Ensuring equitable HIV outcomes for Sydney’s Asian-born gay men

Australia as a whole is on track to become the first place in the world to virtually eliminate HIV transmission.

Australia’s HIV response strategy has been characterized by sustained bipartisanship and community engagement since the 1980s and is now close to achieving the ’95-95-95′ AIDS targets of the Joint United Nations Program on HIV and AIDS ( UNAID), which aims for 95-95-95 targets. % of all persons with HIV who are aware of their status, 95% of whom would receive antiretroviral therapy, with 95% of them achieving viral suppression.

However, further analysis points to a worrying gap: much of the sharp decline in new HIV reports has been concentrated among Australian-born men living in inner cities. Reports of HIV infection have not decreased as quickly – and in some cases have increased – in the suburbs, where there are high concentrations of immigrants, including LGBTQ+ immigrants from Asian backgrounds.

What does the data show?

The latest national HIV surveillance report, which tracks trends from 2012 to 2019, shows that while HIV reporting fell by 43% among Australian-born GBM and among those born outside Australia and Asia, 54 % fewer HIV reports. % increase in HIV notifications among Asian-born GBM over the same period.

Notably, people born in South East Asia, along with those born in Latin America, make up the largest proportion of undiagnosed people living with HIV in Australia, at 25% each. While there was a 35% decline in reporting among Asian-born survey respondents between 2019 and 2021, this decline can be reasonably attributed to strict national border closures due to COVID-19, which prevented international students, workers and others from entering Australia . and many who were in Australia returned to their home countries. Also troubling, we found that among Asian GBM living with HIV in Sydney, only 72% self-reported that they had achieved viral suppression, significantly lower than the UNAIDS target of 95% and the Australian national suppression rate of 98%.

We are the principal investigators of the Gay Asian Men’s Survey (GAMS), a cross-sectional study of the sexual health and well-being of Asian gay, bisexual and other men who have sex with men (GBM) in Sydney. It started in 1999 and has been conducted biannually since 2015. The research is managed by the Center for Social Research in Health at the University of New South Wales in Sydney, with collaborators from government, local health districts and community groups.

Findings from the GAMS show that important health promotion messages have not reached Asian GBM communities, especially those with lower English proficiency and on temporary visas.

Low testing rates and persistent HIV transmission among Asian-born immigrants, especially among those on temporary visas, may also be related to the fear of having their visa applications rejected and their employers notified if they test positive for HIV. Despite its robust HIV response, Australia remains one of only about 40 countries that apply visa restrictions to people living with HIV.

How can we move forward?

PrEP (Pre-Exposure Prophylaxis) – proven to be highly effective in reducing the risk of HIV transmission – remains a barrier ‘particularly for international students with limited work rights and relatively low income’, despite evidence that Medicare -ineligible individuals on free PrEP show high PrEP uptake and adherence.

GAMS results support the finding that Asian-born GBM who are international students face multiple challenges that put them at greater risk of contracting HIV or being diagnosed late (i.e., in advanced stages of HIV) , because they may:

• being in a new environment with many opportunities and uncertainties about exploring their intimate options;
• have difficulty negotiating boundaries around safer sex due to cultural and language factors;
• have financial problems that make them dependent on their partners, employers or landlords;
• wrongly view PrEP with suspicion due to doubts about its safety and efficacy; and they might view PrEP as a sign of sexual promiscuity rather than as an effective tool for HIV prevention.

GAMS’s findings indicate that sexual health awareness among Asian GBM – especially those born abroad – is low. It is therefore important that health promotion is culturally informed and accessible to communities in the languages ​​and locations that suit them best. Examples include producing health promotion materials in languages ​​such as Chinese, Nepali and Thai (three of the top five source countries of international students in New South Wales), and developing health care services in the areas where many live and work, such as GreaterWestern. The Sydney region, where there has long been a lack of LGBTQ-specific sexual health care.

Healthcare providers play a key role in ensuring that underserved populations are adequately supported when presenting for care, and care must take into account individuals from culturally and linguistically diverse backgrounds, and the different ways in which sexuality and gender diversity are understood and expressed. Effective access to appropriate interpretation and translation services is needed that support a strengths-based approach without reinforcing stigma, and the role of opportunistic screening (tests proactively offered to all patients as part of a routine medical check-up) should be considered .

Critically, GAMS data has repeatedly suggested that to encourage testing and treatment, HIV visa restrictions should be lifted – as has been done in the US, Britain and New Zealand.

Note: The 2023 round of the Gay Asian Men’s Survey is recruiting participants through April 2024.

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