HIV fears as needle exchange to close
The impending closure of the Dunedin-run needle-exchange service could lead to a rise in HIV cases throughout the city, advocates fear.
The Otago Daily Times has been told DISC Trust has lost its contract to administer the programme, which will now be run by Christchurch-based health services provider He Waka Tapu.
The trust, which includes the Southland Harm Reduction Programme, Dunedin Intravenous Organisation, Timaru Needle Exchange Trust and Nelson Injecting Community Health Enterprise, is part of a community network that has run the programme for more than 35 years.
It is understood at least 15 South Island support staff will lose their jobs as a result of the contract's move.
This includes three of the five Dunedin staff.
A Dunedin worker said he was worried about the new provider's lack of experience and "on the ground" knowledge.
In particular, he worried it might stop the peer-based system, in which ex-users, or those who had ties to the community, provided harm reduction advice and support, he said.
"Our biggest concern is the lack of peer input — everyone here in Dunedin is a peer, which greatly reduces the stigmatism of the service.
"Often we're the only point-of-health contact for the intravenous drug users, because of the stigma.
"For intravenous drug users, as soon as they are doing it, they are breaking the law. So everyone that we serve is already on the wrong side of the tracks."
The Dunedin branch also ran a free GP clinic for its clients, and so far, there had been no indication about its future, he said.
"It can take years to build up trust as peers, especially when it comes to getting them accessing the health service."
He Waka Tapu provides personalised health consultations, community health initiatives, mental health crisis intervention, addiction support services, reintegration programmes, family violence prevention and educational offerings to promote holistic wellbeing.
Although He Waka Tapu had "lots of experience in the practical health field", it had no experience in the peer service aspects of the needle-exchange programme, the worker said.
"A huge part of New Zealand's success in not having a widespread HIV problem was down to the provision of clean equipment through the needle-exchange programme.
"For many of our clients, we are the only health-related service that they will see at all.
"A huge part of addiction is a background in trauma — and you would be surprised at how many of our clients' trauma is related to abuse within the healthcare system or setting."
The worker was particularly concerned in the possibility of neglect and logistical issues with setting up a new clean-needle service.
"New Zealand is definitely at risk of another HIV pandemic."
The worker said he had been made aware by Health New Zealand Te Whatu Ora (HNZ) that DISC's contract would wind up in September.
"We only found out yesterday who the new provider is. There's been no contact from the new provider. We can't even imagine how they will staff it without peers."
University of Otago (Wellington) public health department Prof Michael Baker said it would be a "grave step backwards" if the new provider moved away from a peer service.
"It was really best practice internationally because it meant that these groups could maintain the trust of injecting drug users — and that's almost certainly contributed to the long-term success of the programme.
"The HIV response in New Zealand was among the most effective in the world because it had a strong emphasis on basically destigmatising human provision.
"We are a pragmatic society. We want things that work."
HNZ and He Waka Tapu have been approached for comment.
matthew.littlewood@odt.co.nz
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