People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.

The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.

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ObjectivesThis study sought to explore health and medical professionals’ antenatal HIV testing practices and the perceived barriers to routine testing in Tasmania, Australia.DesignThis qualitative study undertook a Foucauldian-informed discourse analysis of 23 one-to-one semistructured phone interviews. The focus of our analysis was on language as a medium for interactions between clinicians and their patients.SettingPrimary health care and antenatal health services in the north, northwest and southern Tasmania, Australia.ParticipantsTwenty-three health and medical professionals (midwives (n=10), general practitioners (n=9) and obstetricians (n=4)) providing antenatal care.ResultsAntenatal HIV testing is practised within a discourse of ambiguous terminology, stigma and the perception that HIV is a theoretical risk, generating confusion among clinicians as to how and who is tested. This creates clinical hesitancy towards antenatal HIV testing, a barrier to universal prenatal HIV testing.ConclusionAntenatal HIV testing is undertaken within a discordant discourse generating clinical hesitancy where HIV is perceived as a theoretical risk and surrounded by stigma. Using neutral language and replacing the words ‘routine’ and ‘recommended’ with ‘universal’ testing in public health policy and clinical guidelines could increase health providers’ confidence and reduce ambiguity and the legacy of HIV stigma.