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contents introduction a quick look back at 2004


contents introduction a quick look back at 2004

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 news                                                                  no.5, 2005

introduction                                                           a quick look back at 2004
In this issue of diversity news we highlight key initiatives under-    The year has been both busy       As part of the Late HIV
taken by the MHAHS in 2004 and issues relevant to the expe-            and exciting, with several        Presentation Project, the
rience of HIV and hepatitis C among people from culturally and         major changes and a broad         MHAHS sponsored the third
linguistically diverse (CALD) backgrounds in Australia.                range of initiatives undertaken   African Australians Against
                                                                       in all our key program areas.     AIDS soccer competition.
Following our 2004 readership survey, which elicited mostly                                              Teams from 12 sub-Saharan
positive comments, we have made some changes to diversity              Early in the year Barbara Luisi   countries competed and almost
news.                                                                  was appointed Deputy              500 community members
                                                                       Manager. Barbara brings to        watched the final.
We hope you enjoy our new, improved publication and as                 the MHAHS many years
always welcome your comments.                                          experience in health              At the end of the year the
                                                                       promotion. Her key tasks to       MHAHS moved from the Queen
                                                                       date have been the strategic      Mary Building, which was its
                                                                       planning process for the          home for more than 10 years
contents                                                               MHAHS and the evaluation of       (please note our new contact
Client Support                                                         the clinical support service.     details). We also launched our
Community Development                                                                                    new expanded website,
Cultural Competency Project                                            Mid year, the poster produced
Education/Media                                                        by the Gay Men and Cultural       and, in line with changes in
Statewide Projects                                                     Diversity Project, We know        community needs, extended the
National Projects                                                      our HIV status, do you?, was      co-worker pool to include the
From the MHAHS Desk:
                                                                       awarded the NSW                   following languages: Afrikaans,
     - Strengthening support for the NSW Needle and Syringe Program
       (NSP) among culturally and linguistically diverse communities   Multicultural Communication       Akan (Ghana), Hindi and Shona
     - Women on the margins                                            Award.                            (Zimbabwe).
     - New challenges to the AIDS prevention paradigm                  In September a third national     To provide a quality service, the
     - AIDS: a biosocial problem with social solutions                 project commenced. The            MHAHS continues to draw on
Literature Review                                                      National Hepatitis C Project      the cultural diversity of its staff
Conference Papers and Publications                                     for People from CALD              and its partnerships with ethnic
Global hepatitis C and HIV/AIDS at a glance
                                                                       Backgrounds will build on the     communities, multicultural health
                                                                       work of previous national         services, and the HIV and
                                                                       projects and undertake a          hepatitis C sectors.
diversity news is published annually by:                               range of strategies identified
                                                                       through a national consultation   Barbara Luisi
                                                                       with key stakeholders.
client support
Maria Petrohilos / Effie Katsaros

Client support continued as a core component of the MHAHS.          This year saw the first major review of client support with
There were 21 new referrals and 20 discharges.                      clients, co-workers, and referrers participating. The review is
                                                                    expected to be finished in mid 2005.
Almost all new clients (95 per cent) were people living with
HIV/AIDS (PLWHA). Late presentation with an AIDS diagnosis          Co-workers:
remained a major issue.                                             Rima Alkadamani, Valentina Angelovska, Jose Ascencio, Emilia
                                                                    Bresciani, Toemsak Butcharee, Alan Chan, Rachanepon
The predominant languages spoken by new clients were                Chantara-aree, Arissara Chitsuwan, Anchalee Chung, Jeff
Chinese, Greek, Khmer, Spanish and Thai. For the second             Dabbhadatta, Toros Daniel, Ramli Djakaria, Wilma Espinoza,
consecutive year there was also an increase in African              Jason Gao, Lily Guo, Derya Han, Jorge Henao, Shih-Chi Kao,
languages.                                                          Mohamed Keynan, Man-chiu Lee, Lidya McGowan, Jefferson
                                                                    Moreira, Ahmad Mourad, Edwin Ng, Dharma O’Sullivan, Philip
The gender ratio remained as previously, two thirds male to one     Ovando, Zoran Pletikosa, Ellen Rong, Ardhi Setiyanto,
third female and the males were equally divided into those who      Lychantha Sok, Marina Suarez, Nancy Tam, Aynalem Tessema,
are homosexually and heterosexually identified.                     Sara Tilaye, Anton Sebiady Tjeuw, An Van Tran, Huong Tran,
                                                                    Grazyna Wilczak, Tek Heang Ya.
Most referrals came from the Royal Prince Alfred and Prince of
Wales Hospitals, Sexual Heath Clinics and Positive Central.         Partners: National Centre in HIV Social Research.

Regular individual and group supervision was held for co-
workers supporting clients. Clinical training sessions for the
year included: stress management, cultural competence,
treatments update, and mental illness, depression and suicide.      cultural
The study of the lived experience of PLWHA from culturally and
linguistically diverse backgrounds, carried out in collaboration
with Henrike Körner from the National Centre in HIV Social
Research, was completed with 29 participants, almost all being      Denilson Fukunishi / Wa’el Sabri
MHAHS clients. A final report is expected in 2005.

                                                                    The Hepatitis C Demonstration Project, carried out by the

 community                                                          MHAHS in 2003, highlighted the need for appropriate
                                                                    resources for culturally and linguistically diverse (CALD)
                                                                    communities. It also highlighted the skill set, which health

 development                                                        workers need to develop in order to reach CALD communities
                                                                    appropriately. Cultural competency has been identified as one
                                                                    such key area, where competency refers to both skills and
 Wa’el Sabri                                                        attitudes.

                                                                    In partnership with the NSW Workforce Development Program
                                                                    (WDP), a pilot training module in cultural competency was
The MHAHS’ capacity for undertaking community development           developed and delivered at the Statewide NSW Needle and
was greatly reduced in 2004 with the Community Development          Syringe Program Meeting at the end of 2003.
Officer in the role of Acting Deputy Manager in the first half of
the year and then on leave for several months.                      Based on the positive feedback elicited by the pilot, an
                                                                    MHAHS working group was established to develop an
Some activities conducted in this area include building the         expanded training program with broader applicability. The result
partnership with community organisations for the African            is a program comprising three core modules, which interact
Soccer Tournament, participating in the train-the-trainer           and impact on each other: individual/personal, community and
                                                                    organisational. This is an innovative contribution, which
seminars for the new Everybody’s Business videos, and
                                                                    recognises the multiple domains of cultural competency. Each
contributing to the cultural competency training modules.           module provides a mix of activities related to participants’
                                                                    experiences, including role-plays and discussions.
In late 2004, the MHAHS was successful in obtaining
increased funding for community development work and                The cultural competency training program was piloted with the
activities will be enhanced in 2005 with the recruitment of two     NSW Hepatitis C Council at the end of 2004. Evaluation of the
part-time project officers to conduct more intensive community      program has been positive.
development work with the Spanish and Indonesian speaking
communities. These communities have been selected based on          The MHAHS Cultural Competency Training Program is
a range of HIV/AIDS and hepatitis C indicators.                     available to organisations on request.

