This presentation on key strategies for addressing HIV among people from CALD communities and people who travel to high prevalence countries was given by Corie Gray from Curtin University and CoPAHM at AFAO'S HIV and Mobility Forum on 30 May 2016.
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HIV and mobility in Australia: Roadmap for Action
1. HIV and Mobility in Australia: Road
Map for Action
Gemma Crawford|Roanna Lobo
3 December 2014
Corie Gray
Community of Practice for Action on HIV and Mobility (CoPAHM)
Coordinator
2. HIV diagnoses have been
increasing among people from
high HIV prevalence countries,
including South-East Asia and
Sub-Saharan Africa. Women from
these population groups have a
higher risk of HIV than women in
the general population.
MOBILITY
FACTORS
TRAVEL TO &
FROM OZ
People who engage in unsafebehaviours while travelling, orwho travel to or from highprevalence countries, are athigher risk of exposure tothemselves or transmission toothers. People from highprevalence countries in Australiatemporarily, such as mobileworkers, are emerging assignificant in areas such as WA.
Travellers & Mobile
Workers
Mobile populations: People who move from one place to another temporarily, seasonally or permanently for a host of
voluntary and/or involuntary reasons.
HIV & Mobility:
what are we talking about?
People from High
Prevalence Countries &
Their Partners
Crawford, G (2014). Australian travellers, relationships & risk: exploring the nexus.
3. Impact of Mobility
Mobility can:
•Be a risk factor for HIV
•Increase vulnerability to HIV
•Exacerbate existing risk factors for HIV acquisition
•Drive HIV epidemics
4. A Road Map for Action
71 strategies, Five Action Areas
1. International Leadership and Global Health Governance
2. Commonwealth and State Leadership
3. Community Mobilisation
4. Development of Services for Mobile or Migrant People and
Groups
5. Surveillance, Research and Evaluation
5. Road Map – Examples
Action Area Strategy Action
6. Ten principles for a strategic
approach
• Incorporate a human rights approach—stigma and discrimination directed at mobile
populations and migrants must be reduced
• Reduce all barriers to testing and access to treatment
• Pay attention to the confluence between HIV and mobility
• Move beyond ‘narrow protectionist policies’
• Commit resources to improve migrant health
• Continue to develop links and cooperative partnerships with affected communities
locally and internationally
• Participate in and contribute to global health governance
• Create closer cooperation between Australia and the HIV policy, public health, treatment
and support sectors in countries of origin and destination for Australian mobile
populations and migrants
• Acknowledge that mobile population and migrants need more than information (even if
it is translated). Specialist services as well as generalised services need to be provided.
• Know your epidemic(s)—continue surveillance and monitoring and develop evaluation
strategies in conjunction with migrant populations.
7. Community of Practice for Action on
HIV and Mobility (CoPAHM)
Vision
•Increase partnership and collaboration among stakeholders
•Identify ways of working together to progress the five action areas
•Facilitate policy, research and practice efforts regarding HIV and mobility
Funded in March, 2015 by the WA SHBBVP
74 members from a range of backgrounds, across all jurisdictions.
•Government
•Non-government
•Research
•Community groups
•National peak bodies
9. Report Card
Audit conducted with CoPAHM members (February – May 2016)
• 28 responses nationally
• 184 activities listed across 71 Road Map strategies
Momentum in the Five Action Areas:
11. Report Card: what is needed?
• Partnerships with transnational organisations that employ people in
Australia and high prevalence countries with frequent cross border travel of
employees (3.9)
• Consider needs of travellers before, during and after travel (4.17).
• Further research with migrant communities, including treatment and
support needs of people living with HIV (5.7, 5.8, 5.10, 5.11, 5.14)
• Core evaluation indicators for programs aimed at migrant groups or
mobile populations (5.12)
12. Where are we at today?
• Advocacy to include priority action areas in the second implementation of
the 7th
National HIV Strategy
• Discussions of surveillance data in regards to CaLD groups
• Supporting the push for national surveillance of HIV knowledge and use of
health services among people from CaLD backgrounds
• Maintaining an online CoPAHM as a space for members to network and
host discussions
• Developing case studies with CoPAHM members to showcase work in HIV
and mobility
• Finalising CoPAHM’s 2nd
Report Card to distribute online
To come…
•Evaluation of CoPAHM
•Priority setting with CoPAHM members
13. Acknowledgements
I would like to acknowledge the WA Department of Health’s support of
CoPAHM.
For their valuable time, insights and input to the development and governance
of CoPAHM, I would also like to thank:
Dr Roanna Lobo and Gemma Crawford (SiREN), Dr Graham Brown (ARCSHS),
Lisa Bastian and Sue Laing (Sexual Health and Blood-borne Virus Program, WA
Health), Danny Gallant (Sexually Transmissible Infection and Blood Borne Virus
Section SA Health & Ageing), Linda Forbes and Rob Lake (AFAO).
14. Contact Us
For further information, do not hesitate to contact CoPAHM at
copahm@curtin.edu.au
Follow us on twitter at @CoPAHM or get involved using the hashtag
#HIVMobile
To download the Road Map, the Interim Report Card, for further information
about CoPAHM or to join please visit
http://siren.org.au/hivandmobility-1/community-of-practice/
Notas do Editor
In 2014, the HIV and Mobility in Australia: Road Map for Action was published. This discussion paper explores the links between HIV and mobility in Australia – in particular the increase in HIV diagnoses among people travelling to and from regions of high HIV prevalence either for travel or migration – and provides a research and action agenda for mobile and migrant priority populations.
