The WA partnership response to HIV
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Simon Yam and Bethwyn Hodge from the WA AIDS Council discuss the impact of HIV on migrant and mobile populations in Western Australia, and the health promotion programs that have been developed to address the issues. This presentation was given at the AFAO National HIV Forum in Sydney, 17 October 2014.
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The WA partnership response to HIV
- 1. MAKING PROGRESS ON HIV AND MOBILITY The WA Partnership Response Presented by Simon Yam and Beth Hodge WA AIDS Council in conjunction with the WA Department of Health
- 2. WA Partnership Response • Epidemiology • Operational Directive OD 0391/12 - Provision of treatment of Medicare ineligible patients in WA Public Hospitals • WA Health’s Sexual Health Resources for CaLD Communities • WA AIDS Council (WAAC) Initiatives • End to HIV in WA Strategy • Sex on the Table : GP’s Information And Networking Cocktail Function • Sex in Other Cities • WAAC – Metropolitan Migrant Resource Centre (MMRC) Partnership • African Diaspora in WA • Your Cultural Lens : Online Cultural Competency Training
- 3. HIV EPIDEMIOLOGY IN WA OVERSEAS BORN / OVERSEAS ACQUISITION 2.5M
- 4. WA HIV notifications by place of birth/acquisition 2004-2013 Aus born_Aus acquired Aus born_Overseas acquired Overseas born_Aus acquired Overseas born_Overseas acqured 1.3 : 1 5.3 : 1 11.9 : 1 5.8 : 1 60 50 40 30 20 10 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Number of notifications Year of notifications Male : Female ratio
- 5. WA HIV notifications, 2004-2013: Overseas-acquired cases by place of birth Europe, 17, 13% South- East Asia, 73, 57% Other, 23, 18% Sub- Saharan Africa, 16, 12% Europe, 33, 10% SE Asia, 124, 36% Sub- Saharan Africa, 146, 42% Other, 41, 12% Australian-born overseas-acquired HIV (n=129) Overseas-born overseas-acquired HIV (n=344)
- 6. WA HIV Notifications by Place of Birth 2004-2013 60 50 40 30 20 10 0 80 70 60 50 40 30 20 10 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 % Overseas born Number of notifications Year of notification Australian born Overseas born % Overseas born From 2007, overseas-born > Aus-born cases 15 52
- 7. WA HIV Notifications by Place of Acquisition 2004-2013 60.0 50.0 40.0 30.0 20.0 10.0 0.0 80 70 60 50 40 30 20 10 0 Australia acquired Overseas acquired % Overseas acquired Year 15 52 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
- 8. Provision of treatment of Medicare ineligible patients in WA Public Hospitals Operational Directive OD 0391/12 Issued : 4 October 2012
- 9. Operational Directive OD 0391/12 •Patients requiring emergency treatments will be provided care regardless of Medicare eligibility status. •Aim is to assist and support access to treatments during migration processes, and /or until partial Medicare is granted or full access achieved. •Each hospital has differing processes, but work within the directive guidelines. Quite a grey area of practice and is always tailored for the individual. There is some flexibility within the directive. •Clients can be exempted from costs for HIV consultancy, pathology & medications up to $10,000 •If this is in excess of $10,000, Clinical Director of hospital will have to provide written authorisation.
- 10. Sexual Health Resources for the CaLD Communities (WA Health)
- 11. WA AIDS Council’s End to HIV in WA Strategy
- 12. Sex on the Table – Creating Sexual Health Champions • GP Information and Networking Cocktail Function on the 25th November 2014 • Engage with the personal experiences and challenges of GPs who work closely with population target groups at risk of HIV and/or STIs, especially with people from Culturally and Linguistically Diverse backgrounds • Promotion of our Pre and Post Test Informed Consent Discussion; Edith Cowan University’s online STI learning program; and the Metropolitan Migrant Resource Centre’s Your Cultural Lens – the training resource for cross-cultural communication for sexual health and blood-born viruses.