                                                                    Partners: NSW Workforce Development Program, Hepatitis C
                                                                    Council of NSW

Sonam Paljor

2004 has been an active year with several major awareness            In partnership with FPA Health we completed the series of Fact
raising initiatives.                                                 Sheets, Women and HIV/AIDS. Produced in Arabic, Chinese,
                                                                     Khmer, Spanish, Thai and Vietnamese, the Fact Sheets cover a
First came the launch of the new Everybody’s Business video.         range of HIV/AIDS issues specific to women, including
Produced as part of the National HIV/AIDS and Hepatitis C            diagnosis, testing, symptoms, treatment, pregnancy and
Project, this is a revised version of the 1999 video of the same     parenting.
title and contains updated information on HIV/AIDS and
hepatitis C in Indonesian, Khmer, Somali and Thai, as well as        The World AIDS Day campaign in December was the last major
English.                                                             media initiative for 2004. Inadequate knowledge about
                                                                     HIV/AIDS and poor access to HIV prevention are considered
The video was launched simultaneously with a bilingual booklet       major reasons for nearly half the 40 million people living with
on hepatitis C titled Don’t be afraid to ask. Developed as part of   HIV/AIDS worldwide being women. This year’s focus was on
the statewide Hepatitis C Demonstration Project in Arabic,           “Women, girls, HIV and AIDS” with the slogan being “have you
Spanish, and Vietnamese, Don’t be afraid to ask aims to make         heard me today?” The campaign yielded at least 30 stories and
hepatitis C information available to culturally and linguistically   interviews in the target language media. It was complemented
diverse communities, including injecting drug users. A unique        by the launch of the new MHAHS website with updated
feature of the booklet was an insert targeting the latter.           information on HIV/AIDS and hepatitis C in 18 community
The campaign launch of the video and booklet focussed on how
lack of appropriate information contributes to HIV and hepatitis     Co-workers: Jose Ascencio, Emelia Bresciani, Rachanepon
C transmission, as well as to discrimination against people          Chantara-aree, Anchalee Chung, Jeff Dabbhadatta, Boualem
already living with HIV or hepatitis C. The campaign argued that     Keche, Mohamed Keynan, Cuong Phu Le, Man-chiu Lee, Lidya
appropriate multilingual resources reduce the ignorance, fear        McGowan, Ahmed Mourad, Pich Oum, Marina Suarez, Huong
and shame surrounding HIV/AIDS and hepatitis C. Over 22              Tran, Tek Heang Ya.
stories and interviews were generated in the Arabic, Indonesian,
Somali, Spanish, Thai and Vietnamese language media as a             Partners: FPA Health, Hepatitis C Council of NSW, SESAHS.
result of this campaign.

                                                                          501. Hairdressing demonstration at the African Women’s Health Day,
                                                                                                                            December 2004.

community events

 As always, the MHAHS participated in
 a range of community events, including
 the Gay and Lesbian Mardi Gras,
 Indonesian Independence Day, and the
 Arabic Communities Festival, where
 HIV/AIDS information, condoms, and
 safe sex packs in community languages
 were distributed.

 Co-workers: Rima Alkadamani,
 Arissara Chitsuwan, Ramli Djakaria,
 Lidya McGowan, Dharma O’Sullivan,
 Philip Ovando, Anton Sebiady Tjeuw.

                                                                                                        502. Mardi Gras Fair Day stall, 2004.

statewide projects

late HIV presentation project                                       gay men and cultural diversity project
Mohamed Keynan                                                      Alan Chan

This project has been funded by NSW Health from mid 2001 in         Distribution of the HIV/STI testing posters developed by this
recognition of the fact that people from culturally and linguis-    project, funded by NSW Health, began in December 2003. The
tically diverse backgrounds are more likely than other              posters were developed in Arabic, Chinese, Spanish, Thai,
Australians to present late with HIV, often with an AIDS-defining   Vietnamese and English to address the lower rates of HIV
illness.                                                            testing among gay men from culturally and linguistically diverse
                                                                    (CALD) backgrounds in NSW.
Given that HIV notifications in NSW among people born in sub-
Saharan Africa (2001-2003) are higher than their represen-          More than 1,100 posters were ordered in 2004 by agencies
tation in the overall NSW population, the project continued to      across NSW, mainly universities, youth health services,
work with African communities.                                      community agencies and sexual health and HIV/AIDS services.
                                                                    Posters were also distributed to gay and sex-on-premises
Some of the initiatives undertaken by the project in 2004           venues by ACON, and there was a small advertising campaign
include: GP outreach in targeted communities to improve HIV         in the gay press in February 2004.
testing knowledge; the 2004 African Youth Soccer Tournament
to raise HIV/AIDS awareness; an HIV/AIDS awareness poster           The initiative was evaluated by surveying men at gay venues,
targeting African youth; and an African women’s health day to       including sex-on-premises venues, both pre-distribution in
raise awareness of and reduce stigma associated with                December 2003 and post-distribution in May/June 2004. The
HIV/AIDS.                                                           surveys deliberately over-sampled gay men from CALD
                                                                    backgrounds and about 50 per cent of the gay men in pre and
The project completed its GP outreach with nine African, Thai,      post samples spoke a language other than English at home.
and Khmer speaking GPs who received HIV/AIDS information
and resources, including the MHAHS’ Getting It Right                Recall of the posters was strongest among gay men who spoke
pamphlet.                                                           one of the five target languages and these men were also more
                                                                    likely to correctly identify the main message of the posters.
In partnership with the African-Australian Youth Association, the   Moreover, there were improvements in accurate HIV/STI testing
MHAHS supported the 2004 African Youth Soccer                       knowledge in the post-distribution period, especially among
Tournament. Teams from 12 countries participated and about          CALD gay men.
500 people watched the final in December. During the
tournament, an HIV/AIDS workshop for the team captains was          In July the posters received          the   NSW      Multicultural
held and the recently developed African poster, which targets       Communication Award for 2004.
young people, was widely distributed. The poster carries the
image of the team captains and the English message “Soccer is       Co-workers: Jeff Dabbhadatta, Toros Daniel, Shih-Chi Kao.
the world game…HIV/AIDS is a world problem, Play it safe
and give HIV/AIDS a red card”.                                      Partners: Asian Project, ACON.

Following consultations with African community workers, an
African women’s health day was organized during World AIDS
Day, whose theme this year was women’s issues. General
health information, including sexual health and HIV/AIDS, was
provided and a professional African hairdresser demonstrated
hairdressing and make up during the day.                            503. Tadgh McMahon presents the competition trophy to Emmanuel
                                                                    Achampond, captain of the team of Ghana, 2004 African Youth Soccer
With a recent co-worker recruitment, the African languages          Tournament.
provided by the MHAHS now include: Afrikaans, Akan,
Amharic, Shona, Somali.

Co-workers: Jose Ascencio, Ramli (Eric) Chang, Rachanepon
Chantara-aree, Jeff Dabbhadatta, Nasra Farah, Maung Htun,
Lidya McGowan, Ahmed Mourad, Philip Ovando, Ardhi
Setiyanto, Lychantha Sok, Merle Chit Swe, Aynalem Tessema,
Sara Tilaye.

Partners: African Communities Association, African-Australian
Youth Association.

national projects

national hepatitis C project                                         national HIV/AIDS and hepatitis C project
Lynne Martin                                                         Alan Chan

The national hepatitis C project, funded for 18 months by the        This project, funded by the Federal Government from 2001,
Federal Government, commenced in September and aims to fill          concluded in April 2004. The main strategies implemented in
previously identified gaps related to hepatitis C among culturally   2004 were the completion of the Everybody’s Business
and linguistically diverse (CALD) communities. These aims            resource, its marketing and distribution. The latter included a
include:                                                             series of train-the-trainer workshops held in most capital cites
    ● Increasing awareness of hepatitis C issues and access to       and four community launches held in Sydney. The resource was
    culturally appropriate information on hepatitis C, including     also externally evaluated post-distribution with the four target
    testing and treatment, among people from CALD                    communities.
                                                                     The Everybody’s Business videos, an HIV and hepatitis C
   ● Increasing the capacity of the hepatitis C sector to            resource, were originally developed in 1999. In 2001 these
   respond appropriately to people from CALD backgrounds             versions were externally evaluated and the video scripts revised
   and the inclusion of CALD related issues in the national          and updated to reflect the evaluation feedback. The revised
   response to hepatitis C at all levels.                            scripts were developed into Indonesian, Khmer, Somali, Thai,
                                                                     and English videos, accompanied by a CD-Rom outlining
The project’s strategies include: a national consultation;           supporting HIV and hepatitis C training activities.
production of a written resource in English and up to 15
community languages; promotion of the resource and hepatitis         A series of train-the-trainer workshops in partnership with local
C awareness in national ethnic media; and workforce                  agencies were held across Australia in March/April 2004 with
development initiatives in consultation with hepatitis C specific    over 150 participants. The workshops were designed to
and other health worker educational organisations.                   familiarise participants with the resource and assist in its
The national consultation was completed in November 2004.
The general community, young people, and injecting drug users        In July launches were held with the Indonesian, Khmer, Somali
were identified as the project’s priority target groups. However,    and Thai communities in Sydney. The launches promoted the
the consensus from the consultation was that a single resource       resource and also provided an opportunity to evaluate the
for the three target groups was not possible. The project will       community language versions. This external evaluation found
therefore produce a resource for the general community, which        extremely high satisfaction levels among community members in
will also be targeted to young people and injecting drug users       terms of overall usefulness, impact on knowledge and the
by workers in these areas.                                           cultural appropriateness of the resource.

