“It was protected, except, it wasn’t [with] a condom": a mixed-methods study of BBVs/STIs protective practices among International University Students in Sydney, Australia

Abstract

Background A number of previous sex-related studies among international students in Australia and other Western societies may be limited by conflating students from conservative and non-conservative sexual backgrounds. Such conflation leads to situations where nuances and complexities around sex-related experiences are lost or, at most, tangentially investigated. To address this research problem, this study used a mixed-methods design to examine protective practices against blood-borne viruses and sexually transmissible infections (BBVs/STIs) among Sydney-based East Asian and sub-Saharan African international students. Methods This mixed-methods study generated quantitative data using anonymous online survey (n = 149), and qualitative data through in-depth interviews (n = 20). The main recruitment strategy involved advertising the study through paper and electronic flyers. Quantitative data were analysed using logistic regression, while interviews data were analysed using reflexive thematic analysis. Results Self-reported BBVs/STIs protective practices in the last 12 months include abstinence (28.7%), consistent condom use (19.9%), occasional condom use (18.7%), single partner fidelity (25.1%), other strategies (1.8%), and nothing (5.8%). Further, findings from the bivariate analysis showed higher BBVs/STIs prevention knowledge, lower acculturation into Australian sexual culture, greater access to sexual health information, less conservative sexual norms, greater emotional social support and older age were significantly associated with increased protective practices. Variables significant at bivariate level were entered into a logistic regression. The model was statistically significant, (X2(6) = 31.33, p < 0.01) and explained 33.1% of the variance in BBVs/STIs protective practices. However, only acculturation to sexual norms in Australia (OR = 0.883, 95% CI = 0.820–0.952) was found to be independent predictor of BBVs/STIs protective practices. The results of the study based on the quantitative data, indicated condom use (consistent and occasional) was the most reported BBVs/STIs protective behaviour among sexually active participants. Therefore, interviews data was used to explore condom-use motives and practices. The interviews results showed participants primary concern as regards condom use was around pregnancy and not BBVs/STIs. Thus, some participants described safe sex largely as contraception, with BBVs/STIs constituting a secondary concern or no concern at all. Conclusions Based on the results of this study, tailored sexual health interventions for international students; which incorporate strategies for modifying perceived sexual norms in Australia, are advocated. In addition, this study recommends sexual health interventions that promote dual protection of condoms for both contraception and BBVs/STIs.

“We are studying abroad and need to protect ourselves first”: A mixed-methods study of attitudes towards hepatitis B among university students in Australia of Chinese and Vietnamese background

“…Given that there is a high prevalence of hepatitis B among Vietnamese and Chinese people generally, and fairly large Chinese and Vietnamese communities in Australia 4,46 , it is important to understand how these communities think about hepatitis B because attitudes may in uence access to and engagement in testing and care 31 . As these communities may be hard to access, due to barriers such as language and communication, racism and discrimination, migrant status and cultural difference [47][48][49][50] , one way to reach them is via the university or tertiary student body.…”

“…Literature on the intersection between stigma and racism has further highlighted negative community perceptions, attitudes, and behaviours towards people of migrant backgrounds based on their race, language, and cultural dissimilarities [25][26][27] . However, these situations are not limited to social situations, with extensive research illustrating that stigma acts as a barrier to healthcare and may result in unequal access to health services with stigmatised individuals experiencing judgemental or hostile interactions in health services [28][29][30][31] . Further, racism reported in healthcare services towards migrant populations often takes the form of reduced cultural competency among healthcare providers [32][33][34][35][36] , as seen by misuse or overuse of translators 37 , healthcare workers who are insensitive to the culture and race of clients 32 , and negative attitudes from healthcare workers based on culture or race 36 .…”

‘People Like Us Would Have No Clue If the Information Is Online’: Exploring Understanding and Sources of Hepatitis B Information Among Vietnamese Australians

“…Stigma can also act as a barrier to healthcare access [10,[13][14][15]. People of CALD backgrounds may face additional issues-such as adapting to a new country, understanding the health system, racism, language barriers, history of trauma, family conflict, disengagement from services and mainstream society, low socio-economic status, unemployment, and insecure living arrangements-impacting willingness and ability to access health care, testing, treatment, and prevention care [16,17]. Generally, healthcare access issues experienced by people of CALD backgrounds in high-income countries are largely related to social exclusion resulting from structural barriers, stigma, and discrimination [17][18][19].…”

“…People of CALD backgrounds may face additional issues-such as adapting to a new country, understanding the health system, racism, language barriers, history of trauma, family conflict, disengagement from services and mainstream society, low socio-economic status, unemployment, and insecure living arrangements-impacting willingness and ability to access health care, testing, treatment, and prevention care [16,17]. Generally, healthcare access issues experienced by people of CALD backgrounds in high-income countries are largely related to social exclusion resulting from structural barriers, stigma, and discrimination [17][18][19]. Barriers to healthcare faced by people of CALD backgrounds, particularly accessibility and affordability, are often further compounded by fears that a positive blood-borne virus diagnosis may lead to visa cancellation or refusal of a visa in future [20,21].…”