As HIV numbers surge, advocates push for better access to drugs
Ashley Barratt was shocked when he learnt nearly five years ago that he was HIV positive, as part of a routine blood test.
"My first thought was 'am I going to die? What are people going to think?'" he says.
Despite the diagnosis, Barratt did not qualify for medication, and his HIV went untreated for more than four years.
"Every time I went to see my specialist I would ask for medication, but it was denied," he says.
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Under current New Zealand guidelines, an HIV-positive person cannot access medication until their CD4 count drops below 500.
CD4 are white blood cells that indicate the health of a person's immune system; most healthy people have a count between 500 and 1300.
Barratt had a CD4 count of 800 when he was diagnosed, so his requests for early treatment were refused.
New Zealand's policy dates from a time when HIV treatments were so severe they were delayed as long as possible.
Both the World Health Organisation and the United Nations now recommend that treatment begins immediately.
Dr Peter Saxton from the University of Auckland has spent 14 years researching HIV/Aids, and warns New Zealand needs to follow suit.
"We've got more people living with HIV today than we did at what was considered to be the peak of the epidemic in the 1980s," he says.
There are currently 3,200 New Zealanders living with HIV; 500 of those have been diagnosed but do not yet meet the threshold for treatment.
Saxton says that's particularly concerning, because an HIV-positive person is most infectious just after contracting the virus.
"If you offer treatment early, you render those individuals virtually non-infectious," he says.
"So you're saving the future cost that would be incurred if they infected someone else."
Those who do qualify for treatment can only access a limited range of drugs that are funded by Pharmac.
Barratt was prescribed Atripla once his CD4 count dropped below 500; it's an older drug that left him with unpleasant side effects.
That changed when he moved to Germany to be with his partner.
"I went to see a specialist in Frankfurt, and he actually laughed that I was on Atripla," he says.
"He couldn't believe it.
"I was transferred to a more contemporary drug that has absolutely no side effects."
Sarah Fitt, acting chief executive of Pharmac, acknowledges that HIV treatment in New Zealand needs to improve.
"Pharmac fully recognises the unmet health need for people living with HIV," she says.
"Pharmac has received an application to allow open funded access to HIV treatments by removing the CD4 count criteria.
"Our advisers recommended that we fund this."
However the application only has medium priority, and Fitt says Pharmac isn't yet able to provide a timeframe for when funding might be approved.
Thursday marks World Aids Day,which is held on December 1 each year.
The New Zealand Aids Foundation has set an ambitious target of ending new HIV infections by 2025, but executive director Jason Myers admits that will be difficult.
"It's incredibly frustrating," he says. "You've got the highest rates of HIV the country has ever seen, and it's not a health priority for the government."
"It's really becoming an embarrassment internationally that New Zealand still withholds life-saving treatment from some of the most vulnerable members of society," he says.
"This really is a no-brainer."
Barratt's happy now that he's receiving good treatment, and has around the same life expectancy as an average person.
"Being HIV-positive doesn't define me," he says.
"I really do love my life."