HIV & Hepatitis Needs Analysis Amongst CALD Communities in Tasmania

HIV & Hepatitis Needs Analysis Amongst Culturally & Linguistically Diverse (CALD) Communities in Tasmania Dr. Alistair Pinto

The Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) 319 Liverpool Street, Hobart, TASMANIA 7000 (03) 6234 1242 (03) 6234 1630 7/1/2011

Copyright Š 2011 Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) Hard copies of this report are available from: The Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) 319 Liverpool Street, Hobart, Tasmania 7000, AUSTRALIA Tel: +61 (03) 6234 1242 Fax: +61 (03) 6234 1630 Web: www.tascahrd.org.au PDF copies are freely available from the TasCAHRD and MAN2MAN websites.

TasCAHRD is funded by the Department of Health and Human Services (DHHS), Tasmania Citation: Pinto, A. HIV & Hepatitis Needs Analysis Amongst Culturally & Linguistically Diverse (CALD) Communities in Tasmania: TasCAHRD, July 2011.

Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) July 2011

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TABLE OF CONTENTS

ACKNOWLEDGEMENTS.........................................................................................3 1. EXECUTIVE SUMMARY...............................................................................4 2. BACKGROUND............................................................................................5 i) INTRODUCTION.................................................................................................5 ii) CURENT TASMANIAN CONTEXT........................................................................9 iii) THE NEEDS ANALYSIS PROJECT....................................................................13

3. METHODOLOGY........................................................................................14 4. CONSULTATIONS......................................................................................15 5. ANALYSIS OF OVERALL FINDINGS............................................................17 6. RECOMMENDATIONS................................................................................18 7. ACTION PLAN............................................................................................19 8. ATTACHMENTS.........................................................................................22 9. GLOSSARY OF KEY TERMS.......................................................................26 10. ACRONYMS...............................................................................................27

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Acknowledgements The Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) would like to thank everyone involved for their input into the development of this final report on the health and wellbeing needs of Culturally & Linguistically Diverse (CALD) Communities in Tasmania, in relation to HIV & Hepatitis.

Special thanks to the Department of Health and Human Services Tasmania (DHHS) especially Deb van Velzen - Policy Officer Multicultural Health & Wellbeing, for the valuable information provided that helped in the development of this final report.

Also, TasCAHRD would like to acknowledge all the CALD community leaders, elders and members who provided insight into the experiences, thoughts, suggestions and feedback of the community on the issues affecting them, in relation to HIV & hepatitis.

TasCAHRD consulted many relevant service providers throughout the state during this process and would like to thank them for their time and effort in aiding this project to be successful.

Alistair would also like to thank Susan Neighbour - Refugee & Migrant Liaison Officer, Launceston General Hospital, who was instrumental in helping TasCAHRD make contact with the CALD leaders in the North.

TasCAHRD The Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) is a not for profit organisation, that provides state wide services to the Tasmanian community, to educate, advocate and support them with regards to HIV, hepatitis and sexually transmitted infections.

Programs: • HIV/AIDS Program • Hepatitis C Program • Man2Man Program • CALD Communities Program Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) 319 Liverpool Street, Hobart, Tasmania 7000 AUSTRALIA Tel: (03) 6234 1242 Fax: (03) 6234 1630 Website: www.tascahrd.org.au MAN2MAN Program Website: www.m2mtas.com Hepatitis C Program Website: www.hepintas.com

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EXECUTIVE SUMMARY Tasmania has an increasing migrant population and there is a growing need to address health and wellbeing issues, with regards to HIV, hepatitis and sexually transmitted infections (STI’s) within this population. Both the Sixth National HIV Strategy and the First National Hepatitis B Strategy have indicated people from Culturally & Linguistically Diverse (CALD) backgrounds are a priority population for targeting health promotion campaigns in view of reducing the risk to infection amongst this group of people.

However, the amount of data available on HIV, hepatitis and STI’s within the CALD community in Tasmania is limited and fragmented, making it difficult to provide targeted community development initiatives to this priority population group.