The national hepatitis C project will be evaluated externally.       There has been strong demand for the resource with almost
                                                                     600 videos ordered by agencies nationally since distribution
Co-workers: Aldo Batalla, Alan, Chan, Cuong Phu Le, Ahmed            began in April 2004, representing about 60 per cent of the total
Mourad, Lidya McGowan, Edwin Ng, Lychantha Sok,                      produced.
Tek Heang Ya.
                                                                     Co-workers: Toemsak Butcharee, Rachanepon Chantara-aree, Jeff Dabbhadatta,
                                                                     Nasra Farah, Mohamed Keynan, Lidya McGowan, Pich Oum, Priyadi Prihaswan,
                                                                     Lychantha Sok, Tek Heang Ya.
                                                                     Partners: Cambodian-Australian Welfare Council of NSW; Communicable
                                                                     Diseases Branch, WA Health Department; Ethnic Communities Council of
                                                                     Queensland; Multicultural Health and Support Service, NRCHC, Melbourne;
504. Ghana supporters show their enthusiasm, 2004 African Youth      PEACE, Adelaide.
Soccer Tournament.

                                                                       Everybody’s Business ... an HIV and
                                                                       hepatitis C resource ... was
                                                                       developed into Indonesian, Khmer,
                                                                       Somali, Thai and English videos,
                                                                       accompanied by a CD-Rom outlining
                                                                       supporting HIV and hepatitis C
                                                                       training activities.

national projects

national positive diversity project
Matthew Tyne/Denilson Fukunishi

The National Positive Diversity Project was funded from 2003          Workforce development strategies in 2004 included the project
for two years to respond to the needs of people living with           convening a dedicated session with keynote speakers
HIV/AIDS (PLWHA) from culturally and linguistically diverse           addressing CALD issues at the AFAO/NAPWA HIV Educators’
(CALD) backgrounds in Australia, as well as to increase the           Conference in May and at the Australasian College of Sexual
capacity of the HIV/AIDS sector to address these needs.               Health Physicians Conference in April. The project also
                                                                      developed cultural competence workshops planned for capital
Matthew Tyne, the original project officer, resigned in February      cities around Australia in early 2005.
2004 and Denilson Fukunishi commenced in March. The main
project strategies implemented in 2004 include an upgrade and         As recommended by the national consultation in 2003, the
re-launch of the multilingual MHAHS website, a range of               project is developing an audio resource for CALD PLWHA, to
workforce development initiatives, and the development of an          be called Living a Positive Life. Extensive input from PLWHA,
audio resource for PLWHA from CALD backgrounds.                       including interviews with PLWHA from CALD backgrounds, has
                                                                      resulted in four narratives based on their personal experiences.
Following an external evaluation of the existing MHAHS                The audio resource (double-CDs) in nine community languages
website, the project undertook a major upgrade in both content        and English will be released later in 2005.
and operation. The new website, with more than 400 pages of
information in 18 community languages, was launched in                Co-workers: Aldo Batalla, Besmirella Berberovic, Emilia
October and extensively promoted. This resulted in a doubling         Bresciani, Phillip Camargo, Alan Chan, Arissara Chitsuwan,
of visits from Australian users - a key target for the project - in   Jeff Dabbhadatta, Salwa Gabriel, Derya Han, Jorge Henao,
November/December 2004.                                               Mohamed Keynan, Soomi Kim, Naval Kreso, John Lam, Cuong
                                                                      Phu Le, Man-chiu Lee, Lidya McGowan, Francesco
The project continued to moderate an e-forum (DiversityLink)          Mendolicchio, Ahmad Mourad, Edwin Ng, Mark Novakovic,
and produce quarterly e-newsletters focussing on HIV and              Pich Oum, Philip Ovando, Zoran Pletikosa, Ardhi Setiyanto,
cultural diversity issues. DiversityLink membership increased by      Marina Suarez, Merle Chit Swe, Sara Tilaye, Huong Tran.
80 per cent during 2004 and the group now has more than 210           Partners: ACSHP, AFAO.
members. Both the e-forum and e-newsletter were externally
evaluated as having met their objectives with strong positive
feedback from members.

505. The Everybody’s Business CD resource.                            506. A scene from the Everybody’s Business, the hepatitis C video.

from the mhahs desk

strengthening support for the NSW Needle and Syringe Program (NSP) among culturally and linguistically
diverse communities: the Media Advocacy Project
Sonam Paljor


In 2002 the MHAHS undertook a pilot project to strengthen support for drug harm minimisation in some of the culturally and linguis-
tically diverse (CALD) communities of NSW. Titled the NSP Media Advocacy Project, the initiative targeted the media in four CALD
communities and generated editorials, stories, training opportunities and community forums. This article is about some of the
project’s challenges and lessons.
The NSP is considered the backbone of Australia’s response to the HIV and hepatitis C (HCV) epidemics. It is credited with saving
billions to the Australian taxpayer and thousands of lives since its establishment in 1987. However, these benefits have often been
overshadowed by chronic prejudices prevalent in the community. The tendency to persistently target injecting drug users (IDUs),
rather than the whole community, has meant that these stereotypes and prejudices have proved hard to shift.

The NSP Media Advocacy Project was based on perceptions of the NSP in CALD communities and on the use of media advocacy to
promote the NSP. Media advocacy is taken to be issue oriented and to focus on changing how an issue is understood in a
community rather than on changing individual risk behaviour.

Harm minimisation and CALD communities                              Lack of accurate information on harm minimisation was
Thirty per cent of new HIV cases in NSW attributed to IDU           identified as a major reason for the prevailing stereotypes
(2001-2002) were among people who speak a language other            among CALD communities. Participants described how their
than English at home. There is also evidence of 3increasing HIV     communities have continued to perceive negatively certain
transmission among CALD IDUs in Victoria , as well as               activities of the NSP, for instance distribution of needles and
evidence of high rates of HCV infection among CALD IDUs
                                                                    syringes, despite the evidence of their value. It was suggested
from South Western Sydney.                                          the project’s media promotion should focus on the NSPs’ other
                                                                    functions, such as the provision of free and confidential
Working with CALD communities in the NSP context presents           information, counselling, referral, etc. This was perceived as
similar challenges to working with the English-speaking             being not only more comprehensive but also less provocative.
community, but with the added linguistic and cultural barriers to   However, participants also cautioned against addressing issues
service access and provision. A recent assessment of hepatitis
                                                                    across different communities uniformly.
C prevention among CALD communities in NSW, for instance,
showed their poor understanding of the public health goals of       The consultation also highlighted general concerns about the
the NSP and other drug harm minimisation strategies. Lack of        communities’ readiness to discuss the NSP openly, given their
appropriate information and strong stigma about drug use make       poor awareness of drugs and drug use. Some participants
it particularly difficult to talk openly about the NSP in CALD      argued for supporting a prevention interpretation of harm
communities.                                                        minimisation, rather than disputing the incarceration model. The
                                                                    difficulties of explaining the different aspects of harm minimi-
The Project                                                         sation in community languages were also noted.
The project’s major aims were to: increase awareness and
knowledge of the NSW NSP among CALD communities;                    Stigma in CALD communities is not only attached to drug
increase awareness of issues for IDUs among CALD                    users, it is extended to those associated with them, for example
communities; and increase the awareness and skills of the           family members, friends and NSP workers. The consultation
NSW NSP to respond to IDUs in CALD communities. The                 elicited anecdotal evidence of CALD NSP workers being
project’s process included: consultation with key stakeholders,     ostracised in their own ethnic community. The impact of stigma
a working group, generating media stories and facilitating          regarding drug use and the issue of confidentiality were
community radio forums.                                             probably felt more acutely in smaller CALD communities.

