987 - as New Zealand continued down the path of prevention through condom usage.



Tony Hughes
The HIV outbreak had emerged at what was the most crucial phase in New Zealand's gay history – the Homosexual Law Reform movement was at fever pitch and anti-gay sentiment was scorching.

"It was a very busy time." Despite the tense battle for law reform, Hughes says, New Zealand was very progressive in its response to the epidemic, with funding from the Ministry of Health given to the NZAF from 1985 to promote prevention messages.

He compares our situation to the United States, where in 1987 the Helms Amendment removed federal funding for condom promotion for gay men and provision of clean needles and syringes. By contrast Ministry-funded needle exchange schemes were set up around New Zealand and to this day the number of injecting drug users contracting HIV remains tiny compared with the vast problem in the USA and other countries.

Hughes says the same people who were winning their battle against gay rights in the United States, the religious right, were not winning in New Zealand. Their efforts to make a moral issue of HIV/AIDS failed. Extreme movements like the so-called "Nuremberg Rally" against law reform in September 1985 failed.

Hughes says the gay rights movement and failure of the religious right really was the watershed for HIV prevention. He and his cohorts had realised early it was very, very important to put a strong programme in place – and not rely on preaching that drug use or gay sex were wrong. "It doesn't work," he simply states.

He says although this is quite a socially conservative country, the great thing about New Zealanders is that when the case is made, they change their view.

"And so it was a matter of making a good case," he says. "You certainly can't escape the fact there was trench warfare around Homosexual Law Reform. And I mean I felt very strongly that it was very important we didn't try to pretend . . . try to downplay the AIDS stuff, in order to make it easier to get through Homosexual Law Reform."

Hughes says it was vital to be open and clear that gay men were at greater risk – and HLR must be won amidst an honest discussion about that.

"Our argument was that you've got to decriminalise this and you've got to throw the windows and the doors open and you've got to let everybody come out and you've got to encourage people to come forward for testing . . . and the very worst thing you can do is put a lid on all this."

A Salvation Army protest during the HLR movement
By mid-1986, after a battle that was both passionate and vile, (anti-HLR propaganda included Keith Hay, father of Auckland councillor David Hay and equally religious and anti-gay, advising in a leaflet that if homosexuality was decriminalised women would not be safe from, being sodomised in their own home by their husbands) sex between men was decriminalised. Hughes says it was not just a win for gay rights; it was also a win for the fundamental ability to manage HIV. "And if it had lost and it had stayed criminalised, well, I mean how do you run a prevention programme for a minority if it's in hiding?"

By the end of 1987, needle and syringe exchange laws had also been amended so it was no longer illegal to possess a needle.

Hughes says in the early days New Zealand had worked alongside the USA, where many progressive safe sex guidelines and programmes were emerging from the likes of the San Francisco AIDS Foundation and the Bay Area Physicians for Human Rights.

"It was wonderful, progressive community-generated stuff. Then by the end of 1987 when Reagan was the President and Jesse Helms was in the Senate they just hated it – and they just wanted to close it down and so they removed the federal funding."

Hughes says that started a real divergence between the New Zealand and American programmes, which had initially been very, very similar in their grassroots natures.

"We were facilitated and encouraged by the Government to be explicit, in explicit leaflets. They didn't mind us talking about anal sex."

He says meanwhile in the US under the Helms Amendment you couldn't talk about anal sex any more, as it was 'promoting homosexuality'.

"And so that closed all that down and I think it kick-started a process which actually led to more or less the demise of effective prevention by behaviour change in the United States. So now people just don't think condoms work – well, they've had 25 years of not doing it effectively."

Hughes says it's important to remember this crucial period from 1985 to 1987. "You know what happens over time, over 25 years people just sort of forget the history," he says. "The way things are now are just the way things were."

"But it's quite important to understand just the extent to which we made some radically different decisions in 1986 and 1987 as a country on how to manage this epidemic – and that extended to the safe sex guidelines."

The guidelines started off being fundamentally STI guidelines tweaked to add the information that was known about HIV/AIDS. It was in the middle of 1987 that receptive anal sex was identified as the major risk.

"So in August of that year we sharpened our guidelines very strongly onto condom promotion for anal sex."

It's a message the NZAF has pursued, relentlessly, to this day. Hughes says condom promotion has been audited time and time again against the data – and it remains the best and most successful programme.

He says in public health decisions must be based on science, not fashion, "and so that's the way we've done it. And we have been really lucky to have support for the programme from Governments of both the main colours, National and Labour, all through the years."

"All the countries that have been successful have had Government buy-in," he says, citing Australia and the Scandinavian countries. He says supportive Governments with sex-positive attitudes have won the day.

Hughes says the US now has the worst HIV prevention record for gay men, of any developed country, which considering the amount of money, resources, intelligence and knowledge of the epidemic it has, "to me looking it from the outside there's just incredible disconnect between what could have been done and what has been done."

The NZAF will mark its 25 years with a sell-out anniversary dinner A Night on the Wharf, tomorrow night at the Viaduct Harbour's Floating Pavilion. The event is being hosted by Suzanne Paul and features guest speaker Michael Kirby – an openly-gay former Australian High Court Justice who is a passionate gay rights advocate.

Jacqui Stanford - 17th September 2010

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