Indigenous STI/STD Rates Need Urgent Action

The Aboriginal and Torres Strait Islander Health Program was established at The Kirby Institute in 2007. The Program works collaboratively across sectors to close the gap in health disparity between Aboriginal Indigenous, Torres Strait Islander and non-Indigenous people, with a key focus on sexual health and blood borne viruses.

Each year, the Aboriginal and Torres Strait Islander Health Program collaborates with the Surveillance Evaluation and Research Program on the Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: Surveillance and Evaluation Report. The surveillance report provides information on the occurrence of blood borne viruses and sexually transmitted infections among Aboriginal and Torres Strait Islander people in Australia for the purposes of stimulating and supporting discussion on ways forward in minimising the transmission risks, as well as the personal and social consequences of these infections within Aboriginal and Torres Strait Islander communities.

Australia’s Aboriginal and Torres Strait Islander population continues to be overrepresented in notifications of STIs, and blood borne viruses (BBVs). In particular, outer regional and remote communities continue to experience substantially higher rates of notifiable STIs.

HIV

Between 2012–2014, the notification rate of new HIV diagnosis in the Aboriginal and Torres Strait Islander population (5.9 per 100,000) was higher than in the non-Indigenous population (excluding people from a high HIV prevalence country of birth) (3.7 per 100,000).

Among notifications of newly diagnosed HIV infection in 2010–2014, the most frequently reported route of HIV transmission was sexual contact between males in both the Aboriginal and Torres Strait Islander (50%) and non-Indigenous population (75%).

A higher proportion of notifications from the Aboriginal and Torres Strait Islander populations were attributed to injecting drug use (16% vs 3%) and heterosexual contact (20% vs 13%) and in females (22% vs 5%), as compared with the non- Indigenous population.

Based on tests for immune function, a third (30%) of the new HIV diagnoses among the Aboriginal and Torres Strait Islander population were determined to be late, in that they were in people who had their infection for at least four years without being tested.

In 2014, HIV prevalence in Aboriginal and Torres Strait Islander peoples was similar to the Australian born non Indigenous population (0.11 vs 0.13%).

The higher rate of HIV diagnosis in Aboriginal and Torres Strait Islander peoples in the past five years requires a strengthened focus on prevention in this vulnerable population.

Chlamydia

Chlamydia continues to be the most frequently reported condition in Australia, with 86,136 notifications in 2014.

Of these, 6,641 (8%) were among the Aboriginal and Torres Strait Islander population; 25,365 cases (29%) were among the non-Indigenous population; and for 54,130 (63%) diagnoses, Indigenous status was not reported.

Chlamydia predominantly affects people aged 15–29 in both Indigenous and non- Indigenous populations, with the highest notification rates occurring among women in the 15–19 year age group.

This may reflect greater disease burden, and/or higher rates of access to health services and subsequent testing in these populations (for example, antenatal screening in the younger child-bearing population pyramid of the Aboriginal and Torres Strait Islander population).

Despite just 22% of the Aboriginal and Torres Strait Islander population residing in remote areas, chlamydia notifications reported from these areas accounted for more than half of all notifications in the Aboriginal and Torres Strait Islander population.

Gonorrhoea

Of 15,786 notifications of gonorrhoea in 2014, 3,584 (23%) were among the Aboriginal and Torres Strait Islander population; 6,915 (44%) were among the non-Indigenous population; and for 5,287 (33%) notifications, Indigenous status was not reported.

The rate of gonorrhoea notifications in the Aboriginal and Torres Strait Islander population in 2014 was 18 times higher than in the non-Indigenous population. 71% of cases among the Aboriginal and Torres Strait Islander population were diagnosed among people in the 15–29 year age group, compared with 56% in the non-Indigenous population.

For the Aboriginal and Torres Strait Islander population, gonorrhoea is mostly diagnosed among young women and men living in remote areas, while the majority of cases of gonorrhoea in the non-Indigenous population are among gay men living in major cities.

Infectious syphilis

Nationally, 1,999 cases of infectious syphilis were diagnosed in 2014; 235 (12%) among the Aboriginal and Torres Strait Islander population, 1,588 (79%) among the non-Indigenous population and Indigenous status was not reported for 176 (9%) diagnoses.

The notification rate of infectious syphilis in the Aboriginal and Torres Strait Islander population in 2012 was four times higher than the rate in the non-Indigenous population (32 vs 8 per 100,000 population) increasing to 300 times higher in remote areas.

Rates of infectious syphilis notifications among the Aboriginal and Torres Strait Islander population increased in 15–19 year olds in 2011 (from 34 per 100,000 in 2010 to 95 per 100,000 in 2011), due to an outbreak in the northern areas of Queensland, the Northern Territory and Western Australia, and was 99 per 100,000 in 2014.

Like gonorrhoea, infectious syphilis affects two main population groups: young Aboriginal and Torres Strait Islander women and men equally in remote communities, indicating predominantly heterosexual transmission; and gay men living in major cities suggesting that transmission is primarily related to sex between men.

Implications for Aboriginal and Torres Strait Islander communities

Rates of STIs are particularly high among both Indigenous and non-Indigenous young people living in outer regional and remote areas of Australia; however, it is important to note that rates of chlamydia notifications are higher across all geographical locations for the Aboriginal and Torres Strait Islander population compared to the non-Indigenous population.

Two distinct epidemics exist for gonorrhoea and syphilis and urgent action is required to address levels of knowledge, community awareness and understanding of STIs as well as promotion of testing as a prevention strategy in these communities.

STIs can also have significant physical, psychological and social consequences, especially for young people, who may shy away from seeking health care. Addressing stigma and bringing STI rates under control – particularly in remote Aboriginal communities – should remain a national priority until they are at least comparable to the rest of the Australian population.