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In Australia, surveillance data establish that there are higher rates of late HIV diagnoses among heterosexual migrants from Sub-Saharan Africa and new HIV diagnoses among gay and bisexual men (GBM) from Southeast and Northeast Asia and Latin America. Together, these groups are identified as priority migrant communities in current efforts to eliminate HIV transmissions. HIV health literacy is recognised as a key means of improving access to services and health outcomes. This qualitative paper explores critical HIV health literacy among priority migrant communities in Queensland, Australia. To foreground community voices, peer researchers from priority migrant communities participated in the project design, data collection and analysis, with 20 interviews completed. The findings demonstrate how participants' engagement with HIV health information and services is highly relational and situated within the framework of sexual health and wellbeing. Participants strategically selected where to seek information and who they trusted to help them appraise this information. They further demonstrated reflective capacities in identifying the contextual barriers that inhibit the development of their HIV health literacy. The findings highlight the need for HIV health promotion strategies that embrace a sex positive approach, promote cultural change, and involve collaboration with general practitioners (GPs). [ABSTRACT FROM AUTHOR]

In Australia, the response to HIV, hepatitis C and hepatitis B has largely been through the constructed category of 'blood borne viruses' which treats these viruses as an interconnected set of conditions with respect to their mode of transmission. In this paper, we explore how people understand their viral infection, and compare the logics underpinning these different understandings. In-depth interviews were conducted with 61 participants who were either living with a blood borne virus or were the family members of people living with them. Our analysis reveals that the viral infection was often described as 'just a condition that needs to be managed', albeit in potentially exhausting ways. This understanding hinged upon a biomedical logic in which viral invasion was seen as causing illness and in turn necessitating biomedical intervention. In contrast, some participants with hepatitis B presented their infection as a condition unintelligible through Western biomedical logics, defined instead by symptomology – in terms of 'liver disease', and/or 'liver inflammation'. This focus on symptomology calls into question the soundness of prevention and management responses to hepatitis B based in biomedical logics and reveals the extent to which living with a virus involves multiple, sometimes incompatible, cultural logics. The different logics underpinning HIV, hepatitis C and hepatitis B reveal shortcomings of framing these viruses together as a coherent single construct. [ABSTRACT FROM AUTHOR]

Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson's chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships. [ABSTRACT FROM AUTHOR]

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care. [ABSTRACT FROM AUTHOR]

Globally, women represent more than half the people living with HIV. This proportion varies by country, with an over-representation of HIV among men who have sex with men (MSM) in some regions. For example, in Australia, MSM account for over 60% of transmissions, with heterosexual sex accounting for almost a quarter of transmissions. Irrespective of geographic region, there is evidence that women can have a different lived experience of HIV due to their unequal social and economic status in society, while MSM can have a different lived experience depending on the laws and customs of their geographic location. Gender differences related to risk factors, stigma, access to services, mental health, health-related quality of life and economic consequences have been consistently reported globally. This paper explores the subjective lived experience of gender and sexuality disparities among three individuals living with HIV in Australia: a male who identified as gay, and a male and female who each identified as heterosexual. Analysis of themes from these three case reports indicated discernible differences by gender and sexuality in four areas: access to medical services, social support, stigma and mental health. It is argued that knowledge and understanding of potential gender and sexuality disparities must be factored into supportive interventions for people living with HIV in Australia. [ABSTRACT FROM AUTHOR]

Contemporary sociological work has emphasised that family is not static, but actively shaped by ideas of who and what makes family. Disclosure of an illness, including diagnosis of stigmatised infections such as HIV, hepatitis B virus and hepatitis C virus, can change the dynamics of family relationships. This paper draws on 61 qualitative semi‐structured interviews conducted between 2017 and 2019 with people in Australia with one or more of these blood‐borne viruses (BBVs) and their family members, to understand the experiences of serodiscordant (mixed viral status) families. Through a thematic analysis, we explore the family imaginaries that participants evoked when describing their disclosure practices in relation to (self‐defined) family members, revealing how some participants disclosed in ways that enabled them to shape their family, to maintain boundaries between self and family or to protect family from distress. Participants' accounts of disclosure to family revealed imaginaries of family as a precious web of connections to be nurtured or protected, but also as sites of ambivalent belonging and complex history. We conclude that BBV disclosure practices within families reveal important ideas about families that are imagined in response to the threat of loss, change and stigma. [ABSTRACT FROM AUTHOR]