Based on consultations with a variety of stakeholders, CALD leaders and workers, a number of recommendations have been put forward. A brief overview of the recommendations follows with a detailed proposed action plan at the end of this report that should enable TasCAHRD to work towards addressing some of these emerging issues within the CALD community in Tasmania.

Brief overview of recommendations: 1. Improved collection of CALD data.

2. Increased presence by TasCAHRD in the North and North West.

3. Build networks and links within the CALD communities across the state.

4. Build networks and links with other CALD service providers.

5. Conduct targeted health promotion campaigns.

6. Implement education and information workshops and sessions for CALD youth.

7. Conduct a health promotion campaign targeting asylum seekers housed in detention centres & prisons in Tasmania.

8. Compilation of a CALD resource targeted at the CALD community.

9. Creation of a full time CALD Project Officer position within TasCAHRD.

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BACKGROUND INTRODUCTION Throughout history, migration has shaped the ethnic and cultural diversity of Australia's resident population. Every year more people immigrate to, than emigrate from, Australia, thereby increasing the diversity of Australia's population.

(ABS, 2009) At 30 June 2009, of the estimated resident population (ERP) of Australia (22.0 million people) one quarter were born overseas (5.8 million people).

Table: Regions of birth, Proportion of Australia's population – Selected years at 30 June 1999 2004 2005 2006 2007 2008 2009 % % % % % % % Australia 76.9 76.2 75.8 75.4 74.9 74.2 73.5 Oceania & Antarctica (excl. Aust.) 2.4 2.7 2.7 2.8 2.8 2.9 3.0 North-West Europe 7.9 7.4 7.3 7.3 7.3 7.3 7.2 Southern & Eastern Europe 4.6 4.3 4.2 4.1 4.0 3.9 3.8 North Africa & The Middle East 1.2 1.3 1.4 1.4 1.4 1.5 1.5 South-East Asia 2.8 3.0 3.0 3.1 3.2 3.3 3.4 North East Asia 1.6 2.0 2.1 2.3 2.4 2.6 2.8 Southern & Central Asia 0.9 1.3 1.4 1.5 1.8 2.1 2.3 Americas 0.9 1.0 1.0 1.0 1.1 1.1 1.1 Sub-Saharan Africa 0.7 1.0 1.0 1.1 1.1 1.2 1.3 (Source: Australian Bureau of Statistics)

During the 10 years ended 30 June 2009, there was some change in the ranking of regions of birth in terms of each region's proportion of Australia's population. Since 1999, Southern and Central Asia has moved from 7th to 6th position by 2009 swapping with North Africa and the Middle East. Similarly, Sub-Saharan Africa has moved from 9th to 8th position by 2009 placing the Americas in 9th position. (ABS, 2009) In Australia from 2002 to 2006, people born overseas accounted for about 31% of new diagnoses of human immunodeficiency virus (HIV). Of these, those born in Asia and Sub-Saharan Africa made up about 28% and 18% respectively (National Centre in HIV Epidemiology and Clinical Research, 2007). Studies have also shown that many culturally and linguistically diverse (CALD) communities in Australia have limited knowledge about HIV and AIDS

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Australia's Refugee and Humanitarian Program Australia’s humanitarian program consists of two main areas; 1. Onshore protection: The onshore component of the Humanitarian Program aims to provide options for people who wish to apply for protection (or asylum) after arrival in Australia.

2. Offshore resettlement: The offshore resettlement component comprises two categories of permanent visas. These are:  

Refugee Special Humanitarian Program (SHP)

Outcomes of 2009–10 Programs: In 2009–10 a total of 13 770 visas were granted, of which 9236 visas were granted under the offshore component and 4534 visas were granted under the onshore component. (DIAC, March 2011) 2009–10 offshore visa grants by top ten countries of birth Countries Burma Iraq Bhutan Afghanistan Congo (DRC) Ethiopia Somalia Sudan Liberia Sierra Leone

Number of visas granted 1959 1688 1144 951 584 392 317 298 258 237

(Source Department of Immigration & Citizenship)

From the above table we can see that an increasing number of refugee and humanitarian visas have been issued to people from non- African countries. Even in Tasmania there has been a similar trend amongst new arrivals to the state.

