Sexual healthcare to meet the needs of sexuality and gender diverse aboriginal young people: imagined possibilities.

In Australia, Aboriginal young people who are lesbian, gay, bisexual, trans, queer or otherwise sexuality and gender diverse (LGBTQ+) are recognised within several overlapping priority populations in state and federal sexually transmissible infection and HIV strategies. However, limited research has documented their unique sexual health experiences, needs and preferences. In this qualitative study, semi-structured interviews were conducted with 10 LGBTQ+ Aboriginal young people aged 16-24 years in New South Wales. Interviews incorporated questions about service access, positive and negative experiences and self-determined healthcare priorities. We conducted a strengths-based thematic analysis to understand the issues of greatest importance in sexual healthcare for participants. Using the framework of 'imaginaries', we explored how participants imagined sexual healthcare that would meet their individual and cultural needs. The dominant imaginary centred on respect, representation and the as-yet-unrealised possibility of sexual healthcare designed by and for people who shared the intersection of Aboriginal and LGBTQ+ experience. We identified individual-level, service-level and societal-level factors influencing this imaginary, including relationships, accessibility and experiences of racism. Analysing the imaginaries constructed by LGBTQ+ Aboriginal young people of empowering, culturally safe sexual healthcare that is 'for them' provides insight into potential service design to improve sexual health outcomes for this population.

Yarning as a method for building sexual wellbeing among urban Aboriginal young people in Australia.

This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. It does so to counter the risk-focussed narratives present in much existing research and to showcase the resourcefulness of Aboriginal young people. We used peer-interview methods to collect qualitative data from 52 Aboriginal young people living in western Sydney, Australia. Participants reported a strong desire to stay safe and healthy in their sexual relationships and to achieve this they relied heavily on oral communication and yarning strategies. Participants viewed communication as a way to gain or give advice (about bodies, infections, pregnancy, relationships); to assess the acceptability and safety of potential partners; to negotiate consent with partners; to build positive relationships; and to get themselves out of unhealthy relationships. Participants also discussed 'self-talk' as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people's positive views of self and as deserving of respectful and safe sexual relationships. These findings suggest that future programmes and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy Aboriginal young people already use to build positive relationships and identities.

Beyond deficit: 'strengths-based approaches' in Indigenous health research.

Health research concerning Indigenous peoples has been strongly characterised by deficit discourse-a 'mode of thinking' that is overly focused on risk behaviours and problems. Strengths-based approaches offer a different perspective by promoting a set of values that recognise the capacities and capabilities of Indigenous peoples. In this article, we seek to understand the conceptual basis of strengths-based approaches as currently presented in health research. We propose that three main approaches exist: 'resilience' approaches concerned with the personal skills of individuals; 'social-ecological' approaches, which focus on the individual, community and structural aspects of a person's environment; and 'sociocultural' approaches, which view 'strengths' as social relations, collective identities and practices. We suggest that neither 'resilience' nor 'social-ecological' approaches sufficiently problematise deficit discourse because they remain largely informed by Western concepts of individualised rationality and, as a result, rest on logics that support notions of absence and deficit. In contrast, sociocultural approaches tend to view 'strengths' not as qualities possessed by individuals, but as the structure and character of social relations, collective practices and identities. As such, they are better able to capture Indigenous ways of knowing and being and provide a stronger basis on which to build meaningful interventions.

Working with Aboriginal young people in sexual health research: a peer research methodology in remote Australia.

In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done "on" rather than "with" or "by" them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involving Aboriginal young people as researchers, advisors, and participants in a qualitative sexual health study in one remote setting in the Northern Territory, Australia. We document the methodology, while critically reflecting on its benefits and limitations as a decolonizing method. Findings confirm the importance of enabling Aboriginal young people to play a central role in research with other young people about their own sexual health. Future priorities include developing more enduring forms of coinvestigation with Aboriginal young people beyond data collection during single studies, and support for young researchers to gain formal qualifications to enhance future employability.

Playing Recognition Politics: Queer Theoretical Reflections on Lesbian, Gay, and Queer Youth Social Policy in Australia in the 1980s and 1990s.

This article provides a queer theoretical reflection on the emergence of lesbian, gay, and queer (LGQ) youth as subjects of policy attention in Australia in the late twentieth century. In particular, it focuses on the ways in which specific forms of social, bureaucratic, and organizational recognition have given shape to LGQ youth as categorical policy objects. To this end, this article critically interrogates social policy related to the provision of funding for LGQ youth support during the 1980s and 1990s in two Australian states: New South Wales and Western Australia. More specifically, it focuses on some of the ways in which LGQ youth have been discursively shaped and materially supported in three different organizations, two of which continue to be strongly associated with support of LGQ youth in Australia. This study of the emergence of these organizations, resourced by three different sectors-the state, the church, and the LGQ community itself-necessarily draws on ephemeral resources, reflecting the conditions of possibility in which this work was being enacted. We conclude with an analysis of the necessity for situating policy recognitions within specific contexts to examine the implications for LGQ youth as the subjects such recognitions simultaneously seek to constitute and serve.

