HIV testing in culturally and linguistically diverse contexts
Written by: Dr Daniel Vujcich
In Australia, we have made great gains in our public health response to HIV. While virtual elimination is an achievable goal, it is important to ensure that success is evenly distributed and that communities are not overlooked or left behind.
According to 2021 data collated by the Kirby Institute, the HIV notification rate was 1.7 per 100,000 population for people born in Australia. By contrast, the notification rates are higher for Australians born in Oceania (3.3. per 100,000), Sub-Saharan Africa (3.6 per 100,000), Latin America and the Caribbean (6.1 per 100,000), and Southeast Asia (8.3 per 100,000). Additionally, an observational study found that almost half (47%) of people living with HIV from migrant backgrounds tend to be diagnosed late, compared to 34% of Australian-born people diagnosed. Late diagnosis has implications for both public and individual health outcomes.
According to a systematic literature review, there are many reasons why people from migrant backgrounds may not be tested for HIV in a timely manner. Reasons include:
- A lack of familiarity with the importance of preventative care (e.g. asymptomatic testing) due to the cost and structure of health services in countries of origin.
- A low perception of risk due to a belief that HIV is not a public health issue in Australia.
- Outdated understandings of the consequences of an HIV diagnosis, including a misperception that HIV is untreatable.
- Language and other barriers to service access.
Before joining WAAC, our new CEO, Dr Daniel Vujcich, coordinated a national Migrant Blood-borne Virus and Sexual Health Survey (MiBSS). The aim of MiBSS was to further understand what migrants think, know, and do in relation to HIV and other sexually transmissible infections and blood-borne viruses. A summary of key findings can be found in this video featuring Dr Vujcich and Public Health Physician, Donna Mak.
Importantly, the MiBSS study found less than half (41%; n = 572) of respondents were aware that an HIV test is not routinely conducted whenever blood is taken. This may lead people to incorrectly assume that they have been tested for HIV as part of other serological testing.
Primary care providers play an important role in communicating the importance of HIV testing in accordance with the National HIV Testing Policy. Under the Policy, HIV testing is indicated for people from high-prevalence countries. However, the MiBSS study found that only 8% (n=13) of respondents had undergone HIV testing at the suggestion of their doctor/nurse.
Many health professionals are reluctant to offer testing to people of migrant backgrounds for fear of causing offence. However, the majority of MiBSS respondents said they would be “okay” if a doctor or nurse offered them an STI/BBV test, and only 11% indicated that they would be “offended”.
Normalising HIV testing among clients from high-prevalence countries is an important means of ensuring that no community is left behind in Australia’s HIV response. There are several tools that clinicians can draw upon for assistance in initiating sensitive, culturally appropriate conversations around HIV testing. These include:
- Your Cultural Lens: The Department of Health hosts an online portal with videos and training resources to assist clinicians in building their capacity in cross-cultural communication around sexual health and blood-borne viruses.
- Ethnic Communities Council of Queensland: ECCQ has developed a suite of resources that have been translated into a range of African and Asian languages. The resources include:
- Stay Safe and Protected: Information about HIV/AIDS (pamphlet)
- HIV is still here. Be in control. Know your status (poster).
- Let’s Talk About It: Hepatitis, HIV and Sexually Transmissible Infections (booklet).
- Multicultural HIV and Hepatitis Service: This website offers information on HIV in 19 languages. It also includes a short video outlining ‘7 Reasons to get tested for HIV now’ available in Arabic, Chinese, Indonesian, Portuguese, Spanish, Thai, and Vietnamese.
- Health Translations: This free online library contains multilingual resources, including a pamphlet on HIV Testing Options and an HIV – What you need to know booklet.