Migration, Sexuality & HIV/AIDS
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In this presentation, Alison Coelho discusses the impact of migration on the sexual health of migrant communities in Victoria, Australia. This presentation was given at the Under the Baobab African Diaspora Networking Zone at the International AIDS Conference, AIDS 2014.
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Migration, Sexuality & HIV/AIDS
- 2. CEH • Provides support to agencies in Victoria and across Australia on developing culturally competent service systems. This is undertaken via training, capacity building, research, resource development, project management and consultancy. Multicultural Health & Support Service
- 3. MHSS works with: • Communities from refugee, migrants, international students and asylum seekers; • Service providers, and; • Multicultural organisations including ethno-specific services.
- 4. MHSS Program Logic Reduced incidences of new Blood borne Viruses (BBVs) and Sexually Transmitted Infections (STIs) in CALD communities Client outreach support Community education and outreach Community action Education sessions and trainings on BBVs and STIs Organisational capacity building and advocacy/ sector development Community partnerships in all phases of the project Training and partnership with stakeholders (such as government agencies, generalist, multicultural and ethno-specific organisations) Individualised support and referral to appropriate services (such as housing, education, health etc.) Culturally-responsive services Initiatives by community members to take charge of their health and wellbeing Increase in uptake of relevant generalist and multicultural services Reduction in risk-taking behaviours and increase in uptake of harm minimisation strategies Increase access to relevant screening, testing, treatment and support services Better health outcome for culturally and linguistically diverse (CALD) communities Increased awareness and knowledge of STIs and BBVs, and available care and support services Increased awareness and knowledge of BBVs and STIs
- 5. MHSS client groups recent arrivals: Unaccompanied minors, BVEs, Vertical transmission, HBV postnatal infection, MSM, not vaccinated in home country established communities: Unaware of status, misinformation about transmission risk, IDU, Juvenile Justice, Corrections
- 6. migrant & refugee health issues prolonged camp experience - poor nutrition/oral health - low literacy/health literacy - perceptions of authority - reconfigured families - loss/grief - experiences of torture and trauma - journey experience - visits home - isolation/discrimination- service sector navigation
- 9. Levels of participation 9 Mefalopulos, Paolo 2008 Development Communication Sourcebook: Broadening the Boundaries of Communication, Washington, D C: World Bank
- 10. why involve communities • Ottawa Charter for Health Promotion (1986) which states: • “Health promotion is the process of enabling people to increase control over, and to improve their health. Health promotion focuses on the population as a whole rather than people at risk of specific diseases, with actions directed to improve the health and wellbeing of the whole community.”
- 11. why involve communities • Jakarta Declaration on Leading Health Promotion into the 21st Century (1997), which states • “Health is a basic human right and is essential for social and economic development. It is a process of enabling people to increase control over, and to improve, their health. Health promotion, through investment and action, has a marked impact on the determinants of health so as to create the greatest health gain for people, to contribute significantly to the reduction of inequities in health, to further human rights, and to build social capital.
- 12. health literacy • Understanding information (whose responsibility)? • Making decisions about an individuals health • Taking action • Self advocacy • Influencing change
- 13. decision making- our planning is based on the following: • Global, National, State and Local Data • Policy • research and project evaluations • extensive face to face consultation with communities • consultations with the sector • current issues, trend and needs
- 14. MHSS success with communities • Hip Hop 4 Health • International Students • Corrections • IDU/Mums • African Women's • Outreach- • SWAB • Peer Education
- 15. Thank you Alison Coelho Manager, MHSS T: 9418 9909 M: 0409 166 870 alisonc@ceh.org.au
Editor's Notes
- Before I begin, I would like to acknowledge the traditional custodians of this land, this country upon which we meet gather today: the Wurungeri and Bunerong. I would like to pay my respects to all the elders past and present from across Australia and those that have joined us from other first nations peoples and representatives.
- Globally, we host the only collection of resources relating to culture and health. MHSS is the service delivery arm of CEH with a strong focus on community led health interventions.
- MHSS is funded predominantly by the State Government of Victoria, through the: Department of Health’s: Prevention and Population Health Branch-Sexual Health & Viral Hepatitis Team. The Multicultural Health and Support Service (MHSS) aims to address the overall poorer health outcomes for CALD communities regarding the highly complex and culturally sensitive issues of HIV/AIDS, hepatitis and sexually transmissible infections (STI). We collaborate with communities and agencies to improve access to information, support, testing and preventative health messaging. We seek to increase culturally responsive service delivery. In order to do this MHSS works with: Communities from refugee, migrant backgrounds (including international students and asylum seekers); Mainstream agencies; and; Multicultural organisations including ethno- specific services.
