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Saturday 08 April 2017

HIV prevention: Groping in the dark

Posted in: Health & HIV
By Jay Bennie - 5th October 2016

Nick Laing
Just when the fight against the spread of HIV amongst gay and bisexual men enters one of its most difficult phases, when controversial prevention strategies such as PrEP are being considered and the annual number of new HIV diagnoses reaches its highest level ever and looks set to continue increasing, the Ministry of Health has effectively blindfolded efforts to get the epidemic back under control.

Initially every two years from 2002 but more recently every three years, researchers have spoken in detail with thousands of gay and bisexual men about their attitudes to HIV, sex and in particular safe sex.

Since 2002 the Ministry has willingly been the primary funder of research conducted in two parts, called the Gay Auckland Periodic Sex Survey (GAPSS) and the Gay Online Sex Survey (GOSS). Together they are the most accurate, comprehensive and vital tool used primarily by the NZAF, but also other sexual health agencies, to understand what is happening 'out there' - where HIV and other sexually transmitted infections are becoming once again more prevalent.

Just about every decision made regarding HIV prevention programmes targeted at gay and bisexual men in New Zealand, the group most at risk of contracting the debilitating and expensive to treat virus, is underscored by GAPPS and GOSS.

It's so important that the NZAF has sustained Auckland's huge annual Big Gay Out event year after year specifically so it can study the thousands gay and bi men who flock to it, for the GAPSS component of the research.

One of the most valuable aspects of the data is its ability to clearly identify and measure changing trends in such aspects as condom use, who, how, why and where gay and bi men are hooking up for sex and what their attitude is to staying safe and getting tested – a vital part of HIV prevention. There are many other factors the study measures and the information is real data specifically about real gay and bi men right here in New Zealand.

The loss of GAPSS and GOSS data, for which the Ministry has now denied primary funding, for 2017 at least, is a significant blow to the fight against the resurgent HIV epidemic in New Zealand, an epidemic which is primarily, by a long chalk, happening our amongst men who have sex with men.

“It's definitely a real concern for us,” says the NZ AIDS Foundation's general manager of operations, Nick Laing, “because it's our most important piece of research that enables us to plan our prevention strategies directed at gay and bisexual men... so not having that is a real blow to our ability to plan adequate prevention programmes.

“For example, GAPSS gives us information about condom use, about partnering behaviours, their testing behaviours so it allows us to understand what gay an bi men are doing in the community, how regularly they are testing, how often they are using condoms which allows us target key messages or look at segments of the gay and bi community which we need to specifically target. It also provides us with detail about where and how men are meeting each other.

The many advantages of GAPSS and GOSS include that it is actual NZ data about our actual NZ men, but might that data be available elsewhere?

“This is fundamentally the main piece of research that informs the majority of the work we have to do” says Laing. “And it's the one piece of research that catches a number of areas we look at such as HIV and other sexually transmitted infection risk and it's very difficult to elicit that information from other places because it's the only research that looks specifically at our gay and bisexual men.

How relevant is the last available GAPSS and GOSS info, from 2014, now?

“Being three years back down the track means it is three years behind in terms of some of the key measures that were in place back then or that we were able to identify back then. It certainly puts us on the back foot. We were relying on the 2017 survey to provide us with key baseline data, particularly in relation to how we're utilising the other tools we have for HIV prevention. We're behind the 8-ball there and looking forward we will be missing key baseline data as we try to look at other parts of the epidemic puzzle.”

New NZAF Executive Director Jason Myers just over a week or so told the NZAF is starting in on creating a new strategic plan to address the massive changes happening around HIV infection rates and patterns and how new treatment techniques may impact on the infection rate. How will the loss of GAPSS and GOSS affect that planning?

“We've got some key information that is telling us that there are other tools in the prevention toolbox, such as treatment as prevention, that we could be using and I think we will be pressing ahead with that based on other research from around the world... but we won't have insight into the actual, and ever-changing, NZ-based behaviours gay and bisexual men are engaging in. So moving forward it's going to limit the amount of information we have on what impact any new tools we introduce are actually having and we'll have a time-lag before we fully understand the impact of the things we are implementing.”

The decision not to fund the research, Laing says, sat squarely with the Ministry of Health. “We have provided information and have let them know the importance of GAPSS and GOSS to our programme by providing support to Dr. Peter Saxton and the people at Auckland University. But ultimately the decision was made at Ministry level.

“I guess we're going to have to work with the University to look for other options to try to get funding from somewhere else and to work with them to highlight the importance of this for our programme and for HIV prevention moving forward with possible funders to see if we can get some traction on it.

By this point, less than four months out from the vital Big Gay Out, logistics planning for GAPSS and GOSS is usually well under way, given an inevitable time lag looking for funding and then starting the preparation process, is it already too late?

“Time is definitely not on our side there and it's definitely a concern for Dr Saxton and ourselves.”

Jay Bennie - 5th October 2016

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