Strengthening community capacity to maintain low levels of HIV among Aboriginal gay men and other men who have sex with men (MSM), sistergirls and brotherboys in South Australia
Strengthening community capacity to maintain low levels of HIV among Aboriginal gay men and other men who have sex with men (MSM), sistergirls and brotherboys in South Australia
HIV Australia | Vol. 13 No. 3 | December 2015
By Wills Logue
Indigenous people globally remain at higher risk of HIV and sexually transmissible infections (STIs) than non-Indigenous people.
In Australia, gay and other men who have sex with men are disproportionately affected by HIV, and, as a result, HIV transmission among this population has been well researched; however, there is little known about HIV transmission among homosexually active Aboriginal and/or Torres Strait Islander (hereafter referred to as Aboriginal) men.
Even less is known about how cultural factors specific to the Aboriginal population may influence the sexual behaviours of this population group.1
James Ward suggests that the stable HIV incidence experienced by Aboriginal people should be celebrated with optimistic caution.2
He asserts that the success in keeping HIV prevalence low can be attributed to community capacity building and developing and delivering culturally appropriate health promotion messages.
These include the Condoman campaign, which gained wide support across the Aboriginal community, by employing a sexual health message that was free from embarrassment and ‘shame’.3
Since August 2015, SAMESH (South Australian Mobilisation and Empowerment for Sexual Health) has delivered a range of services in South Australia – including campaign development, counselling, peer support, workforce education, rapid HIV testing, and support for people living with HIV – and is committed to ongoing work with Aboriginal and Torres Strait Islander communities.
The previous Gay Men’s Health program of the AIDS Council of South Australia (2013) partnered with the Aboriginal Health Council of South Australia and other key stakeholders to develop the Respect Test campaign – an HIV and sexually transmissible infections (STI) testing campaign targeting Aboriginal South Australians, irrespective of their gender or sexuality.
Respect Test was the first locally produced campaign in South Australia that saw stakeholders work in partnership and establish meaningful relationships with community members to co-develop and design a culturally appropriate health promotion campaign. The campaign received community endorsement in metropolitan and regional South Australian Aboriginal communities.
Gay Men’s Health South Australia (GMHSA) – a program of Relationships Australia, South Australia (2013–June 2015) – recognised the role Aboriginal and Torres Strait Islander community members and community-based organisations such as the Moolagoo Mob could play in strengthening the profile of community identity in health promotion programs.
A strong sense of community identity was central to the success of the Respect Test campaign in South Australia, which focused on raising community knowledge on issues regarding sexuality, HIV and STI transmission, and prevention strategies.
Community participation, the inclusion of Aboriginal sexual health workers in communities, and an inclusive policy and partnership approach are critical to ensure an escalated epidemic does not occur.4
GMHSA recognised its failure to develop an ongoing relationship and partnership with Aboriginal gay men in South Australia; consequently, an invitation to establish a reference committee was extended to Aboriginal gay men, men who have sex with men (MSM), sistergirls and brotherboys, and community workers from the South Australian Aboriginal LGBTIQ (lesbian, gay, bisexual, transgender, intersex and queer) community.
The committee’s function was to provide expertise to GMHSA; design and distribute a community survey to identify the gaps in services for gay men and men who have sex with men; ensure HIV education for Aboriginal people is culturally appropriate; and encourage the blood borne virus (BBV) and STI sector in South Australia to acknowledge the necessity for an Aboriginal, Gay Men, MSM, Sistergirl and Brotherboy Action Plan.
Online survey
Methodology
As part of the community consultation process, GMHSA has worked with a reference group of community members consisting of gay men, MSM, sistergirls, brotherboys and Aboriginal health workers to develop a survey using the online platform, Survey Monkey.
The survey was open for gay, MSM, sistergirls and brotherboys community responses from 15 June–26 July 2015, and was promoted through community health networks and online social networks including Facebook, Moolagoo Mob, Aboriginal Health Council SA, and various other regional networks and mainstream services.
The results of the survey will assist in the future development of a culturally appropriate Health and Wellbeing Action Plan to address the needs of Aboriginal gay men and other men who have sex with men, sistergirls and brotherboys.
Participants
Survey responses were received from 25 Aboriginal community members; 85% of respondents identified as Aboriginal and 15% as both Aboriginal and Torres Strait Islander.
Participants were spread across all age groups, but the largest age group (41.7%) were people aged 25–40 years. Over half (59.1%) of the participants were female, 27% were male, 9% identified as sistergirl, and 5% identified as other.
Sexuality and relationship status
Half of the participants identified as heterosexual, 27.3% as gay, 9.1% as lesbian, 9.1% as bisexual and one person as pansexual.
Most (77.3%) participants were single, 9.1% were married and 9.1% have multiple partners.
Most (68%) said they would like to have sex with males, 16% with females, 8% with transgender and 8% either with sistergirls or brotherboys.
Where do they live?
The majority of the respondents (80%) were currently living in the city, and most had originally come from outside metropolitan areas (50% from rural areas, and 20% from remote areas).
When asked about the reason to move to the city, the main reason was family (36%), followed by work (32%) and study (16%).
Overall, 12% reported that they moved due to gender-related discrimination, and 8% reported sexuality-related discrimination/violence as a reason to move from a rural or remote location (see Figure 1).