Australia has experience a low prevalence HIV epidemic, concentrated mainly among gay and other homosexually active men. Over the last decade, HIV diagnoses in Australia have been increasing among people migrating from regions of high HIV prevalence (particularly sub-Saharan Africa and South East Asia). In addition, notifications have increased amongst people born in Australia who reside in or travel to or from high HIV prevalence countries.
The relationship between HIV and mobility is complex, and the causal links between peoples experience and HIV are not well understood. Overlayed is international mobility issues – structural, social and behavioural, including issues of stigma, racism, and evolving economic and migration policies.
Mobility can:
Be a risk factor for HIV (opportunity for individual behaviour change, such as an increase in drug and alcohol intake, and change in sexual behaviour).
Increase vulnerability to HIV (access to health service and social support changes during the process)
Exacerbate existing risk factors for HIV acquisition (where normal support is no longer available, such as access to condoms)
Drive HIV epidemics
The Road Map proposed Five Action Areas – this work was informed by the Seventh National HIV strategy; frameworks and approaches successfully used in Australia, and with mobile and migrant populations in similar countries; and discussions with key stakeholders. These action areas are:
1. Develop a whole of government approach paying particular attention to the impact of trade and commerce on health in Australia and the Pacific region
2. Reform policies on universal access to HIV treatment and related health care for temporary visa holders currently without Medicare access.
3. Develop referral pathways, translated documents and migration rights and responsibilities for migration agents and migration health services which have contact with migrants and other temporary visa holders.
4. Support current agencies to implement programs for Australian students overseas and international students doing sex work in Australia.
5. Effectiveness of health screening of asylum seekers.
In total, the Road Map presents 71 strategies across the five action areas to address HIV and mobility.
The 71 strategies were grounded in ten principles – most of which you’ll be aware of. I think, in term’s of today, there are five – bolded above- that are particularly important.
Prevention and health promotion programs will not be effective if people do not feel accepted or if people feel stigmatised. This includes policies that discriminate against migrants.
Providers and clinicians need to be trained and supported in both cultural sensitivity and linguistic capacity.
Australia has a strong foundation in involving affected communities. This can be enhanced through broader community partnerships locally and internationally.
Prevention services that target people from migrant backgrounds need to go beyond translating pamphlets or using images of people from different cultures.
This includes evaluation of existing services, examining which approach work and why, how and in what social context.
So essentially, the Road Map is a tool for discussion, and sets the context for some of the issues of mobility & HIV, but there is more work ahead.
Following on from the release of the Roadmap, a national community of practice for action on hiv and mobility was developed. The CoP was created with the vision of increasing partnership and collaboration among stakeholders; identify ways of stakeholders working together to progress momentum across all five action areas; and to facility policy, research and practice efforts regarding HIV and mobility. In short, CoPAHM was established to keep HIV and mobility issues of the national agenda. Since the funding of CoPAHM last year, we have grown to a membership base of 74; with members across all states and territories, and from a range of backgrounds including;
In general terms, the idea of CoPAHM is to have a resource that is responsive to what is needed on national issues, as well as responding to the needs of people who work in the sector to help them push issues along and to keep HIV and mobility on the national agenda.
Late last year we were able to create an online portal for CoPAHM member’s – here we can see Jill responding to a thread on surveillance data for CaLD groups. Really, this portal has been set up for CoPAHM members to use as they need – to send an email blast to other CoPAHM members, to initiate discussions, to share resources… Whatever they may need it to be.
Most recently, CoPAHM members have been involved in the second mapping of the Road Map. In September last year, mapping of 24 priority strategies from the Road Map was completed by CoPAHM members. At the start of the year, we expanded the existing Report Card to include all 71 strategies form the Road Map. Incredibly, 28 organisations responded with 178 activities listed across the five action areas. Activities is a broad term we use to describe services, programs, evaluation, research or any work that has been done that fits into the Road Map. The results are as follows,
Red being no momentum, orange limited, yellow building and green strong momentum. It is important to note that this mapping is not complete, and this is purely information provided to us from CoPAHM members. If your organisation, or any organisation for that matter, is involved in any of the 71 strategies, and you would like to add to the Report Card, please let me know. Ideally, we would like to get it to a stage where we could say that, ‘yes, this lists all the work that has been done in Australia on HIV and mobility’ – but for now this does give us an idea of where further discussion, and action, is needed.
Little or no momentum reported on some priority strategies (e.g. – need to see some meaningful action to address this.
So based on our recent mapping, here are some strategies from the Road Map – and I’ve added the number if you want to find them – that had no reported action. These activities are just across the last three action areas – Community Mobilisation, Delivery of Service and Research, Surveillance and Evaluation.
In addition to this year’s mapping, CoPAHM has also been involved in a number of activities:
To come: Updating the Road Map to reflect some of the changes and developments in recent years, to keep it relevant.
So in conclusion, this is what CoPAHM, to date, has been part of. The Road Map, and CoPAHM, has helped facilitated some of the discussion around population mobility and HIV. CoPAHM will continue to evolve, as it responds to national issues, as well as meets the needs of it’s members, so they can help keep HIV & mobility on the national agenda.