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QPP would like to acknowledge the importance of our diverse PLHIV communities as they shape the principles that underpin the work we do. The lived experience and peer contributions of PLHIV remains always at the centre of who we are at QPP. We would like to take a moment to remember those who are no longer with us and laid the foundations for QPP and the sector – we remember the courage and sacrifice of many and we will continue to work towards a world where people with HIV live lives to their full potential, in good health and free from discrimination.
This season of SNACK has been produced by Queensland Positive People as part of the COTA Queensland Consortium Home Care Workforce Support Program which received grant funding from the Australian Government.
Produced by Martin Franklin at East Coast Studio
We honour and pay respect to the traditional custodians of the many lands and waters upon which we work and live, paying particular respect to the Turrbal and Jagera peoples. QPP recognizes that this land is unseated and has always been under First Nations’ custodianship. We pay our respects to elders past and present and to emerging community leaders. In this podcast, there may be issues, concepts, information, and reminiscences which may be triggering for some people. Listener discretion is advised, and resources are available should you find sections of this podcast challenging. Hello, and thank you for joining us again for another episode of Snack, the podcast series. That’s looking at aged care where we break down some of the big questions around what it really means to be person centered. My name is Blair Martin. I’m your host. In this season of the podcast, we’re talking about HIV and how the home care workforce can confidently engage with people living with HIV. Today, I’m joined by doctor Lizzo Wojciechowski and Ash Broom to discuss how the home care workforce can create inclusive and safe environments for their HIV positive clients. Lisa is a social worker with several years of experience working alongside people with HIV within hospital and community based settings. Lisa is currently the life plus manager at QPP in Brisbane. Ash Broom is the diversity and equity training at the Queensland Council For LGBTI Health. Ash has worked in the LGBTIQ plus health area for 15 years, focusing on the last 5 years on developing inclusive practice in aged care settings and supporting organizations to embed diversity quality standards. Would you warmly welcome Lisa and Ash and thank you both for joining me and those listening to this podcast today. Thank you. Thanks for having us.
Ash if I may start with you. Pronouns, what pronouns do you use, please? What pronouns are they, them, theirs? Thank you very much. And Lisa? I’m she, her. And mine are he, him, or they, them. Either, I don’t mind. So, we’ll kick off by discussing person centred care. Now, this is a very specific question. We’re looking at people who are living with HIV or, more broadly, people who identify as LGBTQI plus or diverse in gender and sexuality. I’ll ask Lisa first, just how important is the focus to be people centered, person centered? The focus is really important if we think about people living with HIV can engender a broad range of identities. So if we think about within Australia, while the majority of people living with HIV, gay men or men who have sex with men, around about 60%, we also have about 45% of people who weren’t born in Australia living with HIV. When we think about, the idea of intersectionality, which is the idea that the ways in which different aspects of a person’s identity can expose them to overlapping forms of discrimination and marginalization, we think about, how people’s different identities can potentially impact how they might experience home care workers or or how they might receive care and support. The thought that comes to mind is this is probably the most person centered environment that a home care or aged care worker would find themselves in. Ideally, yes. I think we need to acknowledge for workers, though, people don’t know what they don’t know. So if they don’t have personal experience with loved ones in their lives that are HIV positive or from the LGBTIQ plus communities or they haven’t had that professional experience before, it may just not be a part of their world or their frame of reference.
So workers really need to be supported, in ongoing learning and development and actually being able to do person centred care with people from different marginalised groups. In the work that you’ve done, what have you seen as some of the key things that have made person centred care work? I think just normalizing it for peep like, often when I do training people, oh, no. I’m going to get it wrong. I’m going to say the wrong words. It’s okay. You will stuff it up. What matters is that you recognize that and then you repair afterwards. We’re all human beings and working in any kind of diversity equity space of marginalized groups. It’s ongoing learning constantly. We’re never going to get to that gold standard of knowing everything. But, actually, stepping through what has been people’s lived experience and how it has affected them practically, and then what that means for people then accessing services now and how that can make people feel very vulnerable. And kind of we need to the onus is on service providers and workers to be trauma informed and to almost kind of almost, like, over communicate about people’s rights. I like what you said earlier. Just admit, you’ll get it wrong. Say to the person that you’re providing the aged or at home care, I’m really sorry about this. Is there a way we can repair? Learn? I’m just a little bit aware that some people say, I’m not here to educate you. You go and educate yourself. I’m not your teacher. Between your responsibility within your professional role and also if you’re needing professional development to actually go back to your organization and say, actually, I need this support to work with people appropriately and also being clear about whether you’re asking from a point of curiosity or whether you’re asking about information to actually deliver a service properly or appropriately for that person.