Access to sexual health services and the Gay Men’s Health service in SA
Most (73.7%) respondents have access to sexual health services in South Australia. Others said they did not go to sexual health services for a range of reasons including: ‘I don’t know where to go’, ‘[I] see the local GP instead’ and ‘There was no necessity’.
Two out of six gay men who had visited the Gay Men’s Health Service reported that they have other alternative services in convenient places such as their GP, Clinic 275 or services operating in rural areas.
Those participants who did not identify as gay thought that Gay Men’s Health was a service only for the gay community.
Therefore, a communication strategy would need to be developed around the service to attract potential clients who do not identify as gay but who are men who have sex with men, sistergirls or brotherboys.
Services accessed at Gay Men’s Health
Irrespective of whether they had attended the Gay Men’s Health Service, we asked participants what services they would expect to receive at the Gay Men’s Health Service.
Around one-third (32%) said counselling, followed by HIV testing/STI screening (24%), sexual health workshops (20%), and health promotion campaign material (20%), as shown in Figure 2.
Barriers and availability of sexual health resources for Aboriginal and Torres Strait Islander communities
When we asked whether there are enough sexual health resources for Aboriginal and Torres Strait Islander gay men, men who have sex with men, sistergirls, and brotherboys, most participants (87%) stated ‘No’.
They also named the types of resources that they would like to access. Some respondents said they would like to see more resources and promotional material that would broaden community engagement and build connections with the wider community, and increase community awareness about the problems faced by some Aboriginal people related to sexual identity and sexuality.
Nine participants answered the question, calling for more resources to be developed, and more education opportunities for Aboriginal health organisations to explore complex sexuality issues.
This included social media/online information and campaigns and referrals relating to sexual health.
The respondents also saw benefit in increasing community awareness through print media, such as pamphlets, brochures, posters, and booklets.
Most participants considered the main barriers to accessing sexual health resources as a lack of understanding within rural communities and remote health services about issues that affect Aboriginal gay men, men who have sex with men, sistergirls and brotherboys.
STI check-up and HIV status
Most participants (89.5%) had received an STI check-up within the last year; 26% said they had accessed an STI checkup within the last six to twelve months, while 21% said they have had check-ups more recently, that is, within the last month to six months.
Only one out of ten respondents (10.5%) had never had an STI check-up.
10.5% of participants said they were HIV positive, and 21.1% said that they did not know or would prefer not to reveal their HIV status; the majority of respondents (68.4%) reported ‘negative’ HIV status (see Figure 3).
Issues affecting Aboriginal and Torres Strait Islander gay men, MSM, sistergirl and brotherboys in South Australia
All participants were asked to name the three main issues affecting Aboriginal and Torres Strait Islander gay men, men who have sex with men, sistergirls and brotherboys in South Australia.
Over half of respondents (56%) reported lack of acceptance by the wider community/ family as the main issue, followed by lack of support/education about sexual health (28%), safety issues (20%) and the problem of accessing appropriate health and social services (12%) (see Figure 4).
Most of the respondents commented that they felt shame, due to a lack of acceptance by the wider community, and even from their families.
Therefore, they considered that proper education and greater awareness about their complex sexual needs and sexuality-related issues was necessary among the wider Aboriginal and Torres Strait Islander communities.
What did we learn?
The survey results demonstrate that despite stable rates of HIV among Aboriginal and Torres Strait people in South Australia, this population remains at increased risk from HIV and STIs.
Ongoing community capacity building and education – including culturally appropriate health messages – would assist to narrow the gap in services for Aboriginal gay men, men who have sex with men, sistergirls and brotherboys, especially for those residing in rural and remote regions of Australia.
Campaigns addressing issues of ‘shame’, aimed at families within the wider Aboriginal and Torres Strait Islander community, would be highly beneficial in increasing community awareness relating to HIV and STI transmission and prevention strategies.
Further targeted health promotion encouraging access to sexual health services would clearly result in an overall increase in testing rates and reduction in risk.
The survey overwhelmingly highlighted the overall lack of acceptance and the sense of belonging by the wider community and families which resulted in individuals feeling a sense of ‘shame’. This frequently resulted in the need for counselling services.
Individuals strongly believed that wider community education would result in a greater awareness about their complex sexual health needs and sexuality-related issues.
The survey highlighted the need for development of various resources for use by rural and remote health services and community members.
In response to these findings, SAMESH has reinstated the Aboriginal Gay Men’s, MSM, Sistergirl and Brotherboy Reference Committee that was formerly positioned at GMHSA.
SAMESH has entered into a partnership with the Close the Gap team – a program of SHine SA – to recruit an Aboriginal gay man to further engage with the reference committee and to develop a suite of culturally appropriate sexual health training packages for regional and rural Aboriginal health workers and community leaders.
References
1 Lawrence, C., Rawstorne, P., Hull, P., Grulich, A., Cameron, S., Prestage, G. (2006). Risk behaviour among Aboriginal and Torres Strait Islander gay men: comparisons with other gay men in Australia. Sexual Health, 3(3), 163–167.
2 Ward, J., Costello-Czok, M., Willis, J., Saunders, M., Shannon, C. (2014). So far, so good: Maintenance of prevention is required to stem HIV incidence in Aboriginal and Torres Strait Islander communities in Australia. AIDS Education and Prevention, 26(3), 267–279. doi: 10.1521/ aeap.2014.26.3.267.
3 ibid.
4 ibid.
Wills Logue is Team Leader at SA Mobilisation and Empowerment for Sexual Health (SAMESH)