CSIRO PUBLISHING & MINNIS COMMUNICATIONS Letter www.publish.csiro.au/journals/sh Sexual Health, 2007, 4, 209 Cambodian-born individuals diagnosed with HIV in Victoria: epidemiological findings and health service implications Darshini R. Ayton A,C,E , Rebecca J. Guy A,C , Ian J. Woolley B,D and Margaret E. Hellard A,C A The Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Vic. 3001, Australia. B Monash Medical Centre, Infectious Diseases Department, Clayton, Vic. 3168, Australia. C Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia. D Department of Medicine, Monash University, Clayton, Vic. 3168, Australia. E Corresponding author. Email: dayton@unimelb.edu.au Victoria has had a concentrated HIV epidemic among men who have sex with men. However, reports of additional heterosexually-acquired HIV infections have increased. In 2001–2004 there were 182 diagnoses, compared with 134 in 1997–2000. 1 More than half of these diagnoses are among individuals born in countries, such as those of sub-Saharan Africa, Cambodia, Thailand and Myanmar, that are defined as high prevalence (community seroprevalence for HIV greater than 1%). 1 As part of the response a case series was conducted among Cambodian-born individuals diagnosed with HIV in Victoria, describing their HIV diagnosis experience and subsequent use of treatment and support services. Between July and September 2005, potential participants were recruited from two tertiary care teaching hospitals. Of a potential 13 participants, eight were recruited; five males and three females. The treating doctor of the participant completed a HIV medical history questionnaire and further information was collected on demographics, HIV diagnosis experience and subsequent utilisation of HIV treatment and support services by the use of in-depth qualitative interviews. Interpreter services were used when necessary. The treating doctor of the participant also completed a HIV medical history questionnaire. Participants had been living in Victoria for an average of 10 years when interviewed, most spoke Khmer as their primary language and were diagnosed with HIV a median of 3 years before being interviewed. Despite being born in a high prevalence country, six of the eight participants had never been tested for HIV before diagnosis and were predominantly tested due to exhibiting symptoms related to symptomatic HIV infection (four were tested by a general practitioner and three presented at a hospital). A clinician had diagnosed five of these participants with an AIDS defining illness within 8 weeks of their initial HIV diagnosis. When participants were diagnosed with HIV, most reported that they had not been provided with information about HIV (five) or support groups (six) and in the year before the interview none of the participants reported accessing HIV support services. The participants reported disclosing their HIV http://www.publish.csiro.au/journals/sh status to a restricted number of people; mainly those involved in their medical care or immediate family. Three participants had not disclosed their HIV status to anyone outside of their medical team. This study has highlighted the high occurrence of ‘late presentation’ in this group which has both clinical and public health implications; mainly poorer clinical prognosis 2 and greater opportunity to transmit HIV to others due to being unaware of their HIV status. 3 Education of doctors in areas of Victoria with large Cambodian-born populations about the risk of HIV and the need for HIV testing would be helpful in increasing testing in this population. Participants reported disclosing their HIV status to a limited number of people, did not utilise existing Victorian support services and most spoke Khmer. Having a Khmer speaking HIV advocacy agent/social worker available during hospital HIV clinic time would be beneficial in providing support and assistance to patients when accessing both specific HIV services and generic health or government services. References 1 Communicable Disease Control Unit, Rural and Regional Health and Aged Care Services, Department of Human Services. Surveillance of notifiable diseases in Victoria. Melbourne: Communicable Disease Control Unit, Rural and Regional Health and Aged Care Services, Department of Human Services; 2004. Available online at: http://www.health.vic.gov.au/ideas/downloads/annual rpts/snid2004 complete.pdf [verified May 2007]. 2 Gay CL, Napravnik S, Eron JJ Jr. Advanced immunosuppression at entry to HIV care in the southeastern United States and associated risk factors. AIDS 2006; 20: 775–8. doi: 10.1097/ 01.aids.0000216380.30055.4a 3 Hocking JS, Rodger AJ, Rhodes DG, Crofts N. Late presentation of HIV infection associated with prolonged survival following AIDS diagnosis–characteristics of individuals. Int J STD AIDS 2000; 11: 503–8. doi: 10.1258/0956462001916407 Manuscript received 13 March 2007, accepted 14 May 2007 © CSIRO 2007 10.1071/SH07016 1448-5028/07/030209