- 13. SEX IN OTHER CITIES
- 14. WA AIDS Council’s Sex In Other Cities Project Aim: This project aims to address the growing trend of overseas acquired notifications of HIV in Western Australia. Project objectives: •Raise awareness by 10% of the overseas epidemic and prevention methods amongst Australian travellers aged 18+ by the year 2016. •Increase the uptake of packing condoms by 10% amongst Australian travellers aged 18+ by the year 2016. •Increase the usage of condoms whilst travelling by 10% amongst Australian travellers aged 18+ by the year 2016. •Increase sexual health testing before travelling by 10% amongst Australian travellers aged 18+ by the year 2016. •Increase sexual health testing after travelling by 10% amongst Australian travellers aged 18+ by the year 2016.
- 15. WA AIDS Council’s Sex In Other Cities • Target Population: • Men travelling overseas for work/expatriates (both heterosexual and gay/MSM) • Tourists (young men and women); Middle aged single men (and women); Sex tourists (heterosexual and gay/MSM); Backpackers travelling in Australia • Visa holders visiting countries of origin (Permanent residents; Refugees; Temporary workers; students).
- 16. WA AIDS Council’s Sex In Other Cities • Airports • Travel companies • Travel Doctors and STI clinics • Social media • FIFO living zones • SIOC Website
- 17. Sex In Other Cities Health Promotion Strategy www.sexinothercities.com •Create supportive environments – the promotion of local and international sexual health clinics to build an environment that supports pre & post travel testing through targeted social media and SIOC website. •Create supportive environments – enabling people to learn to prepare themselves for travel and safe sex with up to date information and tips. This will be achieved through the SIOC website and SIOC print advertising in a range of settings.
- 19. Additional Health Promotion Strategies •Advocating for healthy public policy in neighbouring countries – The WA AIDS Council identifies public policy as an enabler to the adoption of safe sex practices overseas ie; standardising condom use amongst bar girls. This will be achieved by building partnerships with relevant international travel and sexual health organisations and companies. (planned) •Strengthen community actions – drawing on community champions; existing expats and Australian bar owners overseas (in places like Indonesia) to enhance self-help and social support, and to develop a system for traveller’s participation in safe sex practices. This will require full and continuous access to information and condom distribution. (proposed) •Create supportive environments – facilitating sexual health discussions in the online forum settings. (proposed) •Reorient health services – Directing travel doctor’s/health services increasingly towards sexual health promotion, beyond its responsibility for providing clinical and curative services like travel vaccinations. This will be achieved through professional education and training plus on going support with SIOC promotional resources and print advertising. This will also be achieved by building partnerships with relevant international travel and sexual health organisations and companies. (planned)
- 20. AFRICAN DIASPORA
- 21. Top 10 countries: People living with HIV Rank Country % of people with HIV in the world 1 South Africa 18% 2 Nigeria 9% 3 India 6% 4 Kenya 5% 5 Mozambique 4% 6 Uganda 4% 7 Tanzania 4% 8 Zimbabwe 4% 9 USA 4% 10 Malawi 3% Remaining countries 39% 61% Zambia Source: UNAIDS Global Report 2014 33%
- 22. MMRC: Your Cultural Lens
- 24. AIDS 2014 : Global Village (Photo credit: AFAO)
- 25. Acknowledgements • Lisa Bastian, Sue Laing and Sean Brennan, Sexual Health and Blood Borne Virus Program, CDCD, WA Department of Health • Carolien Giele, Byron Minas, Epidemiology and Surveillance Program, CDCD, WA Department of Health • Anne Sorenson, Project Coordinator, Metropolitan Migrant Resource Centre (MMRC) • ConAds Australia • All stakeholders involved in, and contributing to our programs listed within our An End To HIV In WA Strategy. • AFAO for this opportunity to present at the HIV Forum 2014.
