PRISM: Human Rights issues relating to Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (SOGIESC) in Aotearoa New Zealand - A report with recommendations in older adults feeling forced to conceal their SOGIESC.203 This is not surprising given this generation’s lived history included many years of their identities being criminalised and stigmatised. Historical experiences of rejection from family may result in a feeling of vulnerability as they become dependent on others to assist in meeting their needs. Those who spoke to the Commission recommended that barriers could be reduced through education and acceptance of SOGIESCdiversity in aged care facilities. HIV While new HIV infections have shown a promising decrease for the past two consecutive years, HIV remains an issue of concern for SOGIESCdiverse communities.204 People living with HIV are protected from discrimination under the Human Rights Act.205 There are an estimated 4,000 people living with HIV in Aotearoa, with the most at-risk group of acquiring the virus being men who have unprotected sex with men (MSM).206 For decades, the prevention of HIV infection has centred around sex education and the promotion of condom use.207 Pre-exposure prophylaxis (PrEP) is a modern HIV prevention strategy which complements other safe sex practices to prevent infection. PrEP is a daily oral pill taken by HIV- negative people to prevent transmission of the virus. New Zealand was one of the first countries in the world to fund this medication,208 which reduces the risk of HIV infection by 99% when taken as recommended.209 HIV was classified as a notifiable disease in 2017, meaning that those living with the virus can access treatment for the disease even if they are otherwise ineligible to receive publicly funded health services.210 Starting medication on the day of the diagnosis, rather than delaying it, leads to the best health outcomes.211 Through technological advancements and increasing availability of medication, the life expectancy of a person living with HIV is now the same as a person without the virus, provided they are on treatment212 and have an undetectable viral load.213 An undetectable viral load means there is no risk of transmitting HIV to another person. Mental Health A significant body of evidence shows poorer rates of mental health and a higher risk of experiencing distress, addiction, and suicide for people with a diverse sexual orientation, gender identity and expression, and sex characteristics.214 The Suicide Mortality Review Committee individually reviewed Michael Stevens Rainbow health: The public health needs of LGBTTI communities in Aotearoa New Zealand with policy recommendations (Affinity Services, Auckland, 2013). 204 Of the 178 people newly diagnosed with HIV in 2018, 111 or 62.4% were men who had sex with men. The remaining diagnoses were made up of 45 men and 22 women, three of whom were transgender. See AIDS Epidemiology Group AIDS – New Zealand (University of Otago, Otago, May 2019); and New Zealand AIDS Foundation “Continued dramatic decline in national HIV diagnoses” (media release, 15 May 2019). 205 Human Rights Act 1993 s 21(1)(h)(vii) states that disability means the presence in the body of organisms capable of causing illness. 206 “MSM” includes trans men; see United Nations Population Fund, Global Forum on MSM & HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, World Bank Implementing comprehensive HIV and STI programmes with men who have sex with men: Practical guidance for collaborative interventions (United Nations Population Fund, New York, 2015) at xvii. 207 Stephen Neville, Jeffery Adams and Judith Holdershaw “Social marketing campaigns that promote condom use among MSM: A literature review” (2014) 30 Nursing Praxis in New Zealand p5. 208 The medication was funded from 1 March 2018 for people who are at high risk of contracting HIV infection. See PHARMAC “PrEP for HIV prevention: emtricitabine with tenofovir disoproxil fumarate (Truvada)” (9 September 2019) <https://www.pharmac.govt. nz/>. 209 Ending HIV NZ “Everything has changed. We can end HIV by 2025.” (video, 30 January 2017). 210 A 2017 amendment to the Health Act 1956 classified HIV as an infectious disease. This means that under para B23 of the Health and Disability Services Eligibility Direction 2011, those living with HIV become eligible for certain health services related to the treatment and follow up of the HIV only (but not universal healthcare for other care needs). 211 Nathan Ford and others “Benefits and risks of rapid initiation of antiretroviral therapy” (2018) 32 AIDS p17. 212 Margaret May and others “Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy” (2014) 28 AIDS p1193. 213 Viral load is the term used to describe the amount of HIV in the blood. When the amount of HIV in a person’s blood is no longer able to be measured in a standard blood test, an HIV-positive person is said to have an “undetectable viral load.” 214 Moira Clunie and others Rainbow communities, mental health and addictions: A submission to the Government Inquiry into Mental Health and Addiction (2018); Jeffery Adams, Pauline Dickinson and Lanuola Asiasiga Mental health promotion and prevention services to gay, lesbian, bisexual, transgender and intersex populations in New Zealand: Needs assessment report (Te Pou o Te Whakaaro Nui, Auckland, May 2012). 203 38