Domestic mobility and experiences of disconnection from sexual health care among gay and bisexual men in Australia: insights from a qualitative study
Dean Murphy
A * , Steven Philpot A , Graham Brown B and Garrett Prestage A
+ Author Affiliations
- Author Affiliations
A The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.
B Centre for Social Impact, UNSW Sydney, Sydney, NSW 2052, Australia.
Sexual Health 18(6) 508-511 https://doi.org/10.1071/SH21191
Submitted: 29 September 2021 Accepted: 27 October 2021 Published: 17 December 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Previous research on mobility and HIV acquisition among gay and bisexual men (GBM) has focused on: (1) changed sexual practices in the context of travel; and (2) the association between migration and increased HIV risk. To date, little attention has been given to continuity of sexual health and HIV-prevention services in the context of relocating between different cities or regions within the same country.
Methods: Drawing on in-depth interviews with 17 GBM recently diagnosed with HIV, we explored these men’s access to sexual health care in the period prior to diagnosis.
Results: At least five of these 17 men’s accounts provided examples of becoming disconnected from sexual health care because of mobility within Australia. For some men, this disconnection from care also included loss of access to pre-exposure prophylaxis (PrEP). In all these men’s accounts, reconnection with services only came about at the time of seeking the HIV test associated with their diagnosis. The fact that men who had previously been well connected to sexual health services (as indicated by early uptake of PrEP, or regular HIV/STI testing) did not easily access similar services after relocating suggest that there are other factors – such as the social and physical environment – that have an important bearing on retention in sexual health care.
Conclusions: There is a need for more comprehensive data collection related to mobility in order to ascertain its relative importance. Regarding policy and practice, there are also opportunities for a more formalised process for interstate referral of clients of sexual health services.
Keywords: Australasia, gay and bisexual men, health care retention, HIV/AIDS, HIV testing, migrant and mobile populations, pre-exposure prophylaxis, sexual health care.
References
[1] Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large national sample of U.S. men who have sex with men (MSM). AIDS Behav 2016; 20 1400–7.| Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large national sample of U.S. men who have sex with men (MSM).Crossref | GoogleScholarGoogle Scholar | 26538056PubMed |
[2] Van den Berghe W, Nöstlinger C, Hospers H, Laga M. International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium. BMC Public Health 2013; 13 968
| International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium.Crossref | GoogleScholarGoogle Scholar |
[3] Kaufman MR, Fuhrel-Forbis AR, Kalichman SC, Eaton LA, Cain D, Cherry C, et al. On holiday: a risk behavior profile for men who have vacationed at gay resorts. J Homosex 2009; 56 1134–44.
| On holiday: a risk behavior profile for men who have vacationed at gay resorts.Crossref | GoogleScholarGoogle Scholar | 19882431PubMed |
[4] Lee VC, Sullivan PS, Baral SD. Global travel and HIV/STI epidemics among men who have sex with men: what does the future hold? Sex Health 2017; 14 51–8.
| Global travel and HIV/STI epidemics among men who have sex with men: what does the future hold?Crossref | GoogleScholarGoogle Scholar | 28055822PubMed |
[5] Benotsch EG, Martin AM, Espil FM, Nettles CD, Seal DW, Pinkerton SD. Internet use, recreational travel, and HIV risk behaviors in men who have sex with men. J Community Health 2011; 36 398–405.
| Internet use, recreational travel, and HIV risk behaviors in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20924778PubMed |
[6] Brown G, Prestage G, Down I, Ellard J, Triffitt K. Not so different? comparison of risk profile of gay men who acquired HIV while travelling with those who acquired HIV in Australia. Health Promot J Austr 2018; 29 58–64.
| Not so different? comparison of risk profile of gay men who acquired HIV while travelling with those who acquired HIV in Australia.Crossref | GoogleScholarGoogle Scholar | 29700942PubMed |
[7] Alvarez-del Arco D, Fakoya I, Thomadakis C, Pantazis N, Touloumi G, Gennotte AF, et al. High levels of postmigration HIV acquisition within nine European countries. AIDS 2017; 31 1979–88.
