The 2019 Sex Lecture: the benefits of researching the hard-to-reach

At the annual public lecture, UNSW Associate Professor Limin Mao will discuss the results of 20 years of immersion in research of gay Asian men.

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Over the past two decades, social and behavioural research of HIV has played a significant role in the visible transformation of local gay Asian men, their networks and community-building. During that time, UNSW Sydney Associate Professor Limin Mao from the Centre for Social Research in Health (CSRH) has held a unique vantage point – from a researcher restricted to the fringes, to trusted confidante and friend. 

Associate Professor Mao will reflect on her 20 years of research into engaging and collaborating with ethnic minorities during the third annual Sex Lecture, speaking on the theme ‘Engaging gay Asian men: hard to research among the hard to reach?’

The lecture will be held on Thursday 21 February at 4pm at the Eternity Playhouse in Darlinghurst. A panel discussion on community building, engagement and empowerment for local gay Asian men will follow the lecture. Panellists include Brent Mackie (ACON), Dr Bill Kefalas (UNSW Health Service) and Dr Shih-Chi Kao (Sydney Local Health District).      

“I have a different perspective that can add to this collective body of work,” says A/Prof Mao. “I wouldn’t claim that I am part of the community, but my life and my work are very much immersed with this population. They have become my best friends and my colleagues who I learn from.”

Historically, researchers have found gay Asian men difficult to research because of factors including homosexual identifications, cultural connotations and other definitions. Connecting with the community – knowing who they are, where they live and how to reach them – is central to increasing uptake of HIV testing services and programs, which research indicates is crucial for HIV prevention.

“Gay Asian men are more difficult because of cultural interpretations of what it is to be gay, what it is to be a man who has sex with men and other sexual behaviours. They might not identify as gay,” A/Prof Mao says. “And the Asian definition is broad and involves more than 20 countries, as well as those who are overseas-born, or second-generation born in Australia. Do they identify as Australian or Asian?”

Despite the limitations, research has found that gay Asian men are increasingly engaging with health services due to factors including broader access to services, treatment and care, and innovative programs that promote friendly, confidential and collaborative health clinics. 

A/Prof Mao’s research has also helped to identify and overcome individual-level and structural-level barriers that deter or prevent people from seeking treatment. Individual-level barriers include perceptions of risk and the protection of personal data. Structural-level barriers are services for Medicare-ineligible people and language barriers.  

“The previous thinking was that people, particularly gay Asian men, had lower rates of HIV and STI testing. Our belief was that they didn’t know where to test or that they had a very low awareness of the necessity of testing,” A/Prof Mao says. “But what we have found through survey and consultation is that it’s not like that. The main gap is who they trust: do they go to GPs or do they go to a friendlier sexual health clinic?”

She says understanding how gay Asian men connect and interact within the community has been vital in developing programs, particularly the introduction of peer navigators – people who are trained to assist newly diagnosed HIV-positive people or those re-engaging with community services. Peer navigators are usually trained in the community but may not have medical training. They are typically passionate about the LGBTI community and are concerned with having their friends and people they know test, to learn about HIV and HIV prevention or to get better treatment.

“Peer navigators who look like them make them feel more comfortable,” A/Prof Mao says. “Gay Asian men prefer to navigate health services in a group and will often drop in to places like Oxford Street to get tested when it’s convenient. Understanding these elements helps to engage more gay Asian men.”

A/Prof Mao says her research helped inform the introduction of the new a[TEST] Chinese Clinic, which offers rapid HIV testing in Mandarin through ACON to provide Chinese-speaking gay men and men who have sex with men easier access to sexual health screenings and information.

“I know that we can’t represent every gay Asian man, but we are trying to form a community and trying to cultivate certain communities and networks where people feel comfortable and use their energy and wisdom to shape the community response,” A/Prof Mao says.

“Their voices were hidden in the past, but through my work and through building partnerships, we have become a visible voice collectively for these people. The research is helping all of the community groups – from Local Health Districts to ACON multicultural supports services – come together to identify gaps and help improve services.”

The 2019 Sex Lecture ‘Engaging gay Asian men: hard to research among the hard to reach?’ is part of the Sydney Gay and Lesbian Mardi Gras Festival and is supported by the Darlinghurst Theatre Company.