Sexually Transmitted Infections and HIV in Indigenous People in Western Australia

Aboriginal Health researcher, Michael Wright, and colleagues say that while the overall numbers are still relatively small, this data is a wake-up call that specific sexual health preventative programs must be developed for Aboriginal communities.

From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined but rates for Indigenous people increased.

"Since 1994, notification rates for HIV infection in Indigenous people have been higher than in non-Indigenous people," say the authors.

"Between 1994 and 2002, more than half of all Indigenous HIV infections were in women and most were heterosexually acquired.

"Indigenous females were 18 times more likely to be infected than non-Indigenous females, and Indigenous men were twice as likely as non Indigenous men to be infected with HIV."

The authors analysed data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and HIV infections from 1983 to 2002.

Indigenous people account for between 21.2 per cent and 41 per cent of chlamydia, and between 63.3 per cent and 76 per cent of gonorrhoea notifications.

"There is a strong relationship between poverty and HIV, with people living in poverty highly vulnerable to infection," say the authors.

"Poverty and marginalisation affect many of the HIV-infected Indigenous people in WA, with health providers reporting that many people diagnosed with HIV in recent years have been homeless, unemployed, and had other chronic health issues, including mental illness and alcohol dependence.

"What is of particular concern is high rates of sexually transmitted infections in young people. Most of these infections are easily treated with antibiotics - but it's apparent that general educational messages are not engaging Aboriginal people."

STIs are a serious health issue, as it has been shown that STIs enhance the transmission of HIV.

Untreated STIs can also cause infertility in women and men.

Confidential STI testing and condom availability, access to male and female health workers, systematic population-based screening, and community-wide strategies such as education, improved access to diagnosis and treatment and incentives for individuals to change behaviour are all-important in STI control, and would help prevent STIs.

"In partnership with Aboriginal communities, there is an urgent need to develop culturally appropriate and sensitive public health campaigns, which enhance access to primary health care and address specific needs so that the long term sexual and reproductive health and general well-being for Aboriginal people can be protected."

But the authors point out that shame, stigma and confidentiality issues, especially in small communities, are barriers to dealing with the problem and that the many health, socioeconomic, environmental, legal and political factors that affect the lives of Indigenous people further add to the difficulties.

In the same issue of the Journal, Francis Bowden, Professor of Medicine at the Australian National University and Director of the Canberra Sexual Health Centre at the Canberra Hospital, says the findings demand attention.

He points to evidence that one of the reasons for the high STI rates in the Indigenous population is the limited access to, and utilisation of, STI services in remote areas, rather than major differences in average rates of sexual partner change compared with the non-Indigenous population.

In addition, few Indigenous children in remote areas complete high school and, as a result, there are limited reliable means of informing young people about health risks.

He says that control of HIV will require multiple small interventions that target individual sexual networks and reflect the local socio-cultural conditions.

Professor Bowden states that HIV testing is central to HIV control: "There is no need to reinvent guidelines for testing in Indigenous settings - they already exist. Sustainable implementation is the challenge that faces primary care providers," Professor Bowden says.

The Medical Journal of Australia is a publication of the Australian Medical Association.