Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.12 HIV/AIDS, hepatitis and sexually transmissible infections

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Why is it important?:

Aboriginal and Torres Strait Islander peoples currently experience high notifications of bacterial sexually transmitted infections (STIs) (12%–48% of new cases); continued new cases of HIV; and high notification rates for hepatitis B and C.

Each of these infections can have potentially serious consequences. The impact of HIV/AIDS on life expectancy is well documented. Chronic hepatitis causes serious illness and can also progress to cirrhosis of the liver, cancer, and premature death (Couzos et al. 1999). STIs can also have serious long-term consequences, such as chronic abdominal pain or infertility in women after gonorrhoea and chlamydia, and heart and brain damage caused by syphilis (Bowden et al. 2002; Couzos et al. 1999). Several of these infections can cause miscarriage (Campbell et al. 2011).

Notification data 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 health care, improved screening programs for Indigenous Australians, the accuracy of the tests, whether there is systematic screening for conditions that are common but frequently asymptomatic, and people's decisions about seeking health care. For Indigenous Australians, the accuracy of Indigenous identification in the data is also an issue. Improved primary health care can lead to increased testing and a corresponding increase in notification rates.Top of page

Findings:

During the three years to 2011 there were approximately 19,000 notifications among Aboriginal and Torres Strait Islander peoples for chlamydia. After adjusting for differences in age structure, the notification rate was 4 times as high as for other Australians. Between 1994–96 and 2009–11, in WA, SA and the NT combined, the notification rate for chlamydia tripled for Indigenous Australians and the gap between Indigenous Australians and other Australians widened.

For this same period, there were approximately 11,000 notifications for gonorrhoea among Aboriginal and Torres Strait Islander peoples. After adjusting for differences in age structure, rates were 27 times as high as for other Australians. Between 1994–96 and 2009–11 rates increased by 87% for Indigenous females (with no change detected for Indigenous males), while for other Australians there was a significant increase for males but no change for females.

There were also approximately 1,000 notifications for syphilis among Indigenous Australians over this period. After adjusting for differences in age structure, rates were 8 times as high as for other Australians. Between 1994–96 and 2009–11 the notification rate for syphilis decreased for Indigenous males and females while increasing for other Australian males (with no change detected for females). Rates were highest in the 35–44 year age group. The highest rate for each of these three bacterial STIs was in the NT.

During the three years to 2011 there were approximately 500 new notifications for hepatitis B and 700 for hepatitis C among Indigenous Australians. Rates were 4 and 3 times the non-Indigenous rates for hepatitis B and C respectively. Among Indigenous Australians, hepatitis B notification rates were highest in the older age groups (55 years and over) whereas for other Australians they were higher in the younger age groups (25–44 years). For hepatitis C, notifications were highest in the 25–44 age groups for both populations. Between 2006–08 and 2009–11 there was a significant decline in the hepatitis B notification rate for Indigenous Australians.Top of page

There have been no significant changes detected in the incidence of HIV infection for Aboriginal and Torres Strait Islander peoples between 1998–2000 and 2008–10. For the period 2008–10, the incidence of HIV was 5 per 100,000 for both Indigenous and other Australians. Sexual contact between men was the highest HIV risk for both populations; however injecting drug use represented 20% of Indigenous risk exposure, compared to 2% for others.

Between 1998–2000 and 2008–10, there was a significant decrease in the AIDS notification rate for other Australians during this period but no significant change was detected for Aboriginal and Torres Strait Islander peoples. In 2008–10, the rate of AIDS diagnosis was 0.5 per 100,000 for Indigenous Australians and 0.6 per 100,000 for other Australians.

Implications:

Bacterial STIs are a major health problem for Aboriginal and Torres Strait Islander peoples. High rates of STIs among Aboriginal and Torres Strait Islander peoples are affected by issues with access to services (see measure 3.14) and a younger, more mobile population with a lower socioeconomic status that may impact on health literacy.

Hepatitis B notifications have declined for Indigenous Australians since 2006–08. As at December 2011, hepatitis B vaccination rates were at 94% for both Indigenous and non-Indigenous children aged two years.

The rate of HIV/AIDS is similar between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, although risk exposure patterns are different. Studies have found improvements in years of expected life for people with HIV with early access to antiretroviral treatments compared to the period when no treatment was available (Atkinson et al. 2009).

The National Partnership Agreement on Indigenous Early Childhood Development, with joint funding of $564 million over six years, supports state and territory governments to provide sexual health and young parent programs that aim to encourage increased self confidence in making informed decisions about sexual and reproductive health.Top of page

The third National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2010–13 is one of a set of five national strategies aimed at reducing the transmission of STIs and blood borne viruses and the associated morbidity, mortality, personal and social impacts. Priority action areas include reducing hepatitis B infections and eliminating infectious syphilis, a greater focus on testing, treatment and follow-up for bacterial STIs in sexually active Indigenous young people (aged 15–30 years); increased primary prevention activities that seek to reduce the number of new cases of HIV and viral hepatitis among Indigenous Australians, 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 Aboriginal and Torres Strait Islander peoples in notification systems and the volatility in small numbers means that caution should be used in interpreting trends in these data.
Figure 47—Notification rate for five infectious diseases, Aboriginal and Torres Strait Islander peoples, WA, SA and the NT, 1994–96 to 2009–2011
Figure 47—Notification rate for 5 infectious diseases, Aboriginal and Torres Strait Islander peoples, WA, SA and the NT, 1994–96 to 2009–11
Source: AIHW analysis of National Notifiable Diseases Surveillance System
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Figure 48—Notification rate for HIV and AIDS, Aboriginal and Torres Strait Islander peoples, NSW, Victoria, Qld, WA, SA and the NT, 1998–2000 to 2008–10
Figure 48—Notification rate for HIV and AIDS, Aboriginal and Torres Strait Islander peoples, NSW, Victoria, Qld, WA, SA and the NT, 1998–2000 to 2008–10
Note: NSW excluded from AIDS time trend
Source: AIHW analysis of National HIV and National AIDS registry data
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Figure 49—Notification rate for chlamydia and gonorrhoea by Indigenous status and age, selected states(b), 2009–11
Figure 49—Notification rate for chlamydia and gonorrhoea by Indigenous status and age, selected states(b), 2009–11
(a)Age standardised
(b)For Chlamydia: Vic, Qld, WA , SA, NT, and Tas. For Gonorrhoea: Vic, Qld, WA, SA, NT, Tas and ACT
Source: AIHW analysis of National Notifiable Diseases Surveillance System
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Figure 50—Notification rates for hepatitis B and C by Indigenous status and age, selected states(b), 2009–11
Figure 50—Notification rates for hepatitis B and C by Indigenous status and age, selected states(b), 2009–11
(a)Age standardised
(b)For hepatitis B: WA, SA, NT, ACT and Tas. For hepatitis C: WA, SA, NT and Tas
Source: AIHW analysis of National Notifiable Diseases Surveillance System
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