Today you will hear the views and ideas of our pozcast guests. We're eager to showcase their expertise and provide a platform for their views, but they may not always reflect or align with the views of the Positive Effect or the Map Center for Urban Health Solutions.
Welcome to pozcast. We are created by and for people living with HIV. On each episode, we explore what it means to be poz. We challenge the status quo, and we share stories that matter to us. I'm James Watson and I'm HIV positive. If you're living with HIV, listen up.
The other thing you do is you normalize like when you look at prenatal testing that should be standardized. Everyone should be getting standard prenatal testing. We don't need to ask the questions we're testing you for all these things to make sure that you're healthy, and it includes HIV. It's not a judgment. It's a test to make sure that you're healthy, and we need to make it way more normalized and way more accessible and lots of different ways. Whatever works for that person is what we need to provide, and whether that's buying it from a pharmacy, or having the pharmacist do it for me, or having the community person do it for me, just get it out there. If you want to get 100% you've got to do a lot more in this space.
We have a great show for you. This is pozcast.
Hey everyone, welcome to pozcast. Today, we're going to explore one of the most important tools in our fight against HIV. HIV testing. To give you a little global context, the United Nations and the World Health Organization began a target setting process in 2018 and set 95/95/95 targets the call for the end of HIV as a public health threat by 2030 and the targets state that by 2025 and that's next year, 95% of people living with HIV should be diagnosed. 95% of those diagnosed with HIV should be receiving antiretroviral therapy ART and 95% of those receiving ART should be virally suppressed or undetectable. And it's that first target is what we're talking about today. Testing is that crucial first step to get 95% of people living with HIV knowing their HIV status by 2025 and I think in Canada, we're sitting at around 90% at this point. So if we're to reach that 100% of people living with HIV knowing their status by 2030 we got our work cut out for us, so it's important we keep talking about it like we're going to do today, and highlighting and scaling up our successes and doing whatever we can to break down the barriers to testing, including that beast, HIV stigma. So in today's show, we're going to take on a little more of a global perspective and look at testing in two countries on opposite sides of the world, Canada and New Zealand. And I have two fantastic guests. We have the fabulous Mark Fisher, who's been involved in the HIV sector for over 30 years. Mark is the executive director of body positive, a support organization for people living with HIV in New Zealand. He's also got an extensive background in lab IT work both in Australia and Canada, and we have the equally fabulous Rick Galli. Rick has held senior positions in public and hospital labs as well as the private sector, and more recently, he has worked at Byolitical laboratories, where he directed the clinical and Regulatory Affairs for the insti rapid HIV test. Now he's at reachnexus, working as their director of testing and clinical trial implementation. And if you're unfamiliar with Reach Nexus, it's an exciting and innovative National Research Group tackling HIV, hepatitis C and other stbbi's in Canada, and it also happens to be where I work, so it's got to be amazing. Mark and Rick, welcome to pozcast.
Tha nk you, James, a pleasure to be here. Look forward to the discussion.
Hey, Mark, how are you?
I'm good. Thanks, James. Good to be here.
Excellent. So I know you, Mark from working together at the Ontario HIV treatment network, and Rick, from where I work at reach but I had no idea that you guys knew each other when I invited you on the show. So tell me a little bit. Rick like, how did you guys meet?
Gosh, we go back quite a ways. Back in the days when I worked at public health Ontario lab in the HIV department, we were wanting to bring a laboratory information system into, you know, into play at the labs. You know, sort of get into the 20th century and away from a paper system. And low and behold, Mark Fisher was leading a project called Labyrinth in Melbourne. And so we made arrangements to spend some time at, you know, with Mark and the team there at the lab in Melbourne, and ended up bringing Labyrinth back. So Mark was a very gracious host. Not only did we, you know, succeed in technology transfer, but he was able to show me the sights and sounds of Melbourne. That was my first visit to Australia. So it was really terrific introduction. And, gosh, Mark, when was that? That's like back in the early 90s, I think, or late 80s?
