More work is required to reduce sexually transmissible infections in Aboriginal and Torres Strait Islander communities

HIV Australia | Vol. 11 No. 3 | October 2013

By James Ward¹^, ² Andrew Nakhla,¹ Melanie Middleton,¹ Ann McDonald¹ and Rebecca Guy¹

Australia’s Aboriginal and Torres Strait Islander population continues to be overrepresented in notifications of sexually transmissible infections (STIs) while at the same time maintaining a stable epidemic of HIV.

In particular, outer regional and remote communities continue to experience substantially higher rates of STIs. This article details surveillance data related to STIs and HIV recorded for Aboriginal and Torres Strait Islander communities for the period 1 January–31 December 2012.

Chlamydia

Chlamydia continued to be the most frequently reported condition in Australia with 82,707 notifications in 2012.

Of these, 6,792 (8%) were among the Aboriginal and Torres Strait Islander population, 34,762 cases (42%) were among the non-Indigenous population; and for 41,153 (49%) diagnoses, Indigenous status was not reported.

The chlamydia notification rate in the Aboriginal and Torres Strait Islander population was four times higher than the rate in the non-Indigenous population.

Chlamydia predominantly affects people aged 15–29, with the highest notification rates occurring among women in the 15– 29 year age group.

This may reflect greater disease burden, and/or higher rates of access to health services and subsequent testing in these populations.

Despite just 25% of the Aboriginal and Torres Strait Islander population residing in remote areas, chlamydia notifications reported from these areas accounted for 55% of all notifications in the Aboriginal and Torres Strait Islander population.

Gonorrhoea

Of 13,649 notifications of gonorrhoea in 2012, 3,904 (28%) were among the Aboriginal and Torres Strait Islander population, 4,930 (36%) were among the non-Indigenous population; for 4,815 (35%) notifications, Indigenous status was not reported.

The rate of gonorrhoea notifications in the Aboriginal and Torres Strait Islander population in 2012 was 21 times higher than in the non-Indigenous population.

For the Aboriginal and Torres Strait Islander population, gonorrhoea is mostly diagnosed among young women and men living in remote areas, while the majority of cases of gonorrhoea in the non-Indigenous population are among gay man living in major cities.

This creates two distinct gonorrhoea epidemics in Australia, each of which requires separate responses.

Infectious syphilis

Nationally, 1,534 cases of infectious syphilis were diagnosed in 2012; 167 (10%) among the Aboriginal and Torres Strait Islander population, 1,257 (81%) among the non-Indigenous population and Indigenous status was not reported for 110 (7%) diagnoses.

The notification rate of infectious syphilis in the Aboriginal and Torres Strait Islander population in 2012 was five times higher than the rate in the non-Indigenous population.

In 2012, the infectious syphilis notification rate in the Aboriginal and Torres Strait Islander population was higher in all age groups than the non- Indigenous population, particularly the 15–19 year age group where the rate of diagnosis was 40 times higher.

Like gonorrhoea, infectious syphilis affects two main population groups: young Aboriginal and Torres Strait Islander women and men in remote communities, and gay men living in major cities.

After an increase in the notification rate of infectious syphilis in the Aboriginal and Torres Strait Islander population in 2010–2011, which was attributed to an outbreak of syphilis in a few Queensland remote communities, the notification rate of infectious syphilis declined slightly in 2012.

However, the trends vary across jurisdictions, with a substantial decline in Northern Territory and a plateau in notifications in the Aboriginal and Torres Strait Islander population in Queensland.

View data charts for chlamydia, gonorrhoea and infectious syphilis notifications in 2012 (PDF)

Donovanosis

There have been some successes in the control of STIs in remote Aboriginal communities – for instance the elimination of donovanosis from Australia is on track, with no cases detected in Australia in 2011 and only one in 2012 after a peak in the late 1990s and early 2000s.

HIV

There were a total of 1,253 notifications of newly diagnosed HIV infection in 2012; 32 diagnoses were among the Aboriginal and Torres Strait Islander population.

225 cases of HIV infection were newly diagnosed in the Aboriginal and Torres Strait Islander population in the ten years from 2003 to 2012.

Unlike the STIs mentioned previously in 2012, the notification rate of new HIV diagnosis in the Aboriginal and Torres Strait Islander population (5.5 per 100,000) was similar to that in the non- Indigenous population (excluding people from a high HIV prevalence country of birth) (5.1 per 100 000).

Among notifications of newly diagnosed HIV infection in 2008–2012, the most frequently reported route of HIV transmission was sexual contact between males in both the Aboriginal and Torres Strait Islander (56%) and non-Indigenous population (72%).

A higher proportion of notifications from the Aboriginal and Torres Strait Islander populations were attributed to injecting drug use (13% vs 2%) and a similar proportion to heterosexual contact (18% vs 17%) compared with the non-Indigenous population.

This most recent data relating to Aboriginal and Torres Strait Islander people highlights the gaps that exist in health disparity in this area.

Summary:

Implications for Aboriginal and Torres Strait Islander communities

Rates of STIs are particularly high among both Indigenous and non- Indigenous young people living in regional and remote areas of Australia; however, it is important to note that rates of chlamydia notifications are higher across all Aboriginal and Torres Strait Islander communities compared to the non-Indigenous population.

Improving awareness of chlamydia is required at both community and clinical levels.

Internationally, high rates of STIs in communities are implicated in higher HIV notifications but this is not currently the case in Australia, where rates of HIV diagnoses among the Indigenous population are comparable to the non- Indigenous population.

STIs can also have significant physical, psychological and social consequences for those affected.

Bringing STI rates under control – particularly in remote Aboriginal communities – should remain a national priority until they are at least comparable to the rest of the Australian population.

To achieve this further efforts are required in the following areas:

Education and health promotion in school and teenage years;
Effective clinical service delivery;
Effective prevention strategies are in place across all communities.

Some work is underway in these areas (see pages 10 and 51 for two examples of current trials being conducted in remote Aboriginal communities), but more work is required across all remote and regional communities.

For further information, see the 2013 Aboriginal Surveillance Report of HIV, viral hepatitis, STIs available at http://www.kirby.unsw.edu.au

Author notes

1 The Kirby Institute, University of New South Wales, Sydney, Australia

2 Baker IDI, Central Australia, Alice Springs, Australia