A proposed Health New Zealand scheme offering free HIV prevention consultations to Māori and Pacific people has sparked criticism from the ACT Party, despite official figures showing significant inequalities in access to PrEP.
Health New Zealand Te Whatu Ora is considering a pilot programme that would subsidise telehealth consultations for people accessing pre-exposure prophylaxis (PrEP), a highly effective medicine used to prevent HIV.
However, a leaked draft document obtained by Newstalk ZB has revealed that the proposed subsidy would differ depending on ethnicity and eligibility for existing healthcare support.
Under the draft proposal, Māori and Pacific clients would receive a $79 consultation subsidy, while other eligible clients would receive $33.
This would make consultations free for Māori and Pacific people, as well as Community Services Card holders, while other patients could face additional charges depending on the healthcare provider.
The proposal has drawn criticism from ACT MP Todd Stephenson, who argues it conflicts with the coalition Government’s policy requiring public services to be allocated according to need rather than ethnicity.
Health NZ has stressed that the proposal remains a draft and no final decisions have been made.
What Is The Proposed PrEP Subsidy?
PrEP is a preventative HIV medication taken by people who are HIV-negative and may be at risk of acquiring the virus through sex or injecting drug use.
When taken correctly, oral PrEP is highly effective at preventing sexual transmission of HIV.
Although PrEP medication is already publicly funded for eligible people in Aotearoa, accessing it can still involve costs for medical consultations, prescriptions and ongoing health monitoring.
The proposed pilot aims to reduce some of those barriers by subsidising telehealth consultations, allowing eligible patients to speak with healthcare professionals remotely.
According to the leaked document, the proposed subsidies are:
- $79 for Māori and Pacific clients, covering the full consultation cost.
- $79 for Community Services Card holders, also allowing free consultations.
- $33 for other eligible clients, who may need to pay the remaining consultation fee.
The pilot would reportedly run until 30 June 2027, when it could be evaluated and potentially extended.
However, Health NZ has not confirmed whether the final programme will retain these eligibility criteria or subsidy amounts.
ACT MP Challenges Ethnicity-Based Funding
ACT MP Todd Stephenson has questioned why Health NZ would consider a proposal involving ethnicity-based subsidies after Cabinet issued a directive on needs-based public services in September 2024.
The directive was introduced under coalition agreements involving National, ACT and New Zealand First.
It establishes expectations that public services should be designed and prioritised according to people’s needs rather than ethnicity or other aspects of personal identity alone.
Stephenson told Newstalk ZB he was surprised such proposals were still emerging from government agencies.
“We [ACT] are actually surprised that ministers aren’t on top of making sure that departments and agencies aren’t rolling out programmes that are not based on need only,” he said.
Stephenson also questioned whether HIV statistics demonstrated sufficient need for the proposed ethnicity-based subsidies.
“They need to do some deeper thinking and not just keep reverting back to race, as a way of putting in place programmes,” he said.
However, the Cabinet directive does not categorically prohibit services targeted towards particular ethnic communities.
It allows for targeted investment where agencies can demonstrate an evidence-based need, explain why general services are insufficient and justify the proposed approach.
Whether the PrEP proposal meets those requirements would depend on its final design and supporting evidence.
Official Figures Reveal Māori And Pacific PrEP Access Gaps
While the political debate focuses on eligibility, official health statistics reveal significant differences in access to HIV prevention medication.
The Ministry of Health’s 2025 HIV Monitoring Report found that among surveyed gay, bisexual and other men who have sex with men who met the study’s criteria for PrEP:
- 43.5% of Māori participants reported using PrEP.
- 40.5% of Pacific participants reported using PrEP.
- 56.4% of non-Māori participants reported using PrEP.
The findings indicate that Māori and Pacific participants were less likely to be using HIV prevention medication despite meeting the criteria for its use.
Importantly, these percentages relate to participants in a sexual health survey, rather than every Māori, Pacific or non-Māori person who could benefit from PrEP.
Further research released by the University of Auckland on 28 October 2026 highlighted similar concerns.
Drawing on an earlier national survey, researchers found that while most people who could benefit from PrEP knew about the medication and were willing to take it, significantly fewer were actually using it.
The researchers identified cost, access to healthcare and the availability of suitable services as areas requiring attention.
They suggested that telehealth, pharmacies and other flexible healthcare options could help reduce barriers to accessing PrEP.
The findings provide relevant evidence for the wider debate over how HIV prevention services should be delivered.
Why Access To PrEP Matters For Rainbow Communities
For gay, bisexual and other men who have sex with men, as well as transgender people and others who may benefit from HIV prevention, PrEP is an important part of sexual healthcare.
New Zealand has made considerable progress in reducing HIV transmission, but ongoing access to prevention services remains essential to achieving the country’s goal of eliminating local HIV transmission.
Barriers can include consultation costs, difficulty finding a knowledgeable healthcare provider, travel distances, appointment availability and concerns about stigma or discrimination.
These challenges may be particularly relevant for people living outside major centres or those who face additional barriers to accessing healthcare.
The National HIV Action Plan for Aotearoa New Zealand 2023–2030 specifically identifies improving Māori health outcomes, addressing discrimination and increasing equitable access to HIV prevention as priorities.
Reducing financial barriers is one potential way of improving access, although the effectiveness and fairness of any particular subsidy model would need to be assessed.
Health NZ Says No Decisions Have Been Made
Health NZ has emphasised that the leaked document is not a final policy announcement.
National Clinical Director of Primary and Community Care Dr Sarah Clarke said the agency was still developing the pilot, including its eligibility criteria and any patient co-payments.
“No final decisions have been made and there will likely be changes before being finalised,” Clarke said.
She indicated that Health NZ hoped to begin the pilot over the coming months.
“The pilot reflects the important role that HIV prevention continues to play in New Zealand’s public health response,” Clarke said.
Associate Minister of Health Matt Doocey, who has responsibility for HIV prevention policy, declined to comment when approached by Newstalk ZB.
What Happens Next?
With the pilot still under development, the final subsidy arrangements remain uncertain.
The disagreement raises a wider question about how New Zealand’s health system should respond when particular communities experience lower rates of access to preventative healthcare.
ACT maintains that services should be allocated according to individual need rather than ethnicity alone.
Meanwhile, the Ministry of Health’s own HIV monitoring framework recognises that addressing inequities, including those affecting Māori, is an important part of the country’s HIV prevention response.
For rainbow communities, the practical outcome will be whether the final scheme makes accessing PrEP easier and more affordable for people who need it.
With New Zealand aiming to eliminate local HIV transmission, improving access to preventative healthcare remains a central part of the country’s public health strategy — regardless of how the final subsidy scheme is structured.