Consultation with stakeholders                                      More learning opportunities regarding the NSP for community
An informal needs assessment was carried out to identify the        members were also emphasised during the consultation. Thus,
language groups and priority issues to be targeted in the media     a “process oriented” media campaign, rather than a “product
advocacy campaign. A number of community organisations              oriented” one, was believed more likely to ensure participation,
were consulted at this stage, including key service providers,      as well as to build confidence and learning, while resolving
non-government organisations and ethnic media.                      issues as they arose. As one participant said:

The consultation identified a range of priority issues about the    “A process oriented [campaign] is better because it builds the
NSP and harm minimisation for the media campaign, including         knowledge, the information, the sharing of the knowledge. It
misinformation, attitudes and values about drugs and injecting      builds the capacity of professionals, such as health workers, to
drug use, stigma and discrimination, and confidentiality.           have more knowledge of communities, and vice versa, the
                                                                    community to know more about the health side, which is not
                                                                    their first specialty or skill. So, in the end, of course, it is about
                                                                    building for both.”

from the mhahs desk

Working group                                                      Discussion
A working group to support the project was established.            A key observation from this project was that some CALD
Following the consultation, the group suggested obtaining          community members hesitated to be involved with the media
community feedback after the media campaign and this led to        generally, not only in the context of drug harm minimisation.
four community radio forums in which ethnic organisations          Many had little experience of working with the media and
participated. The working group also endorsed the choice of        were wary of it fulfilling its own agenda. They were also
Arabic, Chinese, Khmer and Vietnamese as the priority              concerned that a drug related project would generate
languages for the project. Chinese was included because it is a    unnecessary media exposure for their community. As one
major cross-over language among several of the Indo-Chinese        community member put it:
communities identified during the consultation.
                                                                   “I had my doubts about the media who jump on an issue
                                                                   and say, oh that community or these communities, they are
Generating the media stories
                                                                   a source of diseases like HIV or hepatitis C, or look they are
Generating the media stories involved choosing a campaign
                                                                   causing some other problems. This to me is not harm
banner and developing a series of media stories specific to
                                                                   minimisation but harm aggravation. At the time, I saw it [the
each target language. MHAHS co-workers from the target
                                                                   project] as something more harmful than helpful.”
languages, specifically trained in harm minimisation and NSP
issues, played an integral role in this process.
                                                                   Moreover, workers in community organisations were
                                                                   apprehensive about how their views might be perceived in
In choosing a banner, the emphasis was on finding a ‘neutral’
                                                                   their community, once these appeared in the media. Providing
one, implying rather than declaring support for the NSP. This
                                                                   support from MHAHS co-workers from the same community
became “Understanding the NSP”. The ‘neutral’ approach later
                                                                   gave more confidence in the project, as did guaranteeing that
appealed to community members reluctant to be perceived as
                                                                   community leaders saw the media stories before their
advocating harm minimisation openly, yet it acknowledged the
significant issues. The non-confrontational approach also made
discussions during the community radio forums more engaging        Some specific lessons learnt during the process of
and less hostile.                                                  generating the media stories include the importance of using
                                                                   information which is not easily open to counter claims,
Based on the issues identified during the consultation, three      avoiding confronting the community, and allowing community
story outlines were developed for the campaign: the relevance      members to check the final translations.
of harm minimisation; community attitudes to drug use and the
NSP; and issues which may lead to the NSP being                    A range of issues emerged from the radio forums. These
underutilised by CALD communities. Direct quotes from              included the reiterated need for increasing community
community leaders were included in the stories to lend             awareness of drug harm minimisation, possibly by using
credibility. Community members and co-workers checked the          school magazines, the question of how government funds are
stories and their translations for overall accuracy and cultural   allocated between the three branches of harm minimisation,
appropriateness.                                                   and the promotion of local NSP services. Given recent NSP
                                                                   closures, several participants lamented the lack of community
Community radio forums                                             consultation.
Community radio forums were held in the four priority languages
in partnership with key umbrella organisations. MHAHS co-          The radio forums underlined that community awareness of
workers, who were the campaign’s trained spokespersons,            and support for harm minimisation were not universal.
moderated the forums, in which some of the campaign’s print        Opportunities for the community to explore these issues need
editorials and recorded radio interviews were played and           to be on-going.
feedback on harm minimisation issues was sought. Pre and
post- forum questionnaires were administered to gauge any          Finally, it is worth noting that community attitudes towards the
shift in knowledge.                                                NSP and understanding of harm minimisation are just as
                                                                   prevalent among ethnic journalists. Consequently the
Outcomes                                                           assumption that media stories dealing with these issues will
The media campaign resulted in 17 editorials and stories in the    be automatically accepted is misleading.
press, as well as 12 interviews on radio in the four language
media.                                                             Conclusion
                                                                   Awareness of hepatitis C and harm minimisation issues
Nearly 90 people participated in the radio forums and              continues to be poorer among people from CALD
undertook the pre and post evaluation. The evaluation indicated    communities than among other Australians. Until this gap is
positive gains in terms of awareness of harm minimisation, as      addressed, people from CALD communities will remain
well as insights regarding the information needs of the various    unaware of the NSP and will not benefit from initiatives
language groups. The results of the evaluation have been           promoting access and equity. The gap forces us to contin-
shared with the stakeholders to inform future work.                uously cater to two communities with vastly different needs.

Presentations about the project were made at several               Piecemeal projects, though useful, may at times give the
conferences to increase the awareness of the NSP workforce         impression that people from CALD communities are being given
to better respond to the use of illicit drugs within CALD          special treatment. Rather than bridging the gap, such projects
communities in NSW. At one of these, a community member            may build resentment and discourage genuine interaction with
was supported to share his experience working on this project.     CALD communities. Consulting and engaging with people from
                                                                   CALD communities long-term remain fundamental to
                                                                   understanding their concerns regarding their own welfare and
                                                                   above all to achieving equitable health outcomes.

                                            from the mhahs desk

women on the margins
Maria Petrohilos and Jeffrey Dabbhadatta

Anne is a Thai woman in her twenties who came        Anne disclosed to her partner, who tested negative and remained supportive of
to Sydney two years ago on a 'contract for sex       her application for permanent residence. This process was long and emotionally
work.' In telling her story, Anne reveals, “I need   gruelling. The uncertainty of her future meant that Anne could not make plans or
to work. I am supporting my family; six lives        decisions, even about fundamental issues such as treatment.
who can't survive on the little they earn back
home. I want to make their life better.”             As Anne did not speak or read English, she found it difficult to access
                                                     information and communicate with mainstream services. Her understanding of
Not long after her arrival, Anne began a             the health system was based on knowledge of the health system in Thailand.
relationship and, with the support of her partner,   Counselling and social workers were unfamiliar concepts to her. Asking for
applied for permanent residence. During this         support and assistance was also difficult. “I bring shame to my family and my
process Anne tested positive for HIV. This was       community ...I am not crazy to see a counsellor and what can a social worker
very traumatic for her. What she knew about          do for me? I am young. I should be able to take care of my family.”
HIV/AIDS was based on what she knew from
Thailand. “I know people in Thailand died            Being a sex worker was another barrier for Anne. She had a contract on arrival
because of AIDS. Do I have AIDS? Am I going          and had to work to pay her debt, as well as to support her family. Anne felt she
to die?”                                             could not disclose to her work peers, as they would pressure her not to work,
                                                     and she was worried they might 'dob on her'. On the other hand, she had no
Increasing numbers of women living with HIV in       other employment options or means of support. Her feelings of shame
Australia are from culturally and linguistically     compounded this. "This is my punishment. I don't want to work in this job
diverse (CALD) backgrounds. Moreover, being          anymore because I don't want more health problems, but I need the money to
born in a high prevalence country has been the       support my family.”
most common exposure category for women
diagnosed with HIV since 1997. In some ways          Being born female is bad karma in Thai culture. To achieve good karma a
Anne's experience is similar to that of other        woman has to gain merit by taking care of her entire family, including parents,
women living with HIV in Australia, but in many      siblings and extended family, and often by providing financial support. Anne's
others it is very different.                         self identity is based on who she is in relation to her family. This is a collective
                                                     view of the self and differs from the Western view, where the individual's
Talking to other people was not possible for         autonomy and rights are of paramount importance.
Anne, because her fear of gossip was so strong,
particularly as the Thai community is relatively     The cultural and linguistic issues which faced Anne contributed to her isolation
small in NSW. Issues of shame and stigma             and marginalisation. She was not able to access mainstream services for
remain strong in her community. “Everyone will       information or support, nor was she able to access traditional community
find out. People in the temple will know. People     supports.
in the Thai shops will know. They will be scared
of me and won't want to be with me.”                 Anne's story is similar to the stories of many women from CALD backgrounds.
                                                     For positive women from these backgrounds, the experience of living with HIV
                                                     /AIDS is compounded by their migration experience, by having lived in another
                                                     country and by linguistic and cultural barriers. Isolation becomes their biggest
                                                     burden. It is in this context that the bilingual and bicultural co-workers of the
                                                     MHAHS provide meaningful support.