Early 90s. Yeah.
Wow. So let's take a step back here. So, and I would just want to talk about testing in general. Why is HIV testing so essential in this fight against HIV? And I'll go to you first mark.
Well, the only way that we're going to get to everybody being on treatment and undetectable is first by people knowing their status. That's the huge challenge. That's the first step, right? And one of the issues is the HIV testing is kind of unique, and it's kind of separate from everything else. So not a lot of people get tested for HIV ever, and so that's where you get people showing up in emergency rooms, never being tested, never being diagnosed, and having late stage HIV as being their first encounter, which is not good. You know.
Not good. So, Rick, are you able to briefly paint us a picture and describe the HIV testing landscape in Canada?
Yeah,
Yeah, sure. I mean, you know, if we go way back to the beginning, I mean, Canada was very, you know, very astute, and began testing back in about the mid 1980s when, you know, when testing first became available. And that testing was essentially facility based, lab based, testing using whatever state of the art technology was in play at the time. And you know, testing itself has enjoyed a huge technological advance over the years. And so back in those days, in the mid 80s, you know, when HIV was at the forefront, and just beginning, you know, Canada was very quick to begin a testing program, centralized through laboratories. That centralized testing program has really been unchanged for many, many, many years. If we fast forward to today, there's been two, I guess, innovations that have been added to that centralized testing model right across the country. The first was point of care testing for HIV that really came into play back around 2005,2006. So the lab model was really the only way to to access testing up until about 2005. And then point of care testing came around, which allowed testing to go outside of the lab and into various clinics or community organizations and others that can deliver point of care test near patient testing, as we call it, outside of the lab. And this was because of these innovative rapid testing technologies that were approved by Health Canada, the first one in Canada being in in 2005 and then the most recent innovation, which really has only come into play in in the last two to three years, is self testing. So we've evolved from centralized lab testing to point of care testing and now to self testing as options for anyone to take tests. So that's where we currently stand. I think taking it one step forward, we're now seeing multiplex testing so HIV can be combined with other markers, such as Syphilis, so that you'll get point of care tests now that can do both HIV and syphilis at the same time, right? So we're really seeing an evolution of testing modalities to try and make it simpler for individuals to access testing. So that's where we're at in Canada right now.
And if you were hearing this Mark, if you reflect on what's going on in New Zealand, is it a similar sort of trajectory?
Yeah, it's very similar. So we've been doing the lab based testing for a long time, like everybody, and then we moved into point of care a while ago, which is a peer led, community based kind of testing. It's fairly limited in terms of access. It's only through HIV community orgs that you can access that point of care testing. And then around, probably about three, four years, we brought in saliva self testing as well, and so that's been popping up in like, vending machines and stuff like that, just to make it more accessible. Yeah.
Right, okay, well, actually, on a scale of of one to 10. Rick, how do you rate the say, Canada's overall testing situation for HIV?
Oh, that's a good question. James, I think I'd look at it from kind of two perspectives, perhaps from, you know, the technology application, I would give Canada a 10 out of 10. I mean, you know, they're using state of the art technology, whether it's in the lab, whether it's point of care, whether it is self testing, which is now available. So all of those tools are really state of the art. And so Canada has always been really upfront with, you know, staying current in in testing developments. In terms of test delivery I think we have some work to do. We're probably, I maybe, let's go with about a seven, 7.5 we have areas of the country, for example, where point of care testing in Atlantic Canada is still not available, the choices for individuals are limited to the lab testing or now self testing. And then in terms of overall access to point of care tests, there's still very limited areas that that people can go and what are the barriers? One of the key barriers for point of care testing is the requirement that most provinces have that you have to be a healthcare professional in order to deliver the test. That kind of rules out community based peer testers, non professional tests, and that's in place in most provinces across the country. So that's a huge barrier. And then, you know, we look at self testing leapfrogging that now, and so we really have work to do to kind of open testing up on a broader scale.
