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

Abstract

exually transmitted infections (STIs) are increasing at a significant rate in men who have sex with men (MSM) in Australia. 1,2 Accessible healthcare is a key element of human immunodeficiency virus (HIV) and STI control because it allows timely testing and treatment to prevent ongoing transmission and also access to biomedical HIV preventions. 3,4 Consistent with this are studies showing a reduction in HIV incidence among Australian-born gay, bisexual and other MSM in Australia in the late 2010s after the implementation of HIV pre-exposure prophylaxis (PrEP). 5,6 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. Medicare is a publicly funded universal healthcare insurance scheme in Australia that provides its beneficiaries with access to a wide range of health and hospital services. It is available to Australian citizens and permanent residents, as well as citizens of countries that have reciprocal health care agreements such as New Zealand, some European countries and the United Kingdom. Individuals without Medicare are charged the full costs of health services including pathology testing and medications. This may serve as a barrier for Medicare-ineligible individuals attempting to access healthcare services in Australia. Given the considerable disparity in health outcomes between Australian-born and recently arrived MSM, this study aimed to compare the demographic characteristics, sexual practices, HIV testing practices and STI diagnoses among MSM accessing a public sexual health service in Melbourne, Australia, to determine if there was evidence of reduced access to healthcare. The sexual health service provides free health care to all individuals regardless of their Medicare status. Methods Study design and population This was a retrospective cross-sectional study using electronic medical records

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

“…53 Given that nurses demonstrated the competencies to provide PrEP, but did not have the prescribing authority to provide PrEP outside of trial conditions, exploring the professional role boundaries in sexual health and PrEP provision services is also warranted. 54 In addressing disparities between different populations acquiring HIV in Australiaparticularly MSM born overseas from Central and South East Asia [35][36][37] a public subsidy of PrEP for all Australian residents (temporary or permanent) would enable equitable financial access to PrEP. This study's findings extend the limited literature on understanding the clinical aspects of providing PrEP in Australia.…”

“…5,19,20 In particular, although PrEP has resulted in a significant reduction in new HIV notifications among Australian-born MSM, 2 overseas-born MSM, especially from Central and South East Asia, account for a growing proportion of new HIV notifications, 34 and may have greater difficulty accessing PrEP due to Medicare ineligibility, and 'cultural and language barriers'. 35,36 Survey research shows that men without Medicare in Australia, particularly those born in Asian countries, are overrepresented among those who are willing to use PrEP, but are not actually using it. 37 The primary focus of PrEP delivery in Australia has been on daily PrEP, although on-demand dosing 38 has been included in guidelines as an option for cisgender MSM since 2018.…”

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

“…This finding is consistent with previous studies that find that promoting free or reduced-cost HIV services among undertested people who have constrained access to healthcare improves their engagement in the HIV cascade ( 23 , 53 – 56 ). In Australia, free HIV testing services are available through state government-funded sexual health centres and community-based health services, regardless of their Medicare status ( 21 , 22 ). Raising awareness among migrants of services that offer free HIV care in Australia may help improve testing uptake.…”

“…With access to Medicare, migrants from RHCA countries have full access to free HIV testing. In comparison, migrants from non-RHCA countries can access free testing through public-funded programmes that are unevenly distributed across Australia or private insurance, which may require reimbursable upfront payments ( 21 , 22 ). Previous studies found that migrants ineligible for subsidised healthcare through RHCA were more likely to be diagnosed with HIV later than those born in Australia or countries covered by the RHCA agreement ( 23 , 24 ).…”

Outcomes in Medicare‐ineligible people living with human immunodeficiency virus in a large healthcare network in Melbourne 2004–2019

“…In the US, initiation and adherence to treatment is limited by financial barriers 13 . Conversely, several countries offer free access to antiretroviral therapies and care related to HIV to all temporary residents, 12 including Sweden – notably the first country to achieve 90–90–90 15 . In the wake of the announcement of free access to ART for all temporary residents, 4 Australia is being given the opportunity to set up better support for PLHIV.…”