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RESEARCH ARTICLE (Open Access)
Contents Vol 21(1)

Hiding in plain sight: highlighting the research gap on access to HIV and other sexual health services for underrepresented gay men in developed Western countries – insights from a scoping review with a focus on Arab men

Bernard Saliba https://orcid.org/0000-0001-8752-4242 A B * , Melissa Kang https://orcid.org/0000-0002-9438-2518 C , Nathanael Wells https://orcid.org/0000-0002-2827-8480 A , Limin Mao https://orcid.org/0000-0003-0995-5789 D , Garrett Prestage https://orcid.org/0000-0003-3917-8992 A and Mohamed A. Hammoud https://orcid.org/0000-0002-7952-7969 A
+ Author Affiliations
- Author Affiliations

A Kirby Institute, UNSW Sydney, Kensington, NSW, Australia.

B School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

C Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.

D Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia.

* Correspondence to: bsaliba@kirby.unsw.edu.au

Handling Editor: Jason Ong

Sexual Health 21, SH23131 https://doi.org/10.1071/SH23131
Submitted: 20 July 2023  Accepted: 30 November 2023  Published: 2 January 2024

© 2024 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

Strategies pertaining to HIV and sexual health for gay, bisexual, and other men who have sex with men (GBMSM) have shifted focus towards underrepresented subgroups within some developed Western countries. Although emerging research exists on some subgroups, limited attention has been given to the needs of Arab GBMSM in these contexts. Considering they are part of a large diaspora, understanding their access to services is crucial. This paper focuses on Arab GBMSM as a case study within a scoping review, highlighting their hidden status within the broader landscape of HIV and sexual health research for GBMSM in the West.

Methods

A multi-method search strategy was employed, including searching four electronic databases using several terms within each of the following search topics: Arab, GBMSM, HIV and other sexual health services, and developed Western countries.

Results

Of the 384 articles found, only one addressed the research question and met the inclusion criteria, revealing a stark scarcity of research on access to HIV and sexual health services for this population.

Conclusions

This review highlights a paucity of research on access to HIV and sexual health services for underrepresented GBMSM populations in developed Western countries. The literature indicates that, for Arab men, this may be due to a difficulty in participant recruitment and poor data collection efforts. By focusing on one hidden population, we aim to advocate for inclusive policies and interventions that promote equitable sexual health access for all. Addressing this research gap aligns with broader local and global HIV strategies to reduce disparities among underrepresented GBMSM populations.

Keywords: Arab, Australia, gay, bisexual, and other men who have sex with men (GBMSM), health access, HIV research, sexual health, sexual minority men, Western countries.

References

1  Kirby T. The Kirby Institute—ending HIV transmission in Australia. Lancet HIV 2022; 9(7): e462.
| Crossref | Google Scholar | PubMed |

2  NSW Ministry of Health. NSW HIV strategy 2021–2025. Health CfP; 2021. Available at https://www.health.nsw.gov.au/endinghiv/Publications/nsw-hiv-strategy-2021-2025.pdf

3  Australian Government, Department of Health. Eighth national EIGHTH HIV strategy. Department of Health; 2018. Available at https://www.health.gov.au/sites/default/files/documents/2022/06/eighth-national-hiv-strategy-2018-2022.pdf

4  Nicholls EJ, Samba P, McCabe L, et al. Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self-Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing. BMC Public Health 2022; 22(1): 809.
| Crossref | Google Scholar |

5  Phillips TR, Medland N, Chow EPF, et al. Newly arrived Asian-born gay men in Australia: exploring men’s HIV knowledge, attitudes, prevention strategies and facilitators toward safer sexual practices. BMC Infect Dis 2022; 22(1): 209.
| Crossref | Google Scholar |

6  Pacheco M, Warfield SK, Hatzistavrakis P, et al. “I don’t see myself represented:” Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services. AIDS Behav 2023; 27(4): 1055-1067.
| Crossref | Google Scholar |

