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Prepared Against HIV: 2.0 PrEPared Against HIV: 2.0 ______________________________________________________________________________ A thesis submitted in fulfilment of the requirements for the Degree of Master of Arts in Political Science Alice Hartley ______________________________________________________________________________ Department of Language, Social and Political Sciences, University of Canterbury 2017 Table of Contents Acknowledgements ................................................................................................................................................... 3 Abstract ........................................................................................................................................................................... 4 List of Figures, Tables and Matrices ................................................................................................................... 5 Abbreviations ............................................................................................................................................................... 7 Chapter 1: Setting the Scene – an Introduction to HIV and PrEP ................................................ 9 HIV and AIDS ................................................................................................................................................................ 9 Pre-Exposure Prophylaxis (PrEP) .................................................................................................................... 22 Thesis structure ....................................................................................................................................................... 28 Chapter 2: Understanding the Complexities of PrEP ................................................................... 30 Introduction to the literature of PrEP ............................................................................................................ 30 First-generation randomised control trials of PrEP ................................................................................. 31 Providers and PrEP ................................................................................................................................................. 34 MSM and PrEP ........................................................................................................................................................... 41 Conclusion .................................................................................................................................................................. 52 Chapter 3: Methodology ......................................................................................................................... 55 Research design ....................................................................................................................................................... 55 Data processing and analysis ............................................................................................................................. 62 Ethical considerations ........................................................................................................................................... 63 Validity ......................................................................................................................................................................... 67 Conclusion .................................................................................................................................................................. 68 Chapter 4: Canterbury MSM and their attitudes towards PrEP ................................................ 70 Introduction ............................................................................................................................................................... 70 Method ......................................................................................................................................................................... 71 Results .......................................................................................................................................................................... 72 Discussion ................................................................................................................................................................... 81 Conclusion .................................................................................................................................................................. 88 Chapter 5: PrEPared Against HIV: 2.0 ............................................................................................... 91 Introduction ............................................................................................................................................................... 91 PrEPared Against HIV: 2.0 ................................................................................................................................... 98 Conclusion ............................................................................................................................................................... 123 Chapter 6: The Beginning of a New Era .......................................................................................... 125 Introduction ............................................................................................................................................................ 125 Reflections on this thesis ................................................................................................................................... 126 Implications of PrEP in the future ................................................................................................................. 129 Directions for future research ........................................................................................................................ 132 Conclusion ............................................................................................................................................................... 135 Appendices .............................................................................................................................................. 137 Appendix 1: List of AIDS defining conditions ........................................................................................... 137 Appendix 2: Facebook and email advertisement for online survey ............................................... 138 Appendix 3: Anonymous attitude scaling survey of Canterbury MSM .......................................... 139 Appendix 4: Information sheet and consent form for interviews ................................................... 144 Bibliography ........................................................................................................................................... 147 Acknowledgements “This is going straight to the pool room” – Darryl Kerrigan, The Castle I would first like to thank my primary supervisor, Associate Professor Amy Fletcher, from the Department of Political Science and International Relations. Your advice helped steer me in the right direction, yet you allowed this research to be my own work. Professor Alex Tan: thank you for being my secondary supervisor. Your constant encouragement and support helped me believe in myself. My supervisor team persuaded me to return to complete a Master’s thesis, and I am so grateful that you passed your passions for policy and political science on to me. Thank you to all those who participated in my thesis as survey respondents, interviewees, and question-answerers via email. I owe this research to you. To my mum and dad, Jon and Chris – thank you for listening to me complain or ramble on about my topic, and offering me advice when I felt lost. Without you both, this thesis would not have been possible. I am so lucky for this opportunity. To my siblings, Jemma, Fiona, and Kim, and my friends – thank you for providing me with laughter and distractions from the stress. And finally, to George: thank you for just being there for the whole journey. This thesis is for my Uncle Robbie, Robert Michael Hartley. 3 Abstract In 2016, there were 244 new HIV infections in New Zealand; this is the fifth consecutive year of rising infection rates, and the largest number of new diagnoses reported since records began in 1985. In New Zealand, men who have sex with men (MSM) can account for up to 80% of new HIV diagnoses yearly. Until now, HIV prevention has focused on behavioural methods, such as condom use, abstinence, and serosorting. However, recent trials show that a new biomedical method, pre-exposure prophylaxis (PrEP), is more than 90% effective at preventing HIV acquisition among HIV-negative, at-risk individuals when taken daily. Unfortunately, PrEP is not a silver bullet for HIV, as cited complexities associated with PrEP include potential antiretroviral resistance, side effects, cost, stigmatisation, and risk compensation. Therefore, this research aimed to answer the following questions: Do MSM from Canterbury feel that PrEP has a place in New Zealand’s public health system, and how could a policy be developed to minimise the difficulties regarding implementation faced overseas? Following Carol H. Weiss’s problem-solving model, this thesis uses a multiple, mixed-methods approach to reduce uncertainty regarding HIV prevention and treatment attitudes
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