Right? I see you say shaking your head Mark, and that's probably from Canada experience, and from what's going on in New Zealand. Can you describe what's going on over there?
Well, that makes no sense to me, because you can do self testing, which is using the same technology, but so I can give you the kit, but I can't administer the kit for you, because I'm a peer, right? So it makes no sense. And one of the models we've always thought about is that I could show you how to do the test, and do the first test with you, and then give you some to take home, so you could test again in three months, right? That's the way it should kind of happen. And as a peer, can totally do this kind of testing. That's why, that's what, how it's designed. So you don't need to be a lab professional. You just need to be trained and linked into services, right? Have referral pathways and stuff like that. And in reality, a peer can probably deliver a better access pathway for a lot of people because they trust you. So if you're going into sex on site venues or something as a peer rather than as a professional, you'll get better engagement. So it just makes sense, right? You know, if I can give you the kit, I should be able to administer the kit. So yeah, that's kind of where we're at. So we're at the point now where I'm doing a training module, so I can train anybody that wants to do testing to be able to deliver that testing to their community. Because it's a different model from a self test. A self test is where I feel confident to do it myself, or I want that discretion, but I may not have the same referral pathways to connect into the care after I've got a positive result, whereas a point of care test is that's delivered by someone you trust will have those connections to support you, enable you to stay engaged in care and take the appropriate steps after a positive I think that's why point of care is a really, really important piece, and it should be everywhere.
Right? So, what's the what's the problem Rick, what's going on?
And it's policy. James, it's, you know, these are legacy policies that have been in place since, really, since HIV testing began in Canada, and it's just they haven't changed. I mean, there, there is some ways of working around that requirement of healthcare professionals administering the test, and that's something called a Medical Directive, where you can have a clinic director, a medical director, issue a directive that would permit non professional staff to do that in Ontario, for example, through the very successful anonymous testing program that is in play. And so most of the people doing the testing and all those anonymous testing clinics are peer testers or non professionals, but that's only through a Medical Directive, and it's only in a limited number of sites. And so it's legacy policy. I like to call it. It's been around since the very beginning, and there hasn't been any change, you know, it's frustrating for a lot of community, you know, and peer workers that they cannot test and in this day and age, yeah, it shouldn't be.
For sure, because, you know, you think, like, How complicated is it to shift away from that? Like, is, it is an enormous bureaucracy and that has to move or, like, I don't understand the problem, you know?
Yeah, it's all provincial. The tests are approved for use the point of care, the insti point of care test, the blood based point of care test, is approved per use by Health Canada for both professional and lay users as a point of care, right? And then, of course, we have the same test in a self test version, which is exactly the same test. As Mark said it makes no sense when you think about it, why do you have this gap of point of care test delivery when anybody can use the same test on themselves? Something has to happen to change policy in in the provinces.
Yeah, it sounds like Mark that community is very welcome, and that's a really great conduit to to get access to testing in New Zealand.
Yeah? Well, you have the trust like I was testing at a rugby game. I tested bars, I test, you know, anywhere that we want to go, we can test, and it makes it accessible. The thing with HIV testing, there's a fear and a stigma around it, because theoretically, everyone should get tested through their GP, right? Theoretically, but the GPS won't ask, and the people won't ask for the test. So they need to go somewhere safe, and that's discrete that they're comfortable with. Is that at their local HIV org, or is it they will call your netball game with during pride or something like that. You know, if you're going to find to get to the 100% of people being tested, you need to ramp this up.
Right? I mean, it's that stigma piece that's really, a real challenge around this, around HIV testing.
Yeah, we get a lot of people that come into our office for testing, and because we're a community org, they ask, Where will this test result show up? Because that's their big fear, is, who's going to know about it? Will my GP know about it? What discretion is around this test? And that's why they've come to us, because they feel safe, and then they can ask all kinds of questions around PrEP and PEP and all these other things that they can't ask their GP. In New Zealand, 50% of gay guys aren't out to their doctor, so they will never have this conversation, and most doctors won't bring it up.