National HIV Strategy 2010-2013: The Sixth National HIV Strategy 2010–2013 has identified people from (or who travel to) high prevalence countries, as one of the main priority population groups at risk of HIV infection in Australia.

This group has also been identified as a priority population by the Tasmanian HIV Implementation Plan.

National Hepatitis B Strategy 2010-2013: The First National Hepatitis B Strategy 2010-2013 has identified people from Culturally & Linguistically Divers (CALD) backgrounds as a priority population.

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Heterosexual Transmission of HIV infection: The number of new HIV diagnoses for which exposure to HIV was attributed to heterosexual contact increased from 841 in 2000 – 2004 to 1 185 in 2005 – 2009, accounting for 20.1% of total HIV diagnoses in 2000 – 2004 and 23.4% in 2005 – 2009.

Men and women from a country with high HIV prevalence accounted for 37.3% of HIV diagnoses attributed to heterosexual contact in 2000 – 2004 and 40.7% in 2005 – 2009, in Australia.

In both five year intervals, the majority of cases came from high HIV prevalence countries in sub-Saharan Africa (64% in both 5 year intervals) and South East Asia (31% in 2000 – 2004 and 25% in 2005 – 2009). Sixty two and 59% of cases from high prevalence countries in 2000 – 2004 and in 2005 – 2009 were among women.

Of new HIV diagnoses in 2005 – 2009 for which the country of birth of the heterosexual partner was reported (80%), 59% of partners were from South East Asia and 35% were from sub-Saharan Africa, respectively.

HIV Infection attributed to heterosexual contact, 2004-2008, by region of birth

1%

4%

4%

Australia

4%

Sub-Saharan Africa

5%

35%

Asia Middle East/North Africa Other Europe

20%

Other Oceania UK & Ireland

27%

South/Central America & the Carribbean

(Source: HIV-AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report 2009)

Among cases of HIV infection diagnosed in Australia from 2005 – 2009 for which exposure to HIV was linked to heterosexual contact, the country of birth was reported as Australia in 35%, sub-Saharan Africa in 27% and South East Asia in 20%.

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HIV Infection attributed to heterosexual contact, 2005-2009, by region of birth

1%

4%

4%

Australia

4%

Sub-Saharan Africa

5%

31%

Asia Other Oceania Midle East/North Africa

22% Other Europe UK & Ireland

29% South/Central America & the Carribbean

(Source: HIV-AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report 2010)

Among cases of HIV infection diagnosed in Australia from 2005 – 2009 for which exposure to HIV was linked to heterosexual contact, the country of birth was reported as Australia in 31%, sub-Saharan Africa in 29% and South East Asia in 22%.

After comparison of the above two pie charts we can notice a slight increase in HIV infection amongst people from a CALD background, thereby possibly justifying the need to focus health promotion campaigns on these groups.

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TASMANIAN CONTEXT Cultural diversity within Tasmania;  In Tasmania, 11.3% of the total population were born overseas (ABS Census 2006).  3.7% of Tasmanian’s speak a language other than English at home (ABS Census 2006).

Tasmania has a unique demography as compared to the other Australian states when it comes to the makeup of its new arrivals to the state. Tasmania’s educational institutions, The University of Tasmania (UTAS) and the Tasmanian Polytechnic house Tasmania’s largest CALD population – International students.

Figure01: Main Groups of people from Overseas Settling in Tasmania:

New Arrivals to Tasmania Permanent Residents Migrants Skilled

Family

Refugees

Humanitarian Entrants

New Zealand

Temporary Residents International Students

UTAS, Polytechnic, Maritime College, DoE etc

Temporary Work Visas

Hospitality, Health, IT etc.

Note: There may also be people who are seeking asylum, or in a visa review process and thus do not hold either a permanent or a temporary visa.

(Source: DHHS, Tasmania)

Refugee Arrivals in Tasmania: The Australian Government is sending an increasing proportion of refugees to regional Australia, that is, outside the capital cities. Tasmania has the highest regional settlement rate of all states and territories - 38% of all arrivals compared to a national average of 6%.

