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To identify and, where possible, measure and value the private costs related to HIV/AIDS, that is, those costs that fall on the person with HIV/AIDS and the family/household/informal caregivers. Twenty-five people living with HIV - ranging from asymptomatic seropositive people, to people with AIDS - were followed prospectively to obtain information concerning the private costs (broadly defined) incurred. The participants resided in the Auckland, Hamilton, Wellington and Christchurch areas. Private direct costs rise steeply as the illness progresses, from around $100 per month for asymptomatic people to around $400 per month for people with AIDS. Both indirect costs (foregone income) and intangibles (measured by a range of indicators) were also considerable. The private costs of HIV/AIDS, defined in terms of direct, indirect and intangible costs, are significant and burdensome. Costing studies which ignore them will conceal, confuse and mislead.
This paper draws on current and earlier literature, together with observational and anecdotal data to reveal the situation of HIV positive women in New Zealand. The present picture is examined in relation to data from a previously unpublished qualitative study undertaken by the author in 2001 using a feminist perspective. It would seem that dominant concerns of the women today are much the same as those surfacing in the earlier study. These include stigma and the associated problem of whether to conceal or reveal. Additionally these women are concerned that health professionals do not always take their problems seriously. Their distress is aggravated by fact of them being women suffering from what is generally seen as a male disease. The feminist perspective highlights the relative powerlessness of many women in the context of sexual relations whereby much of the prophylactic advice--such as insistence on condom use--becomes irrelevant. New women oriented education programmes are needed. It is argued that nurses are well placed to make a positive contribution in this area of care, and in fact are obligated to do so if their practice is to be consistent with the profession's declared aims with respect to cultural safety. However it is noted that there is still a degree of prejudice and ignorance to be overcome before the desired results will be achieved.
We aimed to describe the epidemiology of women with HIV infection in the Auckland and Northland regions, and to assess whether there were missed opportunities for an earlier diagnosis of HIV infection. We undertook a retrospective cohort analysis of women diagnosed with HIV infection between July 2011 and June 2021 under the care of the Infectious Disease Unit, Auckland City Hospital. Fifty-six women (54 cis and 2 trans) were diagnosed during the period. Eleven (20%) were diagnosed following a presentation with one or more AIDS-defining illnesses. Three (6%) died within six months of diagnosis. Fifteen of 44 (34%) women residing in New Zealand prior to their diagnosis of HIV infection had identifiable healthcare interactions that could have resulted in an earlier diagnosis of this infection. Women account for one in eight of the total population of people diagnosed with HIV infection in the Auckland and Northland regions. There are currently inadequate levels of HIV testing for women in the Auckland and Northland regions. There is a need for targeted HIV screening efforts for women. HIV screening needs to be optimised to maximise coverage, normalise testing and reduce the stigmatisation associated with testing.
We describe the characteristics of women diagnosed with HIV and AIDS in Aotearoa New Zealand over the last 25 years, and of women living with HIV in New Zealand in order to guide the response for HIV prevention and care. Data on women diagnosed with HIV and AIDS in New Zealand (1996-2020) were collected through routine surveillance case reports from healthcare providers. CD4 cell count <350 cells/mm³ was considered a late diagnosis. Women living with HIV by 31 December 2020 included those first diagnosed in New Zealand and those previously diagnosed overseas. A total of 634 women have been diagnosed with HIV (18% of all diagnoses in this time): most cases were acquired through heterosexual contact (82%). Twenty-eight percent (n=180/634) acquired HIV in New Zealand, of whom 43% were diagnosed late. AIDS was diagnosed in 128 women (72% within three months of HIV diagnosis). An estimated 570 women (77% aged >40 years) were living with diagnosed HIV at the end of 2020. The number of women diagnosed with HIV each year in New Zealand has remained steady over recent years. More timely testing and diagnosis is essential to ensure women with HIV have access to appropriate treatment and support.
