HIV Australia | Vol. 9 No. 3 | November 2011

by Henrike Körner

Henike Körner profiles new qualitative research examining knowledge of and attitudes towards HIV testing and implications for HIV prevention among Thai gay men living in Sydney.

The aim of the Thai and gay project was to explore how Thai gay men in Sydney perceived, experienced, and managed HIV-related risk. As this was an exploratory study, qualitative methods were used: focus groups and semi-structured in-depth interviews. Participants were recruited from sex-on-premises venues, the gay print media, Thai print media, the ACON website, two Thai social networking websites, a Thai massage shop, and word of mouth.

Regular HIV tests

Some men had regular HIV tests in Sydney, either at their GP or a sexual health clinic. They routinely practised safe sex and viewed regular tests as an additional risk management strategy. Testing provided peace of mind (‘you just never know’) and with Medicare there was no cost (‘In here I don’t worry about it, because in here they have the Medicare card. That’s it. You can go to see doctor ... like that.’)

Men who had had regular HIV tests in Thailand before coming to Sydney usually tested as part of a package such blood donations (in contrast to current policy on blood donations for men who have sex with men in Australia), or employer sponsored health benefits (‘They treat you like the Caucasian ways. They give you free health check, everything, so we quite use that.’). These men also had a positive attitude towards getting tested.

Tom:    And in Thailand I always do a blood donation every three months. More than twenty times for blood donation. ... If have some problem with my blood, they do send a letter for me. But no, no problem. So I feel good because I, every three month I do a blood donation and I check. And I like to do blood donation because it can help many people [when they] almost to die or something like this.

Positive attitudes were also expressed by some who had no history of testing in Thailand and who were referred to sexual health services after they arrived in Sydney. This also seems to have set up a pattern of regular STI checks.

Danny:    When I stay in Thailand, I never check. ... I come to Sydney I check maybe twice time at Sydney Hospital. ... And my doctor say, ‘You must come back to check again in six months.’ And I come back to check in Sydney Hospital maybe two months ago. Everything fine. ... When I come to Sydney first, difficult for me for find a job. ... I come to massage shop, Thai massage shop. And Thai massage shop have something do for customer happy. Just hand relief or masturbation. ... Every person in here, check health. ... For HIV. For gonorrhoea. For STI something and okay, if free, free for check, I go to check. And I go to check, inject, vaccine, hepatitis. All for free.

Testing after an exposure

Some men who did not have regular HIV tests took a test after an actual or a potential incident of exposure to HIV. Knowing their serostatus was important so that they could manage their health if the result was positive.

Luke:    There’s a couple of times in my life that I had unsafe sex. At that moment I enjoyed pretty much but then the next morning, my God, I feel like I was in hell. And then six weeks after that I feel like terrible, terrible. So I waited six weeks so I can get a blood test and see if everything is alright with me. So if I get HIV, so I’ll know what is to do next. I know the plan, like to take the medicine or find a work, to have strong health ...

However, there was also the scenario where a man had been exposed to the virus but avoided seeking medical advice because of embarrassment.

Somchai:    I met one guy and he took me to his place. And we have sex. And I didn’t safe that time. ... And after that I just, you know, clean myself and then use, buy some like antibiotic thing ... And use a lot of stuff to clean. ... Antiseptic cream ... Savlon or something. I used that to clean my dick. ... and then after that I feel guilty because I didn’t safe and yeah, and then I clean myself and just, oh, just like for a week, “My God! What if I’m – .”

DID YOU SEE A DOCTOR AFTER THAT INCIDENT?

Somchai:    I didn’t. ... I feel very shy to see a doctor and talking about that. ... Because the thing like is, I mean I know for myself, Thai people they just, it’s something like very, very embarrassing to talk with somebody. Even a doctor.

Testing and relationships

Some men had a test at the beginning of a new relationship and then no further tests, grounded in an assumption of trust. However, this was disputed in one of the focus groups.

One:    For me, I did one when I’m, I have relationships. For safe sex and for commitment. That’s it. And never do it again.

Tee:    But you may have a commitment. How about your partner? How much can you trust him? He might not, he might have a commitment to you but he might do something behind you. You don’t know that. So in the best way to protecting yourself. As well as protecting him and another as well.

One:    You have to trust with your partner.

Tee:    Yeah, you have to trust but you never know ... especially with gay relationship.

...

One:    If I had to do that … if the case they need the result for the blood test, I would do that. But for the worry I’m not gonna do it.

Trust and testing were, however, not necessarily seen as incompatible but could go hand in hand—trusting a partner emotionally and testing to make sure.

HAS IT EVER HAPPENED TO YOU THAT A CONDOM BROKE?

Pilot:    Yeah, did … and then we go to check but is nothing happen. Because he [boyfriend] said, “Trust, trust me. But you can go to check but trust me.” But because we been together and we … normally we, like we together a lot, you know. We like, we know where we are something all the time, so that’s why … that treatment is not annoy me. Because is like we know, we trust you, I trust you, you know. Okay. And then okay, just check it and it come, is nothing.