Background: People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia.Methods: This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically.Results: Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health.Conclusions: Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial. [ABSTRACT FROM AUTHOR]

Despite the frequent occurrence of unwanted disclosure of HIV status in Australia, there is little understanding of its determinants and consequences. This paper offers an analysis of lived experiences of unwanted disclosure amongst 28 people with HIV in urban settings in Australia. Of the 28 individuals interviewed, 17 men and 8 women had experienced unwanted disclosure of their HIV status by other people in work, health, social and other settings. Through the lenses provided by the concepts of habitus and agentic practice, this paper focuses on unintentional and deliberate practices of unwanted disclosure, and the consequences that may arise from this. Findings reveal how unwanted disclosure may lead to reflexive and agentic action among people with HIV as they struggle to reclaim control over their lives and how they are perceived. Despite what is sometimes assumed, the negative social responses the HIV epidemic has given rise to persist in Australia. Some 30 years into the epidemic, findings highlight the need to establish a social climate that is intolerant of unwanted disclosure, and which recognises the damage it may cause. [ABSTRACT FROM AUTHOR]

This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p < 0.01) and never-testers (OR=2.01; p < 0.10) significantly more likely to do so than optimal-testers. Most were confident (51.7%, 119) or somewhat confident (29.1%, 67) accessing support following a reactive result, however, never-testers were significantly less confident compared to previous testers (OR=3.47; p< 0.05). Less than a quarter (23.6%, 57) were willing to pay for a kit with AUD$15 (R2 = 0.9882) the estimated preferred price. This research confirms that HIVST is an important and accepted adjunct to established HIV testing modalities, particularly among sub-optimal and never-testers and that online (61.6%, 143) or clinic-based (61.6%, 143) dissemination are preferred. Research examining how best to disseminate HIVST in a range of safe and effective models needs to continue to ensure HIVST is part of a comprehensive strategy that facilitates usage and linkages to care. [ABSTRACT FROM AUTHOR]

As treatment improves, people living with HIV (PLWHIV) can now expect to live longer, which means that the foci of HIV‐related care for them and their medical practitioners continue to change. With an increasingly older cohort of patients with HIV infection, practitioners’ key considerations are shifting from issues of acute treatment and patient survival to multiple comorbidities, toxicities associated with chronic therapy, and ongoing health maintenance. Within this context, this paper explores the current standard of practice for the management of HIV infection in Australia. We surveyed 56 Australian practitioners currently involved in managing HIV infection: ‘HIV section 100’ (HIV therapy‐prescribing) general practitioners (s100 GPs; n = 26), sexual health physicians (SHPs; n = 24) and hospital‐based physicians (HBPs; n = 6). Survey results for practice approaches and challenges were broadly consistent across the three practitioner specialties, apart from a few key areas. s100 GPs reported less prophylaxis use among patients whom they deemed at risk of HIV infection in comparison with SHPs, which may reflect differences in patient populations. Further, a higher proportion of s100 GPs nominated older HIV treatment regimens as their preferred therapy choices compared with the other specialties. In contrast with SHPs, s100 GPs were less likely to switch HIV therapies to simplify the treatment protocol, and to immediately initiate treatment upon patient request in those newly diagnosed with HIV infection. Considerably lower levels of satisfaction with current HIV practice guidelines were also reported by s100 GPs. It appears that greater support for s100 GPs may be needed to address these identified challenges and enhance approaches to HIV practice. Across all specialties, increasing access to mental health services for patients with HIV infection was reported as a key management issue. A renewed focus on providing improved mental health and wellbeing supports is recommended, particularly in the face of an ageing HIV‐infected population. [ABSTRACT FROM AUTHOR]