We followed prospectively all patients with HIV infection admitted to the infectious diseases ward at Auckland Hospital over a seven month period. Neurological manifestations of HIV infection were the primary reason for admission in 18 of the 55 patients (33%). Diagnoses were usually presumptive, based on history, clinical findings, radiological appearances and response to empirical therapy. Eight patients had cerebral toxoplasmosis, three primary cerebral lymphoma, two cytomegalovirus retinitis, two HIV neuropathy, one cryptococcal meningitis, one HIV encephalopathy, and one HIV meningitis. Another patient with HIV infection was admitted to the neurology ward at Auckland Hospital with HIV myelopathy during the same seven month period. The median survival of the patients treated for presumptive toxoplasmosis was 7.5 months. Only two patients had not developed AIDS, one having HIV meningitis and the other HIV myelopathy, and in both, symptoms resolved spontaneously with no relapse at one year follow up. The spectrum of neurological manifestations of HIV infection is wide. Investigations to determine the most likely diagnosis are indicated and specific therapy may lead to both excellent palliation and prolonged survival.
To determine the human immunodeficiency virus (HIV) types infecting a West African immigrant to New Zealand. To develop an HIV type 2 specific polymerase chain reaction (PCR). The HIV antibody status of the patient was determined using both HIV-1 and dual HIV-1 and 2 enzyme immuno assays (EIA). Western blot with HIV-2 and HIV-1 and 2 strips was used as a confirmatory assay. DNA from white blood cells was extracted and HIV proviral DNA amplified using either primers specific to the HIV-2 gag region (VB305 and VB312) or to HIV-1 gag (SK38/39) and env (SK68/69) regions. Amplified products were electrophoretically resolved, southern blotted and probed with specific oligonucleotide probes. The patient serum was strongly reactive for HIV antibodies by EIA and showed multiple reactivity when tested by western blot against both HIV-1 and HIV-2 proteins. DNA was only amplified with primers specific to HIV-2 and the 298 bp product hybridized with an HIV-2 specific probe. No HIV-1 DNA was amplified from the patient. This individual is infected with HIV-2 and has most likely developed antibodies that cross-react with HIV-1. We believe this is the first report of an HIV-2 infected individual in New Zealand.
A presumptive clinical diagnosis of cytomegalovirus (CMV) retinitis was made in two patients presenting with atypical ophthalmologic findings. The diagnosis was confirmed by finding specific CMV DNA sequences in sampled vitreous fluid using a polymerase chain reaction (PCR) based assay. Neither of these patients yielded CMV on culture or PCR of peripheral blood leucocytes, nor was CMV present in tears or urine of either patient. Serum antibody titres were stable and did not help in establishing the diagnosis. This report suggests that CMV retinitis can occur in the absence of disseminated CMV disease.
To study the epidemiology, presenting features and outcome of HIV infection among women in Auckland. Retrospective review of the medical records of all HIV infected women cared for by the adult infectious disease unit or the sexual health clinic at Auckland Hospital up to the end of December, 1993. Thirty women with HIV infection were cared for between September 1986 and December 1993. Heterosexual intercourse, often with a man from a country with endemic heterosexual HIV transmission, was the most common means of acquiring HIV infection. Late diagnosis of infection probably contributed to the brief median survival seen in the nine women who developed AIDS. Increased education is necessary to inform women about the risks of acquiring HIV infection. This education should encourage safer sexual behaviour and the use of needle exchange programmes to minimise the growth of this epidemic.
To determine the incidence, demography, clinical features, treatments and outcome for patients with tuberculosis and human immunodeficiency virus (HIV) infection in Auckland. We reviewed the notes of all patients with HIV infection and tuberculosis seen by the Infectious Disease Unit, at Auckland Hospital since the onset of the HIV epidemic in New Zealand in 1984 until 31 December 1995. Eleven patients have had HIV infection and tuberculosis, 2.4% of all those with HIV infection cared for by this unit. Ten were male and eight homosexual. The median age was 30 years (range 24-57). The incidence in Pakeha was 1.2% (3 of 234), in Maori 20% (5 of 25) and in African 27% (3 of 11). Until 1990 we saw one case every two years and since then one or two cases per year. Six patients had normal chest x-rays and five had abnormal chest x-rays; of the latter, three were typical of tuberculosis and two atypical. Ten of the eleven strains of Mycobacterium tuberculosis cultured were fully sensitive but one was resistant to both rifampicin and isoniazid. Conventional treatment regimens were used. Seven patients have died of HIV infection, three continue treatment and one returned to Africa. One patient relapsed with fully sensitive tuberculosis. Three patients had major side effects to rifampicin necessitating alternative treatment. Tuberculosis is uncommon amongst those with HIV infection in Auckland but the incidence has risen in recent years. The risks amongst Maori and Africans are high. Multidrug resistant tuberculosis is uncommon. Those caring for patients with tuberculosis need to be mindful of HIV infection: those caring for patients with HIV infection need to be increasingly alert for tuberculosis.
