Dr Peter Saxton speaks with express on the dramatic increase in syphilis cases across New Zealand.
Syphilis in New Zealand is on the rise. In the year to the end of March, 548 cases of the sexually transmitted disease were reported, up from just 82 in 2013.
The last year had seen a doubling in reported cases alone.
While syphilis is more common among men who have sex with other men (MSM) Dr Peter Saxton from the Gay Men’s Sexual Health (GMSH) research group says “we certainly shouldn’t blame individuals or entire communities: it’s knee-jerk and makes it someone else’s fault but the failures are systemic.”
Rather Saxton says it is governments and DHBs who have failed to respond to the “massive social shifts: and the changes in how people make sexual choices in a “radically different environment compared to 20 years ago” combined with a lack of investment.
“Ultimately that’s where accountability rests.” Dr Saxton says.
Dr Saxton points to the scrapping of the Sexual and Reproductive Health Action Plan as an example and adds that “the sexual health workforce in NZ is wafer-thin.
“Expertise is draining away. Sexual health still isn’t a government priority. We’ve got a small number of public sector officials doing their best, but sufficient funding isn’t being released to them.” Dr Saxton says.
The rise in syphilis in New Zealand is broadly in line with similar increases in other developed nations and in particular with the rates amongst MSM.
“Among MSM, increases in syphilis did coincide with declines in condom use from 2013. But we could have stopped the outbreak early if MSM had better access to convenient, welcoming and relevant sexual health services.” Dr Saxton says.
Dr Saxton says PrEP should not be used a scapegoat for the rise in STIs as the rise began well before PrEP was available.
“Obviously a person’s exposure to STIs will increase if condom use drops and partner change increases. But so long as PrEP is accompanied by regular (3 monthly) STI screening, then any newly acquired infections can be diagnosed and treated early, and contact tracing can begin. Plus, MSM using PrEP and U=U can add condoms to provide more comprehensive sexual health protection.” Dr Saxton says.
“Right now, an increasing reliance on PrEP and U=U does shift the locus of prevention away from communities and towards clinical services. So making clinical services more responsive to the needs of MSM is absolutely critical and urgent if we want this to succeed. That’s this generation’s big challenge.”