Introduction
Methods
Eligibility
Data Collection
Analysis
Findings
Sample
Demographic | Number (n = 24) |
---|---|
Age | |
18–25 | 8 |
26–35 | 8 |
36–45 | 6 |
46–55 | 1 |
56 + | 1 |
Country of birth | |
South Asia | 1 |
Southeast Asia | 9 |
Northeast Asia | 5 |
Latin America | 8 |
Eastern Europe | 1 |
Sexual identity | |
Gay | 21 |
Bisexual | 3 |
Time in Australia at diagnosis | |
< 1 year | 6 |
1–2 years | 2 |
2–3 years | 3 |
3–4 years | 2 |
4–5 years | 2 |
> 5 | 3 |
Unknown | 6 |
Visa on arrival | |
Student | 12 |
Working holiday | 3 |
Partner/family | 2 |
Skilled | 1 |
Permanent Resident | 3 |
Tourist | 2 |
Unknown | 1 |
Medicare | |
No | 11 |
Yes | 13 |
Education | |
Secondary | 2 |
Diploma | 3 |
Tertiary | 19 |
Employment | |
Full time | 6 |
Part time | 5 |
Casual | 9 |
Unemployed | 4 |
Stigma in Countries of Origin
Stigma Regarding HIV and Homosexuality
In [country of origin], there’s a lot of stigma about it [HIV]. It’s the rumour you’d never wanna talk about and there’s a scary ghost lurking around the corner. Like no one wants to talk about the subject. So if you know someone has it you kind of distance yourself from them (35, Latin America)
Socially or culturally, as a Buddhist, it’s a stigma. So gay is still everything under the closet. My society, my community background wouldn’t tolerate this. So just has got to be some sort of a secret movement… Asian countries don’t accept homosexuality. In my family my older sister talk about it and she warn me against being a gay. I think she suspect it (64, Southeast Asia)
I wasn’t sexually active ’cause I was studying, living with family. I’m really careful, and very conservative in my sexual desires. And considering family background, Philippino culture is really conservative and in terms of being gay, it’s an embarrassment for the family. And it might affect reputation… So being a gay in Philippines is hard. And because also we’re a Catholic believer type of country, it’s a big sin. You go to hell straight away (28, Southeast Asia)
With my background, things are so kind of obscure and you don’t want anyone to know, and you have to be very secretive about things, so how can you make yourself not feel dirty or bad yourself? So yeah, most people [in country of origin] will explore but won’t feel very nice about them in the beginning… So then I don’t know anything about HIV because I was already scared of having sex (35, Latin America)
Inadequacy of Health Services and Invisibility of Gay/Bisexual Communities and Identities
Not as much as it is here [Australia] I would say because there’s no governmental campaigns, especially for gay men, to be going for regular tests or getting diagnosed. There is no particular movement. But it’s mostly pocketed within very small, like, the LGBT community is very discreet not very conspicuous in the social health structure (39, Southeast Asia)
Consequences of Stigma on HIV Knowledge, Testing, and Prevention
Barrier | Quote excerpt |
---|---|
Fear, shame, embarrassment, or concern about being exposed as gay/bisexual | You have that kind of fear to go access that sort of place. You feel like people will discrimination [sic]. You walk in the building, people will judge you. Like you are gay or you are like carry some STI (25, Northeast Asia) |
Low perception of risk due to infrequent sex, frequently using condoms, or being in a monogamous relationship | I never thought I should do HIV testing. Because I have protected sex most of the time. I was ignorant. I was healthy and I never thought that it would happen to me (64, Southeast Asia) |
Lack of availability, visibility, and accessibility of health services (for example, waiting up to half a day to get a test, having to pay for it, or lack of confidentiality) | Probably because it [HIV testing] is not very seen back in my country. That’s why people like are less educated for that stuff. And the people who are in charge of that did not really make people know about it. There’s no ads at all and there’s, you don’t know where is the testing (21, Southeast Asia) |
Anxiety about already having acquired HIV and preferring not to find out | I never test because truly, I was very scared. I just worried about positive status. So I didn’t want to get a test (33, Northeast Asia) |
I will say I only understand what HIV is just last year [after migration]. Before, in [country of origin], all the media, they’re warning people, is so strong. It seems like HIV or AIDS people very yucky and must be avoided. Don’t talk to them. Don’t touch them. That the information I got from my country (44, Southeast Asia)
