Out in the CALD
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Dr Chris Lemoh (Infectious Diseases Physician; AFAO Board; Victorian African Health Advocacy Network), examines dimensions of diversity and how these affect the provision of positive support and advocacy services in Australia's evolving HIV epidemic This presentation was given at the AFAO Positive Services Forum 2012.
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Out in the CALD
- 1. Out in the CALD Dr Chris Lemoh Australian Federation of AIDS Organisations Victorian African Health Advocacy Network
- 2. Outline Dimensions of diversity Diagnosis of HIV in African Australians Prior understanding of HIV Need for support after diagnosis Barriers to support after diagnosis Role of positive services
- 3. Dimensions of diversity WHAT? •Politics WHO? •Economy •Family •Government •Friends •Services •Partner •Tradition •Other individuals •Religion •Ethnicity •Gender •Age WHERE? WHEN? •Time/place •Environment • WHY? • External • Faith • Internal • Feelings •Health/illness • Knowledge
- 4. Diagnosis of HIV • Prior understanding of HIV in Africa • Concern about exposure • HIV avoidance strategy • Prior understanding of HIV in Australia • Low self-perceived exposure risk • “Risk group” stereotypes • Competing life pressures Last negative HIV test Exposure Reaction to diagnosis Early diagnosis •Applying for permanent visa •Antenatal screening First positive •HIV+ partner HIV test Late diagnosis Diagnosis Living with •AIDS-defining illness e.g. TB HIV •Other illness
- 5. Prior understanding of HIV • Lack of HIV treatment • No HIV+ migrants • Discrimination • Good health system • Poor/unsafe health system • Media • HIV in media • Sexual imagery • “African disease” • “Gay disease” • Stigma • Hostility • No known HIV+ • Abandonment • Family conflict • HIV+ family/friends • High HIV prevalence • Low HIV prevalence • Ugliness • No visible HIV+ • Suffering • Death • Sexual morality • Shame • Sexual immorality • Reticence • Fear • HIV “risk groups” • Despair • Low perceived • Personal experience Africa Australia HIV risk
- 6. Need for support after diagnosis Access to treatment Childcare Immigration •Self •Spouse Companionship •Family Comfort Encouragement Personal assistance Information Housework •Prognosis Shopping •Treatments Transport •“Cures” Childcare •Childbearing
- 7. Barriers to support after diagnosis Health service capacity •Skills (hetero/F) Religious doctrine •Guidelines (e.g. IVF) Isolation from family Medicare eligibility Relationship strains Stigma Immigration policy Discrimination Welfare policy Morality Pride Infrastructure Guilt/shame Depression Time Lack of Information •Irrelevant Distance •Inappropriate
- 8. Role of positive services Health service Cultural and social context •Capacity •Accessibility Counseling •Marital Policy •Family/child •Immigration •Medicare Community education •Welfare Advocacy Support •HIV in Australia •Disability •Planning Understanding Respect Faith leaders •Capacity Counseling • Pastoral care •Individual •Accessibility Referral • Sexuality • Gender Information inequality •Relevant • Guilt/blame •Appropriate
- 9. Acknowledgements African Australian Welfare Council Melbourne Health Family and Reproductive Rights Program Burnet Institute Sudanese Community Association of Victoria Melbourne Sexual Health Centre Horn of Africa Senior Women’s Group Alfred Health Dinka Jieng Community Council of Victoria Royal Women’s Hospital United Somali Women Southern Health (Monash Medical Centre) Oromo Community Association in Victoria St Vincent’s Hospital (Melbourne) Centre for Youth Multicultural Issues Inner South Community Health Service Scarlet Alliance Special thanks to all study participants New Hope Foundation Positive Women Straight Arrows Islamic Women’s Welfare Council of Victoria HealthWorks Kirby Institute for Infection and Immunity in Society Supported by a Project Grant from the Department of Human Services and a scholarship from the Centre for Clinical Research Excellence in Infectious Diseases
- 10. Acknowledgements Beverley-Ann Biggs Jim Black Suzanne Crowe Tony Korman Shroug Mohamed Margaret Hellard Virginia De Crespigny Eman Naim Suzanna Garland Faten Mohamed Alan Street Jeanette Venkataya Claire Ryan Tim Read Malyun Ahmed Samia Baho Nick Christopher Zamberi Sekawi Tina Schmidt Abdinur Weli Tenenet Taye Thao Nguyen Christopher Fairley Margaret Choul Abraha Gebremariam Paulette Manton Doris Chibo Kerrie Boyd Kofi Osei Sahra Hussein Graham Brown Chris Birch Peter Stanley Janelle Fawkes William Malouk Mary Ljubanovic Tamara Speed Kirsty Buising Julie Futol Daw Jamileh Abu-Duhou Anna Hearps Ian Woolley Alison Coelho Shangale Ali Pascale Allotey Vicki Greengrass Anne Mijch Kate Bean Shiraz Hakim Lisa Morris Christine Bowtell-Harris Naomi Ngo Mohanad Hakim Liz Nichol Kerrie Watson Neveen Hanna Rebecca Guy Sophie Dutertre Rhiannon Palmer Carol El-Hayek Stephen McNally Rachel Tham Lisa Natoli Jeffrey Grierson Mirella Ozols Marion Brown Martha Morrow Christalla Hajisava Keflemariam Martha MacIntyre Megan Brooks Yohannes Sandy Gifford Gina Barri-Rewell Jenny Lewis Katerina Lagios Ann McIntyre Maelenn Gouillou Sonia Curuana Tim Spelman