The impact of visa status and Medicare eligibility on people diagnosed with HIV in Western Australia: a qualitative report.

BACKGROUND: In Australia, temporary visa holders are ineligible for Medicare and subsidised antiretroviral drugs. Additionally, HIV testing is not mandatory for visas unless applicants seek work in the health sector. We sought to understand the impact of HIV and issues of access and adherence to antiretroviral therapy (ART) in people holding temporary visas and permanent residents. METHODS: Data were gathered from interviews with 22 participants. Information concerning medication adherence, side effects, CD4 T-cell count, viral load and rate of response to generic drugs were collected. RESULTS: The mean age was 33.4 years (±s.d.=6.0), 21 out of 22 were from HIV-prevalent areas in East Africa and Asia, 14 out of 22 were on temporary visas, 12 were ineligible for Medicare, 14 out of 22 were diagnosed during health screening, 19 out of 22 risk exposures were in country of origin, 8 out of 17 were taking generic ART at an average cost of $180 per month, adherence was excellent and self-reported side-effects were relatively infrequent. Participants applying for visa continuations and permanent residency were fearful, believing their HIV serostatus would prejudice their applications. Patients cited belief in ART efficacy, were motivated to maintain therapy and were anxious about lack of access to treatment in their countries of origin. CONCLUSION: Adherence to antiretroviral drugs in Medicare-ineligible HIV-infected individuals is excellent despite limited access to treatment. The threat of visa non-renewal and the likely failure of applications for permanent residency result in considerable anxiety and confidentiality concerns.

Lesbian, gay, bisexual, and transgender parents seeking health care for their children: a systematic review of the literature.

BACKGROUND: Few studies have examined the issues faced by lesbian, gay, bisexual, and transgender (LGBT)-parented families in relation to their access to and satisfaction with healthcare services for their children. It is thought that LGBT individuals have experienced negative interactions with the healthcare environment. AIMS: To systematically review the literature investigating the experience of LGBT parents seeking health care for their children. METHODS: A search of the following databases: Cochrane Library, CINAHL, Embase, Google Scholar, Medline, PsychInfo, Science Direct, Sociological Abstracts, Proquest, Scopus, and Web of Science was conducted. Using the PRISMA flow chart and processes of the United Kingdom Centre for Reviews and Dissemination, we selected and analysed relevant studies. FINDINGS: Four studies that met the inclusion criteria were identified. Studies showed that while the experience of LGBT parents seeking health care was largely positive, strategies need to be implemented to improve the quality of healthcare services for LGBT families and ensure that their needs are met. DISCUSSION: Although many LGBT parents have positive experiences of health care, some still experience discrimination and prejudice. IMPLICATIONS FOR PRACTICE: Specific educational interventions are needed to support LGBT parents seeking health care for their children. CONCLUSIONS: Further research is required to explore LGBT-parented families' experiences of healthcare services, and this should include children's experiences.

The experiences of Australian lesbian couples becoming parents: deciding, searching and birthing.

AIM AND OBJECTIVES: To explore Australian lesbian mothers' experiences of becoming parents. BACKGROUND: Lesbians are becoming parents and, since legislative changes in Australia, their numbers are increasing. Prior to legislative changes, fertility and health services for women in Australia exclusively served the needs of the heterosexual community. Although lesbian experience of seeking health services has been studied in other contexts, little has been done to understand their experience of deciding, conceiving and birthing. DESIGN: Qualitative descriptive study. METHOD: Seven interviews conducted with lesbian mothers in Australia. RESULTS: The following themes were identified: 'making the decision'; 'the search'; 'perseverance'; and 'problems of isolation'. CONCLUSIONS: Although legislation now affords lesbians access to reproductive technologies throughout most of Australia, their involvement with health professionals can result in homophobic interactions. One way to address the needs of lesbian families is to provide an environment where the disclosure of sexual identity is encouraged. Further larger scale research should identify changes to service provision required to address the inequalities between heterosexual and lesbian women and ensure health services are provided that are free from discrimination. RELEVANCE TO CLINICAL PRACTICE: Most health services have policies and procedures in place to prevent discrimination on all grounds, including sexual orientation. It is imperative that administrators and clinicians take steps to ensure that these guidelines are applied.

A descriptive study of the experiences of lesbian, gay and transgender parents accessing health services for their children.

AIM: To explore the experiences of lesbian, gay and transgender families accessing health care for their children. BACKGROUND: Although lesbian, gay and transgender families are becoming more common, little is known about their health-seeking experiences. These families may be fearful about disclosing their sexual orientation or gender identity to health professionals. As a result, lesbian, gay and transgender parents may not be receiving optimal care for their children. DESIGN: Descriptive qualitative study. METHOD: Data were collected through semi-structured interviews with 11 lesbian, gay and transgender parents in Australia. RESULTS: Three themes were generated from the data: 'managing health care experiences', 'attitudes' and 'transforming bureaucracies'. Negative experiences included encountering homophobia or transphobia and being required to educate health professionals. Positive experiences occurred when both parents were acknowledged as having an equal say in their child's health care. CONCLUSION: Many health professionals lack the skill or knowledge to meet the needs of lesbian, gay and transgender families. Health services are required to ensure that all policies and procedures are inclusive of all family constellations and that staff receive relevant and up-to-date sensitivity training and create an environment that is respectful of all family groups. RELEVANCE TO CLINICAL PRACTICE: Adopting a philosophy of family centred care can enable health providers and health professionals to provide lesbian, gay and transgender families with inclusive non-discriminatory care.