This paper explores HIV-positive women's accounts of their use and non-use of treatments for the prevention of mother-to-child transmission. In-depth interviews were conducted in 2001 with 34 HIV-positive women who were diagnosed during their childbearing years. This paper reports on the 16 women who gave birth after being diagnosed with HIV. Some women reported experiencing debilitating side-effects of antiretroviral (ARV) therapy, and all were aware that the history of HIV therapy was not one of clear, consistent and benevolent effectiveness. It was evident that women wanted the best outcomes for themselves and their babies. Women represented their role vis-a-vis their children as encompassing protection against a medical fraternity that insisted on the use of ARV and prophylaxis without acknowledging the mothers' concerns about toxicity. From the women's perspective, it made sense not to let their babies become experimental subjects when long-term effects were unknown. To maximise the benefit of ARV therapy to mothers and babies, thereby reducing the risk of vertical transmission, it is imperative to understand a woman's explanation of what therapy means to her, and advisable to presume that she wants the best for her baby. Such an approach will facilitate better communication and encourage clinicians and patients to work towards a shared goal. [ABSTRACT FROM AUTHOR]

This paper explores how experiences of disclosure and passing among heterosexuals living with HIV in Australia can be meaningfully conceptualised beyond therapeutic discourses and habitual metaphors. It engages in a dialogue between qualitative research material, HIV disclosure literature and theory. It is first argued that an emphasis on the therapeutic value of disclosure in much of the literature obscures the complexities of HIV stigma as socially produced and lived. Next, the paper considers the concepts of 'the closet' and 'coming out', which have become short-hand for a range of social stigmas. Although parallels are found between the productive effects of the closet and the research material, the idea of 'coming out' fails to capture the cultural context of HIV in Australian heterosexual society. This raises questions about the contemporary tendency to invoke the closet as a presumedly universal metaphor. Foucault's idea of heterotopia is proposed as an alternative way of conceptualising the lived worlds of disclosure and passing in this research study, with the hope of opening out future discussion and theorising. [ABSTRACT FROM AUTHOR]

Background: Gay and bisexual men typically report high rates of illicit drug use, including methamphetamine use. This paper aimed to analyse trends in crystal methamphetamine ('crystal') and powder methamphetamine ('speed') use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use.Methods: The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005-14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007-14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data.Results: Speed use declined from 25.0% to 10.2% during 2005-14 (p-trend <.001), while regular speed use declined from 7.0% to 2.3% during 2007-14 (p-trend <.001). Any crystal use declined from 15.6% to 11.4% during 2005-14 (p-trend <.001) and increased during 2010-14 (from 9.6% in 2010; p-trend <.001). Regular crystal use declined from 6.1% to 4.0% during 2007-14 (p-trend <.001) and remained stable during 2010-14 (3.9% in 2010; p-trend=.64). Participants who reported regular crystal use were more likely than men who used crystal less frequently to have used gamma-hydroxybutyrate, used party drugs for sex, and to have injected drugs in the previous 6 months. High rates of crystal use and injecting were reported among HIV-positive participants.Conclusion: Rates of both crystal and speed use, despite fluctuations, were consistently high throughout the study period. The high rates of crystal use and associations with potentially risky sexual practices indicate that gay and bisexual men should be a particular focus for targeted harm reduction and combined harm reduction and sexual health services. [ABSTRACT FROM AUTHOR]

Background: HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods: As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results: The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions: Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce. [ABSTRACT FROM AUTHOR]

Increasing international mobility presents a risk for communicable disease transmission. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk, and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This paper draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000 and 2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV-prevention programmes. [ABSTRACT FROM PUBLISHER]

Abstract: The introduction of highly active antiretroviral therapy (HAART) is typically represented as a turning point in the social and medical history of HIV/AIDS, leading to a conceptual division into pre- and post-HAART eras. This paper explores how generational discourse is produced in interviews with general practitioners (GPs) and their HIV positive gay male patients in making sense of this moment and related changes in the Australian HIV epidemic. A theme of ‘HIV generations’ was identified in in-depth interviews with GPs who have HIV medication prescribing rights (based in Sydney, Adelaide and rural-coastal New South Wales) and the HIV positive gay men who attend their practices. In a closer analysis, generational discourse was identified across the interviews with GPs, characterising pre- and post-HAART HIV generations through three main features: treatment histories, socioeconomic status, and modes of survivorship. While generational discourse was less common in the accounts of HIV positive gay men, many of their examples wove together two narrative forms – ‘a different time’ and ‘difference today’ – suggesting that concepts of time and inequity are deeply embedded in these men’s understandings of the HIV experience. Our analysis indicates that generational concepts play a significant role in shaping both professional and ‘lay’ understandings of changes and patterns in the HIV epidemic. [Copyright &y& Elsevier]