7  Boone CA, Bowleg L. Structuring sexual pleasure: equitable access to biomedical HIV prevention for Black men who have sex with men. Am J Public Health 2020; 110(2): 157-159.
| Crossref | Google Scholar | PubMed |

8  Kobrak P, Ponce R, Zielony R. New arrivals to New York City: vulnerability to HIV among urban migrant young gay men. Arch Sex Behav 2015; 44(7): 2041-2053.
| Crossref | Google Scholar |

9  Phillips TR, Medland N, Chow EPF, et al. “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. PLoS ONE 2020; 15(11): e0242788.
| Crossref | Google Scholar | PubMed |

10  Warren JC, Fernández MI, Harper GW, Hidalgo MA, Jamil OB, Torres RS. Predictors of unprotected sex among young sexually active African American, Hispanic, and White MSM: the importance of ethnicity and culture. AIDS Behav 2008; 12(3): 459-468.
| Crossref | Google Scholar |

11  Gunaratnam P, Heywood AE, McGregor S, et al. HIV diagnoses in migrant populations in Australia—a changing epidemiology. PLoS ONE 2019; 14(2): e0212268.
| Crossref | Google Scholar | PubMed |

12  Medland NA, Chow EPF, Read THR, 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(1): 410.
| Crossref | Google Scholar |

13  The World Bank. Arab World. Available at https://data.worldbank.org/region/arab-world [accessed 02 March 2022]

14  Statistics Canada. Immigration and ethnocultural diversity highlight tables: data tables. Available at https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/imm/Table.cfm?Lang=E&T=41&Geo=00&SP=1&vismin=8&age=1&sex=1 [accessed 03 May 2022]

15  Pew Research Center. Arab-American population growth. Available at https://www.pewresearch.org/journalism/2012/11/28/arabamerican-population-growth/[accessed 05 May 2022]

16  Australian Bureau of Statistics. Data from: cultural diversity: census. Canberra: Australian Bureau of Statistics; 2021. Available at https://www.abs.gov.au/statistics/people/people-and-communities/cultural-diversity-census/latest-release#:~:text=27.6%20per%20cent%20of%20the,Punjabi%20(0.9%20per%20cent)

17  Crumley B. Should France count its minority population? Time; 24 March 2009. Available at http://content.time.com/time/world/article/0,8599,1887106,00.html

18  Statista DE. Anzahl der Ausländer in Deutschland nach Herkunftsland von 2019 bis 2021. Available at https://de.statista.com/statistik/daten/studie/1221/umfrage/anzahl-der-auslaender-in-deutschland-nach-herkunftsland/

19  Tutt Italia. Cittadini Stranieri 2020. Available at https://www.tuttitalia.it/statistiche/cittadini-stranieri-2020/ [accessed 5 March 2022]

20  Alessi EJ, Kahn S, Greenfield B, Woolner L, Manning D. A qualitative exploration of the integration experiences of LGBTQ refugees who fled from the Middle East, North Africa, and Central and South Asia to Austria and the Netherlands. Sex Res Soc Policy 2020; 17(1): 13-26.
| Crossref | Google Scholar |

21  Alessi EJ, Kahn S, Woolner L, Van Der Horn R. Traumatic stress among sexual and gender minority refugees from the Middle East, North Africa, and Asia who fled to the European Union. J Trauma Stress 2018; 31(6): 805-815.
| Crossref | Google Scholar | PubMed |

22  Cense M. Sexual discourses and strategies among minority ethnic youth in the Netherlands. Cult Health Sex 2014; 16(7): 835-849.
| Crossref | Google Scholar |

23  Sanjakdar F. Participatory action research: creating spaces for beginning conversations in sexual health education for young Australian Muslims. Educ Act Res 2009; 17(2): 259-275.
| Crossref | Google Scholar |

24  Abboud S, Naal H, Chahine A, Taha S, Harfouch O, Mahmoud H. “It’s mainly the fear of getting hurt”: experiences of LGBT individuals with the healthcare system in Lebanon. Ann LGBTQ Publ Popul Health 2020; 1(3): 165-185.
| Crossref | Google Scholar |

