In the second half of the 20th century syphilis and gonorrhoea were two of a number of sexually transmitted infections (STIs), also termed sexually transmitted diseases (STDs).
In the post-Second World War period, antibiotic-resistant strains of gonorrhoea developed. Rates of other sexually transmitted infections, including syphilis, Hepatitis B and C, chlamydia and genital herpes, rose in the following decades. From the early 1980s the advent of HIV/AIDS made sexually transmitted disease a life and death matter, like syphilis before the advent of penicillin.
Chlamydia was New Zealand’s most common sexually transmitted infection in the late 20th and early 21st centuries. Tests for chlamydia were not routinely available until 1984. Over half of infected people have no symptoms, and symptoms that do appear – discharges, burning sensations when urinating, and abdominal or back pain in women – could be due to other common problems. In women chlamydia can cause pelvic inflammatory disease, resulting in infertility.
Sex information limited
As late as 1965 the Department of Health advised the first national venereologists’ conference not to use the words ‘condom’ or ‘sheath’ in press releases. From 1970 information on venereal disease became much more readily available. However, it remained unlawful to give contraceptive – and therefore condom – information to under-16s until 1990.
Toothpaste or condoms?
Condoms were used more often for contraception than protection against infection until the 1980s. Supermarkets did not stock them, and asking in a pharmacy was embarrassing. In a 1971 New Zealand Herald article, a pharmacist told of a customer bringing back six packets of toothpaste to swap for condoms. On previous visits a female assistant had served him. He had been too embarrassed to ask a woman for condoms, and had bought tubes of toothpaste instead every time.
In the 1970s contact tracing (finding and informing the sexual partners of an infected person) began to play an important part in STD control. Legislated for in 1923, and undertaken on a small scale in the 1940s, contact tracing had then lapsed. Changing sexual behaviour in the 1960s resulted in an increase in sexually transmitted infections, and the reintroduction of contact tracing.
Contact was made by nurses, using identifying details that were sometimes inaccurate or sketchy. The news they brought was unwelcome, and sometimes prompted verbal abuse and even physical attack. With HIV/AIDS, contact tracing became critical. In 2017 HIV/AIDS, syphilis and gonorrhoea became notifiable anonymously under the Health Protection Amendment Act. Doctors had to send data, but not names, to the Ministry of Health so accurate figures could be kept.
Clinics and services
In 2018 there were about 35 sexual health clinics in New Zealand. The Family Planning organisation also provided sexual health testing and information. The New Zealand Venereological Society was formed in 1978 to lobby for more attention to sexually transmitted diseases in the health system.
West Coast immunity
In 1989, the government allocated $1.5 million to combat the spread of sexually transmitted diseases and expand clinic services. When amounts for the various regions were announced, West Coast area health board member and Greymouth mayor Barry Dallas said their $42,000 grant should be sent back. ‘People would be too embarrassed to attend. Anyway the diseases are not a problem on the Coast.’ 1
The major new sexually transmitted disease, Human Immunodeficiency Virus (HIV), arrived in New Zealand in the early 1980s. People infected with HIV usually developed Acquired Immunodeficiency Syndrome (AIDS). With the loss of immune-system strength, opportunistic infections and cancers were rapidly acquired. Before effective treatment was developed, death usually resulted within a year. In 2017 there were estimated to be 3,500 people living with HIV in New Zealand.
Prevention and treatment
The term ‘safe sex’ was coined after the arrival of HIV/AIDS in the early 1980s, with ‘safer sex’ preferred in the 21st century (as condoms do not provide 100% protection against disease transmission). Safe sex methods – primarily the use of condoms – became the focus of campaigns to limit the spread of HIV/AIDS and other sexually transmitted infections.
From the mid-1990s the most common treatment was a combination of antiretroviral drugs, which were first available in 1987. Antiretroviral drugs have meant an extension of active lives for those with HIV/AIDS. Those without permanent residence in New Zealand do not have access to free treatment for HIV/AIDS.
The most recent breakthrough in HIV prevention is the availability of a pill that people at risk can take daily to prevent HIV infection. Pharmac (New Zealand’s drug-purchasing agency) announced in 2018 that it would publicly fund the use of the HIV Pre-Exposure Prophylaxis (PrEP) drug for people at high risk of HIV infection. Access to this drug, Truvada, was funded from 1 March 2018. PrEP drugs have reduced rates of HIV infections in other countries through significantly reducing the chance of acquiring HIV through sexual contact. Approximately 4,000 New Zealanders were eligible to access this drug.
From 1985 all blood for transfusion was screened for HIV. In 1992 Parliament extended the provisions of the Human Rights Act, making it illegal to discriminate on the basis of sexual orientation or the presence in the body of organisms capable of causing illness (a reference to HIV). However, in 2004 government concern at the potential cost of treatment led it to deny permanent residence to those who tested positive for HIV. In 2005 HIV tests for visitors planning to stay a year or more were introduced. Waivers of this requirement were available for family members of New Zealand citizens and permanent residents and for a fixed quota of refugees.
Aucklander Glenn Mills was diagnosed as HIV-positive in May 2007 but continued to have unprotected sex. Seven of about 80 of his partners who were later tested had contracted HIV. Mills faced 28 charges, including wounding and attempting to wound with reckless disregard, and infecting and attempting to infect with a disease, when he was found dead in his jail cell in 2009.
Human papillomaviruses (HPV) are a group of common sexually transmitted viruses which can cause genital warts and may develop into cervical cancer. Between 2008 and 2016 the government funded vaccination against HPV for girls and young women, with the aim of preventing cervical cancer. From January 2017 HPV vaccination was free for males and females aged 9–26, including non-residents aged under 18.
STDs in the 21st century
In the 2000s rates of infection increased. With the availability of effective treatments came complacency and a decrease in condom use. Syphilis, which had virtually died out, reappeared in 2002, and gonorrhoea and chlamydia rose. Rates for most STDs dropped in the 2010s, but incidences of gonorrhoea and syphilis continued to increase. Chlamydia was the most frequently diagnosed sexually transmitted disease, but rates stabilised after 2012. People aged under 25 had the highest rates of sexually transmitted infections.