Staying in: a postcard from Shepparton

HIV Australia | Vol. 10 No. 2 | October 2012

ABIGAIL GROVES discusses life in a regional town for people who are gay or HIV-positive

Shepparton, in northern Victoria, is the kind of town I think of as the heartland of Australia. A regional town built on farming, like Wagga or Dubbo in NSW, its main claim to fame is its canned fruits and vegetables – the ubiquitous ‘SPC’ brand. In the 1960s and 70s it grew rapidly, as the increasing number of cars made it the service centre of a prosperous region.

It’s a place where people work hard, pay off their homes, and raise families. ‘A good place to raise kids,’ people say. Meaning: ‘It’s a bad place to be gay.’

Shepparton is where I grew up. When I lived there, in the 1970s and 1980s, there were no gays in the town. At least, not that I was aware of. It’s fair to say that in those days my gaydar was not highly calibrated: I didn’t realise that Boy George was gay. My mother’s friends tittered that one of the hairdressers in town was gay (and no, it wasn’t Tim Mathieson).

The idea that there might be real gay people walking among us was just beyond me. But even for a sheltered teenager, Shepparton seemed suffocatingly small and conservative. I followed the path beaten by so many kids from regional towns: I left as soon as I could.

I’ve visited Shepparton frequently over the years, mainly to see my elderly father. Now, I know there are gay men and lesbians living there and I know there must be people with HIV. When HIV Australia decided to do an edition on people in rural and regional areas, I determined to try and find out what life is like for them.

‘We do have members in Shepparton,’ said Brent Allen, Executive Officer of PLWHA Victoria, ‘but none of them are out about their status’. Allen’s comment was much as I suspected. Outside metropolitan areas, the stigma around HIV makes disclosure virtually impossible.

Damien Stevens is a community development worker with Uniting Care Cutting Edge, and works with GLBT young people. He could not refer me to any HIV-positive locals either. ‘I’m not aware of any HIV diagnoses among the young people I work with,’ he says, ‘or among older gay men around town, either.’ He adds, ‘There are a few guys who have said things which suggest they might be positive, but I don’t know’.

The picture that Damien paints of gay community in Shepparton appears bleak and isolated. There are a few active community groups, but no local venue. ‘There are a number of beats around town, but there’s no venue or regular gay night here,’ he says. ‘People go to Melbourne to party. You can be anonymous there. On the other hand, there’s a regular gay night in Bendigo, and I know some guys go there. Bendigo is almost as far as Melbourne, so you might not expect them to go there. I think they like Bendigo because it’s a different scene – quieter and less intimidating.’

On the other hand, the emergence of social media has transformed the experience of being gay in towns like Shepparton, making it much easier for people to find each other.

‘Social media is big,’ says Damien. ‘My friends and a lot of the young guys I work with are on Grindr or on squirt.org.’ Not that social media solves everything, as Damien goes on.

‘If you log onto Grindr here, you might see twenty people,’ he explains. ‘In the city there might be hundreds. And often it turns out that you already know those twenty people, and they are online keeping an eye on what everyone else is doing. When there’s fresh meat in town or someone is visiting, everyone notices.’

Associate Professor Jane Tomnay is Director of the Centre for Excellence in Rural Sexual Health. Her service works with other services, capacity building around women’s and migrant health, GLBT and Aboriginal health.

She echoes this theme of disclosure and anonymity, and suggests that these concerns affect the heterosexual community too.

‘The epidemiological data we have about indicates that levels of STIs are roughly the same as in Melbourne,’ she says.

‘But STI data tends to say more about access than of prevalence. If anything, I would suspect that levels of STIs are a bit higher.’

When I visited Shepparton in the 90s, I used to joke that there were two things you could not get there: a decent coffee, and a bulk-billing doctor. That doesn’t say a lot for access to healthcare.

‘Things are certainly better than they were, in that regard. These days there are a few medical centres that bulk-bill,’ says Tomnay. ‘But that doesn’t mean that people will use them. In towns like this there is a perception about lack of confidentiality in health services. We know from experience that it’s often more a perception than a reality, but it’s an important perception, because it influences people’s behaviour.’

‘In Melbourne, for example, an 18-year-old girl can walk in off the street and get a sexual health test – it’s free, quick, and anonymous. That’s much harder here.’