- 26. Websites • OD 0391/12 - Provision of treatment of Medicare ineligible patients in WA Public Hospitals www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=12895 • WA Health’s Sexual Health Resources for CaLD Communities www.public.health.wa.gov.au/2/1716/2/multicultural_sexual_he alth.pm • Sex in Other Cities www.sexinothercities.com.au • Your Cultural Lens www.mmrcwa.org.au/ycl • What an AFAO member learned Under the Baobab Tree (African Diaspora) http://bit.ly/1w7GP6F
Notes de l'éditeur
- What I would like to focus on here are HIV notifications for Australia born Overseas acquired, and Overseas born, Overseas acquired, since the stream we are presenting in today is on HIV mobile populations. If we look at the Aus born, Overseas acquired line (baby blue line with squares), these are mainly heterosexual men who travel to high prevalence countries. Heterosexual men make up 73% of acquisition in SEA and 69% in Sub Sahara Africa. This is 50% of Australian heterosexual males who have acquired HIV in both SEA and SSA (of a total of 129 HIV cases). The ratio between male to female is 5.3 to 1. Looking at the dark blue line with the triangles, these are the HIV notifications for overseas born, overseas acquired. These are primary the refugee/migrant mobile population - people who have moved to WA either on work/family visas, and is a rough split between heterosexual males and females. (ratio of 1.3 to 1). This also includes migrants who return to their country of origin for a break and return with a positive result. Sub-Sahara Africa acquired makes up 42% and SEA makes up 36% out of a total number of 344. *The overseas born – Aus acquired line : International students, travellers into WA, and migrants who have settled in WA and acquired HIV in WA (again mainly men with a 5.8:1 ratio) *Aus born – Aus acquired line: Mainly men who have sex with men
- This slide basically reiterates what I have discussed earlier, but it gives you a clearer visual of what the breakdown is for overseas acquisition.
- In WA overseas born cases have increased over decade from 15-52 cases , while Aus born cases were stable until 2009 when they started increasing. In 2004, the os cases comprised 30% cases. But in 2007, the number of os born cases overtook the Aus born cases, with a resulting increase in the proportion of cases, up to 75% in 2009. Now, they comprise just over half of all cases.
- Similar to place of birth, OS acquired cases have increased over the decade from 15-52 cases , while Aus born cases were stable until 2009 when they started increasing. With the exception of 2004 and 2006, OS acqd cases have outnumbered Aus acqd cases, as reflected in the %os acqd which from 2005 has fluctuated bt high 40’s and 50’s%
- In 2012, The WA Health Department released an OD 0391/12 to assist in providing some clearer direction towards how to address Medicare ineligibile patients who require testing and treatment for HIV and STIs. Western Australian public hospitals are frequently requested to provide medical care for Medicare ineligible patients including: 1. Overseas travellers 2. International students 3. Non-permanent residents of Australia including holders of business, retirement and family visas and 4. Medical tourists who deliberately enter Australia to access treatment.
- Now I will not go too much into detail the contents of this directive. Stemming from my previous slide, I just want to reiterate that patients requiring emergency treatments will be provided care regardless of Medicare eligibility status, and hospitals aim is to assist and support access to treatments during migration processes, and /or until partial Medicare is granted or full access achieved. It is suffice to say that there are grey areas, and hospitals are implementing this OD in the best possible way that fits best with their operations and for the well being of the patient. There is some flexibility within the directive. This includes exemption from costs for HIV consultancy, pathology & medications up to $10,000. If this is in excess of $10,000, Clinical Director of hospital will have to provide written authorisation. WAAC also provides support and assistance for people wishing to access treatment from overseas (online medications).
