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Wells N, Ong JJ, Stackpool-Moore L, Warner M, Carter DJ, McGoldrick R, Wlodek A, Riley B, Holland J, Heath-Paynter D, Stratigos A, Murphy E, Haerry D, Parczewski M, Poonkasetwattana M, Medland N, Wade S, Allan B. Key findings from the 2023 'ACT NOW on Global HIV Migration, Mobility and Health Equity' community forum. Sex Health 2024; 21:SH24006. [PMID: 39137293 DOI: 10.1071/sh24006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/07/2024] [Indexed: 08/15/2024]
Abstract
Background People living with HIV continue to face laws, policies, and practices that impact their potential for travel and migration. These laws include: mandatory HIV testing and involuntary disclosure of HIV; lack of access to affordable HIV-related health care, treatment and counselling during the migration process; deportation of foreign nationals living with HIV; and restrictions on the length of stays. Methods HIV migration laws were the topic of a half-day community forum held as part of the 12th International AIDS Society Conference on HIV Science held in Brisbane, Australia, in July 2023. Over 150 delegates attended and, after a series of presentations, delegates were invited to participate in structured, facilitated conversations about issues related to policy, health and law concerning migration of people living with HIV. In this paper, we report on key themes from those discussions and identify areas for ongoing investigation. Results Advocates recommended the removal of unfair and unjust migration laws and policies that contribute to HIV stigma and discrimination; updated migration policies that reflect the current context and cost of biomedical approaches to HIV management and prevention; expanded and equitable access to HIV-related care regardless of migration or residency status; and the development of advocacy networks to promote changes to migration policies. Conclusions Laws limiting the migration of people living with HIV actively discourage individuals from seeking HIV testing, treatment and care. Ultimately, restrictive migration laws and policies undermine global efforts to end AIDS as a public health concern and to virtually eliminate HIV transmission by 2030.
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Affiliation(s)
- N Wells
- Kirby Institute, UNSW, Kensington, NSW, Australia
| | - J J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; and Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia
| | | | - Melissa Warner
- Queensland Positive People (QPP), East Brisbane, Qld, Australia
| | - D J Carter
- Faculty of Law & Justice, UNSW, Sydney, NSW, Australia; and HIV/AIDS Legal Centre, Sydney, NSW, Australia
| | | | - A Wlodek
- Qthink Consulting, Malmsbury, Vic, Australia
| | - B Riley
- ASHM Health, Sydney, NSW, Australia
| | - J Holland
- Health Equity Matters, Sydney, NSW, Australia
| | | | - A Stratigos
- HIV/AIDS Legal Centre, Sydney, NSW, Australia
| | - E Murphy
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Asia Pacific, Eastern Europe, and Central Asia Regions, Bangkok, Thailand
| | - D Haerry
- Positive Council, Zurich, Switzerland
| | - M Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | | | - N Medland
- Kirby Institute, UNSW, Kensington, NSW, Australia
| | - S Wade
- Gilead Sciences, Melbourne, Vic, Australia
| | - B Allan
- Qthink Consulting, Malmsbury, Vic, Australia
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Yu S, Bavinton BR, Chan C, MacGibbon J, Mao L, Vujcich D, Broady TR, Holt M. Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019-2021. J Int AIDS Soc 2024; 27:e26204. [PMID: 38193629 PMCID: PMC10775631 DOI: 10.1002/jia2.26204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Overseas-born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non-recently arrived GBM from non-English-speaking countries to improve targeting and engagement with HIV testing and prevention. METHODS Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019-2021. Logistic regression was used to identify factors that differentiated between recently arrived (<2 years) and non-recently arrived (≥2 years in Australia) GBM from non-English-speaking countries. RESULTS Among 24,707 participants in 2019-21, 2811 (11.4%) were from high-income English-speaking countries, 714 (2.9%) were recently arrived overseas-born GBM and 3833 (15.5%) were non-recently arrived migrants. Recently arrived GBM were most likely to be born in Asia (36.1%) and Europe (21.1%). Compared with non-recently arrived GBM, recently arrived GBM from non-English-speaking countries were younger (aOR = 0.95, 95% CI = 0.94-0.96, p<0.001), more likely to be students (aOR = 1.43, 95% CI = 1.11-1.85, p = 0.005), less likely to be in full-time employment (aOR = 0.56, 95% CI = 0.46-0.69, p <0.001), more likely to report consistent condom use (aOR = 1.30, 95% CI = 1.01-1.66, p = 0.039), but had lower awareness (aOR = 0.62, 95% CI = 0.48-0.80, p<0.001) and use of pre-exposure prophylaxis (PrEP) (22.8%, vs. 32.3%, χ2 (1, 4185) = 23.78, p<0.001), and similar levels of casual sex with a risk of HIV acquisition or transmission (aOR = 1.29, 95% CI = 0.98-1.69, p = 0.066). Recently arrived GBM reported similar levels of lifetime HIV testing (aOR = 0.97, 95% CI = 0.54-1.74, p = 0.915) and recent HIV testing (OR = 1.03, 95% CI = 0.86-1.22, p = 0.779), but were much less likely to have tested at general practitioners (aOR = 0.53, 95% CI = 0.41-0.68, p<0.001) and more likely to report testing at hospitals (aOR = 3.35, 95% CI = 2.53-4.43, p<0.001), at home (aOR = 2.85, 95% CI = 1.63-4.99, p<0.001), or community-based services (aOR = 1.36, 95% CI = 1.01-1.84, p = 0.043). CONCLUSIONS Recently arrived GBM from non-English-speaking countries reported similar levels of risk of HIV acquisition to longer-term residents in Australia, but lower levels of PrEP awareness and use, and more reliance on HIV testing services which are free or low cost. It is necessary to enhance access to HIV testing and prevention among recently arrived GBM in Australia.