(Source: Dropped from the moon: the settlement experiences of refugee communities in Tasmania, Anglicare, Jo Flanagan, Sept 2007)

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Figure02: Main Groups of People Settling in Tasmania:

(Source: DHHS, Tasmania)

The above graph outlines the main groups of people that have settled in Tasmania from 2005 till 2008. International students have been the largest group followed by permanent migrants including refugees and humanitarian entrants. The fact that international students form the largest group amongst the CALD community should draw attention to this group from service providers who would normally not target them in their campaigns and programs.

The number of international students has grown steadily and still continues to do so, thereby justifying the need for targeting these groups in health promotional campaigns around HIV, hepatitis and STI prevention. Many of the international students also come from high risk countries and travel back and forth during the course of their stay in Tasmania. International students have very basic private health cover with no access to Medicare. These factors make this a high risk group for the transmission of HIV, hepatitis and STI’s.

Amongst the refugee and humanitarian entrants the largest numbers of both male and female entrants has been between the age group of 40–49yrs, from 1998 until 2008 (see figure).

Figure03: Increasing Age of People from a Refugee Background Arriving From 19982008:

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Figure04: Increasing & Changing Diversity of New Permanent Arrivals from 1998 – 2008:

  

Refugee Top 5 countries of birth (2009-10) - Bhutan, Myanmar, Democratic Republic of Congo, Ethiopia and Sudan.

Non-refugee Top 5 countries of birth (2007-08) - UK, New Zealand, People’s Republic of China, India and South Africa.

In general in November 2010 the largest CALD group in Tasmania were International students made up of: - University of Tasmania – Malaysia, Singapore, China, Korea, Middle East & India - Tasmanian Polytechnic – China, Korea & India - Primary & Secondary Schools – China, Korea, India & Japan (Source: DHHS, Tasmania)

The above graph once again demonstrates that international students formed the major group amongst the CALD community in Tasmania.

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HIV Exposures & Country of Birth of HIV Notifications, Tasmania, 2000-2010: (Source: DHHS, Tasmania)

From 2000-2010, in total, 66 notifications (93%) of HIV infection involved sexual conduct. Of these 49 notifications (69%) of HIV infection involved male-to-male sexual conduct.

Of the 76 cases, 5 were from a country which has a high HIV prevalence and only 1 case was potentially derived through vertical transmission. Of the 76 HIV infection notifications, 11 had two possible HIV exposures; the remainder had only 1.

Of the 76 HIV infection cases, over two-thirds (51) were born in Australia, with the remainder born in a range of countries (18 in total), the majority of which were Asian or African and therefore could be categorised as having high HIV prevalence.

Hepatitis C Epidemiology in CALD Communities: Country of birth is not routinely collected on hepatitis C notifications in Australia.

Therefore limited data exists on the impact of hepatitis C among people from CALD communities. However, it is estimated that 29,000 people with hepatitis C antibodies have migrated to Australia from high hepatitis C prevalence countries.

(Hepatitis Australia) There is no data with regards to CALD communities and hepatitis infection within the state of Tasmania.

Note: To gain an overview of the healthcare processes undertaken by refugees on arrival in the state of Tasmania refer to tables and diagrams provided in the attachments section of this document (pages 21 - 25).

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THE NEEDS ANALYSIS PROJECT The primary aim of the CALD Needs Analysis Project was to look at the currently available relevant data for the state of Tasmania and to use this as an evidence base to inform advice and advocate for the expansion of HIV, Hepatitis and STI services and information provision within the state, targeted at CALD communities.

The rationale behind TasCAHRD’s CALD Communities needs analysis was to determine the services and information currently available to the CALD community with regards to HIV & Hepatitis, in Tasmania and identify any gaps in service provision or delivery. This final report was to be provided, outlining the significant priorities within the CALD Community in Tasmania, including recommendations for further action.

TasCAHRD wanted to engage with CALD communities within the state to assess what their needs were with regards to provision of services and how they would like these needs addressed within their communities. For the purpose of this project TasCAHRD employed a Project Officer on a six month part time contract to undertake appropriate consultation with relevant stakeholders, community members, elders and workers.

This needs analysis was conducted over a six month period from January 2011 to June 2011.