Right? And where does that result end up?
With our testing if it's negative, it stays with us.
Right. And if it's positive?
If it's positive, we have to send them off for confirmatory testing. But by that stage, we've had a conversation, and they feel a lot more trustworthy, and they understand what that positive result means, and so they're more comfortable to engage in the system, and we can support them through that, right? That's the important base.
Right, right? So, Rick, what do you think, like, what such story in Canada, in testing? Do you think in the last 10 years?
Well, you know, I think we have made strides to, you know, have testing become more accessible. It's well known that we're all galvanized around the 95/95/95 initiative, and we know that testing is the first 95 you can't have the other two without knowing your status. And we know there's still a percentage, about 10% of the folks living with HIV in Canada remain undiagnosed, and so we have to find those. And so I think we are seeing important strides in opening up testing. I mean, the approval of a self test was a major undertaking here in the last couple of years, and and we've seen since then, it's an it's been all about implementation. And so implementation is still perhaps not where it could be. It's relying a lot on programs, but not necessarily National Implementation policies, but there has been funding through our federal government to enhance self testing, and so we're making strides in the right direction to reach the Undiagnosed, and we're not there yet. But if we can keep doing what we're doing and improving and expanding what we're doing, you know, we could get to that first 95 you know, by 2030 so yeah, Canada's come a long ways. We're late to the party, late to getting Self Test approved, but it's now here, and we're hoping to bring a second self test and provide even more choices for individuals. So we're getting there.
And do you think these programs and research studies and the sort of will reach a critical mass where policy will change with all the proof that's coming out?
Well, well, that's the hope. I mean, you know, you can present the data, you can present the outcomes for people to make informed decisions. But at the end of the day, what's that saying you can lead a horse to water? You know, it remains to be seen. I think it's irrefutable that, you know, something like self testing and point of care testing is really entrenched in the future in terms of standard of care. Now we just have to open things up.
I just wonder who loses. I guess I don't mean to harp on this, but I just wonder who loses by making this change. You know, I was reading about a pilot program conducted in, I think it was 2019, 2020, where pharmacists delivered rapid point of care HIV testing in Toronto and Ottawa too, and it was a great success, but that was in 2019, and 2020, and still, pharmacists aren't allowed to do point of care testing. So I'm just, you know, how long does it take, right?
You know, and then, you know, we look at things like costs, you know, at the end of the day, anybody can buy a point of a self test for HIV. Now, you know you can just buy it online. You can buy it through the manufacturer. But do you really want patients, individuals to pay? There should be support from provincial programs, federal programs. Somewhere the funding has to come. We can't sustain these current self testing programs using research dollars, and that's largely what has been happening. These research dollars are well spent because you're demonstrating huge unmet needs that are being met by self testing. A prime example is more than 40% of the folks involved in the self testing program done through, through, through reach Nexus, the I'm Ready Program, or community Link program, over 40% of those accessing the self test have never tested before for HIV, despite the fact that HIV testing has been here since 1985 40% of the participants, and we're talking several 1000, are testing for the very first time.
That's amazing.
Because of the availability of a free HIV self test.
Right.
So that alone is compelling.
That's great. What kind of Mark, what kind of success are you seeing in New Zealand, what's driving that success?