| High levels of postmigration HIV acquisition within nine European countries.Crossref | GoogleScholarGoogle Scholar | 28857779PubMed |
[8] Taylor TN, DeHovitz J, Hirshfield S. Intersectional stigma and multi-level barriers to HIV testing among foreign-born black men from the Caribbean. Front Public Health 2020; 7 373
| Intersectional stigma and multi-level barriers to HIV testing among foreign-born black men from the Caribbean.Crossref | GoogleScholarGoogle Scholar | 31998675PubMed |
[9] Wiewel EW, Torian LV, Hanna DB, Bocour A, Shepard CW. Foreign-born persons diagnosed with HIV: where are they from and where were they infected? AIDS Behav 2015; 19 890–8.
| Foreign-born persons diagnosed with HIV: where are they from and where were they infected?Crossref | GoogleScholarGoogle Scholar | 25524308PubMed |
[10] Pachankis JE, Hatzenbuehler ML, Berg RC, Fernández-Dávila P, Mirandola M, Marcus U, et al. Anti-LGBT and anti-immigrant structural stigma: an intersectional analysis of sexual minority men’s HIV risk when migrating to or within europe. J Acquir Immune Defic Syndr 2017; 76 356–66.
| Anti-LGBT and anti-immigrant structural stigma: an intersectional analysis of sexual minority men’s HIV risk when migrating to or within europe.Crossref | GoogleScholarGoogle Scholar | 28787329PubMed |
[11] Lewis NM, Wilson K. HIV risk behaviours among immigrant and ethnic minority gay and bisexual men in North America and Europe: a systematic review. Soc Sci Med 2017; 179 115–28.
| HIV risk behaviours among immigrant and ethnic minority gay and bisexual men in North America and Europe: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28260636PubMed |
[12] Medland NA, Chow EPF, Read THR, Ong JJ, Chen M, Denham I, et al. Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013–2017) but not in the newly-arrived Asian-born. BMC Infect Dis 2018; 18 410
| Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013–2017) but not in the newly-arrived Asian-born.Crossref | GoogleScholarGoogle Scholar | 30126355PubMed |
[13] Buttram ME, Kurtz SP. Risk and protective factors associated with gay neighborhood residence. Am J Mens Health 2013; 7 110–8.
| Risk and protective factors associated with gay neighborhood residence.Crossref | GoogleScholarGoogle Scholar | 22948299PubMed |
[14] Egan JE, Frye V, Kurtz SP, Latkin C, Chen M, Tobin K, et al. Migration, neighborhoods, and networks: approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men. AIDS Behav 2011; 15 35–50.
| Migration, neighborhoods, and networks: approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[15] Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Sage Publications, Inc; 1998.
[16] The Kirby Institute. Monitoring HIV pre-exposure prophylaxis uptake in Australia (Issue #1, June 2019). The Kirby Institute, UNSW Sydney; 2019.
[17] Callander D, Mooney-Somers J, Keen P, Guy R, Duck T, Bavinton BR, et al. Australian ‘gayborhoods’ and ‘lesborhoods’: a new method for estimating the number and prevalence of adult gay men and lesbian women living in each Australian postcode. Int J Geogr Inf Syst 2020; 34 2160–76.
| Australian ‘gayborhoods’ and ‘lesborhoods’: a new method for estimating the number and prevalence of adult gay men and lesbian women living in each Australian postcode.Crossref | GoogleScholarGoogle Scholar |
[18] Whitfield THF, John SA, Rendina HJ, Grov C, Parsons JT. Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behav 2018; 22 3566–75.
| Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 29404756PubMed |
[19] Kubicek K, Beyer WJ, Wong CF, Kipke MD. Engaging young men in the HIV prevention and care continua: experiences from young men of color who have sex with men. AIDS Educ Prev 2019; 31 325–43.