Young Aboriginal people's engagement with STI testing in the Northern Territory, Australia.

BACKGROUND: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15-29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people's engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. METHODS: In-depth interviews with 35 young Aboriginal men and women aged 16-21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. RESULTS: Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. CONCLUSIONS: This is the first socio-ecological analysis of factors influencing young Aboriginal people's willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people's lived sexual health experiences and family- and community-based health promotion practices.

Practical justice as an innovative approach to addressing inequalities facing gender and sexually diverse people: a case example from Papua New Guinea.

Cultural values and practices influence many aspects of sexual and reproductive health and rights - from access to and quality of health education and services, to gender roles and responsibilities, to family planning and sexual freedoms. Culture is frequently marginalised in epidemiologically driven analyses of sexual and reproductive health and rights yet remains central to the ways in which inequalities within these fields manifest themselves and are engaged with in society. Using Papua New Guinea (PNG) as a case example, this paper sheds light on the enabling and restrictive role of culture in efforts to work towards equity and justice for gender and sexually diverse people. Drawing on four case stories, we offer insight into where culture can and has been deployed to redress serious inequalities in what is often a hostile environment. In these stories we illustrate how practical justice provides an innovative way to approach issues to do with sexual and reproductive health, particularly as they relate to enhancing the lives of people in visible, grassroots ways. In this way, given evidence, good normative judgement and the opportunity to do good and be fair, practical justice may be seen to be taking place.

The myth of LGBTQ mobilities: framing the lives of gender- and sexually diverse Australians between regional and urban contexts.

Gender- and sexually diverse youth are often represented in popular discourses through concepts of movement and mobility. Conceptual stories of LGBTQ youth transitions to adulthood in particular are marked by narratives of movement from regional (rural and/or small towns) to major urban areas. Although not wholly outside lived experience, a cultural myth that portrays the experience of gender- and sexually diverse young people entering into 'adulthood' via such mobility continues to circulate in scholarship, popular media, personal accounts of coming out, support resources and self-help guidance documents. This paper draws on a recent study of gender and sexual diversity, support and belonging to examine instances of LGBTQ youth mobility in relation to participant interviews and focus groups undertaken in an Australian project examining two generations of sexually diverse subjects' views on growing up, support and belonging. Participants differed generationally in how they experienced mobility from regional to urban settings, demonstrating that contemporary real-world accounts of such mobility are complex, nuanced and diverse and that the felt 'expectation' that one should migrate to a city in order to live a full gender- or sexually diverse life has waned among young people in the more recent generation.

Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia.

Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives. METHODS: In-depth interviews with 35 young Aboriginal women and men aged 16-21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted. RESULTS: Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms. CONCLUSION: Findings broaden understanding of young Aboriginal people's sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people's existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people's sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as 'youth health workers'.

Accessing HIV treatment and care services in fishing communities around Lake Victoria in Uganda: mobility and transport challenges.

Qualitative research exploring the influence of community-level factors on access to and use of HIV treatment and care services among people living in fishing communities is limited, especially with respect to those already in receipt of HIV care and on treatment. To enhance understanding of these issues, semi-structured in-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers from two HIV clinics located in two fishing communities in Uganda. Fisherfolk's mobility and poor transport systems were significant barriers to access to and use of HIV treatment and care. Mobility, which involved regular movement between communities, sometimes led to fisherfolk's inability to access HIV treatment and care. A poor transport system in fishing communities - characterised by irregular transport services and boats in a poor condition - was reported to force both fisherfolk and health care providers sometimes to cancel journeys to centres providing treatment and support. Community-level factors such as these, which relate to the organisation and provision of transport in local community settings, are significant influences on access to HIV treatment and care. Interventions that address these challenges are needed to improve access to and use of HIV treatment and care in fishing communities.

Multiple strategies are required to address the information and support needs of gay and bisexual men with hepatitis C in Australia.

BACKGROUND: Hepatitis C virus (HCV) infection is increasingly reported among gay and bisexual men. However, little is known about the personal and social dimensions of HCV-related experience among these men in Australia. METHODS: An online survey of 474 Australian gay and bisexual men was conducted from August to December 2013. A subsample of 48 HCV mono-infected and HIV/HCV co-infected men was analysed to explore HCV knowledge, sources of information, unmet information needs and use of HCV-related services. RESULTS: More than half of respondents in the subsample were unaware that HIV infection increases the risk of sexually acquired HCV and most wanted information about how to prevent the sexual transmission of HCV. A majority of respondents requested gay-specific HCV services, and approximately similar proportions of men indicated that they would like these services delivered by a hepatitis organization, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization and a HIV organization. Men in receipt of HIV antiretroviral treatments were most likely to request that gay-specific HCV information and support services be delivered by a LGBTI or HIV organization (OR = 8.63). CONCLUSION: These findings suggest that a variety of organizations are required to address the information and support needs of Australian gay and bisexual men with HCV.