Consequences of Stigma on Sexual Identity
It’s not very well seen to be gay and you march [during gay pride] in the main street, and one side of the street is a church and family marching, on the other side is the pro-gay and the community marching. So we never go to the march because it gets violent; it’s not a celebration. And you’re afraid of going there and exposing yourself to whatever might happen (35, Latin America)
Reasons for Migration
Before migration I was, “Okay, I’ll always live a double life.” Outside house I’m free but inside, together with parents or relatives or people who know me, I have to act normal. But this is not normal for me, right? I just started to get tired of living double life. I don’t know when it happened, but I don’t care anymore. I get fed up and so I move here [to Australia] to be free (21, Southeast Asia)
No, because of work. I just go to Australia for work. I just live my own life the way I am. So even though I’m gay I don’t want to go out to meet gay people and to tell people that I’m gay (33, Southeast Asia)
Sexual Identity in Australia
Affiliation with Gay/Bisexual Identity
Sometimes I say, “Why I have to tell people that I’m gay?” because I just want normal life. It doesn’t mean that I want to dress like a girl or ladies, you know. I don’t go out at all. I just stay at home and working, cooking. I’d be at home like, like normal people… I don’t have many gay friend here. That doesn’t mean that I don’t like them though. I’m just not a party boy and I don’t hang out with many people (44, Southeast Asia)
When I was diagnosed with HIV, I needed to know more about it. I needed to get to know more people who are living with HIV. And that’s how I got involved with [LGBTIQ community organisation]. But before that diagnosis, I wasn’t connected, I didn’t need to be, so I wasn’t getting that information about HIV (37, Latin America)
Effects of Internalised Stigma on Sexual Identity
Asian society doesn’t accept it at the moment. I’ve been here [Australia] for 30 years. I was living in a straight community. So I was never out of the closet. My society, my community background back home wouldn’t tolerate this. So it just has to be some sort of secret movement here. I wouldn’t go to parade. I don’t want to participate (64, Southeast Asia)
When you start exploring your sexuality, and with our backgrounds, you don’t want anyone to know you’re gay and you have to be very secretive, so how can you make yourself feel the Australian openness not to feel dirty or bad yourself? So most people will explore but won’t feel very nice about them [sexual encounters] in the beginning. My cousin’s been very hard to accept himself in Australia because we have all these years of conditioning that being gay is bad and you’ll bring dishonour to your families (35, Latin America)
Barriers to HIV Testing in Australia
Barrier | Quote excerpt |
---|---|
Continued fear of HIV testing | Because I’m shy to go to the clinic in [country of origin]. Even if it says it’s a like secret [confidential] clinic, but still you have to meet people in there. So I feel shame, shy and scared. And even now [in Australia], when I go to the sexual-health centre, have to sit in the waiting room, and I’m very shy. It’s hard for me to sit there (44, Southeast Asia) |
Competing interests associated with migrating, such as study, housing, and work, which deprioritised sexual health | The first months I was worried on other things like my study, maybe how I handle the situation here in Australia the first time that I moved to another country. So I wasn’t really like focus on this (25, Latin America) |
Fear of losing a visa | I didn’t take the test before’cause I was really worried about my visa stuff. I felt at the time that, if I got positive, that would be a really huge problem to my visa (25, Latin America) |
Low perception of risk due to frequently using condoms, having infrequent anal sex, or not seeing oneself as part of an “at-risk” (homosexual) population | When I’m in Australia, apart from my partner, I don’t have any other sexual contact. So I don’t test because you don’t have the behaviour (50, Northeast Asia) |
Continued anxiety about already having acquired HIV and preferring not to find out | There’s a niggling fear that, “What if …” You probably want to just be an ostrich and bury your head in the sand and not think about it’cause it’s not gonna go away and what if it happens? What if worst fears come true? So you don’t want to put yourself in that position (39, South Asia) |