25  Awada G. Homosexuality legalization in Arab countries: a shifting paradigm or a wake-up call. J Soc Pol Sci 2019; 2(2): 320-332.
| Crossref | Google Scholar |

26  Michli S, Jamil FE. Internalized homonegativity and the challenges of having same-sex desires in the Lebanese context: a study examining risk and protective factors. J Homosex 2022; 69(1): 75-100.
| Crossref | Google Scholar | PubMed |

27  Kteily-Hawa R, Hawa AC, Gogolishvili D, et al. Understanding the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the Middle East and North Africa (MENA) region: a scoping review of the literature. PLoS ONE 2022; 17(1): e0260935.
| Crossref | Google Scholar | PubMed |

28  Ballouz T, Gebara N, Rizk N. HIV-related stigma among health-care workers in the MENA region. Lancet HIV 2020; 7(5): e311-e313.
| Crossref | Google Scholar |

29  Memish ZA, Filemban SM, Bamgboyel A, Al Hakeem RF, Elrashied SM, Al-Tawfiq JA. Knowledge and attitudes of doctors toward people living with HIV/AIDS in Saudi Arabia. J Acquir Immune Defic Syndr 2015; 69(1): 61-67.
| Crossref | Google Scholar | PubMed |

30  Mumtaz GR, Hilmi N, Majed EZ, Abu-Raddad LJ. Characterising HIV/AIDS knowledge and attitudes in the Middle East and North Africa: systematic review and data synthesis. Glob Publ Health 2020; 15(2): 275-298.
| Crossref | Google Scholar |

31  Obermeyer CM. HIV in the Middle East. BMJ 2006; 333(7573): 851-854.
| Crossref | Google Scholar | PubMed |

32  Clark KA, Keene DE, Pachankis JE, Fattal O, Rizk N, Khoshnood K. A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon. Cult Health Sex 2017; 19(9): 996-1010.
| Crossref | Google Scholar |

33  Wagner GJ, Aunon FM, Rana Y, Khouri D, Mokhbat J. Relationship between comfort with and disclosure about sexual orientation on HIV-related risk behaviours and HIV testing among men who have sex with men in Beirut, Lebanon. J Int AIDS Soc 2012; 15(suppl. 3): 188-189.
| Google Scholar |

34  Ikizler AS, Szymanski DM. A qualitative study of Middle Eastern/Arab American sexual minority identity development. J LGBT Issues Couns 2014; 8(2): 206-241.
| Crossref | Google Scholar |

35  Ilkkaracan P. Deconstructing sexuality in the Middle East: challenges and discourses. Taylor & Francis Group; 2016.

36  Wuestenenk N, van Tubergen F, Stark TH. Attitudes towards homosexuality among ethnic majority and minority adolescents in Western Europe: the role of ethnic classroom composition. Int J Intercult Relat 2022; 88: 133-147.
| Crossref | Google Scholar |

37  Smerecnik C, Schaalma H, Gerjo K, Meijer S, Poelman J. An exploratory study of Muslim adolescents’ views on sexuality: implications for sex education and prevention. BMC Public Health 2010; 10(1): 533.
| Crossref | Google Scholar |

38  Shteyman J. Mark Latham slammed for homophobic tweet at fellow MP. AAP General News Wire. 2023. Available at https://www.proquest.com/wire-feeds/mark-latham-slammed-homophobic-tweet-at-fellow-mp/docview/2792202989/se-2?accountid=17095

39  Kassisieh G. ‘We’re family too’: the effects of homophobia in Arabic-speaking communities in New South Wales. ACON; 2011.

