Newly arrived Asian-born gay men in Australia: exploring men’s HIV knowledge, attitudes, prevention strategies and facilitators toward safer sexual practices

Abstract

Background Asian-born gay, bisexual and other men who have sex with men (gbMSM) newly arrived in Australia are more than four times as likely than their Australian-born counterparts to be diagnosed with incident HIV. Our aim was to explore experiences of Asian-born gbMSM newly arrived in Australia and attending a sexual health centre with regards to their knowledge of and preference for HIV prevention strategies. Results Twenty-four gbMSM aged 20–30 years attending Melbourne Sexual Health Centre who were born in Asia and arrived in Australia in the preceding four years, participated in semi-structured face-to-face interviews from 8th May 2019 and 23rd December 2019. Men were excluded if they were living with HIV. Interviews were recorded, transcribed verbatim and analysed thematically. Men reported little knowledge of HIV prevention strategies outside of condom use prior to coming to Australia. Although participants reported basic knowledge of HIV transmission and treatment, exposure to sexual identity and HIV-related stigma in their countries of birth meant they imagined a HIV diagnosis would be devastating. Most relied on condoms to stay HIV negative however their consistency of use varied. Seven men were on pre-exposure prophylaxis (PrEP); all but one started PrEP after coming to Australia. Many indicated interest in PrEP but described it as too expensive given they do not have access to government-subsidized healthcare. Sexual health counselling and connections with LGBTQI community groups appeared to facilitate PrEP and consistent condom use. Conclusions Asian-born gbMSM newly-arrived to Australia may have limited knowledge of HIV prevention strategies aside from condom use. Increased connections with sexual health services and LGBTQI communities may facilitate more effective HIV prevention strategies.

Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021

“…We found that recently arrived GBM were more likely than nonrecently arrived GBM to be younger, born in Europe, Central or South America and be students. Recently arrived GBM had lower levels of awareness and use of PrEP, echoing pre-vious Australian research [6,8,19], and reported similar levels of casual sex with a risk of HIV acquisition to longerterm residents. Recently arrived migrants were less likely to report HIV testing at services that may incur a cost, like GPs.…”

Preferences for HIV prevention strategies among newly arrived Asian-born men who have sex with men living in Australia: A discrete choice experiment

“…A lack of Medicare coverage has also been independently associated with not using PrEP despite a willingness to use it ( 36 ). Qualitative research from 24 newly-arrived Asian-born MSM reported significant barriers including shame, stigma and fear related to HIV and their sexual identity remained despite living in a more liberal society ( 17 , 18 ). More implementation research is needed to understand how to address the barriers of newly arrived Asian-born MSM to using effective HIV prevention strategies.…”

“…For the formative step of the DCE, we conducted semi-structured in-depth interviews with 24 newly-arrived Asian-born MSM between May to December 2019 to understand their experience of HIV testing and type of prevention strategies ( 17 , 18 ). We found most men relied on condoms for HIV prevention but many indicated an interest in accessing PrEP.…”

The effect of pre-exposure prophylaxis (PrEP) on negotiating casual sex between gay men: disclosure, assumptions, and communication

“…34,35 Overseas-born (particularly Asian-born) GBM may face additional challenges in negotiating PrEP use and HIV prevention due to a lack of knowledge about HIV, racism, and lack of access to Medicare (Australia's subsidised health insurance system). [36][37][38] Further research may be warranted to understand how disclosure and discussion of PrEP use, and the use of other HIV risk reduction strategies, evolves as PrEP use increases and the COVID-19 pandemic impacts on sexual behaviour among GBM.…”