Around 300 people in the Aboriginal and Torres Strait Islander communities currently live with HIV, about 28 000 live with chronic hepatitis B and 16 000 live with chronic hepatitis C. Concern is growing about these BBVs in these communities and the need for focused prevention, diagnosis, treatment and support initiatives. The personal impacts of BBVs on individuals can be severe. Apart from the effects on health and wellbeing, effective management of infection requires individuals to make lifestyle changes, modify behaviours to lower the risk of passing the virus on, and gain access to treatment.
To be effective in providing treatment, care and support options for Aboriginal and Torres Strait Islander peoples with HIV and viral hepatitis, primary healthcare services need to be adequately resourced and sufficiently flexible to accommodate changing individual needs and new treatment options. In particular, access to specialist services to treat hepatitis C is needed, to complement those being provided through primary healthcare services. The links between mainstream and community-controlled healthcare sectors are equally important. Successful programs should be investigated as a model for further implementation in ACCHS.
Programs that aim to increase treatment outcomes for people living with chronic viral hepatitis or HIV should respond to these factors:
- high levels of mobility between urban and provincial centres and communities
- the impact of co-morbidities such as mental health and alcohol misuse, and the impacts these have on treatment initiation and management
- discrimination, particularly against gay men and people who inject drugs, that affects treatment and care, in the community sector and mainstream health services
- general discrimination against people living with these diseases
- the considerable diversity of circumstances for those affected, including cultural differences and wide geographical spread, which demand flexible care and treatment approaches
- treatment and support, which needs to be approached within a framework that recognises the importance of men’s and women’s business
- real or perceived lack of confidentiality.
Priority actions for people living with HIV and viral hepatitis
- Explore options to increase the number of people with viral hepatitis accessing and completing treatment.
- Increase assessment of hepatitis B status, hepatitis B immunisation coverage for those at risk, and management of those who have chronic hepatitis B.
- Ensure that people living with HIV have adequate access to treatment options at a range of health services, including through ACCHS.