Letters
Health services administration Infectious diseases Global health
Volume 196 - Issue 8

Knowledge and access are not enough: HIV risk and prevention among people from culturally and linguistically diverse backgrounds in Sydney

Authors:  Augustine D Asante and Henrike Körner

Med J Aust 2012; 196 (8): 502. || doi: 10.5694/mja11.11342
Published online: 7 May 2012
To the Editor: The HIV epidemic in Australia is changing. The number of new infections attributed to heterosexual contact has increased, and people from culturally and linguistically diverse (CALD) backgrounds account for a significant proportion of these diagnoses. In the period 2005-2009, 41% of new HIV diagnoses linked to heterosexual transmission were in people from ...
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To the Editor: The HIV epidemic in Australia is changing. The number of new infections attributed to heterosexual contact has increased, and people from culturally and linguistically diverse (CALD) backgrounds account for a significant proportion of these diagnoses. In the period 2005–2009, 41% of new HIV diagnoses linked to heterosexual transmission were in people from CALD backgrounds.1 A considerable proportion of HIV diagnoses in people from CALD backgrounds are late diagnoses.

We conducted two studies about HIV and health service use in Sydney: Study 1 addressed HIV knowledge and use of health services2 and Study 2 addressed late HIV diagnosis.3 In Study 1, we interviewed 286 participants from four communities: Thai, Cambodian, Ethiopian and Sudanese. In Study 2, we interviewed 114 HIV-positive participants: 61 from CALD backgrounds (all communities) and 53 from Anglo-Australian backgrounds for comparison.

Both studies showed a considerable gap between participants’ knowledge of HIV risk and prevention plus access to health services on the one hand, and their perceptions of individual risk and stigma plus use of health services on the other. In both studies, people from CALD backgrounds had high knowledge about HIV risk and prevention but rarely applied this knowledge to themselves. They perceived their HIV infection risk as low and used health services rarely. There was evidence suggesting that general practitioners of patients from CALD backgrounds may be reluctant to request an HIV test: 30% of the patients with Anglo-Australian backgrounds indicated that their GP or specialist had suggested an HIV test, compared with only 13% of the patients from CALD backgrounds. HIV-related stigma was a concern for participants in both studies and played a major role in delaying HIV tests and delaying disclosure of positive HIV test results. Further details from both studies are shown in the Box.

Knowledge about HIV and access to health services are essential for prevention, but they are not enough. Our findings suggest that better use of health services in CALD communities would strengthen HIV prevention. Likewise, HIV prevention in CALD communities would benefit from improved sexual health education among GPs who work in these communities. Finally, mainstream health education campaigns seem to have done little to reduce HIV stigma in CALD communities; new and targeted approaches to addressing HIV stigma are needed in these communities.

HIV knowledge and use of health services among people from culturally and linguistically diverse (CALD) and Anglo-Australian backgrounds in Sydney2,3

Percentage (number) of participants

Study 1, people from CALD backgrounds (n = 286)

Study 2, people from CALD backgrounds (n = 61)

Study 2, people from Anglo-Australian backgrounds (n = 53)

Heard about HIV/AIDS

92% (263)

100% (61)

100% (53)

Correctly identified a mode of transmission

96% (274)

—

—

Had access to Medicare

92% (264)

79% (48)

100% (53)

Had a regular doctor (family or personal doctor)

64% (184)

—

—

Sought health care from a GP before diagnosis

—

90% (55)

91% (48)

Rarely use health services (once a year or less)

41% (118)

69% (42)

57% (30)

HIV diagnosed at first test

—

72% (44)

55% (29)

Never thought HIV test result could be positive

—

77% (47)

45% (24)

Very sick at hospital before testing for HIV

—

34% (21)

25% (13)

GP or specialist suggested a test

—

13% (8)

30% (16)

Shame of being HIV positive as main worry before diagnosis

—

61% (37)

38% (20)

Authors

  • Augustine D Asante1
  • Henrike Körner1
  • 1. University of New South Wales, Sydney, NSW.

Correspondence: a.asante@unsw.edu.au

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library

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