40  Targeted News Service. ‘No longer alone’: LGBT voices from Middle East, North Africa. Targeted News Service; 2018. Available at https://www.proquest.com/wire-feeds/no-longer-alone-lgbt-voices-middle-east-north/docview/2025814015/se-2?accountid=17095

41  Boussalem A, Di Feliciantonio C. ‘Like a piece of meat in a pack of wolves’: gay/bisexual men and sexual racialization. Gender Place Cult 2023; 1-18 10.1080/0966369X.2023.2200579.
| Google Scholar |

42  Lessard D, Lebouché B, Engler K, Thomas R. An analysis of socio-demographic and behavioural factors among immigrant MSM in Montreal from an HIV-testing site sample. Can J Hum Sex 2016; 25(1): 53-60.
| Crossref | Google Scholar |

43  Kirby Institute UNSW. HIV in Australia: annual surveillance short report 2018. Kirby Institute UNSW; 2018.

44  Hayek SE, Kassir G, Cherro M, et al. Mental health of LGBTQ individuals who are Arab or of an Arab descent: a systematic review. J Homosex 2023; 70: 2439–2461. 10.1080/00918369.2022.2060624

45  Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018; 18(1): 143.
| Crossref | Google Scholar |

46  Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Int Med 2018; 169(7): 467-473.
| Crossref | Google Scholar | PubMed |

47  Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Method 2005; 8(1): 19-32.
| Crossref | Google Scholar |

48  WESP UN. Country classification – World Economic Situation and Prospects (WESP). WESP UN; 2019.

49  Wong JP-H, Macpherson F, Vahabi M, Li A. Understanding the sexuality and sexual health of Muslim young people in Canada and other Western countries: a scoping review of research literature. Can J Hum Sex 2017; 26: 1 48-59.
| Crossref | Google Scholar |

50  Lessard D, Lebouche B, Engler K, Thomas R, Machouf N. Explaining the appeal for immigrant men who have sex with men of a community-based rapid HIV-testing site in Montreal (Actuel sur Rue). AIDS Care 2015; 27(9): 1098-1103.
| Crossref | Google Scholar |

51  Australian Human Rights Commission. ISMAE report: facts on Arab Australians. National consultations on eliminating prejudice against Arab and Muslim Australians. Australian Human Rights Commission; 2003.

52  Fawaz LT. Merchants and migrants in nineteenth-century Beirut. Harvard University Press; 2013.

53  Harfouch O, German D. The absence of middle Eastern and North African sexual and gender minority Americans from health research. LGBT Health 2018; 5(5): 330-331.
| Crossref | Google Scholar | PubMed |

54  Sweileh WM. Global research output in the health of international Arab migrants (1988–2017). BMC Public Health 2018; 18(1): 755.
| Crossref | Google Scholar |

55  Shawky S, Soliman C, Kassak KM, Oraby D, El-Khoury D, Kabore I. HIV surveillance and epidemic profile in the Middle East and North Africa. J Acquir Immune Defic Syndr 2009; 51: S83-S95.
| Crossref | Google Scholar |

56  Evans AR, Hart GJ, Mole R, et al. Central and East European migrant men who have sex with men in London: a comparison of recruitment methods. BMC Med Res Methodol 2011; 11(1): 69.
| Crossref | Google Scholar |

57  Naber N. Chicagoland study shows why we need a MENA category in The U.S. Census. Chicago Reporter. Available at https://www.chicagoreporter.com/chicagoland-study-shows-why-we-need-a-mena-category-in-the-u-s-census/

58  Awad GH, Hashem H, Nguyen H. Identity and ethnic/racial self-labeling among Americans of Arab or Middle Eastern and North African Descent. Identity 2021; 21(2): 115-130.
| Crossref | Google Scholar |

59  Ajrouch KJ, Jamal A. Assimilating to a white identity: the case of Arab Americans. Int Migr Rev 2007; 41(4): 860-879.
| Crossref | Google Scholar |

60  Chaney MP, Dubaybo F, Chang CY. Affirmative counseling with LGBTQ+ Arab Americans. J Ment Health Couns 2020; 42(4): 281-302.
| Crossref | Google Scholar |