The mental health effects of changing from insecure to secure visas for refugees.

OBJECTIVE: In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies; however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears. METHODS: Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart). RESULTS: Refugees who transitioned from low to medium security visas showed reduced immigration-related fear (B = -0.09, 95% confidence interval = -0.29 to -0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms (B = -0.02, 95% confidence interval = -0.04 to -0.01), social difficulties (B = -0.04, 95% confidence interval = -0.05 to -0.01) and immigration-related fear (B = -0.03, 95% confidence interval = -0.06 to -0.01) compared to those who retained low visa security. CONCLUSION: Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.

Cognitive mechanisms underlying the association between trauma exposure, mental health and social engagement in refugees: A longitudinal investigation.

BACKGROUNDS: Refugees and asylum-seekers are at heightened risk for developing psychological symptoms following exposure to trauma and displacement. Despite this, relatively little is known about the cognitive mechanisms that underlie common mental disorders in refugees. METHODS: In this study, we investigated the associations between self-efficacy, beliefs about others (relating to benevolence and trust) and psychological and social outcomes in 1079 refugees from Arabic, Farsi, Tamil or English-speaking backgrounds who were residing in Australia. Participants completed an online survey assessing exposure to potentially traumatic events (PTEs), at baseline (T1), and self-efficacy, beliefs about others, PTSD symptoms, depression symptoms, anger and social engagement at baseline (T1) and six months later (T2). RESULTS: A path analysis revealed that greater PTE exposure was associated with lower self-efficacy and lower positive beliefs about others at T1. Self-efficacy at T1 was negatively associated with depression and anger at T2, while positive beliefs about others at T1 were positively associated with social engagement and greater depression symptoms at T2. LIMITATIONS: Limitations of this study included the fact that the study sample was not necessarily representative of the broader refugee population, and in particular may have overrepresented those with higher education levels. CONCLUSIONS: Findings point to the critical role that cognitive variables play in the maintenance of psychological symptoms in forcibly displaced persons, and highlight the importance of targeting these in psychological interventions to promote positive posttraumatic mental health.

Profiles of post-migration stressors and mental health in refugees: A latent class analysis.

Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.

The longitudinal association between moral injury appraisals and psychological outcomes in refugees.

BACKGROUND: Refugees report a diverse array of psychological responses following persecution and displacement. Little is known, however, regarding the mechanisms that underlie differential psychological reactions in refugees. This study investigated the longitudinal impact of negative moral appraisals about one's own actions [i.e. moral injury-self (MI-self) appraisals] and others' actions [i.e. moral injury-other (MI-others) appraisals] on a variety of psychological symptoms over a period of 6 months. METHODS: Participants were 1085 Arabic, Farsi, Tamil, or English-speaking refugees who completed a survey at baseline and 6 months later either on-line or via pen-and-paper. The survey indexed demographic factors, exposure to potentially traumatic events (PTEs), exposure to ongoing stressors, MI-other appraisals, MI-self appraisals, re-experiencing and arousal symptoms, and feelings of sadness, anger and shame. RESULTS: Findings indicated that, after controlling for demographics, PTE exposure and ongoing stressors, MI-other appraisals predicted increased re-experiencing and hyperarousal symptoms, and feelings of sadness and shame. MI-self appraisals predicted decreased feelings of shame, and decreased re-experiencing symptoms. In contrast, psychological symptoms at baseline did not as strongly influence MI appraisals 6 months later. CONCLUSIONS: These findings highlight the important role that cognitive appraisals of adverse events play in the longitudinal course of psychological symptoms. These results thus have important implications for the development of tailored psychological interventions to alleviate the mental health burden held by refugees.

Course and predictors of posttraumatic stress and depression longitudinal symptom profiles in refugees: A latent transition model.

Exposure to potentially traumatic events and post-migration living difficulties (PMLDs) may explain the high rates of posttraumatic stress disorder (PTSD) and depression in resettled refugees. Latent class analyses (LCAs) in refugees have identified subgroups that differ in symptom profiles of PTSD and comorbid symptoms. However, knowledge on longitudinal symptom profiles in refugees is sparse. Examining longitudinal PTSD and depression symptom profiles could provide information on risk factors underlying worsening of symptoms post-resettlement. Self-rated PTSD (Posttraumatic Diagnostic Scale) and depression (Patient Health Questionnaire-9) symptoms were assessed among 613 refugees who had resettled in Australia up to two years previously (W1) and at 6 months follow-up (W2). PTSD and depression symptom profiles were identified using LCAs for W1 and W2 separately. Latent transition analysis was used to examine (predictors of) changes in symptom profiles, including gender, age, trauma exposure, and PMLDs. Four classes were identified that were consistent across timepoints: a No symptoms (W1 61%; W2 68%), Low PTSD/Moderate depression (W1 16%; W2 10%), Moderate PTSD/depression (W1 16%; W2 14%), and High symptoms class (W1 7%; W2 7%). Higher levels of problems with PMLDs, including being discrimination and family separation, predicted movements out of the No symptom class at W1 to classes with psychopathology at W2. To conclude, most participants did not develop PTSD or depression symptoms. The risk of developing these symptoms seems higher when problems with interpersonal PMLDs increased, pointing to the need for considering these stressors when addressing the mental health needs in this population.