Moving Beyond Biomedicalization in the HIV Response: Implications for Community Involvement and Community Leadership Among Men Who Have Sex with Men and Transgender People.

As the world enjoys the promise of biomedical advances against HIV, numerous challenges remain. Some of these are connected to politics, others are connected to resource constraints. Other barriers are linked to the need to ensure that the concepts used to think about HIV remain current. Terms such as "MSM" (men who have sex with men) and "community" require critical interrogation at a moment when their political origins seem forgotten. Likewise, struggles between groups most affected by HIV and scientists and policymakers (an enduring feature of the epidemic) remain a key aspect of the response. The dangers of co-option and distraction remain real. In this context, it is vital to promote community ownership, political commitment, solidarity, and respect for differences, not as competing values, but as part of the ultimate solution to HIV.

Same-sex practicing men in Tanzania from 1860 to 2010.

This article offers a review of published texts describing sexual relations between men in Tanzania in the period 1860-2010. It explores ways in which men who have sex with men have been named and understood; describes the sexual and social roles associated with differing same-sex identities and subjectivities; tracks politics, policies, and sociocultural expressions relating to sex between men; and explores the ways in which men's same-sex sexual practices have been responded to in the context of health and HIV. Among the impressions emerging from the historical record is that sex between men is not (and has not been) uncommon in Tanzania; that a significant conceptual distinction exists between men who are anally receptive and men who penetrate anally; and that there has been a range of views on, and opinions about, same-sex relations within the wider society. There is evidence that same-sex practicing men in Tanzania have been affected by HIV at least since 1982, with one seroprevalence study indicating that the burden of HIV among men who have sex with men was quite disproportionate as far back as 2007. However, while men who have sex with men have been defined as a "vulnerable population" with respect to HIV in national frameworks since 2003, this had not led to any significant amount of targeted HIV prevention work being reported by either local or international actors by 2010.

Between individual agency and structure in HIV prevention: understanding the middle ground of social practice.

When HIV prevention targets risk and vulnerability, it focuses on individual agency and social structures, ignoring the centrality of community in effective HIV prevention. The neoliberal concept of risk assumes individuals are rational agents who act on information provided to them regarding HIV transmission. This individualistic framework does not recognize the communities in which people act and connect. The concept of vulnerability on the other hand acknowledges the social world, but mainly as social barriers that make it difficult for individuals to act. Neither approach to HIV prevention offers understanding of community practices or collective agency, both central to success in HIV prevention to date. Drawing on examples of the social transformation achieved by community action in Australia and Brazil, this article focuses on this middle ground and its role in effective HIV prevention.

Aboriginal young people's perspectives and experiences of accessing sexual health services and sex education in Australia: A qualitative study.

Aboriginal and Torres Strait Islander (Aboriginal) young people seek information and access health services for their sexual health needs. This study examined Aboriginal young people's perspectives on sexual health services and sex education in Australia. Overall, 51 Aboriginal people aged 16-26 years were interviewed by peer researchers in Sydney, Australia in 2019-2020. The findings suggest that the internet was used to assess information quickly and confidentially, but Aboriginal young people questioned its reliability and accuracy. Family, Elders and peers were seen as sources of advice because they had real-life experience and highlighted intergenerational learning that occurs in Aboriginal communities. School-based sex education programmes had mixed reviews, with a preference for programmes delivered by external specialists providing anonymity, clear and accurate information about sex and relationships and positive approaches to sex education, including how to gain consent before sex. There was a need identified for school-based programmes to better consider the needs of Aboriginal young people, including those who identified as LGBTQI + . Aboriginal Medical Services were highly valued for providing culturally safe access to services, while sexual health clinics were valued for providing specialised confidential clinical services with low levels of judgement.

Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam.

Based on research in Tanzania, this paper critically examines the widely circulating notion that African same-sex attracted men are hard-to-reach individuals and populations. Despite expectations to the contrary, it was neither time consuming nor difficult to identify and get to know same-sex attracted men in Dar es Salaam. On the contrary, a large and diverse group of such men could readily be encountered, befriended and involved in HIV-related research. The fieldwork was characterised by communicative openness and the researcher was treated with immense kindliness, hospitality and inclusivity. While we may not be in a position to say that the situation is identical everywhere else, we find reason to caution against accepting and propagating unexplained, unexamined and unverified claims to the effect that same-sex attracted men in Africa cannot be reached. We argue that such claims contribute to stigmatise same-sex attracted men and to hinder much-needed HIV-related research and programming.