Equity of access…enough talk, time for action

A report back on Nick Medland, Christopher Bourne, Gemma Crawford, Roanna Lobo's presentation Mobility/Migration. 

Thursday morning and it is the last day of the HIV conference. The Symposium on Mobility/Migration is of crucial importance as we see the increasing divergence in HIV notifications between Australian born MSM and their overseas born peers. Nick Medland started the conversation with sobering data for Southeast Asian-born people living in Australia. Their HIV diagnosis and care cascade last year predicted 27% of HIV in this community remains undiagnosed. They face significant challenges accessing biomedical HIV prevention that has shown to be so successful for Australian born MSM. The sophistication required to navigate the layers of HIV prevention and the language we use to describe it can be an obstacle for those newly arrived. Their perception and understanding of risk, HIV health literacy, language and culture, as well as potentially discriminating immigration policies are all barriers to access. Treatment access can also be difficult and there was considerable discussion during question time about treatment access for people living with HIV who are inegligible for medicare. Nick didn’t beat around the bush in his conclusions stating that “failing to provide adequate HIV prevention and treatment to people living in Australia in intolerable, unethical and irresponsible”, and that “elimination of HIV transmission through biomedical prevention will fail while there are unequal coverage of ART and PrEP”. 

Chris Bourne followed with an overview of the work being undertaken in NSW to address some of the issues around equity of access, including the NSW HIV testing “Discreet Life” campaign to target less community connected/visible MSM including those from CALD backgrounds and those who identify as heterosexual. Programs for international students were also described and had been outlined by others earlier in the conference. 

The other difficult to reach group touched on in this session were Australian (mainly men) who travel to areas of high HIV prevalence. Gemma Crawford presented her data from the Curtin university on Australian ex-pats and travellers to Thailand which identified some opportunities to intervene with this group including online forums and travel medicine providers.

The main take home messages from this session were clearly communicated by Roanna Lobo in the final presentation – “We know what needs to be done”, we just “need to do it”. We have been incredibly successful in orchestrating a coordinated response in the past to the HIV epidemic in this country with meaningful engagement with and representation from affected communities. It is time to turn our attention to these emerging population groups and undertake similarly effective strategies here.  What is urgently required is leadership and resourcing.  It is definitely time for these issues of equity to take centre stage.

Author bio: Sharon is the Clinical Nurse Consultant for HIV & Sexual Health at St George Hospital, Sydney, NSW.