A Not So Grim Future

Does anyone remember the days of the Grim Reaper?  No, not the scythe carrying, black cloaked skeletal figure of the 15th century, but the 20th century version, made famous in the 1987 TV ad to raise public awareness of AIDS.

Travelling back to the past seems to be a thing we do regularly and with good reason.  If we don’t know where we’ve been how do we know how far we’ve come?  In the case of HIV and AIDS, time travel can give us a real insight into what needs to be done to end the epidemic, particularly as it relates to immigrant and refugee communities living in Australia.

It is 32 years since the first case of HIV/AIDS was diagnosed in Australia and at the time of the Grim Reaper ads, the first cases in heterosexual communities were diagnosed. Although the luxury of time has made us all a lot more aware of, if not more knowledgeable about, HIV/AIDS prevention, we also need to be aware that Australia is a different place to what it was back in the 1980s.

While the jury is still out on whether the public image of AIDS will forever continue to be linked to gay men and more worryingly, homophobic attitudes, community advocates have continued to work hard at broadening and raising the level of discussion that is centred on public health responses. The shift in mainstream thinking from ‘gay disease’ to a legitimate public health issue is admirable (big pat on the back) and has allowed us to focus on those who are and could be most affected.   The news, however, isn’t as good for immigrant communities living in Australia. People born overseas, and women in particular, are disproportionately bearing the burden of new HIV infections.

During the 2008-2012 period, of the HIV infections attributed to heterosexual contact, 72% were among the overseas born, while 67% were among people from non-English speaking countries.  Other statistics follow a similar trend.  In Victoria, for example, HIV is disproportionately represented among migrant communities, particularly amongst Sub-Saharan African women.

According to the Burnet Institute, the challenges in HIV prevention and detection for immigrant communities continue to be cultural barriers in health promotion, testing and treatment, especially for recent arrivals.  The urgency of this issue is evident in the data: of the 1,507 HIV notifications with country of birth recorded, 32% were born overseas and of this group, 54% were classified as recently arrived migrants.  A breakdown of this last figure shows that 29% were from high prevalence countries (92% were from Africa) and 90% acquired their infection overseas.  Of the high prevalence countries, 66% were women born overseas (compared to 35% of Australian-born Victorian women currently living with HIV).

Do we still need the Grim Reaper?  Our first thoughts are that such a—dare we say—sensationalist campaign would never be effective for immigrant communities.  Our recommended approach would be much kinder and simpler: tailored, gendered and culturally responsive sexual and reproductive health education programs are the key.