Access to HIV information and services: are we doing enough for MSM who recently immigrated? Horas Wong, Tim Chen, David Lewis, Brent Mackie, Azizul Haque, Andrew Stone, Ashley Ubrihien, Gabrielle Stackpool, Jeffrey Dabbhadatta, Marty Janssen, Shih-Chi Kao, Limin Mao Culturally and Linguistically Diverse (CALD) Gay Men Action Group Presenting Author: Horas Wong PhD Candidate, Centre for Social Research in Health, UNSW Horas.wong@unsw.edu.au

CALD Gay Men Action Group Form in 2006 HIV health promotion interagency working group ACON Multicultural HIV and Hepatitis Service (MHAHS) Centre for Social Research in Health (CSRH), UNSW Sydney LHD HARP Unit South Eastern Sydney LHD HARP Unit Sydney South Western LHD HARP Unit Western Sydney LHD HARP Unit Northern Sydney LHD HARP Unit The Action Group aims to address CALD gay men’s HIV and health promotion needs by developing, implementing and coordinating social research, health promotion and social marketing activities, consistent with NSW HIV and STIs Strategic Plans The group members plan, implement and evaluate HIV and STI initiatives targeting gay men and MSM of CALD backgrounds through partnerships between member organisations. The Action Group comprises community organisations, Multicultural HIV and Hepatitis Service , social research institute, HIV and related program units from 5 Sydney local health districts. and community representatives.

Study background In Australia, nearly 30% of the nation's population were born overseas. Many of those are from Asian countries. It is well-documented that immigrants’ and migrants’ access to quality health care is often impeded by a variety of linguistic, socio-economic and even environmental obstacles.  Few data on the access to information and the health needs of gay men and other MSM who are new to Australia. In NSW, HIV notification among CALD gay men and other MSM has risen over the past few years. Most of these newly diagnosed men were of South East or East Asian background. A study was conducted to understand the health needs of CALD gay men and other MSM living in Sydney, to provide useful data for developing more effective HIV responses In Australia, around 28 % of the nation's population, or  6.6 million people, were born overseas. Many of those are from Asian countries.

Study Design Design Cross-sectional study Eligibility Adult MSM of Asian background in Sydney Recruitment SOPV, gay events, ACON, sexual health clinics, massage parlours, the internet Questionnaire English and Thai languages Demographics Risky sexual behaviours, HIV/STIs testing behaviours, Knowledge on PrEP/PEP, Community attachment Study period Since Dec 2015 (pilot: Sep 2015) Expected to be completed by June 2016

Characteristics of participants (n=317) By April 2016, Mean age 32.7= (SD 8.8) Top races/ethnicities: Chinese: 40% Filipino: 12% Thai: 12% Vietnamese: 8% Top countries of birth: China (including HK and Macau): 21%, Australia: 14%, Philippines: 12%, Thailand: 12% Occupation: Employed full time: 49.5% Student: 25.2% Year of residence in Australia: Below 5 years (recent immigrants): 38% Countries of birth of participants (n=317)

Sexual practices and HIV testing (n=317) About a quarter of all participants had ever had unsafe sex with a casual and/or a regular partner in the past 6 months

Characteristics of recent immigrants (n=120) Top races/ethnicities: Chinese (42%), Thai (17%), Filipino (15%) 33.3% had stayed in Australia for less than 1 year 26.7% do not use English for routine communication in Australia

Univariate analysis of recent immigrants and non-recent immigrants on PEP/PrEP knowledge and HIV testing p-value<0.001 p-value<0.001

Multivariate comparison of RI and non-RI Odds ratios from logistic regression comparing recent immigrants and other participants* n.s. n.s. The odds of recent immigrants that being age below 30, being a student, and using other languages for routine communication are more than 2 times greater than the odds of non-recent immigrants. The odds of recent immigrants that having HIV test in the last 12m, and having heard of PEP/PrEP are aroudn 2 times smaller than the odds of non-recent immigrants. 0.461 =2.2 times less likely 0.359 =2.7 times less likely More likely Less likely *Ratios are graphically presented on a logarithmic scale

Main messages Compared with those who have been living in Australia for a longer time, Asian MSM who are newer to this country : 1) have a similar practice of unsafe sex 2) are disadvantaged in their access to HIV information and services They are significantly less likely to have an HIV test in the past year and to have ever heard of PEP/PrEP.

Recommendations What can be done? There is a need for health service providers to convey information in a manner that is accessible by those who are new in Australia Continue evaluation of immigrant/migrant MSM’s barriers to access quality health care Whom to target? Younger people (including overseas students) People with limited English proficiency What messages? Strengthen messages on HIV testing services in Australia and updates of HIV information (esp. treatment as prevention)

Limitations Only focused on Asian men Questionnaires were only prepared in English and Thai Sampling bias Data from Chinese, Filipino and Thai participants could be over-represented

Thank you Presenting Author: Horas Wong Horas.wong@unsw.edu.au