We first must acknowledge the incredible work done by people like Bruce Burnett, and many others, in our early AIDS and HIV response. People living with HIV have also been integral to our success; an increase in early diagnoses and treatments have led to more people with undetectable viral loads, and this ultimately means zero risk of transmission.
Today, there are a lot of factors at play with increasing use of combination prevention being first and foremost. Critical policy changes including enabling early access to funded HIV treatment for everyone diagnosed with HIV in Aotearoa and increasing availability of PrEP have likely played a key role. In the last two years, many suspect that COVID-19 border closures and physical distancing rules contributed to the decreases because of reduced sexual networks of our core populations.
Over the last four decades, healthy policies such as early introduction of needle exchange programming and decriminalisation of sex work were key to keep the population rates of HIV low among people who inject drugs, sex workers, and prevent ongoing transmission among heterosexuals. These continue to be important part of our success.