However, testing did not feature in all relationships, even when no condoms were used.

HAVE YOU HAD AN HIV TEST IN SYDNEY?

Major Tom:    No.

...

IF YOU WANT AN HIV TEST, WOULD YOU KNOW WHERE TO GO?

Major Tom:    I don’t know the, but I used to, to see the address, the number. But now I didn’t keep. ... Sometime I feel afraid as well. Yeah, afraid that we didn’t use a condom. But – [let’s out big sigh]

WHY ARE YOU AFRAID?

Major Tom:    I mean if I use is better. But he [boyfriend] don’t like.

Reoccurring themes: ambivalence, fear and uncertainty

One recurring theme in the narratives was fear and uncertainty. Some men did not know where they could get an HIV test and whether they had to pay for it. Sometimes they had vague recollections of having seen some advertisements somewhere but were not sure of anything more specific, and information from friends was not always reliable, for example, about the window period.

Tom:    In here I never go to check my blood. ... maybe in a few months, two or three months I have to go to check because my last sex about ... January ... So if I want to check, I have to wait until five or six months. That about June or July I have to go to check.

WHY DO YOU HAVE TO WAIT FIVE OR SIX MONTHS?

Tom:    I think but I’m not sure, but many people told me if I want to sure about HIV, at the last time for my sex I have to count until five or six month, then I go to check for HIV test.

While some men had boyfriends who supported and encouraged them to get tested, others were concerned about negative reactions if they raised the topic.

Pat:    Yeah never, I never. Not in Thailand as well. ... Because I always protect myself every time. But okay, I still want to check. ... But I’m not sure because I don’t know. But I use condom every time. So okay.

DO YOU THINK IT’S A GOOD IDEA TO HAVE A BLOOD CHECK ... EVEN IF YOU USE CONDOMS ALL THE TIME?

Pat:    Of course. I want to check as well but I don’t know where in Australia for HIV. I heard that, as I told you, my friend told me, “Okay, in here has one place to check,” but they don’t know where.

DOES YOUR BOYFRIEND KNOW?

Pat:    I don’t, I’m not sure. I never ask him. ... If I ask him, he gonna have a question. ...  “You have sex with someone?” ... So you know, you know where? Let me know.

There was also fear and uncertainty about what sexual practices, apart from anal intercourse, posed a risk of HIV transmission, and fear prevented some from seeking medical advice even if they knew where to get it.

Tom:    I know [where to get an HIV test]. ... And sometime I very scare. I don’t want to go there because I’m not sure. But just a few time I have sex here, but I always protect. But sometime I do make mistake and just I mean sucking from some people. But not fuck. But I not sure if I suck how can I get the HIV?

There was also some ambivalence and tension around the importance of testing and actually getting tested, and some tension between a man’s perception of his own sexual practices as ‘safe’, and the fear of a positive test result.

Top:    I think it’s important to check your status but for me, I don’t think I want to test because [focus group participants laughing] because I didn’t do anything risky. And I mean in my opinion, I mean if you know that you’ve got HIV, that might ruin your life and just feel like, “Oh God, you know, I can’t live longer, blah, blah, blah,” you know. ... But for me I just don’t want to know. It’s important to test HIV but I just, for me, not important. For me, for myself.

Conclusion

For Thai gay men in Sydney HIV testing is not a straight forward matter. Positive attitudes towards testing, associated health benefits and peace of mind co-exist along with ambivalence, uncertainty and fear. Generally speaking, getting tested was perceived as a good idea. For some regular tests were routine but for others actually getting tested was an issue. A similar disconnect between the importance of knowing one’s serostatus and getting tested was found in a recent survey of four CALD communities, including Thais¹.

For international students and those without Medicare, lack of familiarity with sexual health services and costs were barriers to testing. However, once the men had been pointed towards these services and actually used them, they were satisfied with the services they received.

Another barrier to using sexual health services was embarrassment, fear and uncertainty: uncertainty about risk, when and where to get tested, the fear of a positive result, and embarrassment to discuss sexual matters.

There is some need to promote sexual health services among Thai gay men in Sydney. However, we also need to acknowledge the fears that can prevent them from using these services, even though they are free, and the role that partners can play in negotiating access to sexual health services.

References

1. Asante, A., Körner, H., McMahon, T., Sabri, W. and Kippax, S. (2009) Periodic survey of HIV knowledge, perceptions and use of health services among people from culturally and linguistically diverse (CALD) backgrounds (Monograph 2/2009). Sydney: National Centre in HIV Social Research, University of New South Wales. Available at: http://nchsr.arts.unsw.edu.au/media/File/1_CALDperiodicsurvey.pdf (accessed 27 September 2011).