I think the challenges, the successes are that we get. We have really good accessibility. So we just brought in the orasure saliva test. So that's the one we're sending out. We send that up through the post. It's in vending machines. We have vending machines in universities and six on site venues. And basically you just fill out some demographics and you get a test. So it's really easy, but it's a three month window on that test, so, and it's only HIV. So what we're kind of seeing is that what, oh, what I'm seeing is a challenge, is that we've silent, siloing our testing. We're doing Hep C testing as one stream. We're doing HIV testing is another stream, syphilis testing is another stream. And what we're seeing is we're seeing gaps. So we'll go into a venue and we'll do our HIV syphilis combo test, and they'll never, ever go and get tested for gono and Chlamydia, because it's like, well, I've done HIV, so I'm good, whereas if we go into family planning, they'll do the gono and Chlamydia because that's what they think is important, and they won't do the HIV and the syphilis. So we're missing because of this silo nature, we're missing the opportunities to catch all these things, and we're seeing lots of prenatal stillbirths because of syphilis, and that's a huge issue, and we're not doing the syphilis testing. So I think we need to look at normalizing sexual health and STI testing so you get like a package. And the challenge we have is there's this issue around the pre counseling consent process for HIV testing. So we tried to get opt out testing in emergency rooms. So if somebody came into the emergency room did a blood draw, we'd do an HIV test, and they said, No, we have to have explicit, informed consent before we can do that test. And the emergency room guys are like, we don't have time, so they wouldn't do it. So that's a gap, and I think as we're moving into this more accessibility, availability of HIV testing, it's like we don't have to do that with everything else. It's just with HIV. And I think where the learnings come from is with covid. Like covid rapid testing is everywhere. And, you know, people post their photos online. You know, it's just everywhere, and it's super accessible, and people as normalized rapid testing. And I think that's what we really need to learn from. It's still kind of stuck in the the old ways of doing things. Rapid testing has become mainstream, so we need to make it more accessible and just just take the stigma away from it. Don't have people be afraid of getting an HIV test. Just make it normalize easy, but incorporate it into a sexual health so we don't lose all the other components. Is kind of where we're kind of leaning towards, and that's why we're doing a lot of stuff with needle exchanges, where they're doing Hep C testing now, but they should be doing HIV testing as well as point of care, right, making it just everywhere and just easy and right, no judgment around it. It's a test.
That's a really good point, and a really good point around covid. There's really normalized testing in so many ways. And in Canada here as well. And you mentioned, like, well, you both mentioned, like, rapid testing. So how reliable are rapid HIV tests compared to, like, the traditional lab tests?
They're very comparable. One thing about these rapid tests, and at least in Canada, and I'm sure the same in New Zealand is they're highly regulated, and in order to to get approved, Oh, Mark, shaking his head, in Canada, at least Health Canada has to approve the performance of any test that's used, whether it be a self test or a point of care test or a lab test. And those approval standards are very high. They're they're published performance that you have to, you have to meet in order to be able to use that test. So that, in itself, can be a huge barrier, because, you know, getting these tests approved by Health Canada can be a very expensive ordeal for manufacturers, you know, to bring their technology through the regular, rigorous clinical trials and then have those tests licensed after maybe two or three years of study work, and that's an enormous burden on manufacturers to enter a market in Canada that may not be that attractive. So as a result, right Health Canada is working on more streamlining of getting approval processes that will accept data from other parts of the world, for example, and not just for Canada. That has helped bring some of the new technology into approval, and that's why we're seeing the self test. We're seeing multiplex test license. So in terms of reliability, the license tests are extremely reliable and every bit as sensitive and specific as what's in the lab, with some very minor variations but not significant.
Okay, so talk to us, Mark about regulation, what's going on?
We're
We're pretty much of the Wild West, so like when I moved to New Zealand, I saw the insti we were using. It was a leer before, and that was a 20 minute test. It was a good test, but the insti is a 62nd test. So I'm like, I want that test, and I just brought it in. We did the same with Oracquick. We just brought it in and we use it because I have the lab background thinks that people like Rick, we use really good tests, but we don't have to go through an authentication process for for medical devices. And so the good thing is that we've got good control, but the bad thing is, like, we've got some people that just decided to import some point of care gonorrhea tests and point of care chlamydia tests, and they're as good as flipping a coin, but they could bring them in because we don't have the regulation processes. That's the danger. And you can basically buy a kit online from anybody. You can just set up a little shop and start selling kits, and people and people will buy them. That's the risk when you don't have regulations. And that's where, if you had an authentication process like with what I want to do is I want to authenticate people as being trained and qualified to do point of care testing, and they're using validated equipment. And so that's where you go if you want to get a point of care test, if you order it for somebody on the net, then you're buyer beware
And and so what are some of the misconceptions around rapid testing that you've encountered? I guess I'll start with you Rick.
