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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 …

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.

Published in: Health & Medicine
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  • 1. Out in the CALD Dr Chris LemohAustralian Federation of AIDS OrganisationsVictorian 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 diversityWHAT?•Politics WHO?•Economy •Family•Government •Friends•Services •Partner•Tradition •Other individuals•Religion•Ethnicity•Gender•AgeWHERE? 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 diagnosisEarly diagnosis•Applying for permanent visa•Antenatal screening First positive•HIV+ partner HIV testLate 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 diagnosisAccess to treatment ChildcareImmigration•Self•Spouse Companionship•Family Comfort EncouragementPersonal assistance Information Housework •Prognosis Shopping •Treatments Transport •“Cures” Childcare •Childbearing
  • 7. Barriers to support after diagnosisHealth service capacity•Skills (hetero/F) Religious doctrine•Guidelines (e.g. IVF) Isolation from familyMedicare eligibility Relationship strains StigmaImmigration policy DiscriminationWelfare policy Morality Pride Infrastructure Guilt/shame Depression Time Lack of Information •Irrelevant Distance •Inappropriate
  • 8. Role of positive servicesHealth service Cultural and social context•Capacity•Accessibility Counseling •MaritalPolicy •Family/child•Immigration•Medicare Community education•Welfare Advocacy Support •HIV in Australia•Disability•Planning Understanding RespectFaith leaders•Capacity Counseling • Pastoral care •Individual•Accessibility Referral • Sexuality • Gender Information inequality •Relevant • Guilt/blame •Appropriate
  • 9. AcknowledgementsAfrican Australian Welfare Council Melbourne HealthFamily and Reproductive Rights Program Burnet InstituteSudanese Community Association of Victoria Melbourne Sexual Health CentreHorn of Africa Senior Women’s Group Alfred HealthDinka Jieng Community Council of Victoria Royal Women’s HospitalUnited 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 AllianceSpecial 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 SocietySupported by a Project Grant from theDepartment of Human Services and ascholarship from the Centre for ClinicalResearch Excellence in Infectious Diseases
  • 10. AcknowledgementsBeverley-Ann Biggs Jim Black Suzanne Crowe Tony Korman Shroug MohamedMargaret Hellard Virginia De Crespigny Eman Naim Suzanna Garland Faten MohamedAlan Street Jeanette Venkataya Claire Ryan Tim Read Malyun AhmedSamia Baho Nick Christopher Zamberi Sekawi Tina Schmidt Abdinur WeliTenenet Taye Thao Nguyen Christopher Fairley Margaret ChoulAbraha Gebremariam Paulette Manton Doris Chibo Kerrie Boyd Kofi OseiSahra Hussein Graham Brown Chris Birch Peter Stanley Janelle FawkesWilliam Malouk Mary Ljubanovic Tamara Speed Kirsty Buising Julie FutolDaw Jamileh Abu-Duhou Anna Hearps Ian Woolley Alison CoelhoShangale Ali Pascale Allotey Vicki Greengrass Anne Mijch Kate BeanShiraz Hakim Lisa Morris Christine Bowtell-Harris Naomi NgoMohanad Hakim Liz Nichol Kerrie WatsonNeveen Hanna Rebecca Guy Sophie DutertreRhiannon Palmer Carol El-Hayek Stephen McNallyRachel Tham Lisa Natoli Jeffrey GriersonMirella Ozols Marion Brown Martha MorrowChristalla Hajisava Keflemariam Martha MacIntyreMegan Brooks Yohannes Sandy GiffordGina Barri-Rewell Jenny Lewis Katerina LagiosAnn McIntyre Maelenn GouillouSonia Curuana Tim Spelman