Late HIV diagnosis of people from culturally and linguistically diverse backgrounds in Sydney: The role of culture and community

Abstract

In Australia more than 85% of newly diagnosed HIV infections in 1999–2003 were homosexually acquired. In contrast, among people from culturally and linguistically diverse backgrounds, there is a much higher proportion of heterosexual exposure and many of the heterosexually acquired infections are diagnosed ‘late’, with people sometimes presenting with symptoms of AIDS. This paper reports on circumstances of late HIV diagnosis, meaning of an HIV-positive diagnosis and perceptions of risk among HIV-positive people from a variety of cultural and ethnic backgrounds in Sydney. The focus was on commonalities across cultures and ethnicities. Data were collected through semi-structured in-depth interviews with clients of the Multicultural HIV/AIDS and Hepatitis C Service and a sexual health clinic. Regular HIV tests were the exception in this group. Testing was usually motivated by a serious health crisis. Participants interpreted their diagnosis in the context of their knowledge and experiences with HIV/AIDS in their country of birth and the perceptions of HIV/AIDS in their ethnic communities in Australia. Many were not aware of the relationship between HIV and AIDS. Risk was perceived in terms of ‘risk group’ membership not in terms of practices and behaviours. Late diagnosis cannot be explained solely by association with country of birth, race or ethnicity. Rather, it is located within complex sets of social and cultural relations: the values attributed to HIV/AIDS and those infected and the social and cultural relations of ethnic communities in Australia and the dominant culture. These are enacted in healthcare seeking behaviour, perceptions of people with HIV and perceptions of being ‘at risk’.

Acknowledgments

The National Centre in HIV Social Research is funded by the Commonwealth Department of Health and Ageing. This study was funded by NSW Health. Thank you to Daniel Madeddu, Maria Petrohilos, Tadgh McMahon and the co-workers of the Multicultural HIV/AIDS and Hepatitis C Service. Thank you to the participants, Susan Kippax for her comments on an earlier draft of this paper.

Notes

1. The Multicultural HIV/AIDS and Hepatitis C Service has co-workers from more than 20 different language backgrounds. their role is to provide clinical support to people with HIV/AIDS.

2. Decisions of the Department of Immigration and Multicultural Affairs and Indigenous Affairs can be reviewed by three independent tribunals: the Migration Review Tribunal, the Refugee Review Tribunal and the Administrative Appeals Tribunal (http://www.immi.gov.au/facts/09litigation.htm, 13 November 2004)

3. In addition to successfully passing the immigration selection criteria, all applicants for permanent residency must meet the health requirement, which includes an HIV test for those 15 years and older.

4. There are more than 90 different kinds of visas in Australia with different entitlements and restrictions (http://www.mrt.gov.au/operations.html, 29 October 2004). ‘Temporary visa’ here means any visa that does not entitle its holder to reside in Australia permanently and with the full rights of a permanent resident.

5. Australia's universal healthcare system provides free or subsidised treatment by doctors and in public hospitals and subsidised prescription medicine.