Experiences of recently HIV-diagnosed gay and bisexual migrants in Australia: Implications for sexual health programmes and health promotion.

Gay and bisexual migrants from low- and middle-income countries living in high-income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV-negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi-structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non-permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV-diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high-HIV caseload sexual health clinicians provide confidential and comprehensive care.

'Make a move' falls prevention project: an area health service collaboration.

ISSUE ADDRESSED: Since a lack of physical activity is a risk factor for falling, effective interventions to increase participation rates among older people need to be found. This project assessed the viability of a metropolitan Area Health Service collaboration to increase physical activity rates among older people. METHODS: A collaboration involving six Area Health Services in the Sydney metropolitan area, central coast of New South Wales (NSW), and NSW Department of Health was established. Interventions included a communication strategy to raise awareness of the benefits of physical activity for preventing falls and enhancement of local physical activity programs for older people. A repeated measures cross-sectional design was used to assess increases in physical activity programs and older people's participation, and data of fall-related hospital admissions were examined. Annual activity logs were completed to track local project activities. Semi-structured interviews with key stakeholders and workshops were used to review the collaborative management model. RESULTS: Response to the communication strategy and gains in physical activity programs for older people varied among Area Health Services. Overall, approximately 2,929 people called the campaign inquiry hotlines in response to the media campaign, Area Health Service-supported exercise programs for older people increased by 19%, participation rates increased by 16%, and fall-related hospital admissions were observed to plateau. The collaborative management model used was somewhat effective, but had difficulties for the issue being addressed. CONCLUSION: 'Make a Move' added value to local physical activity programs for older people and increased the number of older people participating in Area Health Service-supported exercise programs. Collaborative projects are worthwhile if they address the right issue, involve the right partners and have sound management processes.