Carmen Gianfrancesco, Bridge Truell, Roanna Lobo, Gemma Crawford
Collaboration for Evidence, Research and Impact in Public Health, Curtin School of Population Health

“…whenever you say HIV, people will relate to the sexual disease that is causing pain to everyone. Especially CALD people like me,
we don’t speak about sex. For people who are at really high risk for HIV they will never go to these places [clinics/organisations] to learn more about HIV in Australia.”

Over the past decade, Australia has experienced increasing HIV notifications in some populations, including amongst migrants from sub-Saharan Africa, Southeast Asia, and Northeast Asia . Findings from the first national Migrant Blood-borne Virus and Sexual Health Survey  suggest low STI testing rates and low Pre-Exposure Prophylaxis (PrEP) awareness among heterosexually identifying migrants from these populations. Using qualitative inquiry, our team explored HIV risk related to understanding and susceptibility, assessment and management, awareness and uptake of PrEP, and influences of the COVID-19 pandemic.

What did we do?

Supported by multicultural community organisations in South Australia, Queensland, and Western Australia, we recruited 16 participants, mostly female, to engage in qualitative interviews.

What did we hear?

Participants were commonly highly educated and employed within health contexts, with knowledge of HIV transmission, prevention, and treatment. These levels of knowledge influenced preventive practices. However, participants also reflected limited PrEP awareness or uptake and reluctance to use it. While knowledge of PrEP was low, its use and, by association, practices and contexts surrounding its use were stigmatised. For example, an HIV diagnosis was commonly linked to practices that participants suggested were considered “immoral” or “indecent” in their communities and reflected a lack of personal responsibility, such as multiple sexual partners. PrEP was often associated with these practices.

We identified varied perspectives regarding HIV risk and prevention at the individual and community levels.

For example, Asian participants reported a lack of sexual health education during their schooling and higher levels of cultural stigma toward activities deemed “higher risk”. Conversely, participants from sub-Saharan Africa reported higher levels of sexual health education in schools and generally broader exposure to and visibility of HIV messaging before migration. These participants commonly demonstrated a stronger recognition of the broad sociocultural factors that influence HIV risk practices.

Proximity to people living with HIV influenced participants’ perceived susceptibility to HIV transmission and subsequent severity. Participants who reported knowing someone living with HIV were more likely to acknowledge the potential for HIV risk and lower levels of perceived severity. Community capacity was reportedly valuable for HIV-related advocacy and destigmatisation efforts. For example, participants suggested the need to: broaden sexual-health education in schools to include more HIV-related material, facilitate HIV-related information through social gatherings, and increase awareness within healthcare settings.

What’s next?

Findings support previous research demonstrating the complex intersection between HIV risk and migration-related factors. Low PrEP awareness suggests a need for more visible and widely understandable public health messaging outside dedicated sexual health spaces (including in general practice). Wide-ranging sociocultural attitudes to HIV reinforce calls for public health approaches that reflect migrant diversity and heterogeneity and which explicitly target stigma at all levels. We contend that community-led and targeted health promotion responses will be more acceptable and impactful than universal approaches. Participant insights support this recommendation and point to the importance of peers/community-led services in enhancing prevention and HIV testing. Findings support the need to prioritise migrants and people from culturally and linguistically diverse backgrounds in Australia’s HIV response.

More information about the study can be found here.

Acknowledgements

We want to thank co-researchers Sheriden Emmott and Mackenzie Lappin as well as the participants and multicultural organisations who contributed to the research: Australian Federation of AIDS Organisations (AFAO), Community of Practice for Action on HIV Mobility, Ethnic Communities Council of Queensland, Ethnic Communities Council of Western Australia, Migrant Blood-borne Virus and Sexual Health Survey Project, ODYSSEY Migration & Mobility in Public Health Research Hub, Office of Multicultural Interests, Relationships Australia (RASA), Sexual Health Information Networking and Education South Australia, and WA Sexual Health and Blood-borne Virus Applied Research and Evaluation Network.

Published: April 2023