As more heterosexual people are diagnosed with HIV, sexual health stigmas among Māori are putting wahine at risk, a Rotorua health advocate says.

“It’s a tapu subject,” said Milly Stewart, a specialist indigenous service provider pushing for more public education around the human immunodeficiency viruses [HIV].

When transmitted, HIV attacks the body’s immune system and develops to Aids at the most advanced stage of infection.

Stewart wanted her community to know the stigma of shame, and lack of education about HIV, had contributed to a rise in transmission among heterosexuals in the latest data from 2023.

Stewart, who founded health organisation Toitū te Ao three years ago to serve Māori, Pasifika and indigenous people living with HIV across the North Island, said she had seen evidence of the trend on the ground last year.

“Heterosexuals are coming through that have been diagnosed, the number is increasing,” Stewart said.

Milly Stewart started Toitū Te Ao to focus on culturally appropriate approaches for Māori, Pasifika and indigenous people living with HIV in Aotearoa.

She was also concerned about the rising number of transmissions locally.

The latest annual data from the University of Otago Aids Epidemiology Group showed the number of people in Aotearoa living with HIV in 2023 increased by 235 — up 74% on the previous year — to an estimated total of 3272.

Of the 97 diagnosed in New Zealand in 2023, 10 were in the Bay of Plenty and 17 were infected via heterosexual contact.

Fifteen per cent of people with HIV in New Zealand were Māori and Pacific, however, research showed they were more likely to be diagnosed late and have advanced infection.

Stewart said Māori men were a growing population contracting the virus and stigma around maintaining sexual health had deterred them from seeking medical care.

That also put their sexual partners at risk.

“It’s just not with Māori, when somebody steps out of the relationship and then steps back in, carrying that virus is always a concern,” she said.

Women may not know they were living with HIV because they were not getting checked regularly.

“Ninety-nine point nine per cent of the time, heterosexual Māori women are diagnosed late because they don’t fit the risk group.

“So they’re not being diagnosed until they present with symptoms or they’re having a child,” she said.

Everyone should get tested once, and people with multiple sexual partners should be tested regularly, Stewart said.

As an advocate for the Māori, Pasifika and indigenous HIV communities based in Rotorua, she said more needed to be done to support Kiwis living with HIV.

That included more accessible resources to educate Māori and Pasifika living with HIV and culturally appropriate approaches toward treatment.

In 2022, the Labour Government unveiled an action plan to eliminate the transmission of HIV and deaths in New Zealand by 2030, with Prime Minister Chris Hipkins pledging it would be the first country to eliminate HIV.

Stewart was worried a lack of education nationwide meant this goal would not be achieved.

She said her work was about “ensuring that today’s Government honours that agreement”.

In a 2022 opinion piece, Victoria University associate Faculty of Health dean Māori Clive Aspin expressed similar concerns for Māori women.

“If Māori women are not identified as a group at increased risk of HIV and progression to Aids as a result of late diagnosis, the plan’s effectiveness in stemming the spread of HIV infection will be severely limited. This glaring omission could easily derail [then-Associate Health Minister Ayesha] Verrall’s goal and instead exacerbate current HIV disparities,” Aspin wrote.

At the end of November, Associate Health Minister Matt Doocey held a breakfast following up with advocates for people with HIV in New Zealand to update them on Hipkins’ promise to achieve the Stop Transmission 2030 commitment.

Stewart attended, hoping to make progress on having more resources available for Māori and Pasifika health providers and see a stronger focus on educating the public about what HIV is.

Doocey told the Rotorua Daily Post two prioritised actions were under way: development of an HIV campaign to challenge stigma and discrimination, and development of community-led social marketing to Māori.

“It is expected that these campaigns will help to provide more culturally appropriate education.

Doocey said stopping HIV transmission by 2030 was the goal of the HIV Action Plan, “and the government remains committed to it,” he said.

He said increasing knowledge of HIV was another theme of the plan.

“This includes increasing information to improve HIV prevention and care programmes. This is a specific focus of the ‘Combination prevention and health promotion’ section of the HIV Action Plan.”

Medication allows for a ‘good life’

Stewart said remembering to take medication was another challenge for Māori she had worked with, and high stigma toward HIV in her community was a barrier for some.

She said developments in medication allowed those with HIV to “live a good life” and it was not “a death sentence”.

“Even with a partner.”

She said health professionals were concerned for undiagnosed people.

“If you transmit it without knowing that you have it, it is not a crime. But if you know that you have it and you’re still continuing to transmit it, then it’s a crime,” Stewart said.

Tapu subjects

HIV was a difficult topic for indigenous people to broach, Stewart said.

“Especially for Māori when they hear HIV, they always automatically think about Aids and then automatically think about death.

“You know how Māori feel about talking about sex… we don’t. Not in that respect anyway … it’s quite a tapu subject.

“We’re talking about a woman’s whare tangata [womb] and the life of an individual, and that’s really important to us as Māori,” Stewart said.

Education was important for tackling the rising number of diagnoses in Aotearoa.

Toitu Te Ao offered free blood tests in Rotorua as well as wrap-around support for people living with HIV.

Aleyna Martinez is a multimedia journalist based in the Bay of Plenty. She moved to the region in 2024 and has previously reported in Wairarapa and at Pacific Media Network.