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METHODOLOGY The methodology in the needs analysis was divided into the following areas: 1. Consultations: i.

Consultation with organisations providing services and programs for CALD community members within the state. ii.

Consultation with CALD elders, workers and members.

2. Detailed analysis of the available relevant data: 3. The development of recommendations based on the consultations and evidence.

4. The formulation of a draft Action Plan outlining strategies and program activities to address the relevant issues raised.

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CONSULTATIONS During the course of the CALD Needs Analysis Project, discussions were conducted with service providers in the North, North-West and South of the state of Tasmania.

Health and wellbeing issues with regards to HIV, Hepatitis and STI’s within the CALD community were identified and possible measures to address these issues were explored.

Discussions with CALD community members, workers and elders (leaders) in the North and South of the state also raised a number of issues and concerns within their community. Valuable feedback was also obtained on possible methods to address these issues.

Issues Raised in Consultations with Service Providers and CALD leaders, workers & elders in Launceston & Hobart:      

Lack of awareness about HIV, Hepatitis & STI’s within the community.

Stigma and social isolation associated with HIV infection within CALD communities.

Lack of access to information and education with regards to HIV, Hepatitis & STI’s.

Lack of access to service providers who are mainly located in the south of the state.

Misinformation within the community about the existence of HIV in Australia.

CALD youth at risk due to cultural differences in Australian society.

List of some of the Organisations & Service Providers Involved in CALD Needs Analysis Project:          

DHHS Royal Hobart Hospital Launceston General Hospital Migrant Resource Centre, Hobart Sexual Health Clinic Hobart, Launceston & Devonport.

UTAS International Student Advisors Tasmanian Polytechnic International Student Advisors.

African leaders and community workers in Launceston African Communities Council of Tasmania in Hobart.

Centrelink

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On the 31st of March 2011, an Inaugural State-wide Refugee Health Forum was held in Campbelltown. TasCAHRD’s participation in the forum was a valuable networking opportunity for the CALD Program and also offered useful information and feedback that helped in the development of this report.

During the course of the project another opportunity was made available, through participation in a national forum, to obtain a perspective on similar issues and ways used to address them by community organisations interstate.

The Australian Federation of AIDS Organisations (AFAO) held a “HIV & African Communities Forum” in Sydney in May 2011. This was the first time that CALD service providers, workers and leaders from all over Australia converged in Sydney to address this growing concern of HIV and its impact on the African community in Australia.

Key Issues arising from the AFAO discussions with African leaders & service providers: 

   



Lack of awareness that HIV exists in Australia. HIV prevention information in Australia is chiefly targeting gay men and therefore seen as not relevant to most Africans.

HIV education and awareness raising for community leaders.

Stigma both within African communities around HIV & towards Africans in relation to HIV. Challenges in engaging African men, which appears to be due to their changed gender role in Australian society.

Concerns about young people and sexuality, risk-taking, inter-generational conflict and the role of sex education in schools.

Some specific issues for women around negotiating safe sex.

TasCAHRD’s CALD Program (Officer) also participated in a number of other local CALD stakeholder network meetings, such as;  62 Providers Meeting at the Migrant Resource Centre  Bridges Meeting at Relationships Australia The CALD Program Officer was also part of the HIV working group for the Tasmanian Blood Borne Virus Implementation Project (BBVIP) 2011, in Tasmania.

Through participation in these meetings and projects TasCAHRD was able to gain valuable insight into the CALD community in Tasmania and keep up to date with the issues and concerns of this community, whilst building valuable networks with other service providers in the state.

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ANALYSIS OF OVERALL FINDINGS Analysis of existing relevant data: After studying the available HIV, hepatitis and STI data for Tasmania, there seems to be an urgent need to improve the existing data collection system in the state.  Access to available data with regards to HIV, hepatitis and STI is limited.  Data collection with regards to CALD communities and HIV, hepatitis and STI’s is fragmented.

