Relaxed condom use among gay men has been blamed for New Zealand's syphilis epidemic, but the AIDS Foundation says the problem lies within the system.
In 2013 there were 82 reported cases of syphilis. In the 12 months ended March 2019, there were 548 - a rise health authorities called "concerning".
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It's been theorised that new developments in HIV treatment are behind the spike.
While the diagnosis was effectively a death sentence in the 1980s and 90s, those who are HIV-positive can now live long, healthy lives. The invention of Pre-Exposure Prophylaxis (PrEP) means HIV-negative people can stay that way simply by taking a daily pill.
Of the 548 cases of syphilis in New Zealand in the last year, 350 occurred in men who have sex with men - the majority of which were aged between 20 and 39.
Some health professionals have indicated young gay men have more relaxed attitudes about safe sex because of HIV treatments like PrEP, meaning they're using condoms less often and thus putting themselves at risk of STIs such as syphilis.
The rise of dating apps and "hook-up culture" has also been blamed for the epidemic.
But Jason Myers, CEO of the New Zealand AIDS Foundation, isn't convinced.
"It's too simplistic to say gay people are being too relaxed," he told Newshub.
He says NZAF's own surveys show gay and bisexual men are still very much aware of the dangers of HIV and understand the importance of condoms.
Myers says it's not that gay men don't care about being safe, but that the New Zealand heath system is not designed to support them.
Only 50 percent of the country's gay men are out to their GPs, which often means they aren't receiving the targeted care they need such as being offered certain sexual health tests.
"The system is designed for 'mainstream' Kiwis," Myers says. "There needs to be culturally appropriate care for everyone."
For members of the LGBT community, that could involve doctors using gender-neutral language, not assuming patients are in heterosexual relationships or even displaying a pride flag at the reception desk.
"It's the small things that create an environment where people feel welcomed and comfortable having these conversations," Myers says.
"We need to promote healthy behaviours, promote protection and normalise testing."
He also says the Government should invest more in developing "sex positive" public awareness campaigns around staying safe from syphilis and other STIs.
While NZAF conducts its own surveys, there has been no independent national data taken about the LGBT community's attitudes since 2014. Myers says we need a new set of data to better understand gay people's habits, including why more people are contracting syphilis.
"There has been a total absence of leadership and strategy in the sexual health space."
The Government has not released a national-level strategy for sexual health since 2001. Last week it published the National Syphilis Action Plan, which Myers says is a positive action but "three or four years behind the ball".
"Syphilis is now a significant problem, and it could have been caught earlier," he says.
"There is no excuse for a developed country to have these syphilis rates. It is totally inexcusable for babies to be dying from syphilis."
Myers says the NZAF is committed to raising awareness of STIs where it can, but the organisation's focus is always HIV.
"We're being asked to address more and more issues, but we haven't received any new funding."
After the terror of the AIDS crisis at the end of the 20th century, Myers says it worries him to see another dangerous sexually transmitted disease disproportionately affecting the gay community.
"What we don't want is another serious STI epidemic to emerge, which is what we're seeing."
Syphilis can be treated with penicillin, but Myers says antibiotic resistance has proven an increasing danger to some STI drugs overseas.
"These trends are alarming and should be taken seriously."
Associate Health Minister Julie Anne Genter, who is responsible for sexual health, was unavailable for comment.
Newshub.