If it’s curiosity, that means you need to go Google Yeah. At least. Good old doctor Google. Welcome. Welcome. But that is actually a bad thing that if you can start your search and then engage with the people that are your provider as your employer saying, let’s do better. Yeah. Let’s be better than this. And people will say, yeah, I like working with you because you’ve made an effort to understand. Lisa, coming back to the world of social work and looking at those very specific problems, the people sitting around this table recording this podcast, none of us immediately identify by image or by any other form as First Nations or born overseas or people of colour, we have a responsibility to just take a bit more of time of allowing that space to be filled by those people by having language and cultural differences talked about. In your world of social work, what are the things that work in allowing that to happen? I think it’s tricky. Right? If we think about, the people providing care and support, have a think about where you might come from. What did HIV mean in your country of origin where you grew up, and what have your experiences with HIV stigma and discrimination been, and how might that meet with the person you’re actually talking to? The other thing that’s important to consider as well is with, particularly for people who might belong to the LGBTIQA plus community or people living with HIV, you might not even know their status or their sexuality. They might not tell you and they might not feel safe to tell you if you start using language that doesn’t feel quite right or doesn’t feel safe either. So, again, that point, Ash, that you made around Googling it, doing better, asking if you think that there’s gaps in your knowledge or understanding or you feel a bit funny about these sorts of things, then absolutely go out there and find out a little bit more.
The understanding of making sure you know how you’re going to interact with the person. What is it that someone can understand just how much of an impact, a negative impact that can have on people? Yeah. There’s an activity we do decades of discrimination, and we actually go back to the forties. So what was happening in Australia during that time for, particularly LGBTIQ plus communities, and, obviously, a large part of the eighties is around the HIV epidemic. And it’s about unpacking, for example, gay men back in the day having criminal convictions for consensual adult relationships that stayed on their record records for years. So that impacted their ability to have a job, apply for a bank loan. They’ve got to write that down. Can they even volunteer and contribute to their community? So they’ve not only has that happened back in the day, it stayed with them for years. It’s taken a long time for authorities, the powers that be to say, oops, sorry. That wasn’t a great idea doing that. Sorry about all the trauma. And so now suddenly people are just going to be okay with that. So if they’re going to have reminders or triggers of those things in the past of course there’s going to be distrust and hurt and pain there, and people are going to be self-protective. So that’s why we need to overly communicate and indicate you are safe, you have rights here. If you’re not safe, here’s the here’s where you can go for support. You can talk to me. I might not know everything, but my intention is to be a positive support to you. And I think a key phrase that’s often used in the work that you do is inclusive care recognizes there are complexities. There are bits on top of bits on top of bits that some fit together, some don’t, and one size fits all simply doesn’t work for everybody.
Everyone is going to have a different experience with that. There are so many interesting steps that we can go through here, and I would like to hear from both of you about fostering open and nonjudgmental communication with a client. What are some of the ways, if I could ask both of you, to share from your experience? What are some of the ways that a person providing aged care and or at home care can develop that relationship with the client? From my perspective, my brain keeps going back to the concept of cultural humility. Every interaction you have with someone, no matter who they are, it’s got there’s going to be differences in your experiences, identities, let alone some of those bigger things that can feel like they divide us. If you just approach it that every conversation you have is cross cultural and being mindful of that and having the humility note, Like I said, you will stuff it up and that’s okay. But I love that phrase you’ve just used, cultural humility. It’s wonderful. It’s a beautiful phrase to carry. And a part of that is being aware of your own privileges and disadvantages as well and how that plays into the lens which you view the world. And then, obviously, the assumptions that we inherently make about people, we do that. That’s how our brains understand the world around us. We want to categorize and label and do all of that. So I think in person centered care, it’s where you practice and you develop the skills to kind of pump those mental breaks on labelling too quickly when we’re working with people. Lisa? A couple of things. I think, like you said, labels can be really important or useful or even powerful when people are using them for themselves.