| Engaging young men in the HIV prevention and care continua: experiences from young men of color who have sex with men.Crossref | GoogleScholarGoogle Scholar | 31361519PubMed |
[20] Spinelli MA, Laborde N, Kinley P, Whitacre R, Scott HM, Walker N, et al. Missed opportunities to prevent HIV infections among pre-exposure prophylaxis users: a population-based mixed methods study, San Francisco, United States. J Int AIDS Soc 2020; 23 e25472
| Missed opportunities to prevent HIV infections among pre-exposure prophylaxis users: a population-based mixed methods study, San Francisco, United States.Crossref | GoogleScholarGoogle Scholar | 32294338PubMed |
[21] Blashill AJ, Brady JP, Rooney BM, Rodriguez-Diaz CE, Horvath KJ, Blumenthal J, et al. Syndemics and the PrEP cascade: results from a sample of young Latino men who have sex with men. Arch Sex Behav 2020; 49 125–35.
| Syndemics and the PrEP cascade: results from a sample of young Latino men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 31591666PubMed |
[22] Holt M, Lee E, Lea T, Bavinton B, Broady T, Mao L, et al. HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018. J Acquir Immune Defic Syndr 2020; 83 e16–22.
| HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018.Crossref | GoogleScholarGoogle Scholar | 31913993PubMed |
[23] Newman PA, Guta A, Lacombe-Duncan A, Tepjan S. Clinical exigencies, psychosocial realities: negotiating HIV pre-exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada. J Int AIDS Soc 2018; 21 e25211
| Clinical exigencies, psychosocial realities: negotiating HIV pre-exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada.Crossref | GoogleScholarGoogle Scholar | 30474351PubMed |
[24] Pathela P, Jamison K, Blank S, Daskalakis D, Hedberg T, Borges C. The HIV pre-exposure prophylaxis (PrEP) cascade at NYC sexual health clinics: navigation is the key to uptake. J Acquir Immune Defic Syndr 2020; 83 357–64.
| The HIV pre-exposure prophylaxis (PrEP) cascade at NYC sexual health clinics: navigation is the key to uptake.Crossref | GoogleScholarGoogle Scholar | 31904700PubMed |
[25] Frye V, Latka MH, Koblin B, Halkitis PN, Putnam S, Galea S, et al. The urban environment and sexual risk behavior among men who have sex with men. J Urban Health 2006; 83 308–24.
| The urban environment and sexual risk behavior among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 16736379PubMed |
[26] Kelly BC, Carpiano RM, Easterbrook A, Parsons JT. Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men. Soc Health Illn 2012; 34 1085–102.
| Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men.Crossref | GoogleScholarGoogle Scholar |
[27] Koblin BA, Egan JE, Rundle A, Quinn J, Tieu H-V, Cerdá M, et al. Methods to measure the impact of home, social, and sexual neighborhoods of urban gay, bisexual, and other men who have sex with men. PLoS ONE 2013; 8 e75878
| Methods to measure the impact of home, social, and sexual neighborhoods of urban gay, bisexual, and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 24146785PubMed |
[28] Cassels S, Meltzer D, Loustalot C, Ragsdale A, Shoptaw S, Gorbach PM. Geographic mobility, place attachment, and the changing geography of sex among African American and Latinx MSM who use substances in Los Angeles. J Urban Health 2020; 97 609–22.
| Geographic mobility, place attachment, and the changing geography of sex among African American and Latinx MSM who use substances in Los Angeles.Crossref | GoogleScholarGoogle Scholar | 32996024PubMed |
[29] Ghaziani A. Why gayborhoods matter: the street empirics of urban sexualities. In: Bitterman A, Hess DB, editors. The life and afterlife of gay neighborhoods renaissance and resurgence. Springer; 2020. pp. 87–113.
[30] Hermanstyne KA, Green HD, Cook R, Tieu H-V, Dyer TV, Hucks-Ortiz C, et al. Social network support and decreased risk of seroconversion in black MSM: results of the BROTHERS (HPTN 061) study. J Acquir Immune Defic Syndr 2018; 78 163–8.
| Social network support and decreased risk of seroconversion in black MSM: results of the BROTHERS (HPTN 061) study.Crossref | GoogleScholarGoogle Scholar | 29424789PubMed |
[31] Grulich A, Nigro S, Chan C, Patel P, Bavinton B, Holt M, et al. Trends in HIV and HIV prevention indicators in gay, bisexual and other men who have sex with men in NSW, 2015–2019: implications for new interventions and for monitoring and evaluation in a new NSW HIV strategy. Kirby Institute, UNSW Sydney; 2020.