- MHSS works through a partnership and capacity building model that incorporates four key areas: Outreach support to individuals and families to assist them to access information, testing and services relating to blood‑borne viruses (BBV) and STIs; Community education targeting high prevalence communities with culturally appropriate and gender sensitive sessions on sexuality, healthy relationships and drug and alcohol related risk taking behaviours; Community action which aims to raise awareness, prevent transmission and provide more effective responses to meeting the needs of Multicultural communities; and Sector Development to increase culturally competent sexual health and support services. To support systems that respond better to Multicultural communities and their complex needs regarding BBV/STI. The work we do is resource intensive, but effective.
- So, who do we work with? The prevalence of HBV infection is especially high in South-East Asia and Sub-Saharan Africa. (Marcellin, 2009). Perinatal infection: is likely to be detected during the pregnancy tests. However, postnatal infection in early childhood is of concern for CALD children born to positive mothers from sub-Saharan Africa. Issue 1: Concern for unaccompanied minors. Eg. Sudanese lost boys who resettled in Australia. In the inner North West (particularly because of the City of Melbourne-nearly 50% of population are young people or aged under 30) the rates of Liver cancer rates resulting from high numbers of CHB infection are relatively low, given that Liver Cancer diagnosis is at its highest in the 50 and over age groups. Perhaps signifing an opportunity to affect long-term cancer rates in this area if culturally appropriate treatment and care options are made available now.
- Mefalopulos, Paolo 2008 Development Communication Sourcebook: Broadening the Boundaries of Communication, Washington, D C: World Bank MHSS engages at all different level. But the end game is to get to community control! non-participation: No involvement passive participation: When communities attend meetings to be informed Participation by consultation: when communities are consulted but the decision making rests in the hands of the experts functional participation: when communities are allowed to have some input, although not necessarily from the beginning of the process and not in equal partnerships (might participate for ‘material gain’ empowered participation/ self-mobilization: where communities are involved throughout the whole evaluation process
- But MHSS operates in the space that acknowledges that ‘one size’ does not fit all. It is accepted that : targeted, systemic approaches that address the needs of the most vulnerable benefit the whole population. Understanding the ‘social determinants of health’ is critical to addressing their health issues. As a partitioner, when working with CALD communities, working with and for communities ticks all the boxes relating to resource allocation because the ‘intervention’ is sustainable. Because all key decisions were made by the community itself. Therefore, we can expect the ‘reach’ and the sustainability to better than that of programs that are imposed. Also, it is important to remember that individuals and communities that we may come into contact with, may well be all too familiar with ‘colonial’ approaches or models that focus on the individual and not inclusive of family and social/collective contexts. As a worker, you may also be perceived as carrying a level of authority, it is important to create a sense of safety and sensitivity in our daily practice.
- The lowest rates of HIV are achieved where strategies partner with affected communities-(Michele Sidibe 2014)
- Good Health Literacy acts beyond functionality, it enables the individual and communities to determine the course of action regarding their health options. Most importantly, Health Literacy is ‘our’ responsibility, not the clients’. This means that it is our job to ensure that these things happen by providing appropriate information to clients regarding prevention, testing, treatment and management etc. This results in better health outcomes for clients. Example: 1). Health Rights Poster at the Royal Melbourne-one point was focussed on better communication-it is your right to have an interpreter present, but the poster was in English. 2). The label on a particular medication states that : ‘take three tablets a day with food’. Many assumptions including the person eats three meals a day, and doesn’t take all three doses after breakfast.
- Data is not always accurate. GPs don’t always record background, ethnicity is harder to capture due to a lack of systems. Think about someone who is from Ethiopia, which community will also help determine, risk intervention, support. Is the individual from Oromo, Tigrigna or Amharic communities. Is the community too ‘new’ is the consumption with initial settlement issues going to negation any health promotion interventions. Timing is critical, we need to know when and where is appropriate. We need to use a multifaceted approach that supports an on-going process towards better health outcomes for our communities. More collaboration is needed with GPs and specialists.
- Show clip.
- Personal anecdote-Student at la Trobe in 1992 studying the same subject.