I think they can be problematic or a little bit dangerous if we are ascribing labels to other people and so part of that is about listening to other people’s ways in which they describe themselves and, respecting that and using them just like we introduced ourselves and our pronouns, for example, in this space. Gender affirming language, Ash, I think we’ve talked about that. That has to be a key point. Like, don’t assume. Ask. Get into the stories with people. I am very interested in another thing, and I’ve started to notice this because I’ve done some work in some other areas, particularly education, and I’ve noticed people wearing rainbow badges saying ally or just the rainbow badge or trans ally or things that say you’re safe with me. How important is that? And, again, I’d like both of you because you both come from the same, but quite different experiences of working in people living with HIV. Ash? It’s really important. And if I just reflect on my own personal experience just as a person in the community, if I go to even just a cafe and they have the little rainbow flag on the door, and that’s created a sense of safety for me. So for people that are feeling quite isolated, they have a lot of mental distress, or they don’t have safe spaces, particularly at home or with their family of origin, that kind of stuff can be really, really important. Mhmm. Lisa? Absolutely. I I echo that. I think in the context of HIV where as a home care worker you might not even know that some someone’s, HIV status because it might not be relevant to your role if you’re doing some domestic work. It’s not relevant for you to know their HIV status, but if you’re ribbon, for a red ribbon for example to indicate that you’re an ally or that, you know, you have some understanding in that space, that that’s going to be a visual indicator for someone to go, okay, they get it, I feel safe.
They may or may not disclose, but it’s absolutely something that will, indicate to them that they’re in an environment where they could if they wanted to potentially. What does an aged care or at home care worker really need to know about people who would like to keep their privacy and not disclose status and not disclose their identity and the reasons why? Sure. I mean, there’s a few things to unpack there, isn’t there? So if people’s HIV status is known, that can be a source of potential or actual stigma or discrimination. Many people living with HIV have had experiences where their status has been disclosed without their consent and that has then also eventuated into some form of stigma or discrimination. So because in the perfect world we would love be able to say, yeah, disclosing my status, disclosing my gender identity, my orientation, how I identify. It’s fine. It’s perfect. It’s not going to have any comebacks, but unfortunately, we don’t live in the perfect world. Yeah. So, while HIV now is a chronic condition that’s manageable, because of the stigma and we’re, you know, going back to the crisis years in the eighties, there is, it’s a stigmatized condition. So, if someone has HIV on their records or on their care documentation, that can potentially open them up to experiences of stigma. It’s not like writing diabetes or writing any other kind of health condition on there, it’s different, it just is. So I guess there’s a few things that it’s really important to think about when you’re working with people living with HIV in that space, like don’t write HIV on documentation if it’s not relevant. Have a chat if you are aware of their status, if they have disclosed their status to you and it might be relevant or important to mention that in the process of your providing care or support, talk with the person first and find out whether or not they’re comfortable with you sharing that information with others.
Don’t just share someone’s status without their consent. Because they may not have disclosed that to the people, they are closest to. Their family, their friends may not know, and confidentiality needs to be kept. Absolutely. Other really key parts as well is, I mean, we were talking before about coming from a place of humility, not assuming things, but also balancing that with being educated or you know filling in the gaps of your own understanding around certain things. Ash, in the work that you’ve done in education and helping people understand how to communicate, that area of confidentiality and informed consent, Is there any way people don’t get it? I think sometimes people can get caught up in that curiosity, well-meaning curiosity, and don’t realize that they’ve overstepped. They’re just not thinking. But, ideally, I try to frame it for people that we want to provide people invitations to disclose. They can disclose if they’re comfortable. If they want to tell us, great. But if it’s not necessary for care, then we don’t need to know. We want people to have that control over their own personal information. In the work that you’ve done with people living with HIV and, again, acknowledging, Ash, you have more of a work in the aged care area. Do you have any real world examples of where things have turned around and you’ve had a great success, something really good has happened? Yeah. So we had an example where we had one of our community members going into an aged care space actually and one of our workers had noticed that the staff were using PPE equipment that wasn’t required. So and that’s another form of, maybe inadvertent stigma and discrimination. You know, their bosses had gone and had a look at their health and safety requirements, said yep you need to use PPE for this situation.
So it was a situation organizationally was incorrect, they had the incorrect information, well-meaning people, but obviously harm had been created because it was an inappropriate use. Anyway, we were able to provide some education, to the organisation with the consent obviously of the person, who was receiving care and that all changed people once they had knowledge, modern knowledge of HIV, not knowledge stuck back in in the eighties, once people had a good understanding then they were absolutely able to provide really good person centred care for this this individual. Well, thank you very much for joining all of us, those of us having this conversation, and those who are listening. I give my warmest thanks again to Doctor Lisa Wojciechowski of QPP and Ash Broom of QC LGBTI Health. Thank you for joining us on Snack. QPP are a peer led, community based organisation based in Queensland who are committed to improving the lives of all people living with HIV. For more information on anything you have heard in this podcast, please refer to the show notes associated with this episode. Funding for this podcast has been provided by the Council on the Aging Queensland Home Care Workforce Support Consortium as part of the Home Care Workforce Support Program, which was funded through grant funding from the Australian government.