                                                       NOTES from:
                                                       strengthening support for the NSW Needle and Syringe Program (NSP) among
                                                       culturally and linguistically diverse communities: the Media Advocacy Project

                                                       1. The Australian media guide to Hepatitis C,, 2001, p.17.
                                                       2. Return on Investment in Needle and Syringe Programs in Australia Report, Commonwealth
                                                       Department of Health and Ageing, 2002, p.3.
                                                       3. Quoted in Maher, L,, Risk behaviours of young Indo-Chinese injecting drug users in Sydney
                        No respect. No hope.           and Melbourne, Australian and New Zealand Journal of Public Health, v.25 (1), 2001: p.5
                                                       4. Risk behaviour and antibody hepatitis B and C prevalence among drug users in South-Western
                                                       Sydney, Australia, Maher, L. et al, Journal of Gastroentelogy and Hepatology, 19:pp 1114-11120. See
                                                       also review p.14
                                                       5. Sargent, P, Maher, L, and Cunningham, M, How do you translate hepatitis C? There’s no word for
                                                       it: A Rapid Assessment of Hepatitis C Prevention in NESB communities, MHAHS, 2001.

                                                       NOTES from:
                                                       women on the margins
                                                       This is an edited version of an article in Talkabout (2004): 135, p.4-5.
                                                       Anne is not the client’s real name.

507. World Aids Day poster, UNAIDS, 2004.

new challenges to the AIDS prevention paradigm
Edward C Green

Evidence is mounting that the global model of HIV/ AIDS              Some argue not enough condoms are used in Africa to have
prevention, designed by Western experts, has been ineffective in     made a difference, if only we exported them in the billions not
Africa. The model is based on risk-reduction, for instance           the millions. Perhaps, but we know from recent USAID data that
promoting condoms and treating sexually transmissible                after more than 15 years of condom social marketing, the result
infections (STI) with drugs, rather than on risk avoidance, for      in Africa today is an average of only 4.6 condoms available (not
instance promoting mutual monogamy, abstinence, or delay of          necessarily used) per male per year. This figure was actually
age of first sex. The dichotomy is imperfect because, for            somewhat higher in the mid-1990s and has declined in spite of
example, reduction in number of sexual partners could be             the explosion of AIDS in southern Africa. The problem seems to
classified as risk reduction, not avoidance. But the global model    be low demand.
does not promote partner reduction or address multi-partner sex.
                                                                     Uganda’s Approach
John Richens has proposed the term primary behaviour change
(PBC) to denote changes in sexual behaviour, including partner       In addition to condoms, the other relatively expensive prevention
reduction, which do not rely on devices or drugs. We have            programs funded by major donors are mass treatment of STIs,
suggested treating AIDS as a behavioural issue calling for           voluntary counselling and testing, and prevention of mother-to
behavioural solutions, although not to the exclusion of risk         child transmission with Nevirapine. Remedies rather than
reduction remedies. The dominant paradigm treats AIDS as a           behaviour change. These programs, with condom social
medical problem requiring medical solutions. PBC deals with          marketing, had not started in Uganda when infection rates
the problem itself, with what is needed for primary prevention.      began to decline in the late 1980s. Yet Uganda has
                                                                     experienced the greatest decline of HIV infection of any country.
Risk-Reduction Model                                                 Its home-grown prevention program was based largely on
                                                                     behavioural change.
The dominant prevention paradigm was developed for high-risk
groups in US cities. Part of the risk reduction model was to not     Uganda’s approach to AIDS led to a delayed age of first sex,
address sexual behaviour because to do so was to make value          less casual sex, and high condom use rates among those
judgments. AIDS experts settled for harm reduction, which            engaging in casual sex. Uganda also pioneered approaches in
assumes behaviour is difficult to change, therefore efforts ought    reducing stigma, opening discussion of sexual behaviour,
to be made to mitigate the consequences of risky behaviour.          involving HIV-infected people in public education, persuading
Thus condoms and clean needles (if legal) were provided to           individuals and couples to be tested and counselled, and
reduce risk of sexually transmitted and blood borne HIV              improving the status of women.
infections. There was and is no discouragement of any form of
sexual behaviour, or injecting drug use.                             The genius of Uganda’s ABC program (Abstain, Be faithful, use
                                                                     Condoms) is its focus on what individuals themselves can do to
This approach might have been suitable for San Francisco or          change or maintain behaviour and so avoid or reduce risk of
Bangkok. But when exported to Africa and other parts of the          infection. But it also confronted the difficult social and institu-
world, despite claims to the contrary, there was little attempt to   tional problems, which only committed governments can do in
adapt the model to other cultural settings or epidemic patterns.     the near- to intermediate-term. These programs were led by the
In the US, Europe and most of Asia, HIV infections are concen-       government but also involved many NGOs and community-
trated in defined high-risk groups. In sub-Saharan Africa, most      based local organizations.
infections are found in the general population. Actually, many
are opposed to this distinction, arguing, “let us not single out     Providing More Options
risk groups, that will stigmatize them, as well as make the
general public feel they are not at risk. The message should be,     It has been difficult for Western donor agencies and others
‘we are all at risk of AIDS.’” This has a nice egalitarian ring.     involved in AIDS prevention to accept evidence that what they
Nevertheless, differences in epidemiological patterns and            have been doing in Africa may not have been effective, while
cultural settings are real, calling - among other things - for       something they have not supported has worked better. Some
different approaches to prevention.                                  have dismissed the ABC approach as simplistic. Yet the ABC
                                                                     approach adds behaviour change (the A and B) to existing
AIDS Prevention in Africa                                            programs which, for the most part, do not go beyond “C,”
                                                                     beyond condom (and drug) remedies. Adding primary behaviour
How has the Western risk-reduction model fared in Africa?            change provides people with more options for preventing HIV
Most efforts have focused on condoms. There is no evidence to        infection than are currently available and these are sustainable
date that mass promotion of condoms has resulted in decline of       options independent of relatively high-cost Western imports.
HIV infection rates at the population level. The UNAIDS multi-
centre study (published in AIDS in 2001) found that condom
user levels made no significant difference to HIV prevalence
levels. And a 2003 UNAIDS review of condom effectiveness
concludes, “there are no definite examples yet of generalized
epidemics which have been turned back by prevention
programs based primarily on condom promotion.”

                      AIDS: a biosocial problem with social solutions
                                                                                                                                Paul Farmer

