Understanding the role of law and culture in Aboriginal and/or Torres Strait Islander communities in responding to and preventing family violence

ANROWS, 2020

Family violence within Aboriginal and Torres Strait Islander communities attracts considerable attention in policy, research and practice.

Many Aboriginal and Torres Strait Islander peoples have advocated for community-led approaches to family violence that are culturally safe, involve Aboriginal or Torres Strait Islander justice models and recognise Aboriginal or Torres Strait Islander Law and Culture.

This project used a strengths-based approach to explore the role that Aboriginal and Torres Strait Islander Law and Culture plays in prevention, intervention and healing in Aboriginal and Torres Strait Islander family violence, and how this can be supported. The project was grounded in an understanding of family violence as shaped by the impacts of colonisation.

The research was undertaken in partnership with Aboriginal and Torres Strait Islander place-based programs in six sites: the Kimberley (two sites) and the Pilbara (Western Australia), the Tiwi Islands and Darwin (Northern Territory), and Mornington Island (Queensland).

The final report emphasises the need for improved understandings within mainstream systems and services of the nature of Aboriginal and Torres Strait Islander family obligations and interconnections, as well as acknowledgement of the link between violence and issues that stem from colonisation, such as alcohol misuse and intergenerational trauma. It recommends a greater focus on prevention, healing and diversions from the criminal legal system; the involvement of both men and women in the design and implementation of local family violence strategies; and interventions that worked at the family, rather than individual, level.

Impact of COVID-19 on Migrant and Refugee Women and Children Experiencing DFV

Women’s Safety NSW, Published: July 31, 2020

Whilst research on the prevalence of violence against migrant and refugee women is limited, what is known is that cultural, language and systemic barriers serve to reduce access to safety and support for this group of women, and they are at higher risk of domestic homicide. (AIC 2020)

This also corresponds with lower rates of reporting amongst migrant and refugee women experiencing domestic and family violence, as distrust for authorities, limited knowledge of rights and services and concerns about both material and cultural ramifications can serve as insurmountable barriers to accessing the supports needed. (AIFS 2018)

What has not yet been investigated is the specific impact of COVID-19 on migrant and refugee women experiencing domestic and family violence. This report from Women’s Safety NSW offers the experiences and professional observations of multicultural domestic and family violence specialists supporting hundreds of these very women at this critical time. What they’ve reported is that migrant and refugee women who are experiencing domestic and family violence are at higher risk than they have ever been before and that urgent action is needed if we are going to save lives.

Rapid HIV testing increases testing frequency among gay and bisexual men: a controlled before–after study

Sexual Health – https://doi.org/10.1071/SH18161

Keen Phillip, Jamil Muhammad, Callander Denton, Conway Damian P., McNulty Anna, Davies Stephen C., Couldwell Deborah C., Smith Don E., Holt Martin, Vaccher Stefanie J., Gray James, Cunningham Philip, Prestage Garrett, Guy Rebecca, (2019)

Published online: 4 April 2019

Abstract:

BackgroundRapid HIV testing was introduced at 12 clinics in New South Wales (NSW) for routine testing and promoted with social marketing. The effect of the availability of rapid HIV testing on testing frequency among gay and bisexual men (GBM) was evaluated.

Methods: An observational design using patient data from 12 clinics was used. The primary outcome was the mean number of HIV tests in 12 months. The intervention group comprised GBM who had one or more rapid tests from October 2013 to September 2014 and this was compared with two control groups; a concurrent group (no rapid test in the same period) and a historical group (attended between July 2011 and June 2012). Independent sample t-tests were conducted to compare mean number of tests among men in the intervention, concurrent and historical groups. Multivariate logistic regression was used to assess the association between rapid HIV testing and testing frequency.

Results: Men in the intervention group (n = 3934) had a mean of 1.8 HIV tests in 12 months, compared with 1.4 in the concurrent group (n = 5063; P < 0.001) and 1.4 in the historical group (n = 5904; P < 0.001); testing frequency was higher among men at increased risk of HIV in the intervention group compared with the other two groups (mean 2.2, 1.6 and 1.5 respectively; P < 0.001). Membership of the intervention group was associated with increased odds of having two or more HIV tests in 12 months (AOR = 2.5, 95%CI 2.2–2.8; P < 0.001) compared with the concurrent group, after controlling for demographic and behavioural factors.

