ABSTRACT
If advances in biomedicine have transformed HIV infection into a chronic condition, managing a chronic condition requires access to health care and social services. Such access is directly determined by a patient’s legal status as a citizen or resident of a country, and is also inextricably linked to ethnicity, language, gender and sexual orientation. In addition, studies from several countries have shown that health services for people with HIV also have an important social function, providing emotional support (Jorgensen and Marwit 2001; Anderson and Doyal 2004) and sometimes even becoming substitute family (Shedlin and Shulman 2004). Migrant women, in particular, may rely heavily on health and social services for physical, social and emotional support (Chin and Kroesen 1999; Doyal and Anderson 2006). Sexual orientation and language affect access to health and social services in
complex ways. As just one example, Caucasian gay men in the USA tend to be self-directed in their use of such services, exercising a high degree of control and actively involved with service organizations. For Spanish-speaking women, in contrast, the perception of HIV as socially unacceptable can make it extremely awkward for them to approach HIV services directly: their access was driven by agencies (Takahashi and Rodriguez 2002). In Australia, gay men tend to use gay-identified doctors, and HIV-positive gay men prefer physicians with a high HIV case load (Fogarty et al. 2003, 2006) whereas HIV-positive heterosexuals mainly use sexual health clinics and hospitals, and have little or no contact with other HIV services (Persson et al. 2006). Asian gay men in Australia make less use of sexual health services than do their Anglo-Australian counterparts (Mao et al. 2003). Other data from Australia suggest that migrants from nonEnglish-speaking countries have less contact with health services before they are diagnosed with HIV: they are more likely than Australians to be diagnosed for HIV late (McDonald et al. 2003) and are more likely to develop AIDS (Dore et al. 2001). This paper uses data from in-depth interviews with 28 HIV-positive men and
women living in Australia but born in Asia, South America and southern Europe, to explore how they negotiate migration status, language, gender and sexual orientation in their quest for the health and social services.