Oh, misconceptions. I think one of the most often asked questions, you know, for people who are new is, how accurate are they? You know, are they as good as the lab? I mean, the lab's got a history of testing for decades, and point of care is relatively new. So that's, that's an often asked question, but it's not a, it doesn't seem to be a barrier, because people will, you know, not run away from a point of care test. And they see too, that these tests are widely in use around the world and often as the only way to access testing other than that, you know, maybe another misconception is, is cost. When you look at the price of a point of care test, retail versus the cost of a single lab test result, point of care test can be quite on paper, look quite, a bit more expensive, but when you look at the total cost per reportable result, that's where point of care actually ends up with a cost savings single visit. You're not having to have a blood drawn and come back, and you add in all the factors that add up to what it costs to get a reportable result from a lab versus a reportable point of care test. It's actually cheaper. That also may be on on the surface of misconception.
Oh, interesting. And you'd agree, Mark?
Yeah. And the other the other thing is, we get a lot of people that come in on a Monday saying, something happened on Saturday, I want to get a test, and then they don't understand that there's a window period. The window period slightly longer with the point of care, but even with lab based testing, you couldn't test within a week, and they don't understand that. That's just the yeah, there's a sense, right?
Could you explain what the window period is?
It's so if you pick up HIV, it takes a while for it to replicate and show up on a test. And so how long that is will depend on the accuracy or the sensitivity of the tests that you're using, like the Orasure, the oral saliva, one we use, that's a three month hard wait before you can detect it, whereas with the insti, it gets down, I say 28 days for around 95% of people. And if you're doing a lab test, they could theoretically pick it up earlier than that, but you know, I can't test you on Monday after something happens on Saturday, and people get a little bit upset with that, that they have to wait. And there's that whole thing where now I'm really freaked out, that I don't know what happened. And that's where, by talking to a peer, like, if they come to us on a Monday, we can talk about pep and say, actually, you know what you need to do if you're really concerned about this incident, you need to go on pep now. And we can facilitate that. And I think in reality, what should be happening is, if you move to a community peer based model, is that they should be able to offer pep at that point in time, rather than what happens is you keep bouncing people through the system to get into where they need to be, and they fall out at that process. Whereas, if they come to the pier and say, Look, this happened. The condom broke. I think I've been exposed, we could give them a starter pack, and we can do the test just to get them familiar with it and connect them into services, because that's the big risk, is if people get lost and don't re engage with the system, that's where you're going to get issues that continue to happen, because that person won't come back and get a test right because they had a bad experience.
So I mean you work in a community organization, so you're at the front line there of making sure that people are connected to care. And I wonder, what role should community organizations play in HIV testing?
We do so we do testing. We ran a community led prep clinic where I could give people starter packs for PrEP as a community organization under a standing order, and then connect them into ongoing prep services, because we can assess risk right? Because they trust us, they'll talk about things they wouldn't talk about to their GP because they're not out. And that process has worked really, really well, and even for us, it's still a struggle, like we do testing at sex on site venues, and there's a lot of downlow guys that go there so they're not out about their their sexuality, and we did this thing where we're not going to ask you a name, we're not going to get you to fill out any forms. We just want you to do the test, and we're going to get, actually even give you a free coupon to come into the venue next time, right as an incentive. And we still had people said they did not want to test because it wasn't enough incentive for them to do it, because they didn't want to know, and they didn't want other people to know. So it's just this whole fear and stigma around just doing the test itself is I'd rather not know. And how do we break down those barriers to make it easier and normalized? And that's the HIV stigma piece, which is just huge. It's everywhere.
Yeah, what do you think, Rick, about the role of community organizations in testing?