Lack of knowledge of the available services in Australia, often among participants who were Medicare ineligible | I never got tested in Australia because I think you have to go to the GP, ask the doctor, “Hey, I want to get tested,” and pay and maybe there would be stigma? Now I know that you can always walk to a sexual clinic and get tested. Before that, I didn’t know. Otherwise, I walk to the sexual clinic straight away (64, Southeast Asia) |
Barriers to Condoms and Discussing Sexual Health in Australia
So this is the thing: I’ve hooked up with many guys but we’ve never really talked about HIV. Like seriously I never met a guy that actually talked about HIV or any STI. If we use condom, we just pull it out. If he doesn’t, he just don’t. So, yeah, we don’t talk about STIs at all (21, Southeast Asia)
Barrier | Quote excerpt |
---|---|
Ongoing discomfort discussing HIV prevention with partners, originating from a country of origin where discussing sex and HIV was taboo | Interviewer: Do you ever discuss HIV with partners? Participant: Never in [country of origin], it wasn’t taught there, it’s a taboo topic, and so I never think to do it here (33, Northeast Asia) |
A perception that a partner posed little risk | I only knew he was working in medicine, so I’m assuming he was taking care of himself pretty well (25, Northeast Asia) |
Focusing on the pleasure of a sexual event, with HIV risk a secondary consideration | Once you’ve had the feeling of not using condoms, it’s completely different to using condoms. Once it’s [the condom] in there it feels different. I get that temptation. It’s just ask them to remove condom (19, Southeast Asia) |
Trusting a partner, particularly with those with whom romantic potential was felt | Once you get to know them, I found there’s a lot of common between the two. And I’m afraid that popping the question, “Are you positive? Are you tested?” would ruin the atmosphere and the intimacy at that time. So I didn’t pop the question. Rather, we kind of trust each other (27, Southeast Asia) |
Struggling to adapt unfamiliar sexual norms, with condomless sex being far more normative in Australia than in participants’ countries of origin | I would say that 85% of the people who reside in Australia do not use a condom, that is the truth. The person does not take the time to ask either. If there is more than one person who does not use it, no one will come and say well I use the condom. Well then, you see that and that leads you to practice the same as others do. It shouldn’t be like that, but that’s the way it is (23, Latin America) |
Barriers to PrEP Uptake in Australia
Barrier | Quote excerpt |
---|---|
Perceived lack of relevance due to infrequent sex or rarely engaging in HIV-risk | It’s very hard to know when you will need it. I have always been careful with having sex with someone. I only have sex without condom with those people I think are fine. (50, Northeast Asia) |
Perceived inaccessibility through cost or lack of knowledge of where to get it | When I started researching PrEP was like, "But how am I going to pay for it? Because I don't think student insurance covers those expenses." So also for the AIDS test (HIV) because it surely has a cost (28, Latin America) |
Concern about potential short- or long-term side effects, or taking medication deemed unnecessary for healthy people or people who have infrequent sex | It wouldn’t be the collateral effects that you have in the beginning, but the collateral effects that you have over a lifetime. Almost all the medicine for those under treatment produces some type of problem in the future, for example, I have major chances of getting osteoporosis. If you take the medicine, it will fix this and this, but it could attack something else. So, medicine is not good. I think that I have other ways of protecting myself, which is a condom. (25, Latin America) |
I’d been turned down so many times on apps [due to preferring condoms] so I was feeling like I was left behind because everyone basically in the gay community in that area is on PrEP. And I was feeling like, “Oh, yeah, should I take this tablet? I mean I don’t really want to take a tablet,” because I’m not quite good with taking meds. But I felt a little bit of pressure on that… And to be honest, it was much easier to go on the gay apps and hook up with someone for the fact that you are on PrEP (37, Latin America)