Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.11 HIV/AIDS, hepatitis C and sexually trasnmissible infections

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Why is it important?:

Several sexually transmissible infections (STIs) (chlamydia, gonorrhoea, syphilis and donovanosis) are much more common for Aboriginal and Torres Strait Islander peoples than for other Australians. Although each of these infections can be treated and cured once diagnosed, each can have serious long-term consequences, such as chronic abdominal pain or infertility in women after gonorrhoea and chlamydia, genital damage from the eroding ulcers caused by donovanosis, and heart and brain damage caused by syphilis (Bowden et al. 2002; Couzos & Murray 2003). Several of these infections can cause miscarriage and permanent damage to new-born babies.

Notification rates for hepatitis C are significantly higher for the Aboriginal and Torres Strait Islander population compared with other Australians. The prevalence of HIV among Aboriginal and Torres Strait Islander people is similar to that of the general population, but higher rates of STIs and poorer access to primary health care services make the population more vulnerable to HIV trans-mission. Unlike the STIs listed above, hepatitis C and HIV/AIDS are viral infections which can both be fatal. HIV/AIDS remains incurable and management of both HIV and hepatitis C requires specialist services for which access may be poorer for Aboriginal and Torres Strait Islander peoples.

The bacterial STIs and HIV are transmitted through sexual contact while hepatitis C is most commonly transmitted through contact with infected blood (usually injecting drug use). HIV is also transmitted through contact with infected blood.

Notification data on sexually transmissible infections reflect diagnosed cases for the condition rather than the extent of the problem in the population. These data exclude information from those people who have the condition but have not been diagnosed. Therefore notification rates reflect a range of issues including access to responsive and effective health care, the accuracy of the tests, whether there is systematic screening for conditions that are common but frequently asymptomatic, people’s decisions about seeking health care for sexually transmissible conditions and for Indigenous Australians, the accuracy of Indigenous identification in the data. Improved primary health care can lead to increased testing and a corresponding increase in notification rates.

Findings:

Chlamydia has now overtaken gonorrhoea as the most common STI notification for Indigenous Australians. Each of these infectious diseases has significantly higher notification rates for Aboriginal and Torres Strait Islander peoples than for other Australians. In the period 2006–08, notification rates for gonorrhoea among Aboriginal and Torres Strait Islander peoples were 38 times as high as for other Australians. For syphilis they were 18 times as high, for chlamydia 4 times as high and for hepatitis C 4 times as high. All these diseases occur more frequently in the young adult age groups, particularly the 15–24 years age group.

Notification rates for chlamydia and gonorrhoea have increased across the whole Australian population over the last decade. The notification rates of gonorrhea and chlamydia increased significantly between 1994–96 and 2006–08 for Indigenous Australians in WA, SA and NT.

There have been no significant changes in the incidence of HIV infection for Aboriginal and Torres Strait Islander peoples between 1998–2000 and 2006–08. For the period 2006–08, the incidence of HIV was 4 per 100,000 for Aboriginal and Torres Strait Islander peoples and 5 per 100,000 for other Australians, and rate of AIDS diagnosis was 0.4 per 100,000 in Aboriginal and Torres Strait Islander peoples and 0.8 per 100,000 for other Australians. The distribution of HIV infection is different in the two populations.

Male homosexual/bisexual contact was the largest risk exposure category for both populations; however injecting drug use represented 26% of Indigenous risk exposure, 10 times the non-Indigenous rate.

Implications:

Bacterial STIs are a major health problem for Aboriginal and Torres Strait Islander peoples. Notification rates for gonorrhoea and chlamydia have continued to increase between 1994 and 2006. High rates of STIs among Aboriginal and Torres Strait Islander peoples are exacerbated by: poorer access to services (see measure 3.12), including limited access to clinical staff who are experienced in sensitively managing these conditions in Aboriginal and Torres Strait Islander people; a younger and more mobile population; and lower socioeconomic status that may impact on health literacy.

The third National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy, released in April 2010, is one of a set of five national strategies aimed at reducing the transmission of STIs and blood borne viruses (BBVs) and the associated morbidity, mortality, personal and social impacts in Aboriginal and Torres Strait Islander communities. Priority action areas include: a greater focus on testing, treatment and follow-up for bacterial STIs in sexually active (15–30 years) Aboriginal and Torres Strait Islander young people; increased primary prevention activities that seek to reduce the number of new cases of HIV and viral hepatitis among Aboriginal and Torres Strait Islander people, with a focus on those who inject drugs; and competent and accredited workforces consistent across all jurisdictions.

Previous strategies have increased testing and may account for improvements in detection and increased rates. However, under-identification of Indigenous Australians in notification systems means that caution should be used in interpreting trends in these data.

Figure 29 – Notification rate for 4 infectious diseases, Aboriginal and Torres Strait Islander peoples, WA, SA and NT, 1994–1996 to 2006–2008


Figure 29 – Notification rate for 4 infectious diseases, Aboriginal and Torres Strait Islander peoples, WA, SA and NT, 1994–1996 to 2006–2008
Source: AIHW analysis of National Notifiable Diseases Surveillance System
Text description of figure 29 (TXT 1KB)

Figure 30 – Notification rate for four infectious diseases by Indigenous status(a), selected states, 2006–2008


Figure 30 – Notification rate for four infectious diseases by Indigenous status(a), selected states, 2006–2008
(a) Chlamydia – WA, SA & NT ; gonorrhoea and syphilis – Vic., Qld, WA, SA & NT; hepatitis C – NSW, Vic., WA, SA & NT.
Source: AIHW analysis of National Notifiable Diseases Surveillance System
Text description of figure 30 (TXT 1KB)

Figure 31 – Notification rate for HIV and AIDS, Aboriginal and Torres Strait Islander peoples, NSW, Vic., Qld, WA, SA and NT, 1998–2000 to 2007–08


Figure 31 – Notification rate for HIV and AIDS, Aboriginal and Torres Strait Islander peoples, NSW, Vic., Qld, WA, SA and NT, 1998–2000 to 2007–08
Source: AIHW analysis of National Notifiable Diseases Surveillance System
Text description of figure 31 (TXT 1KB)

Figure 32 – Notification rate for four infectious diseases, by Indigenous status, all states, excluding ACT(a), 2006–2008


Figure 32 – Notification rate for four infectious diseases, by Indigenous status, all states, excluding ACT(a), 2006–2008
(a) Chlamydia – WA, SA, Tas. & NT; gonorrhoea and syphilis – Vic., Qld, WA, SA, Tas. & NT; hepatitis C – NSW, Vic., WA, SA, Tas. & NT.
Source: AIHW analysis of National Notifiable Diseases Surveillance System
Text description of figure 32 (TXT 1KB)

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