Edward Green’s piece raises two major questions about AIDS            All this will be argued in journals, but time is short. We know
prevention paradigms. Why are they ineffective? And what can          that a true accounting of what happened in Uganda needs to be
be done to make them less so?                                         biosocial. In addition to behaviourist approaches, we will need
                                                                      to understand political economy, troop movements, trade,
Green begins his overview by noting, “evidence is mounting            structural adjustment policies from above and abroad and of
that the global model of AIDS prevention, designed by Western         course cultural factors.
experts, has been largely ineffective in Africa.” It would be hard
to argue with him on this point as thousands of infections            To return to the second burning question, what is to be done?
accrue each week. With millions of new infections each year,          Green argues that AIDS is a “behavioural problem with
AIDS prevention has largely failed, especially in the world’s         behavioral solutions.” Perhaps. But AIDS is also, surely, a social
most burdened continent, which is, not coincidentally, the            problem with social solutions. Some of these can be classed as
globe’s poorest.                                                      behavioural and there is nothing wrong with the ABC campaign.
                                                                      Others are clinical: improved HIV care will decrease death,
Quibbling over terminology is not important, but permit me to         increase uptake of voluntary counselling and testing, also
object to the term “Western.” Africa is a vast and heterogeneous      destigmatize AIDS and lessen provider burn-out. And is a
continent where many “traditional healers” are as likely to use       vaccine not part of the solution? Vaccines are hardly
[“Western”] ampicillin as the wisdom of elders.                       “behavioural.” What about repealing laws penalizing women
                                                                      who lose a partner to AIDS? Gender discrimination against
However, this is not the only reason why the term “Western” is        poor girls? Prohibitively high school fees?
misleading. “Western,” in development-speak, means wealthy
countries, whether the US or Japan. The “global north” is more        The list goes on, and it is not a very “behavioural” list, unless we
accurate but the most apposite is “the haves.” Those who have -       mean the behaviour of the powerful. I would ask Green to make
we who now self-righteously call ourselves “the donor nations” -      his analysis and prescriptions more social. What needs to
decide the fate of hundreds of millions. So it is crucial we          underpin behavioural models, at the minimum, is the recognition
understand why HIV prevention has not been more effective             that current AIDS prevention tools work least well where
and Green is to be lauded for arguing this topic.                     individual agency is most constrained, usually by poverty and
                                                                      gender inequality. Because what the “have-nots” lack is agency.
Green is also to be applauded for contesting some of the
sloganeering in AIDS prevention work. He summarizes such              The only way to rehabilitate behavioural models honestly, is to
thinking: “‘Let us not single out risk groups, that will stigmatize   scrutinize the behavior of the powerful: those who set economic
them, as well as make the general public feel they are not at         policies for countries like Uganda or Haiti or Mozambique. Those
risk. The message should be, ‘we are all at risk of AIDS.’ This       who write laws. Those who decide who will have access to care
has a nice egalitarian ring. Nevertheless, differences in epidemi-    and who will not. And many of these people, whose agency is
ological patterns and cultural settings are real, calling – among     decidedly unconstrained, are not on the continent of Africa.
other things – for different approaches to prevention.”
                                                                      Finally, I would ask Green to consider the issue of treatment for
True, but Green should pursue this. Why is HIV concentrated in        HIV disease as part of the prevention agenda. Long lists of how
the poorest parts of the world? Why do social inequalities,           improving HIV care enhances prevention are available. These
including gender inequality and racism, fuel the AIDS pandemic,       have been mostly ignored, since prevention and care have been
whether in Africa or US cities? Why do economic policies              divorced, absurdly enough, by the “Western” experts who run
foisted on poor countries heighten HIV risk? Part of the answer       much of the world. We need to help these experts resocialize
to each question is: because risk for HIV is conjoint with not        the worst epidemic the world has ever known.
having. The “have-nots” constitute the global risk group, if there
is one. Thus a behavioural model of HIV prevention needs to be
embedded in a broader social analysis.

Green also contests other prevention pieties, including those
regarding condoms. Condom promotion and social marketing are
not “the” solution to the problem. But what other solutions are
there? I hope he is right in praising Uganda as a model for other     This is an abridged version of a piece and its rejoinder, which appeared in
African nations, though what he calls Uganda’s “home-grown            Pukkar, issue 44, 2004: pp.22-23.
approach” does not seem particularly indigenous to Uganda.            Edward C Green, is an anthropologist and senior researcher at the
                                                                      Harvard School of Public Health, who has written for many years on
Quibbling over the origins of customs or behaviours is hardly         African and Latin American/ Caribbean issues.
the issue. The issue is what happened in Uganda and what is           Dr. Paul Farmer is a medical anthropologist who has published widely on
happening now. What worries me is that Uganda-as-an-AIDS-             health and social justice and whose most recent book is Pathologies of
success story has already taken on a paradigmatic quality.            Power: Health, Human Rights, and the New War on the Poor, University of
There are sceptics - I am one - who think that what happened in       California Press, 2003.
Uganda is complex and has as much to do with war, migration,
and many other events and processes - including, for instance
in Kampala, increased access to better HIV care - which are not
readily classed under “ABC campaign.”

literature review
Masha Eisenberg

i. Gay Asian men in Sydney resist international trend: No                Did rates of UAI among gay Asian men increase in line with those
change in rates of unprotected anal intercourse, 1999-2002,              in the gay community in Sydney and elsewhere?
Van den Ven, P., Mao, L., and Prestage, G. (2004). AIDS Education        The proportion of gay Asian men who reported any UAI with regu-
and Prevention, 16 (1): pp.1-12.                                         lar partners in the previous six months did not change significantly
                                                                         over time: 28 per cent in 1999 and 24 per cent in 2002. Similarly
ii. Gay Asian men in San Francisco follow the international              rates of any UAI with casual partners remained steady: 16 per cent
trend: Increases in rates of unprotected anal intercourse                in 1999 and 14 per cent in 2002.
and sexually transmitted diseases, 1999-2002, McFarland, W.,
Chen, S., Weide, D., Kohn, R., Klausner, J. (2004). AIDS Education and   As the authors put it, gay Asian men in Sydney are resisting chang-
Prevention, 16(1): pp.13-18.                                             ing norms in the larger Sydney gay community and challenging an
                                                                         international trend of increasing UAI.
Studies of men who have sex with men (MSM) worldwide have
been reporting increases in HIV incidence and risk-related               What factors are associated with sexual risk practice?
behaviour. Less is known about trends within minority populations        Risk factors, which corroborated previous findings regarding this
of MSM, particularly those of Asian background.                          population, included multiple sex partners and recreational drug
                                                                         use, but interestingly, unlike in previous research with gay Asian
These two papers, from Sydney and San Francisco, are reviewed            men, age and educational level were not associated with risk.
here together but have contrasting conclusions. They highlight the       Of all the variables assessed, only engagement in ‘esoteric’ prac-
diversity of Asian MSM, even in parallel Western urban centres, and      tices such as fisting, SM, group sex, and rimming was indepen-
suggest that prevention needs among these men are also likely to         dently associated with sexual risk practice.
be diverse. The papers appeared in a thematic volume of AIDS
Education and Prevention, “HIV Prevention for Asian and Pacific          The authors suggest that the non rise in UAI rate among gay Asian
Islander Men Who Have Sex With Men,” which deserves reading as           men possibly relates to successful HIV education and prevention
a whole.                                                                 among them, but the persistent lower rate of testing for HIV or not
                                                                         knowing one’s status argue the limitations of this explanation. On
i. Gay Asian men in Sydney                                               the other hand, the reasons given by study participants for not test-
Behavioural surveys among gay Asian men, who are a significant           ing or not knowing their status – “not wanting to know the result,”
and growing minority in the Sydney gay community, were conduct-          “not knowing where to go for a test,” “not wanting the government
ed in 1999 (N=319) and 2002 (N=457).                                     to know,” “fear of stigma and discrimination” – point to both the cul-
                                                                         tural and access barriers operating for this community.
Key findings from the 1999 study were that gay Asian men were
less likely than other (mostly Anglo-Celtic) gay men to engage in        As the authors themselves point out, their work had two important
sexual risk practice, but that many more among them had not test-        limitations. The samples of gay Asian men were convenience sam-
ed for HIV or did not know their HIV status.                             ples, which could not account for men not frequenting gay identified
                                                                         venues, and moreover, Asian MSM who do not identify as gay were
This paper presents temporal trends in risk behaviour among the          underrepresented.
gay Asian men and compares them to gay men in general. Its main
questions regarding gay Asian men are whether rates of HIV test-         ii. Gay Asian men in San Francisco
ing changed since 1999, whether rates of unprotected anal inter-         Annual trends in four indicators for which there was data to com-
course (UAI) changed, and what factors are associated with sexual        pare Asian and Pacific Islander (A&PI) MSM with White MSM in
risk practice.                                                           San Francisco were monitored. These included UAI with two or
                                                                         more partners in the last six months, UAI with two or more partners
Recruitment of participants in both 1999 and 2002 was at gay             of unknown HIV serostatus in the last six months, the incidence of
bars, gay social functions, and gay sex-on-premises frequented by        male rectal gonorrhoea, and the incidence of early syphilis among
large numbers of gay Asian men. The two samples differed some-           MSM.
what in terms of ethnicity. Short self-administered questionnaires
were used.                                                               Data on UAI came from brief structured interviews with MSM, con-
                                                                         ducted by the Stop AIDS Project in the course of outreach activi-
The data was analysed using frequencies and summary statistics,          ties at various gay venues and neighbourhoods with large gay pop-
while linear trends in any UAI were examined separately for sex with     ulations. Participants self-identified for ethnicity as A&PI or White
regular and casual partners. In 2002 for the analysis of factors asso-   (1999: A&PI N=272, 2002: A&PI N=115).
ciated with current sexual risk practice, participants were divided
into two groups of “no risk” and “some risk”, based on HIV serosta-      The incidence of male rectal gonorrhoea and early syphilis among
tus and sexual practice.                                                 MSM was given by STD surveillance data reported from medical
                                                                         providers and laboratories in San Francisco. Incidence is shown as
Did rates of HIV testing change?                                         rate of infection per 100 000 MSM. The denominators of A&PI and
The proportion of gay Asian men reporting they had not been test-        White MSM were constructed using previously derived estimates of
ed for HIV or did not know their HIV status did not change signifi-      overall MSM and A&PI MSM populations (A&PI MSM N=2,285).
cantly over time: 26 per cent in 1999 and 23 per cent in 2002. This
is significantly higher than the approximately ten per cent for Anglo-   Trends in the four indicators from 1999 – 2002 show that:
Celtic gay men in Sydney and other major Australian cities.              Although UAI with multiple partners and UAI with multiple partners