Factors associated with COVID-19 vaccine hesitancy amongst refugees in Australia.

Background: Refugees may be especially vulnerable to the adverse effects of COVID-19. Therefore it is critical that refugee communities are supported to access COVID-19 vaccines and for public health responses to address vaccine hesitancy. Objective: To investigate the key demographic factors, barriers and attitudes associated with vaccine hesitancy in a community sample of refugees. Method: Participants in the Refugee Adjustment Study, a cohort of refugees living in Australia, were invited to complete a survey about their COVID-19 vaccine intentions, barriers to access and attitudes relating to the vaccine. Results: Of the 516 participants, 88% were unvaccinated and 28.1% were classed as vaccine hesitant. Key predictors of vaccine hesitancy were younger age, information and trust barriers, lower logistical barriers, and attitudes relating to low control and risk posed by COVID-19. Conclusions: Findings suggest that public health strategies need to address trust, control and risk perception attitudes to increase COVID-19 vaccine uptake in resettled refugee communities.

Antecedentes: Los refugiados pueden ser especialmente vulnerables a los efectos adversos del COVID-19. Por lo tanto, es fundamental que las comunidades de refugiados reciban apoyo para acceder a las vacunas COVID-19 y para que las respuestas de salud pública aborden la indecisión ante las vacunas.Objetivo: Investigar los factores demográficos clave, las barreras y las actitudes asociadas con la indecisión ante las vacunas en una muestra comunitaria de refugiados.Método: Se invitó a los participantes en el Estudio de Adaptación de Refugiados, una cohorte de refugiados que viven en Australia, a completar una encuesta sobre sus intenciones de vacunarse contra el COVID-19, barreras de acceso y actitudes relacionadas con la vacuna.Resultados: De los 516 participantes, el 88% no estaban vacunados y el 28,1% se clasificaron como reacios a vacunarse. Los predictores clave de la vacilación a la vacuna fueron menor edad, las barreras en información y confianza, menores barreras logísticas y las actitudes relacionadas con bajo control y el riesgo que plantea el COVID-19.Conclusiones: Los hallazgos sugieren que las estrategias de salud pública deben abordar las actitudes de confianza, control y percepción del riesgo para aumentar la aceptación de la vacuna COVID-19 en las comunidades de refugiados reasentados.

The association between COVID-19 related stressors and mental health in refugees living in Australia.

BACKGROUND: Refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to their traumatic pasts and the challenges of the postmigration environment. OBJECTIVE: To evaluate the prevalence of COVID-19 related stressors and their relationship to key mental health and functioning outcomes in a resettled refugee sample. METHOD: N = 656 refugees and asylum seekers living in Australia completed a survey in June 2020 to index their mental health (posttraumatic stress disorder (PTSD), depression, health anxiety and disability) and COVID-19 experiences. The relationship between COVID-19 stressors and mental health was examined using a series of hierarchical linear regression models while controlling for other key demographic factors. RESULTS: Refugees' most prevalent stressors related to worries of being infected by COVID-19 or the risk COVID-19 posed to others, which predicted health anxiety and PTSD. Social-related difficulties predicted depression and disability symptoms. Accessing and trusting information from authorities were the least prevalent stressors and were not significantly associated with mental health outcomes; neither was accessing basic supplies and financial support. Fears relating to the future such as concerns about visa application processes predicted health anxiety and disability. Crucially, the strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of difficult past events. CONCLUSIONS: Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past conflict and persecution trauma. It is critical that mental health strategies accommodate the specific needs of refugees during the COVID-19 pandemic.