Well, I think it's vital. I mean, you know, they're the front lines. They're frontline agencies. They're right on the front lines, engaging with people in their community. And you know, they've built the trust of these individuals. And you know, it's not just about being able to test, but it's also that without Linkage to Care, testing doesn't have the same meaning. You know, communities are really the conduit to the to the linkage to care. You know, they are the pathway in a vital pathway for that. When we set up the I'm ready program for access to self testing, for example, we had to work very, very closely with community organizations in order for that to work. And you know, that's expanded now. You know in terms of community link, where the communities themselves, a community organization, and we have well over 400 in the program across Canada now, are acting as distribution points for the self test, where people can come, they can pick up a test, they can talk to somebody. But importantly, after they self test, they come back to that clinic and become linked, whether it's linkage to prep, whether it's linkage to care and treatment, but linkage to what they need. And so without the community organizations, we would not have sort of closing the loop from testing to Linkage to Care, the way it needs to be a vital, vital piece of the whole continuum of care is with the community organizations for sure, right?
I think the thing with self testing, like I love self testing, and it makes testing a lot more accessible, but it has a huge risk of test connection. So you give the person the test, they go away and do it, they test positive, and they don't connect, and they don't follow up. And I had one guy who tested in Queenstown, and he says, Well, I was a little bit drunk. I did it about a month ago, and it came back positive and I didn't follow up. And so he did another one a month later, came up positive again. And then he called us, because we're the HIV Org. It's like, well, you it's not our test. Other people are distributing it. You should. You should have known the steps to go through, and there should have been follow up to you following the self test to ensure that you were supported through the process. And it didn't happen. And I think that's going to happen a lot is that people who are afraid of testing will do a self test secretly and then be afraid to then engage with the positive result. And that's where I think point of care testing is a lot better. And if you've got 400 people that are distributing self tests, they should be doing point of care testing as well to give people choice.
Because that support is just immediate. Yeah, that connection is immediate, right?
Yeah. And that goes sort of full circle to where we started about those same community organizations are not able to deliver point of care testing, and so they're acting as a distributor for self tests and doing the counseling and linkage for those who seek that. But as Mark said, if they had the ability to do point of care testing, you know that that would certainly augment the program, because now you're there and you're with a person, and they don't leave with a test and then have to come back. It can all be done at those same sites. So that's a gap without without a doubt.
Yeah. So what do you both? I'll start with you, Mark like, what do you see as the future of HIV testing in New Zealand and globally?
There's a thing called differentiated service delivery, which is where we give people choice and options. And what we want to move towards, too, is a one stop shop so that you can access everything you need at that center as we move towards the 95/95/95 that's not a population thing. That's when you dig down into specific categories, like different ethnicities, different locations, all those kinds of things, you're going to get different numbers right. So you have to put you have to engage those communities, to engage with that audience, to get them to 95 right. You can't just do a an advertise, advertisement on TV, and expect everybody to respond to that. It has to be delivered by the communities, to their communities, to be accepted. If they can deliver a one stop shop through their community, then you're going to get the people into testing, into prep, into PEP, into treatment, and that's where you engage it. And then the other thing you do is you normalize, like when you look at prenatal testing that should be standardized, everyone should be getting standard prenatal testing. There should just be a panel. We don't need to ask the questions we're testing you for all these things to make sure that you're healthy. And it includes HIV, the pre counseling, consent, post counseling thing, it's kind of done its day. So we need to make sure we're testing people. It's not a judgment. It's a test to make sure that you're healthy, and we need to make it way more normalized and way more accessible, and lots of different ways. Whatever works for that person is what we need to provide. And whether that's buying it from a pharmacy, or having the pharmacist do it for me, or having the community person do it for me, just get it out there. If you want to get to 100% you've got to do a lot more in this space.
Yeah, absolutely. Would you agree, Rick?