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Affiliation(s)
- Simin Yu
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Curtis Chan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Vujcich
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Chan C, Mao L, Bavinton BR, Holt M, Prankumar SK, Dong K, Wark T, Chen T, Wijaya HY, Wong HTH. The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia. Sex Health 2023; 20:479-487. [PMID: 37743096 DOI: 10.1071/sh23036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM. METHODS Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6months. RESULTS Among 509 participants who had casual partners in the last 6months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL. CONCLUSIONS CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sujith Kumar Prankumar
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Kevin Dong
- Western Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | | | | | - Horas T H Wong
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia; and Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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Lemoh C, Xiao Y, Tran L, Yussf N, Moro P, Dutertre S, Wallace J. An Intersectional Approach to Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4879. [PMID: 36981797 PMCID: PMC10049575 DOI: 10.3390/ijerph20064879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Hepatitis B is a chronic condition, primarily associated with hepatitis B viral infection in early life. The failure of prevention and appropriate management can lead to subsequent liver cirrhosis and cancer. Hepatitis B most commonly affects people born in Asia and Sub-Saharan Africa and their global diasporas. The physical, psychological, and social impacts of hepatitis B are strongly influenced by sex and gender. Inequities in access to timely, sensitive diagnosis and effective management arise from interactions between structural inequalities related to race, ethnicity, Indigenous/settler status, class, and geography. The biomedical response to hepatitis B has led to advances in prevention, diagnosis, and treatment, but many affected communities have explanatory health belief models that differ from that of biomedicine. We argue that an intersectional approach, led by affected people and communities, can integrate biomedicine with the lived experience and social context that give purpose to and shape all personal, communal, clinical, and public health responses to hepatitis B. This approach has the potential to enable a consciously equitable, effective response to the biopsychosocial complexities of hepatitis B, improve the health and wellbeing of people living with hepatitis B, and reduce hepatitis B-associated mortality.
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Affiliation(s)
- Christopher Lemoh
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Yinzong Xiao
- Burnet Institute, Melbourne, VIC 3004, Australia
| | - Lien Tran
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Infectious Diseases, The University of Melbourne, Melbourne, VIC 3004, Australia
| | - Piergiorgio Moro
- Centre for Culture, Ethnicity and Health, North Richmond Community Health, Richmond, VIC 3121, Australia
| | - Sophie Dutertre
- Centre for Culture, Ethnicity and Health, North Richmond Community Health, Richmond, VIC 3121, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW 2052, Australia
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Krulic T, Brown G, Graham S, Hoy J, Bourne A. Revealing an enabling environment: How clinical community and clinical stakeholders understand peer navigation to improve quality of life for people living with HIV in Australia. Front Public Health 2023; 11:1101722. [PMID: 37151586 PMCID: PMC10157390 DOI: 10.3389/fpubh.2023.1101722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
People living with HIV have unique resources to offer each other and health systems. This study investigated how peer navigation might contribute to a socially supportive, health enabling environment in Victoria, Australia. We used semi-structured interviews with 30 program staff, management, peer workers and clinician stakeholders. Our analyses considered the interplay between the program, users, HIV-related stigma and discrimination and the health service environment. Peer relationships offered reassurance, acceptance and belonging, which people living with HIV can use to create personal change. Peer engagement coproduced insights for life with HIV and may help to overcome stigma and structural barriers to access services and community support. As a partnership between peer and clinical services, participants described how the program fostered appreciation of peer practices and insights, which were used to improve the quality and continuity of care offered in the state. These findings allude to the value of the community engagement and policy alignment peer responses produce and can be used to guide implementation of similar programs elsewhere.
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Affiliation(s)
- Timothy Krulic
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Living Positive Victoria, Melbourne, VIC, Australia
- *Correspondence: Timothy Krulic,
| | - Graham Brown
- The Centre for Social Impact, UNSW, Sydney, NSW, Australia
| | - Sara Graham
- Living Positive Victoria, Melbourne, VIC, Australia
| | - Jennifer Hoy
- Alfred Hospital Infectious Diseases Clinic, Melbourne, VIC, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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