                                                                       literature review

of unknown HIV serostatus were substantially lower among A&PI                 and, in particular, provide a measure of the effect of World AIDS
MSM in 1999, by 2002 reported levels were even higher than                    Day on HIV testing among the target community languages.
among White MSM.
Similarly, the incidence of male rectal gonorrhea and early syphilis          A total of 1067 HIV tests were carried out in the three Sexual
were lower among A&PI MSM in 1999 but higher than among                       Health Centres during the study time. While the number of tests
White MSM after that.                                                         from the target group increased from 66 pre-campaign to 122 in
                                                                              the post-campaign period, as a proportion of the total number of
As the authors themselves point out, this study was limited by con-           tests, this increase was not statistically significant.
venience sampling, but especially by the uncertainty of the true
denominator of A&PI MSM. A small difference in the used estimate              There was, however, a significant increase in the proportion of HIV
would have a large impact on the apparent relative rates of STDs.             tests for the target group from 1999 compared to both the pre and
                                                                              post campaign periods in 2000.

Evaluation of an ethnic media campaign on patterns of HIV                     In their discussion, the authors consider a range of factors which
testing among people from culturally and linguistically                       may have contributed to the non significant rise in HIV testing
diverse backgrounds in Australia, McMahon, T., Fairley, C. K.,                attributable to the campaign.
Donovan, B., Wan, L., and Quin, J. (2004). Sexual Health, 1 (2): pp. 91-94.   Among these are: the shortness of the evaluation period (two work-
                                                                              ing weeks), the testing of the target population may have occurred
This paper evaluates the effect of a national pilot ethnic media              elsewhere, and the scale of the campaign was insufficient to pro-
advertising and editorial campaign on patterns of HIV testing                 duce a substantive effect, particularly as there had been significant
among people from selected culturally and linguistically diverse              increases in testing among the target population since 1999.
(CALD) backgrounds in Australia.
                                                                              The authors argue that the importance of ethnic media intervention
The campaign was run in ethnic print and radio media, with a mix of           in increasing HIV awareness and testing among CALD populations
advertising and editorials, between November and December 2000                should not be minimised and that future campaigns should focus
in conjunction with World AIDS Day. The major aims were to: raise             more resources on fewer languages as well as allow for more com-
awareness about current HIV/AIDS issues, inform regarding free                prehensive evaluation.
anonymous HIV testing and the benefits of early diagnosis, and pro-
mote access to treatment and care services.
                                                                              Ethnic and cultural determinants influence risk assessment
The themes for the campaign were based on assessments of the                  for hepatitis C acquisition, Dev, A., Sundararajan, V., and Sievert,
needs of people from CALD backgrounds living with HIV/AIDS and                W. (2004). Journal of Gastroenterology and Hepatology, 19: pp.792-798.
the key messages were developed following a national consultation
process.                                                                      Hepatitis C (HCV) infection in the developed world is largely asso-
                                                                              ciated with contaminated equipment shared by injecting drug users
Since national HIV notification data does not include ethnicity, the          (IDU). In developing countries other risk factors have been impli-
target communities were prioritised following the national consulta-          cated, including inadequately sterilized medical equipment, blood
tion, census data, HIV/AIDS prevalence in selected countries of ori-          transfusion, and cultural practices. Appropriate risk factor assess-
gin, and the availability of media to carry the campaign. The 14 tar-         ment is important when targeting culturally diverse populations for
get languages were: Arabic, Chinese, Croatian, Greek, Indonesian,             education and risk minimization.
Italian, Khmer, Macedonian, Portuguese, Serbian, Spanish, Thai,
Turkish, and Vietnamese.                                                      In this Australian study, patients from the Monash Medical Centre
                                                                              Liver Clinic completed a questionnaire to assess their HCV risk fac-
Print outlets with national distribution were chosen based on their           tors, their perceived risk factors, and their knowledge of transmis-
circulation. At least one set of three advertisements was placed in           sion and risk factors. Medical records were audited for doctors’
each outlet. In all, 156 advertisements were placed in the 14 com-            assessment of HCV risk factors. Ninety participants were identified
munity languages. Media releases were developed in each lan-                  as Australian-born ‘Caucasians’ and 72 as South East Asians
guage and circulated to ethnic print and radio outlets. Monitoring            (being largely Vietnamese and Cambodian born).
identified 26 instances of press coverage directly related to the
media release in the target language and 18 interviews or feature             Among the ‘Caucasians’ the major HCV risk factors were IDU, body
stories were broadcast on target language radio.                              piercing, and tattooing (89, 47, and 32 per cent respectively), while
                                                                              among the South East Asian participants the risk factors were
Clinic attendances for HIV antibody testing at the Melbourne,                 immunisation outside Australia, dental therapy outside Australia, and
Sydney, and Liverpool (Sydney) Sexual Health Centres before and               surgery outside Australia (89, 70, and 38 per cent respectively).
immediately after the campaign were used as the outcome mea-
sure. These sites were chosen because of their proximity to CALD              Almost all (94 per cent) of the ‘Caucasian’ participants could iden-
populations, access to interpreter services, and having designated            tify their most probable mode of HCV acquisition, but only a third of
clinics for Thai and Chinese speakers.                                        the South East Asian participants did, and the most important fac-
                                                                              tor in participants’ ability to correctly identify their own risk for HCV
Data was also obtained for a comparison period in December 1999               was ethnicity.
to see if HIV testing rates had changed between 1999 and 2000

literature review

The medical record audit showed that for almost all (94 per cent)       The mean age of participants was 23.1 years, one third were
the ‘Caucasian’ participants the risk factors documented corre-         women, and approximately half identified as ethnic or cultural
sponded to what participants reported in the questionnaire, but this    minorities, including Asian (27.4 per cent). They had been injecting
was so for only a third of the South East Asian participants. For       drugs for a mean of four years with more than half injecting daily and
most South East Asian participants, the only risk factor document-      heroin being the last drug injected by most. Participants recruited in
ed was country of birth (unless the patient had a history of IDU,       Cabramatta were different from those recruited elsewhere, being
blood transfusion, or tattooing).                                       significantly younger, with shorter histories of injecting, and more
                                                                        likely to be from NESB and Asian backgrounds.
Both the ‘Caucasian’ and South East Asian participants almost
always recognised blood-to-blood contact as a major mode of HCV         Over one third (36.6 per cent) of participants tested HCV positive
acquisition. However, a third of the South East Asians believed         and over one quarter (28 per cent) had been exposed to HBV.
transmission occurred through food, water, and poor hygiene, while      Asian participants, NESB participants, and those reporting sharing
most (80 per cent) did not identify medical injection or traditional    injecting equipment in the previous month were less likely to have
cultural practices (such as acupuncture, eyebrow and eyelid tattoo-     been previously tested for HCV. Being HBV positive was associat-
ing) as risk factors.                                                   ed with country of birth and incarceration in the previous year.

