Domestic mobility and experiences of disconnection from sexual health care among gay and bisexual men in Australia: insights from a qualitative study.

Abstract

Background Previous research on mobility and HIV acquisition among gay and bisexual men (GBM) has focused on: (1) changed sexual practices in the context of travel; and (2) the association between migration and increased HIV risk. To date, little attention has been given to continuity of sexual health and HIV-prevention services in the context of relocating between different cities or regions within the same country. Methods Drawing on in-depth interviews with 17 GBM recently diagnosed with HIV, we explored these men's access to sexual health care in the period prior to diagnosis. Results At least five of these 17 men's accounts provided examples of becoming disconnected from sexual health care because of mobility within Australia. For some men, this disconnection from care also included loss of access to pre-exposure prophylaxis (PrEP). In all these men's accounts, reconnection with services only came about at the time of seeking the HIV test associated with their diagnosis. The fact that men who had previously been well connected to sexual health services (as indicated by early uptake of PrEP, or regular HIV/STI testing) did not easily access similar services after relocating suggest that there are other factors - such as the social and physical environment - that have an important bearing on retention in sexual health care. Conclusions There is a need for more comprehensive data collection related to mobility in order to ascertain its relative importance. Regarding policy and practice, there are also opportunities for a more formalised process for interstate referral of clients of sexual health services.