However, Tomnay insists that there is nothing to suggest that there is a hidden epidemic of HIV occurring in Shepparton.

‘We did have an s100 prescriber in the town until a couple of years ago,’ she said. ‘But he stopped renewing his accreditation, and I think that was because he didn’t have enough patients to justify it. My perception is that people with HIV from around here go to Melbourne to access services. Some might go to their local GP, with a shared care arrangement.’

Tomnay’s view is confirmed by Tom Schulz, an infectious diseases physician who visits Shepparton fortnightly.

‘In small towns, people just won’t access sexual health services even if they exist, because of fears about privacy,’ he says.

‘But Shepparton is a middle-sized town, so some people will access services here and some won’t.’

Schulz agreed with Jane Tomnay’s assessment that people with HIV are more likely to travel to Melbourne. He says he has seen only a handful of patients with HIV in Shepparton, and most are gay men.

‘Melbourne is two hours away, so yes, people with HIV will usually go there, to the Alfred or Melbourne Sexual Health. Often they will combine the trip with something else that they want to do, so they don’t mind doing that.’

Such is the life of people across regional Australia. When I was growing up, any serious or complicated health problem involved travel. Some of my earliest memories are of catching the train to
Melbourne with my mother.

Though that trip is a little easier than it was forty years ago, access to specialist health care hasn’t changed all that much.

‘The positive people I see,’ he adds, ‘are often the ones who are sick of travelling up and down to Melbourne. It’s a very small sample, so it’s hard to generalise about their needs, but they are pretty similar to the kind of patients I would see in Melbourne.’

Instead, most of Schulz’s patients are people from newly-arrived migrant communities. Perhaps the most striking change that has occurred in Shepparton since I left in the mid-1980s is the growth of new migrant communities.

It had long been home to Italian and
Greek communities, but in the last twenty years Albanian, Iraqi, Afghan, Sudanese and Congolese refugees have settled in the town. One writer called Shepparton ‘a model of how multiculturalism can work’.¹

During a visit in 2006, I walked into a kebab shop on the main street. Seeing an Afghan flag on the wall, I asked the owner, ‘Are you from Afghanistan?’

He was very excited by this level of recognition. ‘You’ve been there?

‘Um, no,’ I answered sheepishly.

I didn’t like to admit that my knowledge of Afghanistan was limited to what I learned in a Year 10 geography class.

His English was not great, but I understood that he was a refugee and had been in detention. When I imagined transplanted from Afghanistan to the wide, flat streets of Shepparton, I couldn’t help wondering what he thought of us.

‘So how do you like Shepparton?’ I asked.

He paused for a moment and I could see that he was trying to think of a diplomatic reply. Smiling ruefully, he said, ‘Well, is better than … ’ he drew his finger across his throat to demonstrate what the alternative of remaining in Afghanistan would have held for him.

‘Yes,’ I gulped. ‘Yes, I suppose it is.’

‘There is a bit of racism around,’ says Tom Schulz, ‘so I would not like to promote the view that refugees are bringing in diseases. That’s just not the case. Refugees with HIV aren’t allowed into Australia. That has changed a little bit in the last few years, but Australia would still only accept perhaps 20 refugees a year with HIV. I’ve only seen a handful of refugees with HIV in my whole time in refugee health.’

Schulz explains that most of his refugee patients have health concerns other than HIV.

‘Often people don’t speak English and their health literacy is poor. Sometimes they have been exposed to TB, and hepatitis B is endemic in some countries. Refugees have health screening as part of the visa process, o if they have problems they will get referred to us.’

‘One of the exciting things that we are doing,’ Schulz went on, ‘is getting more into telehealth, so that we can link patients up with specialists in Melbourne by Skype. Not everything can be done by Skype, but it can be really useful, and a lot more convenient for patients.’

Talking to Schulz, I’m reminded of how much Shepparton has changed. And yet, in some ways, not changed at all. There are many places much more isolated than Shepparton, but those two hours to Melbourne can still seem a long way.

Reference

1 Strong, G. (2010, 12 July). Hope for multiculturalism, found at home in a little city. The Age.

Photo: Jorge Henao, a photographer from Pottsville, NSW.

Abigail Groves is a freelance writer and former policy analyst at AFAO.