Analysis of consultations with CALD service providers: There were similarities between many of the issues and concerns of CALD service providers throughout the state. They were all conscious of the need for raising awareness amongst the CALD community on the health issues of HIV, hepatitis and STI’s. They recognised the need for targeted health promotion campaigns and measures to reduce stigma within the community with regards to people living with HIV. There was also a sense of urgency as related to them by their clients and consumers, towards addressing these issues swiftly and effectively.

Analysis of consultations with CALD leaders, workers and members: The feedback and information provided by the CALD community in Tasmania reflected similar concerns and issues, as experienced by CALD communities from other states in Australia.

There is an immediate need to bridge the gap between current knowledge and community perception of HIV, hepatitis and STI’s within the CALD community in Tasmania. Misconceptions and perceptions about HIV, hepatitis and STI’s within the CALD community can lead to behaviours that make people more susceptible to these infections. They can also serve as barriers to testing and contribute to stigmatisation of people living with HIV. There is a lack of availability of services targeting CALD communities in the North and North West of the state with regards to HIV, hepatitis and STI information provision and targeted health promotion campaigns.

Sexual Health Education to CALD students: During the course of this project TasCAHRD’s CALD Program Officer in liaison with the Phoenix Centre, provided sexual health information to CALD youth at Elizabeth & Hobart College. The feedback received indicated that this was an essential health promotion area that could be possibly expanded.

Shortcomings of the Needs Analysis Project: Given the limited time frame within which this needs analysis was conducted, there was insufficient time for consultation with several minority CALD populations within the state, whose feedback might have provided a unique perspective to this report.

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RECOMMENDATIONS Based on the consultations and feedback from relevant stakeholders, CALD community members, leaders and workers; the CALD Needs Analysis makes the following recommendations to address the health care and other related issues within the CALD community in Tasmania with regards to HIV, Hepatitis and STI’s: 1. Improved collection of CALD data by service providers and the Department of Health. Improved access and sharing of appropriate CALD data between service providers in the state to help identify at risk populations and target specific at risk groups.

2. Increased presence by TasCAHRD in the North and North West: regional visits to CALD communities, clients and workers in the North and North West of the state every six to eight weeks.

3. TasCAHRD should continue to build networks and links within the CALD communities in the state of Tasmania by providing on-going care and support and improving relationships with CALD community representatives and elders throughout the state.

4. TasCAHRD should continue to build networks and links with other organisations state wide that provide services to and work with CALD communities.

5. TasCAHRD should conduct targeted health promotion campaigns for international students, refugees and migrants in Tasmania, with regards to increasing awareness and knowledge about HIV, Hepatitis & STI’s.

6. TasCAHRD should implement education and information workshops and sessions for CALD youth who are at risk due to the cultural and other barriers that exist within their communities.

7. TasCAHRD should conduct a health promotion campaign targeting CALD community members within Tasmanian prisons aimed at reducing risk of infection.

8. TasCAHRD should conduct a health promotion campaign targeting asylum seekers housed in Detention Centres in Tasmania, after consultation with relevant bodies and in liaison with other stakeholders from the state.

9. The CALD Program at TasCAHRD should work towards the compilation of a resource outlining various community organisations and programs which provide services or engage with CALD communities within the state of Tasmania, targeted at the CALD community. Including but not limited to a listing of multicultural events around the state and interstate, forums and conferences on CALD communities etc.

10. In view of the above recommendations, TasCAHRD will have to review the part time role of the CALD Project Officer position and reconsider the possibility of expanding the position to a full time job role. This will enable and ensure the development of many of the outcomes suggested in this report.

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ACTION PLAN In view of the above recommendations the following action plan has been drafted in order to envision possible strategies for the development of a CALD business plan for TasCAHRD. Strategy Increase the availability of information on AIDS, Hepatitis & STI’s

Activity Conduct a targeted community awareness, education and information campaign to prevent HIV, Hepatitis & STI’s amongst CALD communities in Tasmania Health survey amongst CALD community

Conduct an OH&S campaign focusing on sexual health (HIV & STIs) for sex workers in Tasmania with a focus on sex workers from CALD backgrounds Conduct a targeted ethnic media campaign on HIV, focusing on transmission and testing.