The authors conclude the identified differences between South           Independent predictors of being HCV positive included: being HBV
East Asian and others with HCV are a result of inadequate risk fac-     positive, incarceration in the previous year, injecting on the street,
tor assessment, poor understanding of cultural aspects of disease,      length of injecting, and Asian ethnicity. Individual risk behaviours,
and lack of culturally appropriate prevention by the treating doctors   including sharing of injecting equipment and being injected by oth-
and nurses. Moreover, they argue that information and education         ers were not significant in either bivariate or multivariate analysis.
resources should be culturally appropriate and address the specif-
ic needs of all populations with HCV.                                   In their discussion, the authors underline some implications of the
                                                                        study findings. The number of IDUs who reported never being test-
                                                                        ed and were found to be HCV positive suggests that regular and
Risk behavious and antibody hepatitis B and C prevalence                ongoing testing is required. NESB IDUs were significantly less like-
among injecting drug users in south-western Sydney,                     ly to report previous testing for HCV, HBV, and HIV, but were more
Australia, Maher, L., Chant, K., Jalaludin, B., Sargent, P. (2004).     likely to test both HCV and HBV positive, and within this group
Journal of Gastroenterology and Hepatology, 19: pp.1114-1120.           Asian background IDUs were particularly vulnerable, suggesting
                                                                        ongoing access and equity issues. And the relationship between
Hepatitis C (HCV) infection is now the leading notifiable disease in    incarceration in the last year and HCV positivity, especially among
Australia, with injecting drug use (IDU) accounting for up to 80 per    indigenous and NESB IDUs, suggests differential policing and, in
cent of existing cases and 90 per cent of the 16000 new infections      particular, the over-policing of young Asian men in Cabramatta.
annually. In comparison, the prevalence of HIV among injecting drug
users (IDUs) is less than two per cent.                                 The authors conclude that research to date has focused on individ-
                                                                        ual risk factors to the neglect of risk environments or contexts and
This study aimed to determine the prevalence of HCV and hepatitis       that there is urgent need for interventions to reduce the exposure of
B (HBV) infection as well as associated risk behaviours among           IDUs, particularly indigenous and Asian injectors, to risk environ-
IDUs in south-western Sydney, who were screened as part of a            ments. Among such structural interventions they include, population
wider multisite prospective cohort study in NSW. South-western          based hepatitis B immunization, expanded access to NSP and drug
Sydney (SWS) has a very diverse population with at least one third      treatment, as well as prison diversion programs and medically
of residents born in non-English-speaking countries. During the         supervised injecting facilities.
study period, Cabramatta, which is one locality in SWS, was often
described as Australia’s ‘heroin capital’ and hosted visible street-
based injecting.

Participants were recruited using several methods, including adver-
tising, snowball sampling, street outreach, and word-of-mouth. Entry
criteria were a history of IDU in the previous six months and hepati-
                                                                         ...differences between South East
tis C antibody serostatus not known to be positive.                      Asian and others with HCV are a result
Between 1999 and 2002, 377 participants were interviewed using           of inadequate risk factor assessment,
a structured questionnaire and tested for exposure to HCV and
HBV. The questionnaire was designed to screen participants for the       poor understanding of cultural aspects
wider cohort study but also to provide information comparable to         of disease and lack of culturally
the national Needle and Syringe Program survey. The blood speci-
mens were labelled using a unique study identifier.                      appropriate prevention by the treating
Participants were considered to be from non-English speaking             doctors and nurses.
background (NESB) if they met one or more of the following crite-
ria: spoke a language other than English at home, were born in a
non English speaking country or identified as such.

conference papers and
publications in 2004

“Everybody’s Business”: A tool for hepatitis C health promotion         Identity, culture, and living with HIV, Maria Petrohilos, Masha
among culturally and linguistically diverse communities, Tadgh          Eisenberg, and Effie Katsaros, presented at the Living and Loving in
MCMahon and Denilson Fukunishi, presented at the National               Diversity Conference, Melbourne, October 16.
Hepatitis C Educators’ Conference, Adelaide, February 11.
                                                                        Developing a multilingual website - sharing experiences,
Culture and language in the access mix, Tadgh McMahon, pre-             Denilson Fukunishi, presented at the Community Web Workers’
sented at the Inequities Affect Everyone Forum, Sydney, February 20.    Conference, Sydney November 8.

Working with diversity, Tadgh McMahon, presented at the
Australasian College of Sexual Health Physicians Conference,
Adelaide, April 2.

Reaching the margins: The gay men and cultural diversity pro-           HIV among migrant and mobile populations, Matthew Tyne, HIV
ject, Alan Chan, presented at the AFAO/NAPWA HIV Educators’             Australia, 3 (2), December 2003-February 2004: 10-12.
Conference, Sydney, May 19.
                                                                        Late HIV presentation among African communities, Mohamed
Adherence and diversity, Maria Petrohilos, Masha Eisenberg, and         Keynan, Talkabout, no.131, February-March 2004: 33-34.
Effie Katsaros, presented at the ASHM Conference, Canberra,
September 4.                                                            Evaluation of an ethnic media campaign on patterns of HIV
                                                                        testing among people from culturally and linguistically diverse
The HIV multilingual recorded information lines, Mohamed Keynan,        backgrounds in Australia, Tadgh McMahon, Christopher K. Fairley,
presented at the ASHM Conference, Canberra, September 4.                Basil Donovan, Lilian Wan, and John Quin, Sexual Health, 1(2), June
                                                                        2004: 91-94.
Practical tips in accessing culturally and linguistically diverse
needs and developing responses, Denilson Fukunishi, presented           Women on the margins, Maria Petrohilos and Jeff Dabbhadatta,
at the NSW NSP Advances Meeting, Sydney, September 9.                   Talkabout, no.135, October-November: 4-5.

current staff                                                           contact us

Manager: Tadgh McMahon                                                   telephone: (02) 9515 5030
Deputy Manager: Barbara Luisi (from May 2004)
Administrative Assistants: Jan Dennis/Mary Bourke                        fax: (02) 9550 6815
Clinical Supervisors: Maria Petrohilos/Effie Katsaros
Community Development Officer: Wa’el Sabri (from May 2004)
                                                                         freecall: 1800 108 098 (NSW)
Co-worker Liaison Officer: Riza Yaman                                    postal address: post office box M139,
Education/Media Officer: Sonam Paljor
Research and Service Development Officer: Masha Eisenberg                missenden road, nsw 2050
National Hepatitis C Project: Lynne Martin (from September 2004)         web:
National HIV/AIDS and Hepatitis C Project: Alan Chan (until May 2004)
National Positive Diversity Project: Matthew Tyne (until February        email:
2004)/Denilson Fukunishi (from March 2004)
NSW Late HIV Presentation Project: Mohamed Keynan

85 Co-workers from more than 20 language backgrounds:
Afrikaans, Akan, Amharic, Arabic, Bosnian, Burmese, Chinese,
Croatian, Greek, Hindi, Indonesian, Italian, Khmer, Korean, Laotian,
Macedonian, Polish, Portuguese, Serbian, Shona, Somali, Spanish,
Thai, Turkish, and Vietnamese.

diversity news is edited by Masha Eisenberg

global hepatitis C at a glance…
                     Global Hepatitis C, 2004
                                                                diversity in
                                                                hepatitis C in
                                                                Australia at a
                                                                glance ...

                                                                Currently, there are no accurate estimates
                                                                of hepatitis C among culturally diverse
                                                                communities in Australia.

                                                                Source: WHO,

global HIV/AIDS at a glance…
                                                                Source: UNAIDS, and
      Estimated percentage of people receiving antiretroviral   WHO,
     therapy among those in need of therapy (December 2004)

                                                                diversity in
                                                                HIV/AIDS in
            Adults and children estimated to be living
                                                                Australia at a
              with HIV/AIDS as of the end of 2004               glance ...

                                                                21 per cent of HIV cases in Australia in
                                                                2002-2003 were among people born in
                                                                non-English speaking regions of the

                                                                14 per cent of HIV notifications in NSW
                                                                for the years 2001-2003 were for
                                                                people who spoke a language other than
                                                                English at home and 20 per cent were for
                                                                people born in non-English speaking

                                                                Source: 2002 Annual Surveillance
                                                                Report, NCHECR, pp.36 - 37 and NSW
                      Total: 39.4 (35.9-44.3) Million

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