Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

Abstract

Objectives: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. Methods: A retrospective, cross‐sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Results: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01‐AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Conclusions: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.

Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men

“…Our findings show that Medicare‐ineligible MSM are less likely to report condomless sex with male partners, despite anorectal chlamydia being more common among Medicare‐ineligible MSM compared to Medicare‐eligible MSM. Our finding is consistent with a previous Australian study showing anorectal chlamydia was more commonly detected in Asian‐born MSM (who are predominately Medicare‐ineligible) compared to Australian MSM (who are Medicare‐eligible) newly diagnosed with HIV 9 . The reasons of this difference are unclear, but it is possible that the actual sexual risk might be under‐reported due to language barriers or cultural factors.…”

“…The reasons of this difference are unclear, but it is possible that the actual sexual risk might be under‐reported due to language barriers or cultural factors. Furthermore, previous research has shown that Medicare‐ineligible MSM, including international students, have a higher prevalence of STIs in comparison with Medicare‐eligible MSM 9 . Most of these Medicare‐ineligible individuals originated from south‐east and central Asia, where the stigma surrounding homosexuality is highly prevalent and sexual health literacy levels are quite low 15,16 .…”

“…However, there has been no reduction in new HIV cases among MSM who were not born in Australia, particularly among those who have recently arrived in Australia. Furthermore, the new diagnoses of HIV in MSM born overseas are diagnosed at a more advanced stage of HIV than in Australian‐born MSM 7-9 . MSM who are born overseas and have recently arrived in Australia are less likely to have Australian citizenship or permanent residency; hence, they are more likely to not be eligible for Medicare.…”

Comparing HIV Post-Exposure Prophylaxis, Testing, and New Diagnoses in Two Australian Cities with Different Lockdown Measures during the COVID-19 Pandemic

“…The HIV epidemic has changed during the 2010s [33]. Before the COVID-19 pandemic, new HIV diagnoses among Australian-born MSM were decreasing but new HIV diagnoses among overseas-born MSM were increasing, particularly individuals who are recently arrived migrants and international students [33][34][35][36]. Given Australia has closed its border to international travellers, fewer migrants and international students would have been tested for HIV in 2020 than in 2019 [37].…”

“Moving from one environment to another, it doesn’t automatically change everything”. Exploring the transnational experience of Asian-born gay and bisexual men who have sex with men newly arrived in Australia

“…Sexual identity concealment, in turn, is associated with worse mental health outcomes [15], a decreased sense of belonging, and social isolation [4,16]. In Australia, Asian-born gbMSM are more likely to have advanced HIV upon diagnosis but to report fewer numbers of male sexual partners compared to Australian-born gbMSM [17]. This may indicate an underlying stigma related to HIV and sexual identity, particularly given the reported prevalence of such stigma in several Asian countries [18][19][20][21][22].…”