Conclusion: Introducing and promoting rapid HIV testing in clinics in NSW was associated with increased HIV testing frequency among GBM.

 

Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal?

AIDS Res Ther. 2018 Dec 12;15(1):26. doi: 10.1186/s12981-018-0213-z.

Abstract

The World Health Organization estimates that smoking poses one of the greatest global health risks in the general population. Rates of current smoking among people living with HIV (PLHIV) are 2-3 times that of the general population, which contributes to the higher incidence of non-AIDS-related morbidity and mortality in PLHIV.

Given the benefit of smoking cessation, strategies to assist individuals who smoke to quit should be a primary focus in modern HIV care.

Tobacco harm reduction focuses on reducing health risk without necessarily requiring abstinence. However, there remains uncertainty about the safety, policy and familiarity of specific approaches, particularly the use of vaporised nicotine products. Evidence suggests that vaporised nicotine products may help smokers stop smoking and are not associated with any serious side-effects. However, there is the need for further safety and efficacy data surrounding interventions to assist quitting in the general population, as well as in PLHIV specifically.

In addition, official support for vaping as a harm reduction strategy varies by jurisdiction and this determines whether medical practitioners can prescribe vaporised products and whether patients can access vaporised nicotine products. When caring for PLHIV who smoke, healthcare workers should follow general guidelines to assist with smoking cessation.

These include: asking the patient about their smoking status; assessing the patient’s readiness to quit and their nicotine dependence; advising the patient to stop smoking; assisting the patient in their attempt to stop smoking through referral, counselling, pharmacotherapy, self-help resources and/or health education; and arranging follow-up with the patient to evaluate their progress.

Cultural and linguistic diversity of people living with chronic hepatitis B

Cultural and linguistic diversity of people living with chronic hepatitis B in 2011–2016: changing migration, shifting epidemiology
Aust NZ J Public Health. 2018; 42:441-3; doi: 10.1111/1753-6405.12826
Abstract
Objective: To estimate the cultural and linguistic diversity in Australians currently living with chronic hepatitis B (CHB), the majority of whom were born overseas, and to identify trends in this diversity over time.
Methods: Estimates were generated by combining Australian census country of birth
information with seroprevalence data generated from antenatal serology linked with
surveillance notifications. The number of people living with CHB was assessed according to country of birth using the 2011 and 2016 censuses.
Results: The total number of Australian residents living with CHB increased by 20% between 2011 and 2016, substantially outpacing population growth. The most common country of birth continued to be China, with the number of Chinese-born Australians living with CHB increasing by 60% in the 5-year period. Decreased numbers were observed for people born in European countries.
Conclusions: The epidemiology of chronic hepatitis B in Australia has shifted over time due to changing migration patterns, with increases in many countries in the Asia-Pacific, African and Middle Eastern regions. 
Implications for public health: Interventions to improve the health of people living with CHB are imperative, and these up-to-date estimates identify priority groups and communities, which are constantly changing.

“No‐one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal gay and bisexual men

“No‐one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men

Aust NZ J Public Health,  2019; 43:18-23; doi: 10.1111/1753-6405.12852
Objective: HIV prevention tools such as pre‐exposure prophylaxis require equitable access and uptake to protect all at‐risk populations. This project assessed the perceived barriers to accessible HIV prevention for Aboriginal and Torres Strait Islander gay and bisexual men (GBM) and evaluated the presence of health promotion for pre‐exposure prophylaxis (PrEP) for this population from the perspective of service providers.

Methods: Eighteen semi‐structured interviews with healthcare providers, researchers and AIDS Council employees were qualitatively analysed for themes and concepts related to PrEP‐specific health promotion.

Results: Respondents noted AIDS Councils and affiliated sexual health clinics had been instrumental in promoting PrEP to at‐risk GBM. However, many Aboriginal gay and bisexual men who are not well connected with these communities and services may not have been exposed to this health promotion and therefore have not accessed PrEP effectively.

Conclusions: Aboriginal community and gay community controlled health organisations need to collaborate to ensure they deliver effective and tailored health promotion to Aboriginal communities.

Implications for public health: The rising HIV notification rates in Aboriginal Australians is an example of the health gap experienced by First Nation people. Effective HIV prevention is required to ensure this gap does not widen further, and that Australia meets its goal of preventing all new HIV infections. However, these efforts will be hampered by ineffective health promotion of HIV prevention tools, such as PrEP, for Aboriginal Australians.