Background/Aims: Syringe dispensing machines were introduced into needle syringe programs (NSPs) two decades ago. The few published studies on dispensing machines have focused on feedback of machine users and service providers' feedback has rarely been reported. This study obtained the feedback of health staff of NSPs, other sectors of Drug Misuse Treatment Services and of other health services adjoining dispensing machines on the role and effectiveness of dispensing machines. Methods: Between August and November 2006, questionnaires were anonymously completed by NSP and drug misuser treatment staff in an Area Health Service in Sydney, as well as by the staff of two nondrug-related health services located adjacent to needle syringe dispensing machines. The questionnaire was available in either paper or Internet based forms. Results: Almost 80% of 94 participants rated dispensing machines as either moderately successful or successful in reducing sharing of needles and syringes. Staff considered that introduction of these machines to NSPs had improved services for injecting drug users without increasing unsafe disposal of used equipment, community drug use, or vandalism. However 78% of respondents felt that dispensing machines either reduce or may reduce IDUs' opportunity for staff contact and hence opportunity for engagement or education. The study limitations were noted. Conclusion: Syringe dispensing machines are perceived to be a successful and appropriate outlet of NSPs that complement other outlets. Lack of staff-user contact was seen as their main disadvantage. [ABSTRACT FROM AUTHOR]

In order to address HIV infection among college students, a comprehensive measure is needed that can be used with samples from culturally diverse populations. Therefore, this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness-factual knowledge, prejudice, personal risk, and misconceptions about HIV transmission, and will enable cross-cultural research. The International AIDS Questionnaire-Chinese Version (IIQ-C) was developed and validated by Davis, Tang, Chan, and Noel (1999) for use with Chinese populations. In this study, the validity and reliability of the International AIDS Questionnaire-English Version (IQA-E) was assessed on a sample of English-speaking college students from the United States (N = 200) and Australia (N = 74). The results of the CFA supported the four-factor model, and the normative data show patterns similar to previous research. The total IAQ-E had a high internal consistency (Cronhach's alpha = 0.88). The Cronbach's alphas for the sub-scales were 0.87 (myths), 0.81 (attitudes), 0.66 (personal risk), and 0.40 (facts). A 2-week test-retest reliability study on a sub-sample of 32 students revealed a Pearson product-moment correlation coefficient of 0.882 (p < 0.001). This instrument provides a valid and reliable comprehensive measure of HIV/AIDS for use with English-speaking samples. [ABSTRACT FROM AUTHOR]

If you want to understand educational work and workers in the HIV community sector, how do you access, model and theorize educational practice and those who do it, and how do you generate critical perspectives on this? Further, how do you determine the ways in which effective educational development and changes might be effected? How do you proceed through a set of practices that generate knowledge collaboratively with those whose practice is the focus of the research? Whose knowledge is generated and whose is described in the research process? In order to explore these questions, this paper addresses the principles and approach to a set of collaborative action research projects conducted within community-based HIV organizations throughout Australia. The Community Educational Workforce and Training project has attempted to describe and critique the educational work and workforce of this sector, approaching the research as an action-based collaborative endeavour. A central premise of the research has been that complex and expert systems of knowledge about educational practice reside with practitioners. As researchers our challenge is to find ways to extricate these knowledges and to interpret, link, structure and analyse the data with a view to developing the theory and practice of educational work. Principles of discourse analysis and theory generate a perspective on the differently positioned views and roles of the research partners, and allow the research enterprise to be seen as one that is as much embedded in interpersonal and relational interaction as it is in intellectual endeavour. The methods of data collection and analysis, embedded within critical discourse analysis, ethnography, models of action and collaborative research produced a critical, iterative and rigorous research process. Reflexivity as a research principle and practice demands a continuous, critical dialogue between researchers, participants and ideas. This occurred within individual moments of research and in an accumulating sense, over time as each project was undertaken. Our understanding of educational logics, problematics and meta-structures deepened during the research process. [ABSTRACT FROM AUTHOR]

Discusses the abstract of the research paper 'Do Prospective Blood Donors Understand HCV and HIV Risk Factors? The Australian Experience,' by C.R. Seed, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.