PrEPared Against HIV: 2.0
Thesis DisciplinePolitical Science
Degree GrantorUniversity of Canterbury
Degree NameMaster of Arts
In 2016, there were 244 new HIV infections in New Zealand; this is the fifth consecutive year of rising infection rates, and the largest number of new diagnoses reported since records began in 1985. In New Zealand, men who have sex with men (MSM) can account for up to 80% of new HIV diagnoses yearly. Until now, HIV prevention has focused on behavioural methods, such as condom use, abstinence, and serosorting. However, recent trials show that a new biomedical method, pre-exposure prophylaxis (PrEP), is more than 90% effective at preventing HIV acquisition among HIV-negative, at-risk individuals when taken daily. Unfortunately, PrEP is not a silver bullet for HIV, as cited complexities associated with PrEP include potential antiretroviral resistance, side effects, cost, stigmatisation, and risk compensation. Therefore, this research aimed to answer the following questions: Do MSM from Canterbury feel that PrEP has a place in New Zealand’s public health system, and how could a policy be developed to minimise the difficulties regarding implementation faced overseas? Following Carol H. Weiss’s problem-solving model, this thesis uses a multiple, mixed-methods approach to reduce uncertainty regarding HIV prevention and treatment attitudes (specifically regarding PrEP) among a particular cohort (MSM) and thus, informs more effective future policies. The methods used are a survey, interviews, and document analysis.
The first research question was answered using an anonymous, online, Likert scale survey. Participants were recruited using non-probability purposive sampling. 42 MSM from the Canterbury region were surveyed to measure their attitudes towards HIV, PrEP and condom use. 100% of participants agreed that taking PrEP is a good way to reduce their chances of HIV infection, 100% of participants agreed that PrEP is a worthwhile prevention method for MSM, and 97.5% believed that PrEP should be subsidised for MSM.
Building upon the preliminary data, I propose PrEPared Against HIV: 2.0 as a solution to the second research question that follows Weiss’s problem-solving model. This policy is designed specifically to fit within New Zealand’s public health system and is informed by the grassroots input and empirical evidence collected through interviews with HIV experts, survey data, and document analysis. PrEPared Against HIV: 2.0 pays specific attention to ‘PrEP problem areas’ such as developing adequate clinical guidelines, ensuring PrEP providers receive adequate support, encouraging adherence, and reducing stigmatisation linked to PrEP use. This research shows there is a need for greater investment in HIV prevention rather than costly HIV treatment. PrEP can reduce future HIV infections and there is obvious support from both HIV experts and MSM for a PrEP policy in New Zealand. However, PrEP needs to be one plank in a multi-faceted policy for wider HIV prevention to ensure that it can have a positive impact on the HIV epidemic in New Zealand.