Community-led efforts: Aboriginal and Torres Strait Islanders

OBJECTIVES

To plan and implement an improved and sustained response to HIV and STIs among Aboriginal and Torres Strait Islander communities.


CURRENT ISSUES

  • There have been slow but sustained increases among Aboriginal and Torres Strait Islander communities in Australia, such that HIV rates are now trending above the rate for non-Indigenous people for the first time in Australia‚Äôs HIV epidemic. Rates of HIV diagnosis are higher in all areas (urban, regional and remote), with women, people who inject drugs and heterosexuals over-represented in diagnoses among Aboriginal and Torres Strait Islander people;
  • At the same time, rates of STIs (chlamydia, gonorrhoea, infectious syphilis and trichomonas, all of which are implicated in HIV transmission) are at all-time highs in Aboriginal and Torres Strait Islander communities;
  • It is well-established from overseas experience (particularly in Canada) that Indigenous communities are vulnerable to rapid increases in HIV because of younger age, poorer access to primary health care, very high background rates of STIs, higher mobility, incarceration and drug use and lack of employment opportunity. These factors also make HIV extremely difficult to manage in Indigenous communities once it is established at any scale;
  • The impact of current activities notwithstanding, the response to HIV and STIs in Aboriginal and Torres Strait Islander communities is not of sufficient scale to reduce new infections and improve uptake to testing and treatment.

PROPOSED ACTIVITIES

  • Unlike the broader HIV response, the response to HIV and STIs in Aboriginal and Torres Strait Islander communities should of necessity be highly localised, with nationally- coordinated backbone support, and as such informed by and responsive to existing conditions, rates of infection and vulnerability;
  • The High-Level Summit to address HIV and other STIs (Brisbane 2015) and other key consultation fora have identified the following priorities for action:
    • increasing the clinical and health promotion capacity of Aboriginal Community Controlled Health Organisations and non-Indigenous organisations to respond to HIV and STIs in Aboriginal and Torres Strait Islander communities;
    • a national project to reduce sharing of injecting equipment among Aboriginal and Torres Strait Islander people, incorporating education and improved access to the means of prevention;
    • establish clinical and community surge capacity in areas that experience HIV outbreaks, including rapid testing, HIV case management, availability of Pre-Exposure Prophylaxis, Post Exposure Prophylaxis, clean injecting equipment and pharmacotherapy; , targeted health promotion in urban and regional areas addressing both HIV and STIs, for:
      • gay men and men who have sex with men; and
      • heterosexuals, especially young people
    • ongoing support for Aboriginal HIV Awareness Week, the Anwernekenhe National HIV/AIDS Alliance and the biannual Anwernekenhe Conference;
    • research and evaluation to monitor behavioural risk factors, epidemiological trends, knowledge levels and patterns in access to services and to evaluate the impact of strategies implemented; and
    • sentinel surveillance to generate clinical and behavioural data.

IMPACT

  • Improve health outcomes for Aboriginal and Torres Strait Islander people with HIV or at risk of HIV acquisition; and
  • Reduce the risk of onward HIV transmission from undiagnosed infection.

COST-BENEFIT

This investment will substantially reduce the pool of individuals at risk of HIV and who have undiagnosed HIV and reduce the long- term clinical care costs associated with treating new infections.

ADDITIONAL INVESTMENT

$15 million per annum