Develop or accumulate HIV resources in multiple languages for use within the

Performance Indicators Health campaign, including education and information workshops targeting migrants, refugees and international students implemented

Timeline July 20112012

Lead Agency TasCAHRD

Partner Agencies DHHS, Sexual Health Services, Family Planning

Conducted a qualitative study on the improvement in health knowledge amongst the CALD community OH&S Campaign implemented for sex workers who are either migrants, refugees or international students.

July 2011 2012

TasCAHRD

Other relevant agencies

July 2011 2012

TasCAHRD

Scarlet Alliance

Number of communities reached by media campaign

July 20112012

TasCAHRD

Other relevant agencies

Number of community resources developed or assimilated

July 20112012

TasCAHRD

Other relevant agencies

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Increase the information available to young people on HIV, hepatitis, sexual health and harms associated with impaired decision making

CALD communities Improve CALD services’ knowledge and referrals of existing HIV, hepatitis and STI services Build partnerships which support the design and delivery of sexual health programs for students from CALD communities Assemble a volunteer group to assist in the delivery of safe sex messages

Increase access to HIV, Hepatitis and STI information, prevention and testing for inmates of Tasmanian prisons and persons in detention centres from CALD backgrounds Increase understanding of the importance of HIV & STI prevention amongst CALD communities in Tasmania

Negotiate with Department for Correctional Services and Detention Centre Services on provision of health promotion to persons from CALD backgrounds Organise forums and workshops throughout the state for migrants, refugees and international students to discuss the need for sexual health activities and how they can

Targeted CALD services know where and how to refer CALD clients to HIV, Hepatitis and STI services.

Agreement reached with educational institutions for design and delivery of sexual health program with harm minimisation messages for CALD students

July 20112012

TasCAHRD

Other relevant agencies

July 20112012

TasCAHRD

DHHS, Migrant Resource Centre (state wide), Centacare, Red Cross

Formation of an age appropriate CALD volunteer group to help in delivery of information and resources to the CALD community Agreement reached on the future provision of services and health promotion campaigns within prison and detention environments

July 20112012

TasCAHRD

Volunteering Tasmania

July 20112012

TasCAHRD

Red Cross, Relationships Australia

Sexual health forums and workshops conducted in both the north and south of the state with representatives of various CALD communities.

July 20112012

TasCAHRD

Other relevant agencies

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Deliver HIV, Hepatitis & Sexual health prevention programs to CALD communities which are culturally appropriate

Increase the capacity of CALD communities to identify health services available within the state Build on the skills of CALD community members to provide prevention, care and support to people with or at risk of HIV

best be provided Implement a campaign to promote the wider use of condoms in CALD communities, in a culturally appropriate manner Integrate HIV information and prevention messages with appropriate hepatitis & STI messages to reduce the incidence amongst CALD communities Develop a comprehensive database of service providers, programs and services available to CALD communities within Tasmania Identify CALD community workers most likely to be working with people around sexual health issues and train these workers in STI, HIV and hepatitis.

Condom use campaign developed, implemented and evaluated in consultation with CALD communities

July 2011ongoing

TasCAHRD

Other relevant agencies

July 20112012

TasCAHRD

Other relevant agencies

Development of a CALD website or information booklet/directory outlining the various programs and services available to persons from CALD communities

July 20112012

TasCAHRD

Migrant Resource Centre (state wide), Centacare

Development of a training program for CALD community workers in sexual health.

July 20112012

TasCAHRD

Other relevant agencies

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ATTACHMENTS

(Source: Communicable Diseases Network Australia) Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) July 2011

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Tasmanian Migrant Demographics:

(Source: DHHS, Tasmania)

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On-Arrival Refugee Health in Southern Tasmania (May 2010) Refugee Arrives in Hobart 

IHSS fax Registration Form to RHH

Within 24 hours, meet with Settlement Team (IHSS and CSR for orientation & assistance to access the health system, apply for Medicare card, etc.)

Discuss the importance of their health when settling, explain role of GP and encourage appointment ASAP Fax Registration Form to Royal Hobart Hospital

 

Assist or Arrange GP appointment (with interpreter if needed) If they have a “Medical Alert”, then to see a GP

General Practitioner 



within 24hrs or DEM as appropriate

Assess health status and determine any further action for treatment or medical inquiries.