Three decades after the first government-funded HIV prevention campaign in 1985, gay and bisexual men (GBM) remain the population most at risk of infection in New Zealand. We review the major determinants of the elevated HIV risk for GBM, describe New Zealand's prevention response over the first 30 years, and summarise the public health record. HIV incidence among GBM is driven by the heightened biological efficiency of HIV transmission during unprotected anal intercourse, dense sexual partnering networks, and endemic HIV prevalence. Responses in New Zealand have emphasised evidence-based primary prevention by condom use, which were implemented in communities and supported by comprehensive public health action. New Zealand has a good international HIV prevention record among GBM, however HIV diagnosis rates are now higher than they were during the epidemic nadir of the late 1990s. Lessons from the first three decades must underpin future HIV control efforts.
Two cases of mania in homosexual men with AIDS are presented. Particular emphasis is placed on the psychodynamic and psychosocial factors thought to be aetiologically significant. AIDS is seen both as an example of a terminal illness, and also as creating unique difficulties. It is suggested that integrative rather than reductionist thinking is needed in cases which under DSM-III-R would simply be classified as "organic mood disorder", that is, that all causal and contributory factors need to be considered in affective disorder occurring in the physically ill.
to study condom use amongst those who practice anal intercourse. a sample of 814 clients attending anonymously for pretest counselling for HIV infection at the Burnett Clinic, Auckland, gave detailed information about their sexual behaviour. insertive or receptive anal intercourse was reported in 39% of clients. This included 89% among homosexual men, 78% among bisexual men, 17% among heterosexual men and 21% among heterosexual women. In those practising anal intercourse concomitant condom use was reported by 71% of homosexual men, 53% of bisexual men, 16% of heterosexual men and 7% of heterosexual women. Those most likely to use condoms were homosexual men, prostitutes, those with multiple partners and those with an HIV infected partner. Those least likely to use condoms were heterosexual men or women. whilst substantial changes in sexual practices appear to have been made in the homosexual community, heterosexuals practising anal intercourse have made few such changes. More explicit AIDS education may be necessary which acknowledges that anal intercourse is practised by heterosexuals and advises condom use accordingly. This study examined condom use among those practicing anal intercourse. 814 clients attending anonymously for pretest counseling for HIV infection at the Burnett Clinic, Auckland, New Zealand, provided detailed information concerning their sexual behavior. Insertive or receptive anal intercourse was reported in 39% of the clients, including 89% among homosexual men, 78% among bisexual men, 17% among heterosexual men, and 21% among heterosexual women. In those who practiced anal intercourse, there was also concomitant condom use reported by 71% of homosexual men, 53% of bisexual men, 16% of heterosexual men, and 7% of heterosexual women. Those most likely to use condoms were homosexual men, prostitutes, those who had multiple partners, and those with an HIV-infected partner. Those least likely to use condoms were heterosexual men and women. While significant changes in sexual practice appear to have been made in the homosexual community, heterosexuals who practice anal intercourse have not made many changes. More explicit AIDS education may be necessary which acknowledges that anal intercourse is practiced by heterosexuals and which advises condom use accordingly.
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To investigate the lifetime self-reported incidence of sexually transmitted diseases and hepatitis A, B and C in a national sample of men who have sex with men (MSM) in New Zealand. A national telephone survey of MSM was conducted in 1996 with the aim of collecting baseline information on the sexual behaviour, safe sex practices, socio-sexual milieu and HIV knowledge of a broad range of MSM. Of the 1852 respondents, 37.1% reported a lifetime history of sexually transmitted diseases (STDs), 7.0% reported hepatitis A, 8.0% hepatitis B and 1.8% hepatitis C. A quarter (26.2%) had been for a sexual health check-up or treatment in the year prior to survey. Logistic regression analysis revealed independent associations with STD history (older age, higher number of lifetime partners, seeking partners in public venues, tested HIV positive), HAV (older age, higher number of lifetime partners, use of sex venues, tested HIV positive), HBV (older age, seeking partners in public venues, tested HIV positive), HCV (lower income, recent injecting drug use, tested HIV positive). This is the first time that information on STDs and hepatitis among a large national sample of MSM has been collected in New Zealand. The findings corroborate previous evidence that MSM are disproportionately affected by sexually transmitted infections other than HIV.
