Doctors frustrated as Kiwis struggle to access STI testing clinics

Sexual health specialists are calling for a review of the Auckland Sexual Health Service, alongside further investment in public clinics around the country.

Patients who cannot afford to see a GP are forced to navigate restrictive walk-in hours for Auckland’s clinics, and those in the South Island may have to travel hundreds of kilometres to see their nearest specialist.

Dr Massimo Giola has worked as a sexual health specialist for 30 years, first in Italy and now in the Bay of Plenty. He is one of just a handful of qualified experts spread throughout the country.

Giola said his work was vital.

“We deal with very intimate questions and problems,” he said.

“Sometimes people trust us with information they wouldn’t tell anyone else. That’s the reason why we need to keep our doors open.”

But keeping those doors open hasn’t been easy. Aotearoa’s sexual health clinics have been operating with the same staff and resources for almost a decade, despite increasing demand.

A study in the current issue of the New Zealand Medical Journal showed referrals to public clinics had almost doubled in the last five years, from 1218 to 2036.

A 2014 review of the Auckland Sexual Health Service resulted in the dismissal of two specialist physicians, reducing capacity instead of increasing it. The rationale behind this decision was to transform clinics into a secondary-level service only accessible by referral, which was expected to reduce demand by 30 percent.

That didn’t happen.

The review, in Giola’s words, was unfortunate.

“I think it could be used in schools as a case-in-point of how you do not manage a health service,” he said.

Since then, Auckland’s sexual health clinics had floundered under the DHB system while infections like gonorrhoea and syphilis continued to spread. Demand grew, but clinics didn’t.

Melbourne, in Australia, had almost three times as many specialists as the entirety of New Zealand, Giola said, despite both having a similar population size.

“In Melbourne, they have one sexual health centre for the whole of Victoria. That centre employs 35 sexual health physicians,” he said.

“By comparison, in New Zealand I think we have about a dozen across the whole country.”

That means, depending on where someone lives, accessing a vital service – like a free STI test – could be nigh on impossible. South Islanders hoping to consult a free sexual health specialist would need to travel to Christchurch, potentially hundreds of kilometres away.

The Burnett Foundation, previously the New Zealand AIDS Foundation, has been at the forefront of the response to HIV and other sexually transmissible infections for decades.

Its chief executive Joe Rich said the system was not fit for purpose.

“My observation is that sexual health services have faced death by a thousand cuts; just not prioritised at all.”

That was especially troubling for young people in the South Island, he said.

“Queenstown is a party city, lots of young people go there and hook up, but there’s no free sexual health services in Queenstown,” Rich said.

“It’s appalling really, if you were to acquire an STI while you’re in Queenstown, well good luck to you because the nearest clinic is many hours of driving away.”

Even when clinics were available, it didn’t make them easy to access.

“A barrier to accessing testing services are physical access constraints around the location of clinics, the hours or days,” Rich said.

“In Auckland, some of the clinics are open only a handful of days a week simply due to shortages.”

Auckland had four clinics, but none were open on weekends and just two accepted walk-ins. One clinic, on the North Shore, was open for just six hours a week – on Tuesdays.

Rich suspected the lack of resources for sexual health services was a knock-on effect of Kiwis’ underlying prudish attitudes.

“New Zealand has, in the past, tended to have a pretty Victorian attitude towards sex,” he said, “which is that we don’t talk about it.”

“Does that flow through into what becomes politically acceptable to talk about or to prioritise?”

With the newly centralised health system under Te Whatu Ora, Giola has spotted an opportunity to re-emphasise the importance of sexual health.

“I am optimistic, but I know Te Whatu Ora has a long list of things to prioritise,” he said.

“I hope sexual health is in the top priority list, because it’s the typical example of something that’s very easy to forget about.”

The current system, Giola said, just wasn’t cutting it.

“You can go around and ask everyone in the sexual health sector, there is not a single person that will tell you our sexual health services are adequate,” he said.

If sexual health services continued to be ignored, Giola worried infections would continue to escalate and place additional strain on an already suffering health system.