Suggested visit schedules and other materials are in the Guide for General Practitioners in Tasmania– Refugee Health Care, or more advice is available by phone from the RHH Infectious Diseases (ID) Specialists or the Public Health and Immunisation Hotlines If indicated, GP refers to the RAHAC GP Practice makes a named (Refugee and Humanitarian Arrival Clinic) referral to the RAHAC

RHH DEM

RAHAC (Royal Hobart Hospital - Refugee and Humanitarian Arrival Clinic)

 



Patient registered at the RHH to create the patient’s file and U.R.N.



Clinic books screening appointments and sends letter to Patient



Interpreter booking made if needed



IHSS Volunteers contacted prior to appointments to assist attendance



3 visits for tests & co-ordinated treatment planning with Infectious Disease, Respiratory and Paediatric Medicine clinics



Specialist Referrals (eg Gastroenterologist)



Follow-up appointments for Infectious Diseases as needed



Medications organised and dispensed



Links with RHH Refugee/Migrant Liaison Officer if needed

Ongoing Health Management Liaison with other Professionals including Phoenix Centre for survivors of torture & Trauma, etc.

Patient information, Results, Treatment Plan and Follow-up sent to the referring GP

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[Source: Refugee and Humanitarian Arrival Clinic (RAHAC), DHHS] Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) July 2011

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GLOSSARY OF KEY TERMS AIDS Acquired Immune Deficiency Syndrome. The last stage of HIV infection, when a group of illnesses occur because HIV has severely weakened the immune system.

Asylum seeker A person who has left their country of origin, has applied for recognition as a refugee in another country and is awaiting a decision on their application.

Blood-borne virus (BBV) A virus that is transmitted by blood (and some body fluids). Examples are hepatitis B (HBV) and hepatitis C (HCV) and HIV. Culturally and linguistically diverse (CALD) Term used to describe people who “identify as having a specific cultural or linguistic affiliation by virtue of their place of birth, ancestry, ethnic origin, religion, preferred language, languages spoken at home, or because of their parents’ identification” (Victorian Department of Human Services Multicultural Strategy Unit, 2002). It includes – but is not limited to – refugees, migrants and international students.

HIV Human Immunodeficiency Virus - the virus that causes AIDS. There is no cure and no vaccine to protect against HIV infection, but treatments are available to prevent progression to AIDS and keep people with HIV healthy.

Humanitarian entrant Someone who has arrived in Australia under the Humanitarian Program. This includes refugees and people outside their home country who are subject to discrimination amounting to human rights abuses in their home country.

Migrant Someone who leaves their country of origin voluntarily for a range of personal or economic reasons. They have made a choice to leave, had a chance to prepare for migration and generally can return at any time if they wish.

Refugee A person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of their nationality and is unable to or, owing to such fear, is unwilling to avail himself/herself of the protection of that country” (United Nations Convention Relating to the Status of Refugees, 1951).

Sexually transmissible infection (STI) A disease which can be passed on from one person to another during sexual contact.

Viral hepatitis Inflammation of the liver caused by one of the hepatitis viruses. Hepatitis B, C (and in some cases D) viruses are those with the potential to produce chronic (long-term) infection and liver damage. Hepatitis A and E typically cause acute (short-term) hepatitis, and are acquired through contaminated food or water.

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ACRONYMS ABS – Australian Bureau of Statistics AIDS – Acquired Immune Deficiency Syndrome AFAO – Australian Federation of AIDS Organisations CALD – Culturally & Linguistically Diverse DHHS – Department of Health & Human Services, Tasmania GLBTI – Gay, Lesbian, Bisexual, Transgender, Intersex HAV – Hepatitis A Virus HBV – Hepatitis B Virus HCV – Hepatitis C Virus HIV – Human Immunodeficiency Virus STI – Sexually Transmitted Infections TasCAHRD – Tasmanian Council on AIDS, Hepatitis & Related Diseases

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Tasmanian Council on AIDS, Hepatitis & Related Diseases (TasCAHRD) July 2011

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