"No-one's driving this bus" - qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men

Sexual healthcare to meet the needs of sexuality and gender diverse aboriginal young people: imagined possibilities

In Australia, Aboriginal young people who are lesbian, gay, bisexual, trans, queer or otherwise sexuality and gender diverse (LGBTQ+) are recognised within several overlapping priority populations in state and federal sexually transmissible infection and HIV strategies. However, limited research has documented their unique sexual health experiences, needs and preferences. In this qualitative study, semi-structured interviews were conducted with 10 LGBTQ+ Aboriginal young people aged 16-24 years in New South Wales. Interviews incorporated questions about service access, positive and negative experiences and self-determined healthcare priorities. We conducted a strengths-based thematic analysis to understand the issues of greatest importance in sexual healthcare for participants. Using the framework of 'imaginaries', we explored how participants imagined sexual healthcare that would meet their individual and cultural needs. The dominant imaginary centred on respect, representation and the as-yet-unrealised possibility of sexual healthcare designed by and for people who shared the intersection of Aboriginal and LGBTQ+ experience. We identified individual-level, service-level and societal-level factors influencing this imaginary, including relationships, accessibility and experiences of racism. Analysing the imaginaries constructed by LGBTQ+ Aboriginal young people of empowering, culturally safe sexual healthcare that is 'for them' provides insight into potential service design to improve sexual health outcomes for this population.

Clinicians' perspectives on why young Aboriginal people are not testing for sexually transmissible infections in Western Sydney

BACKGROUND

Incidence of sexually transmissible infections (STI) amongst young Aboriginal people in Australia are significantly higher compared to the wider population. Low levels of engagement with public sexual health services also exacerbates health inequity. This study sought to understand the access barriers facing Aboriginal People with local Sexual Health services from the perspective of local clinicians within Western Sydney.

METHODS

Six clinicians (six registered nurses, two medical practitioners) and two social workers, working in a Sexual Health service, were interviewed using a semi-structure questionnaire. Interviews were audio recorded and transcribed verbatim. Interview texts were analysed using NVIVO 12 and a thematic analysis undertaken.

RESULTS

Thematic analysis revealed three broad themes: personal, practical, and programmatic. Clinicians believed the involvement of Aboriginal people in service delivery would contribute to greater inclusion and more culturally competent services. Clinicians also considered that young Aboriginal people were unaware of the risks of untreated STIs, and that greater STI-related education regarding risk and prevention may reduce STI incidence and improve participation in services. Clinicians believed that culturally-competent STI education would be more effective if co-designed with the local Aboriginal community. Clinicians identified that Aboriginal young people were concerned about their privacy when accessing services, and that barriers could be reduced by greater community engagement in service delivery design and quality improvement initiatives.

CONCLUSION

The three themes identified in this study provide guidance for service providers about approaches that may enhance the access, participation, and cultural safety sexual health services for Aboriginal clients.

‘We Want to Help but We Don’t Know What to Do’: Service Providers Working with Indigenous LGBTIQ+ Youth in Australia

Access to adequate and appropriate service provision has a direct positive impact on health and wellbeing. Experiences of inaccessible, discriminatory, and culturally unsafe services and/or service providers are considered a root cause for the health inequalities that exist among Indigenous queer youth. Experiences of discrimination and cultural inappropriateness are commonplace, with Indigenous queer youth noting issues related to access to services and treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This paper examines the perspectives of Indigenous LGBTIQ+ youth and health service providers to identify what challenges, obstacles and opportunities are currently being faced and what could be implemented to improve the health and wellbeing outcomes for Indigenous LGBTIQ+ youth in the future.

Barriers and enablers for young Aboriginal people in accessing public sexual health services: A mixed method systematic review

BACKGROUND

A mixed method systematic review was undertaken to address the research question, Do young Australian Aboriginal people barriers in accessing public sexual health services? Aboriginal people are disproportionally affected by significantly higher incidence rates of sexually transmissible infections (STIs), compared to the rest of the Australian population. This problem is particularly acute for young people under 30 years of age who suffer from the consequences of STIs due to the number of sexual partners and challenges faced in accessing healthcare.

METHODS

The study inclusion criteria were: papers published between January 1999 and September 2019 inclusive; published in any language, discussed healthcare barriers and facilitators; included people under 30 years of age; contained research with one or more of the following terms; Aboriginal, Health, Access, Barriers and Sexual Health; was published or discussed Australia research. Articles were extracted from MEDLINE, Embase, PsychINFO, Proquest Social Sciences, Open Grey and NLM Bookshelf. An initial search identified 770 articles; 23 duplicate articles were removed. 642 were excluded for not meeting inclusion criteria following a title and abstract review of articles. 60 articles underwent full text review by two reviewers and 15 articles were included in analysis.

RESULTS

This review found that novel approaches to service delivery such as incorporating STI testing into other targeted initiatives, providing self-testing kits and achieving high levels of cultural competency were key facilitators to access. Whereas location of services, inconsistent service provision, shame and differing levels of knowledge about the effects of STIs were key barriers.

CONCLUSIONS

This systematic review identified barriers and facilitators of access to sexual health services for Aboriginal young people. System level changes are needed to improve physical environments, service integration and consistent provision of culturally competent services. This review highlights the need for further research focussed on assessing the real-world pressures of young Aboriginal people and how healthcare providers can better offer a person-centred service.

Aboriginal and Queer Identity/ies in Western Australia: When There is a Need to Know in Therapeutic Settings

A central question for the exploratory Aboriginal and LGBTQ+ researcher led project 'Breaking the Silence: Being Indigenous and identifying LGBTQ+' (Breaking the Silence) is how provision of genuinely inclusive service responses for Aboriginal and Torres Strait Islander people identifying as LGBTQ+ can be developed. This article presents the qualitative findings of this mixed-methods research project to show how organizational staff working in health, education and social support services in Western Australia consider the Aboriginal LGBTQ+ identity/experience. Analysis of the written, interview and focus group responses to a question about the relevance of LGBTQ+ identity show that these questions need to be considered and evaluated within diverse service cultures and philosophies of services. Staff views are diverse and organizational consensus on the relevance (or not) of LGBTQ+ identity needs to be the precursor before the development or consideration of changes to service delivery and models.

Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study

Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited.

METHODS

Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study.

RESULTS

Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system).

CONCLUSIONS

Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.