- In 2013, Developed multi-language online factsheets for various diseases in Arabic, Burmese, Chinese, French, Indonesian, Thai, Vietnamese and, of course, English A companion suite of SHBBVP printed sexual health brochures in the same languages are also available for distribution. Workforce development trainings to help improve sector staff’s cultural competency Crucial to mention this was in consultation with various stakeholders including OMI, Humanitarian Entrant Health Service, several NGOs including Women’s Health Services, SRHWA (FPWA), WAAC, Hepatitis Council and MMRC Made available for download or distribution across service providers in WA
- This is a strategy that was born out of a collaborative approach with WA Health in addressing priorities target groups in WA. 4 streams – talk through it, and highlight the importance of partnership, conversations, collaborations and multi-prong approach (campaigns, marketing, capacity building, com devt and clinical services)
- The rationale behind Sex On The Table stems from recent increases in diagnosis of HIV and STIs by general practitioners in WA. WAAC realised there was an urgent need to further improve the quality of the consultation and testing process by providing training and development to health professionals, with the primary intention of mobilising everyone towards a collective effort in reaching the primary goals of Ending HIV. These goals are congruent with our comprehensive End to HIV in WA Strategy – testing often, treating early and practising safe sex. The Information and Networking Cocktail Function for General Practitioners will provide a valuable space for GPs to: Receive an overview of what the current epidemiological landscape is like in WA, and what emerging priorities are for health professionals in regards to sexual health; Engage with the personal experiences and challenges of GPs who work closely with population target groups at risk of HIV and/or STIs, especially with people from Culturally and Linguistically Diverse backgrounds, and men who have sex with men and Aboriginal and Torres Strait Islander people; Network with other GPs and share experiences and ideas; and Be aware of, and consider enrolling for the WA AIDS Council’s Pre and Post Test Informed Consent Discussion Training tailored for GPs (Read from slide)
- In 2013, Developed multi-language online factsheets for various diseases in Arabic, Burmese, Chinese, French, Indonesian, Thai, Vietnamese and, of course, English A companion suite of SHBBVP printed sexual health brochures in the same languages are also available for distribution. Workforce development trainings to help improve sector staff’s cultural competency Crucial to mention this was in consultation with various stakeholders including OMI, Humanitarian Entrant Health Service, several NGOs including Women’s Health Services, SRHWA (FPWA), WAAC, Hepatitis Council and MMRC Made available for download or distribution across service providers in WA
- Name of Project Leads: Beth Hodge – Community Development and Advocacy Officer Matt Ranford - Marketing and Communications Coordinator Rationale In Western Australia between 2008-2013, heterosexual transmission of HIV increased by 83% overtaking men who have sex with men (MSM) for the first time. Nearly 30% of heterosexual transmissions were acquired in South East Asia and of these cases, 35% were Australian born. The World Health Organisation raised issues regarding HIV infection and international travel due to the potential rise in risk for travellers. It is impossible to guarantee overseas medical, tattooing and sex worker standards are equal to those in Australia. In some countries, their standards might be lower and equipment might not be adequately sterilised, utilised nor blood screened for HIV. Other research indicated points for consideration such as Australians have sex overseas, often fuelled by alcohol and other substances When travelling, Australians may partake in risky activities and adopt new behaviours due to the freedom & adventure found from being away from home, judging eyes and routine. These factors are leading to risk taking behaviour where people underestimate the risk or take the same risks that they take at home. There is a need for more information and understanding of overseas sexual cultures and the exchange of sexual services with or without money. Aim and objectives The aim and objectives you see on the screen are created to address this. Most of the evidence informing the project can be found in the detailed literature review and rationale as outlined in the ‘Sex and Other Cities HIV/AIDS Prevention Project’ 2008. Consultation with WAAC staff, Health department and SiREN team has also informed the direction of this project. Specific research and surveillance previously conducted for rationale Literature to support qualitative study of men who have acquired HIV overseas General literature review Airport audits Analysis of WA epidemiology data Engagement with travel expo Specific research and surveillance that is still required to be conducted for rationale Travel industry consultation Condom distribution data
- Target populations were shaped by the epidemiology, literature review, report and consultation. Clearly there are differences between all these sub-groups but we just don’t have the capacity to develop projects for each. So we spent a long time thinking about how to reach them all- how to you remain relevant and engaging for both leavers traveling to Bali and Business men? We did find some similarities. What happens in Vegas, stays in Vegas mentality. Risk taking because you’re away from either teachers and parents or wife with kids. Sense of freedom and letting lose. If you don’t do it here and now, when would you do it? Experimentalism and party culture.
