Aboriginal and Torres Strait Islander Health Performance Framework - 2010

2.25 Unsafe sexual practices

Page last updated: 26 May 2011

Why is it important?:

Unsafe sexual practices involve the failure to take precautions during sex, which may result in sexually transmitted infections (STIs), reproductive tract infections and a range of adverse reproductive health consequences such as unintended pregnancy, abortion, infertility and cancer resulting from STIs, sexual dysfunction and certain aspects of mental health (WHO 2006). The consequences of unsafe sexual practices can be high and the impact on individuals, families and communities can continue long after the unsafe sexual practices have ceased. STIs are more prevalent among Indigenous Australians than for other Australians (see measure 1.11). Bacterial STIs can have serious long-term consequences, such as chronic abdominal pain or infertility in women caused by chlamydia and gonorrhoea, genital damage due to donovanosis, and heart and brain damage caused by syphilis. Unsafe sexual practices can in some cases result in sexual dysfunction.

Currently, 1 in 5 Indigenous births are to mothers under the age of 20 (ABS 2007a). Pregnancy at a young age is generally associated with higher rates of complications during pregnancy and delivery. Teenage births are associated with lower annual income, educational attainment and employment prospects for the mother (Women’s Health Queensland Wide Inc. 2008).

It should be recognised that teenage pregnancy is only a proxy measure of unsafe sexual practices. Not all unsafe sexual practices result in teenage pregnancy and not all teenage pregnancies are unplanned.

The burden of disease study (Vos et al. 2007), attributed 1.2% of the total burden of disease in the Aboriginal and Torres Strait Islander population to unsafe sex, primarily cervical cancer, chlamydia and HIV/AIDS.

Findings:

For the period 2006–08 notification rates for Aboriginal and Torres Strait Islander peoples were 4 times higher for chlamydia, 38 times higher for gonorrhea and 18 times higher for syphilis compared with non-Indigenous Australians (see also measure 1.11). Over the period 1994–96 to 2006–08, notification rates for chlamydia and gonorrhoea have increased significantly for Indigenous people (199% and 61% respectively), but have fallen for syphilis (by 14%).

In the period 2005–07, there were 6,396 mothers aged less than 20 years who identified as Aboriginal or Torres Strait Islander. This represented 22% of all Indigenous mothers and a rate of 47 per 1,000 women. Non-Indigenous mothers were less likely to be aged less than 20 years, with a rate of 9 per 1,000 women. A higher proportion of Indigenous women giving birth in very remote areas were aged less than 20 years (25%) compared with those living in remote areas, outer regional, inner regional areas and major cities (21%, 20%, 20% and 18% respectively).

In the period 2005–07, approximately 13% of Indigenous teenage mothers had births that were preterm and the same proportion gave birth to low birthweight babies. The low birthweight rate for young Indigenous mothers was the same as the overall Indigenous rate while for non-Indigenous mothers low birthweight was higher for young mothers (8%) compared with an overall rate of 6%. Around 10% of non-Indigenous teenage mothers had pre-term births.

Implications:

Very little data are available on unsafe sexual practices for Aboriginal and Torres Strait Islander Australians. National surveys on this topic do not have sufficient sample sizes to produce reliable estimates for Indigenous Australians. The two proxy measures that are available show high notification rates for STIs and high rates of teenage pregnancy for Aboriginal and Torres Strait Islander peoples. They suggest that there are significant issues with unsafe sexual practices within the population. Several national strategies have specifically addressed the issue of STIs among Indigenous Australians. These strategies recognise the need for integrated solutions that address both individual sexual behaviour and education. In relation to health behaviours, key strategies focus on improved surveillance and increasing access to health services. In the education domain, entry points include improved education for young people about safe sexual practices; risks of unplanned pregnancies and STIs; increasing the number of Indigenous health workers trained in sexual health; and community-based awareness programs that target out-of-school people who are particularly vulnerable.

The goal of the Third National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2010–2013 is to reduce the transmission of, and morbidity and mortality caused by, STIs and blood borne viruses and to minimise the personal and social impact of these infections. Having identified the priority populations within Indigenous communities, priority action areas have been recommended to achieve this goal. An important element of the strategy is to ensure that unsafe sexual practices are reduced.

In October 2008, COAG signed the Indigenous Early Childhood Development National Partnership Agreement to improve the developmental outcomes of Indigenous children. The Partnership seeks to provide young Indigenous children with the best start to life by implementing strategies to improve access to pre-pregnancy, teenage reproductive health and sexual health services to support good sexual health, healthy reproductive decision making, and healthy pregnancies that give rise to healthy children.

Figure 130 – Notification rate for gonorrhoea, chlamydia and syphilis, Aboriginal and Torres Strait Islander peoples, WA, SA and NT, 1994–1996 to 2006–2008


Figure 130 – Notification rate for gonorrhoea, chlamydia and syphilis, 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 130 (TXT 1KB)

Figure 131 – Rate per 1000 women aged less than 20 years who gave birth, by Indigenous status, 2005–2007


Figure 131 – Rate per 1000 women aged less than 20 years who gave birth, by Indigenous status, 2005–2007
Source: AIHW analysis of National Perinatal Statistics Unit National Perinatal Data Collection
Text description of figure 131 (TXT 1KB)

Figure 132 – Aboriginal and Torres Strait Islander women aged less than 20 years who gave birth as a proportion of total women who gave birth, by remoteness, 2005–2007


Figure 132 – Aboriginal and Torres Strait Islander women aged less than 20 years who gave birth as a proportion of total women who gave birth, by remoteness, 2005–2007
Source: AIHW analysis of National Perinatal Statistics Unit National Perinatal Data Collection
Text description of figure 132 (TXT 1KB)

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