Antecedentes: Los refugiados pueden ser particularmente vulnerables a los efectos adversos de la pandemia del COVID-19 en la salud mental a consecuencia de sus pasados traumáticos y los desafíos del ambiente post migración.Objetivo: Evaluar la prevalencia de los estresores relacionados al COVID-19 y su relación a resultados claves funcionamiento y salud mental claves en una muestra de refugiados reubicados.Método: N = 656 refugiados y personas en búsqueda de asilo que viven en Australia completaron una encuesta en junio de 2020 para identificar su salud mental (trastorno de estrés postraumático (TEPT), depresión, ansiedad de salud y discapacidad) y las experiencias de COVID-19. Fueron examinadas la relación entre los estresores de COVID-19 y la salud mental usando una serie de modelos de regresión lineal jerárquica mientras se controlaron otros factores demográficos claves.Resultados: Los estresores más prevalentes de los refugiados se relacionaban con la preocupación de infectarse de COVID-19 o el riesgo del COVID-19 hacia otros, lo cual predijo la ansiedad de salud y TEPT. Las dificultades sociales predijeron los síntomas de depresión y discapacidad. Acceder y confiar en la información proporcionada por las autoridades fueron los estresores menos prevalentes y no se asociaron significativamente a los resultados de salud mental; tampoco lo fue el acceder a insumos básicos y apoyo financiero. Los temores asociados al futuro tales como preocupaciones sobre los procesos de aplicación a la visa predijeron la ansiedad de salud y discapacidad. De manera crucial, el predictor más fuerte de todos los resultados de salud mental fue el COVID-19 sirviendo como un recordatorio de los eventos pasados difíciles.Conclusiones: Los refugiados pueden estar afectados de forma única por el COVID-19 porque la pandemia sirve como un recordatorio de sus conflictos pasados y trauma de persecución. Es crítico que las estrategias de salud mental se acomoden a las necesidades específicas de los refugiados durante la pandemia del COVID-19.

Mechanisms underlying the mental health impact of family separation on resettled refugees.

OBJECTIVE: Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact. METHODS: A sample of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and individualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects. RESULTS: The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group; whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group. CONCLUSION: These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.

'Tell Your Story': a randomized controlled trial of an online intervention to reduce mental health stigma and increase help-seeking in refugee men with posttraumatic stress.

BACKGROUND: Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men. METHODS: Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees ('Tell Your Story', TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up. RESULTS: Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19-1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group. CONCLUSIONS: This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.

Barriers to Mental Health Help-Seeking Amongst Refugee Men.

Rates of help-seeking for mental health problems are low amongst refugee communities, despite the high prevalence of PTSD reported amongst these individuals. Research suggests that the key barriers to seeking help for psychological problems include structural barriers (e.g., unstable housing), cultural barriers (e.g., mental health stigma), and barriers specific to refugees and asylum seekers (e.g., visa status). This study examined the effect of structural, cultural and refugee specific barriers on the relationship between PTSD symptom severity and intentions to seek help from professional, social, and community sources. Data was collected from 103 male refugees and asylum seekers with an Arabic-, Farsi-, or Tamil-speaking background. Participants completed measures indexing demographics, trauma exposure, PTSD symptoms, mental health stigma, and help-seeking intentions. Path analyses indicated that PTSD severity was associated with lower help-seeking intentions indirectly via mental health stigma (self-stigma for seeking help and self-stigma for PTSD) and visa security. PTSD severity was also associated with greater help-seeking intentions from community members indirectly via structural barriers. These findings are important to consider when identifying key barriers to mental health help-seeking and developing interventions designed to increase help-seeking for psychological problems, within this group.

The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia.

Background: The vast majority of the world's refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity. Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement. Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership. Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.

Antecedentes: la mayoría de los refugiados del mundo y las personas que solicitan asilo viven en un estado de desplazamiento sostenido. Sin embargo, se conoce muy poco sobre el impacto en la salud mental de la inseguridad prolongada.Objetivo: este estudio investiga la asociación entre el estatus inseguro de la visa y la salud mental, la suicidalidad, la discapacidad y la participación social en una gran muestra de refugiados y solicitantes de asilo que viven en Australia.Metodología: Los participantes fueron 1.085 refugiados. Un grupo tenía un estatus seguro de la visa (como por ejemplo residencia permanente o ciudadanía australiana n=826, 76.1%) y otro grupo tenía un estatus inseguro de su visa (como por ejemplo solicitantes de asilo, visa puente1, visas temporales, n = 259, 23,9%). Los sujetos llegaron a Australia desde Enero de 2011, y eran de origen árabe, farsi, tamil o angloparlante. Los participantes completaron un cuestionario online que evaluaba las experiencias pre y post migración, salud mental, discapacidad y participación social.Resultados: Los resultados indican que después de controlar factores contextuales importantes, los refugiados con visas inseguras tuvieron síntomas de TEPT significativamente mayores (ß=0.15, 95%; intervalo de confianza (IC) = 0,05-0,26), síntomas depresivos (ß=0.22, 95% CI=0.069-0.34), pensamientos de estar mejor muerto (OR=1.9, 95% CI=1.26-2.89) e intentos suicidas (OR=2.41, 95% CI=1.03-5.62), comparados con aquellos que contaban con visas seguras. No existen diferencias entre grupos para la discapacidad. Los refugiados con visas inseguras recibieron el apoyo de muchos más grupos que aquellos que tenían visas seguras (Chi ­ cuadrado de Wald= 33.01, p <.001). Además, los refugiados con estatus de visa inseguro con baja pertenencia al grupo mostraron mayores síntomas de depresión (B=0.17, t=3.85, p <.001) e intentos suicidas que aquellos que tenían un estatus de visa seguro y una baja pertenencia a un grupo (B=−1.25, OR=0.29, p =0.006).Conclusión: Los resultados destacan las consecuencias negativas para la salud mental de vivir en un estado de incertidumbre prolongada para los refugiados y las personas que solicitan asilo, y el papel clave de la participación social para influir en la salud mental entre los titulares de visas inseguras. Los resultados también subrayan la importancia de diseñar e implementar políticas y servicios que faciliten una mejor salud mental para las personas con visas inseguras.