- People are not always travelling, You wont find travelers all together or in the same place. This creates some challenges when designing a program. Where shall we target? Online spaces allow access at any time from anywhere.
- *Explain how it works and show website on screen* (two minutes) Potential risks Social media risks- content and engagement appropriate? Social media risks- it may be corrupted by inappropriate comments and content from others Raising the SIOC profile may raise complaints. General risk for volunteers and staff working on SIOC
- Evaluation: Formative Evaluation was done through literature and report review, stakeholder and organisation consultation. Process Evaluation taking the shape of an airport survey to find out more about the target group, their current knowledge, behaviour and attitudes (which is actually more formative evaluation) but also the best ways to communicate to them. Do they want to visit a website? Would they prefer something else? Unfortunately we haven't been able to secure access to the airport to conduct these surveys. This highlights the importance of strong rapport with key stakeholders and we are currently assessing other settings to conduct the surveys. Impact Evaluation I will just highlight now some of the metrics we will employ to find out if the project has done what it set out to do: Recording any outcomes/achievements as a result of building partnerships with relevant stakeholders. Measures: Outcomes & achievements Social media: re-posting and sharing on other Facebook pages. Number of ‘Likes’ and ‘comments’. Page analytics- more valid or telling than ‘likes ‘because it is possible people wont want to be affiliated with a page titled ‘Sex in other Cities’. Clicks on links for clinics and sexual health services will be additional measures. (AdWords and other internet analytics to be collected by communications coordinator) . As a health promotion practitioner I am concerned that finding out how many people visit a website or share/like a Facebook post does not inform us if the project has been successful. If you remember the project objectives are based around the uptake in condom use, testing and treatment. Not gaining ‘likes’ and ‘visits’. Just because someone likes/visits a page does not mean they are practising safe sex. So, as well as checking for visits, we plan to conduct website polling consisting of on going pop up questions to evaluate the website as an educational tool method to educate and influence behaviour change. Measures: number of visitors who find the website user friendly and engaging plus increased awareness, knowledge and skills amongst website visitors. (Skills being: condom use, testing and treatment). Plus we plan to conduct a 3 month survey at Royal Perth Hospital and other sexual health clinics. Measure: Number of sexual health screening patients who identify SIOC messaging (via website/print advertising/other) as an enabler. This will indicate if website visitors have been enabled to engage in testing and treatment. And naturally we will continue to monitor the epidemiology and notifications of STIs and HIV amongst the target group to measure if the number declining or growing?
- Here are some additional planned health promotion strategies to complement the website. For the sake of time I wont be going into detail but please come and speak to me afterwards if you wish to know more.
- So what about all the other mobile populations? We do not have the capacity to reach out to all mobile populations and subgroups. And so, a focus has been given to African Diaspora communities within WA. 61% of the HIV epidemic is within African Diaspora as clearly demonstrated in this slide. They have also been selected because of the End of HIV in WA Strategy and local epidemiology as mentioned before by Simon. The work we do for these communities in another hour presentation and this is really my baby and once I start talking about it, I can’t stop. So again, come chat with me afterwards.
- I’ve also been asked to talk about the recent development of the cultural lens training. It is an online interactive and video based training resource in cross-cultural communication for sexual health and blood borne viruses. This training is an outcome for the bigger ‘sharing stories program’ through the Metropolitan Migrant Resource Centre. Sharing stories is theatre based sexual health education. It’s innovative in raising sexual health awareness amongst families & young people from new and emerging migrant communities. So it: Empowers learning through peer education Is based on WA sexual health research Is culturally appropriate in tackling sensitive topics like HIV Encourages knowledge sharing within communities Engages participants through theatre, filmmaking and community workshops
- I would like to take this opportunity to quickly highlight a very positive outcome of the partnership with AFAO. As a result of being on the African Reference group, I was able to contribute to and participate in the African Diaspora zone at the AIDS 2014 conference. If you want to know about this, check out the blog on the AFAO website.