Comparing Pacific and Australian approaches to gay men’s health: reflections on the 2014 AFAO National Gay Men’s HIV Health Promotion Conference

HIV Australia | Vol. 12 No. 2 | July 2014

By Isikeli Vulavou

Reflections on the 2014 AFAO National Gay Men’s HIV Health Promotion Conference.

The AFAO National Gay Men’s HIV Health Promotion Conference is held every two years. The conference is an opportunity for HIV health workers, policy makers and researchers to network, highlight best-practice, and discuss practical and strategic health promotion responses to emerging issues in the HIV epidemic in Australia.

It also provides opportunities for others working in our region to network, share information and ideas, and to learn from each other.

Isikeli Vulavou, the founding Director and President of the Rainbow Pride Foundation (formerly MENFiji) and current Fijian representative to the Pacific Sexual and Diversity Network (PSDN), was one of 110 delegates who attended the 2014 conference, held 7–10 April in Sydney.

In this article, Isikeli reflects on his experiences at the conference, and shares some insights about differing approaches to gay men’s health in Fiji and Australia.

I first received notification about the call for scholarships for the AFAO National Gay Men’s HIV Health Promotion Conference in January when the PSDN secretariat circulated a call to all its board members.

It instantly grabbed my attention, as there has never been an opportunity in Fiji nor in the Pacific region (excluding Australia and New Zealand) for a conference solely focused on Gay Men’s Health.

After reading the background information I became keener to participate and wrote to the conference secretariat to see if the conference was open to participants from outside Australia – the Pacific in particular – and to see if scholarships were available.

The initial reply was that scholarships were open to the Pacific, but I would have to to pay some costs. I approached two UN organisations based in Suva for assistance but this was declined due to unavailability of such funds.

However, two days later I received good news that the conference organisers would cover registration, and that the Albion Centre could cover travel and accommodation under the Pacific Healthcare Workers Support project in which MENFiji (now Rainbow Pride Foundation) was a collaborating partner.

I arrived in Manly, Sydney Australia on 7 April, not sure what to expect. I was both excited and anxious about all the new things I would learn during the three-day conference.

The vast difference between the HIV response in developing countries and developed nations like Australia was clearly evident during the first afternoon’s information sharing session.

I joined a group workshop reviewing health promotion campaigns and social media strategies currently used in Australia and New Zealand to advocate for and mobilise communities, impart knowledge and influence behaviour change.

In these discussions, several health promotion staff shared examples of Australian and New Zealand health promotion programs using mobile and internet technologies to increase coverage and mobilise target populations.

The different scope of HIV programs for gay men and other men who have sex with men (MSM) in affluent countries compared to resource limited settings like Fiji was immediately obvious.

Most of the target audience in Australia and New Zealand owns a smart phone and has easy access to the internet, which is not the case for similar target audiences in Fiji and the Pacific.

Discussions in the workshop even covered using different mobile applications to reach different segments of the target population – at this point I was totally lost!!

However, the two days that followed were very informative and gave some insights into the respective differences in HIV responses to address the epidemics in Australia and in Fiji.

Fiji is classified as a low prevalence country, with estimates from UNAIDS and World Health Organization (WHO) indicating the number of people living with HIV in 2012 to be around 1000, and a prevalence rate of HIV among 15–20 year olds at approximately 0.2%.¹

Although there has been no epidemiological HIV sero-surveys conducted for the general population, the number of cases identified among HIV tests undertaken annually supports these estimates. In 2012 and 2013, the total number of new HIV infections identified was 62 and 64 respectively.²

Unlike the picture in Asia, where HIV transmission is largely among men who have sex with men, sex workers and people who inject drugs, the same cannot be said about the Pacific and Fiji.

The main mode of transmission in Fiji is primarily heterosexual followed by perinatal, homosexual and bisexual, and one case related to injecting drug use, noted some years back.

In 2013 we saw an equal distribution of male and female cases, where previously the majority of the cases were among men.³

In Fiji, the low prevalence rate among gay men and other men who have sex with men results in the response and strategies used for these men focusing on conventional preventative strategies such as safe sex promotion, mainly through condom use.

Currently, peer education is the main approach used to promote safe sex among men who have sex with men and transgender people in Fiji.

Given our strong oral cultural traditions, where interpersonal communication tends to appeal more, face-to-face communication with peers is both low-cost and effective.

MENFiji has also organised event-based safe sex campaigns with Information Education and Communications (IEC) materials like posters, drop down banners and t-shirts distributed to disseminate key messages on safe sex.

At the 2014 International AIDS Conference I will share a poster outlining the Condomising Suva Hotspots project, where MENFiji partnered with five nightclubs to distribute condoms supplied free of charge by UNFPA (United Nations Population Fund).

At the AFAO conference, a range of additional approaches were discussed – I found myself listening and participating in discussions where the prefix sero- was frequently mentioned, issues of gay men and men who have sex with men living with HIV were raised frequently, and the use of treatment as prevention and preexposure prophylaxis was covered.

Most of these terms I heard I had come across before, but never understood their meaning, nor made an effort to understand them, as they were seldom used in strategy discussions for HIV responses for men who have sex with men or transgender people back home.

I learnt how numerous HIV programs targeting gay men in Australia were using rapid testing, while testing in Fiji is very low across the board – those who do get tested are often tested through opportunistic events, and then often do not return to the clinics to collect the results.

The conference illustrated to me how rapid testing can increase testing uptake, and would be a useful tool to advocate for in Fiji.

There seems to be ongoing discussions within the Fiji Ministry of Health on rapid testing, but a limiting factor has been funding.

At some points in the discussion I felt the conference was only focused on gay men living with HIV, but I soon realised this was due to the nature of Australia’s HIV epidemic, which is concentrated among gay men.

The use of treatment as prevention was another interesting discussion given the challenges in translating knowledge and education into action and behaviour change, as evidenced in the results of the MENFiji Integrated Behavioural and Biological Survey.

The three main takeaways for me from the conference were: 1) how to effectively use social media to reach a target audience and disseminate information; 2) methods to mobilise target communities and advocate for behaviour change; and 3) opportunities to advocate with the Ministry of Health back in Fiji for introduction of rapid HIV testing and use of treatment as prevention strategies.

Thank you to AFAO and the Albion Centre for the funding support that ensured my participation in this very important conference.

I hope that more opportunities will be afforded to other participants from Fiji and the Pacific in the future.

Isikeli Vulavou is the President of Rainbow Pride Foundation (formerly MENFiji), a MSM and TG organisation in Fiji and a board member of Pacific Sexual Diversity Network (PSDN).

References

1 See: UNAIDS (2012). HIV and AIDS Estimates (2012). Retrieved from: www.unaids.org

2 Ministry of Health – Fiji Islands. (2014). Global AIDS Progress Report 2013. Fiji Islands. Report submitted to UNAIDS 31 March. 6.

3 ibid.