100% and I'm going to add maybe a little bit of a technological spin to that question as well, just because you know, the industry, the biotech industry, in the manufacturers, are really moving towards the development of these multiplex tests. It's now possible to combine 234 markers on one test with a single drop of blood or with a, you know, a swab of oral fluid. You can test for HIV. You can also test for hepatitis C. You can test for syphilis, potentially Hepatitis B and other st, you know, STIs, in a very similar fashion. And so I think the technology is moving very much in that direction. And then it really becomes all about implementation, you know, which is what Mark said about getting these, these tests, into the hands of people, where they are and when they need them, and not having a number of barriers, you know, for access to that. And so when we combine, I think, these terrific technological advancements that are at play and are emerging with more open access, you know, the future's bright, and we will find people that are living with whether it be HIV or another STI, I mean syphilis, as we know, in Canada, we won't necessarily get into that, but Syphilis is a huge, huge problem, and it's all because of lack of testing, lack of access. You know, we have to. We have the tools now, and the tools are being developed more and more, it's just about implementation.
It's just about implementation. Absolutely. So, you know, sort of to close off a little bit, actually, I never asked you Mark on scale of one to 10, how do you think? Did I ask you? No, I don't think I did. How's New Zealand performing in testing?
I'd probably say an eight. We're doing okay with gay guys but but not anybody else.
I'm gonna do another scale of one to 10 here. Do you think it's possible Rick in Canada, that what is it, six years from now that 100% of people living with HIV are gonna know their status?
A scale of one to 10, I would say I'm about 80 to 85 or eight to 8.5 confident that we're going to get there.
Okay, what about you? Mark in New Zealand?
I'm pretty confident, because we've had a lot of change just in the last year, and now there is actually a focus on it, some money being put towards it. So I think I'm pretty confident, because what we want to do is just normalize it, and so I think that's how we'll get it out to everybody.
right?
Right. Well, that's hopeful. We're all hopeful. That's good. Well, thank you both very much. I really appreciate your time. We're going to, as I always do, finish off with a little this or that question, which has nothing to do about with what we're talking about. So I'm going to ask this or that there's no wrong answer. So number one is five. I'll start with you. Rick, forgiveness or vindication?
Forgiveness.
What about you? Mark.
Yeah. Forgiveness.
Forgiveness. Okay. Rick, watching sunrise or stargazing?
Definitely sunrise. I'm a morning person.
Mark?
Sunrise. You haven't seen my photos. We got lots of sunrise photos.
Oh, that's right, you're both early risers. No, not me. Courage or patience. Rick?
Courage.
Courage, and what about you Mark?
It's probably both have courage best to have patience to get to where we go. I put a lot of boundaries, so I have a lot of courage.
Rick, education or experience?
Oh, gosh, I think you can't beat experience.
Right, Mark?
I probably say education. I do a lot of reading and seeing what other people are doing, because I learn from what every I don't reinvent. I see what other people are doing if they're doing it really well, I steal it.
That's a great approach. Well, Rick, this one's sort of for you. Oh, I don't know this could be hard for you, canoeing or swimming?
I do a lot of both. Look at i i have paddles, canoe paddles on my wall. Um, swimming, though, I would say, because that's my more. That's like a daily pastime, and I'm pretty passionate about it, competing, um, World Championships, all that fun stuff, so...
Amazing. What about you Mark?
Pass, neither.
No, okay, well, then give me a pastime.
Oh, cycling,
Cycling? of course, absolutely, all right. Well, thank you both very much. Enjoy the rest of your day.
You as well. It's was great. Good to see you again. Mark.
Yeah, you too, Rick,
That's it for us this month. Thanks for tuning in. We hope you'll join us next time on pozcast. And if you have any comments or questions or ideas for new episodes, send me an email at pozcast4u@gmail.com that's the number four and the letter U. Pozcast is produced by the Oositive Effect, which is brought to you by Reach Nexus at the Map Center for Urban Health Solutions. The Positive Effect is a facts based lived experience movement powered by people living with HIV, and can be visited online at positiverefect.org. Technical production is provided by David Grein of the Acme podcasting company in Toronto.