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention.

BACKGROUND: Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. METHODS: We undertook a realist review to answer the research question: 'How are HIV prevention interventions in high-income countries adapted to suit immigrants' needs?' A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. RESULTS: Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of 'consonance' mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms - 'understanding', 'specificity' and 'embeddedness' - which indicated that using the language of immigrants, usually the 'mother tongue', targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of 'authenticity' and 'framing' mechanisms and only partial evidence to support role of 'endorsement' mechanisms. CONCLUSIONS: This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.

Using HIV notification data to identify priority migrant groups for HIV prevention, New South Wales, 2000-2008.

Non-Australian-born people comprise a third of HIV notifications in Australia. With increasing numbers of immigrants in Australia, public health and health promotion programs will need to adapt to the emerging epidemic of HIV among people from culturally and linguistically diverse (CALD) backgrounds. This study uses HIV notification data to compare Australian-born and non-Australian-born cases in New South Wales and aims to determine if income of source country is useful in identifying high priority CALD groups. Notified cases of newly diagnosed HIV between 2000 and 2008 in New South Wales were divided into Australian-born, persons born in high-income countries and persons born in middle and low-income countries based on World Bank classifications. These three groups were then compared to determine their risk factors for HIV infection. Of the 3,397 newly diagnosed HIV infections in New South Wales, 2,906 (86%) had a country of birth reported from 102 different countries. Cases born in high-income countries were similar to Australian-born cases; predominantly men reporting homosexual acquisition. Both these groups were different to cases born in middle and low-income countries; they were younger, more commonly female and reported heterosexual acquisition of HIV. Using income from source countries is useful as a model to better understand and target responses to HIV in non-Australian-born populations in New South Wales as it suggests that the public health and health promotion response in New South Wales and Australia should also focus on the priority communities drawn from low and middle income countries.

Guarding against emerging epidemics: addressing HIV and AIDS among culturally and linguistically diverse communities in NSW.

In Australia, people from culturally and linguistically diverse backgrounds, largely born in low- and middle-income countries, accounted for 24% of HIV notifications in the period 2004-2008. NSW has one of the most culturally diverse communities in Australia and is also the most popular destination for both permanent and temporary migrants. Consequently people from culturally and linguistically diverse backgrounds have recently been recognised as a priority in the NSW HIV/AIDS Strategy. The National Health and Medical Research Council provides a cultural competency framework for re-orienting public health and health promotion programs to better meet the needs of these communities. It is being applied to re-orientate the HIV response in NSW. Examples of how this framework can be implemented are provided.

Evaluation of an ethnic media campaign on patterns of HIV testing among people from culturally and linguistically diverse backgrounds in Australia.

OBJECTIVE: To evaluate a 2-week pilot ethnic media campaign that was implemented in 14 languages to promote awareness of HIV/AIDS and HIV testing among selected non-English speaking populations in Australia in November/December 2000. METHODS: The main outcome measure was clinic attendances for the purpose of HIV testing by individuals from the target populations at one ofthree public sexual health clinics in Sydney and Melbourne prior to and immediately after the campaign. RESULTS: The number of HIV tests on members of the 14 target language communities attending the clinics almost doubled from 66 to 122 tests. However, as a proportion of the total number of HIV tests performed at the three clinics this increase was not significant (16.3-18.8%; P = 0.31). For both periods in 2000 the proportion of HIV tests that were performed on members of the target language group were higher than during a 1999 comparison period (10.5%, both P < 0.01). CONCLUSIONS AND IMPLICATIONS: This study did not demonstrate a significant increase in testing attributable to the pilot intervention. A larger campaign, with a more extensive evaluation, would probably be needed to demonstrate a measurable effect.