HIV pre-exposure prophylaxis (PrEP) is a daily pill that prevents HIV acquisition. In March 2018, New Zealand became one of the first countries in the world to publicly fund PrEP for individuals at high risk. PrEP promises significantly improved HIV control but is unfamiliar to most health practitioners here, compromising its potential. In this article we review the rationale for PrEP and identify barriers to rapid implementation. The latter include: consumer and health practitioner awareness; acceptability; scale-up targets; prescribing and pharmacy bottlenecks; service capacity to manage follow-up; primary care training; monitoring systems for uptake and quality; equity; eligibility; risk compensation and policy. Many of these areas are ripe for research and innovation. By addressing these obstacles we can realise the potential of PrEP and move closer to ending HIV in Aotearoa/New Zealand.
To determine the diagnostic accuracy of upper gastrointestinal endoscopy in a selected group of patients with HIV infection, who had severe symptoms unresponsive to empirical treatment. We reviewed all patients with HIV infection, who had undergone upper gastrointestinal endoscopy at Auckland Hospital. Specific diagnoses were based on the endoscopic appearances and on the histological and microbiological examination of endoscopic biopsies taken from the oesophagus, stomach and duodenum. A definitive diagnosis was reached in 16 of the 21 patients endoscoped, of whom 13 had a good clinical response to treatment. The median survival was three months. The most common diagnosis was oesophageal candidiasis seen in six patients, all of whom responded to treatment with a median survival of six months. Invasive cytomegalovirus gastrointestinal disease was seen in three patients, none of whom had positive blood cultures for cytomegalovirus. All responded to intravenous ganciclovir. Three patients with severe diarrhoea had opportunistic infection of the small bowel. All three had advanced AIDS with a median survival of less than one month. Upper gastrointestinal endoscopy has a high diagnostic yield in patients with HIV infection with oesophageal symptoms which fail to respond to antifungal therapy, or with severe weight loss and diarrhoea and it should be considered in these patients because excellent palliation may be possible.
To examine the incidence of sexually transmitted diseases according to gender, age, sexual orientation, sexual behaviour and drug use. Data were collected from 814 clients attending anonymously for HIV testing at the Burnett Centre in Auckland. During pretest counselling clients were asked questions designed to assess their risk of HIV infection including a detailed history of sexually transmitted diseases (STDs). Amongst attenders 44% reported at least one lifetime STD including 16% reporting more than one. Multiple STDs were not associated with gender or sexual orientation but they were associated with the practice of anal sex and with a history of multiple sex partners. Alcohol and drug use were also related to multiple STDs. For men the most common STD was NSU with 20% of them reporting it whereas for women genital warts was the most common reported by 18%. Amongst those under 20 years 9% reported genital warts, 7% NSU and 6% chlamydia. The findings confirm that it is sexual practices which put people at risk of infection from STDs rather than their sexual orientation. They also draw attention to the role that drugs and alcohol play in the practice of unsafe sex and the consequent transmission of STDs. Finally they suggest that screening for STDs as well as HIV in AIDS clinics should be encouraged.
To assess the survival of Auckland residents diagnosed with AIDS between 1983 and 1989. Retrospective case review Sixty nine Auckland residents were diagnosed with AIDS between 1983 and the end of 1989, and were cared for by the infectious disease unit, Auckland Hospital. The overall median survival was 289 days with 48% and 20% surviving at one and two years respectively. Survival was longer among those who were infected through homosexual contact, were younger, and not known to the infectious disease unit prior to the diagnosis of AIDS. Although survival was longer for those diagnosed in 1988 compared to earlier years, it was shorter again for those diagnosed in 1989. Pneumocystis carinii pneumonia, the AIDS defining condition in 63.8% of people, was found less frequently in 1989, and overall was associated with a longer survival than most of the other AIDS-defining diagnoses. A quarter of the people were not known to be infected with HIV prior to the AIDS-defining condition. In New Zealand, as in other countries, changes in treatment strategies of people with HIV infection may impinge on the survival of people with AIDS.