NACCHO #HIV #AIDS2016 : Fears for Indigenous HIV epidemic as diagnosis rates rise in Australia

HIV

” The potential exists for HIV to escalate rapidly in the Aboriginal and Torres Strait Islander population – as has been the experience in other Indigenous populations globally. This potential is due to three main issues:

  • very high rates of other sexually transmissible infections (STIs) exist in many communities, and the presence of these increases the chances that HIV can be transmitted
  • increasing rates of injecting drug use – including increasing rates of methamphetamine (ice) use in Aboriginal communities, and
  • the close proximity of Papua New Guinea (PNG) to the Torres Strait Islands, and the mobility and interaction of PNG nationals and Torres Strait Islanders. PNG has the highest recorded rates of HIV in the Asia-Pacific”

Associate Professor James Ward is Head, Infectious Diseases Research Aboriginal and Torres Strait Islander Health at South Australian Health and Medical Research Institute (SAHMRI) and a guest editor of HIV Australia.U And Me Can Stop HIV (article second)

“Public health authorities are warning that Australia could be on its way to an HIV epidemic in Indigenous communities.

We know that Indigenous Australians have poorer health overall and often have poorer access to health services, so just getting diagnosed can be a real problem, Support structures for HIV infection are not always in place in Indigenous communities.

The Aboriginal and Torres Strait Islander community traditionally hasn’t had high levels of HIV, so there’s still a lot of stigma and fear,

‘The young people we’ve diagnosed have known very little about HIV, so we have a lot of education to do for them, their sexual partners and sometimes their families if they’re willing to involve their families, which often they’re not.

Cathy Van Extel reports on the latest figures from far north Queensland.

“Research into a cure for HIV has been gathering momentum. Global investment in cure research has more than doubled in the last four years, in contrast with investment in other HIV programs.

Given the effectiveness of antiretroviral drugs in both treating and preventing HIV infection, however, cure research raises a range of important questions about priority setting in global health.

Curing HIV – or at least achieving long-term remission – is possible, under the right circumstances.”

Author Lecturer in ethics, HIV prevention, UNSW Australia: The Conversation Remind me again, how close are we to a cure for HIV?

Image above : To acknowledge #AIDS2016 Conference in South Africa NACCHO  presents an update on Indigenous Australia : Today, there are 36.9 million people living with HIV/AIDS in the world and more than 95% of those living with HIV are in developing countries where access to effective health care is often challenging. SEE WEBSITE http://www.aids2016.org/

In the same week that Australia declared AIDS was no longer a public health issue, doctors have raised the alarm about a spike in new HIV cases involving Indigenous Australians in far north Queensland.

If we don’t act soon, there could be a whole lot of misery ahead for a lot of people.

Darren Russell, Cairns Base Hospital

Cairns normally records one or two new cases of HIV infection annually. This year, however, there have been nine diagnoses to date—and all have been Indigenous patients.

Dr Darren Russell, the director of sexual health at Cairns Base Hospital, says the spike comes on the back of a small increase in new cases in north Queensland last year.

‘We’re up to nine cases so far this year and we are only halfway through the year,’ he says.

‘We are concerned about it, and although we don’t think things are out of control, we are a bit worried.’

North Queensland a HIV hotspot

Nationally, homosexual men account for around 85 per cent of HIV cases, compared to 65 per cent among Indigenous people.

The new HIV infections in Cairns primarily involve younger gay or bisexual men, aged in their 20s and 30s.

While Cairns has emerged as a hotspot for new HIV infections, there is concern the virus could spread.

‘A lot of these people are very young and very mobile so there is the potential for spread to occur outside of Cairns,’ Russell says.

Health authorities are worried that Australia could follow Canada in experiencing an HIV epidemic in its indigenous population.

‘The Canadian epidemic came out of nowhere and has been a huge problem,’ Russell says.

‘If we don’t adequately address issues around Indigenous sexual health the same thing could happen here.

‘We don’t want to be too alarmist but at the same time if we don’t act soon there could be a whole lot of misery ahead for a lot of people.’

Indigenous access to services a factor

Russell says there are a range of challenges in managing HIV in Indigenous populations.

‘We know that Indigenous Australians have poorer health overall and often have poorer access to health services, so just getting diagnosed can be a real problem,’ he says.

He says support structures for HIV infection are not always in place in Indigenous communities.

‘The Aboriginal and Torres Strait Islander community traditionally hasn’t had high levels of HIV, so there’s still a lot of stigma and fear,’ he says.

‘The young people we’ve diagnosed have known very little about HIV, so we have a lot of education to do for them, their sexual partners and sometimes their families if they’re willing to involve their families, which often they’re not.

‘In order to address those issues we need to reduce the stigma, get more people tested and diagnosed, and we need to enable them to stay on their medications.

‘They are all big challenges for anyone, let alone the Indigenous population.’

What’s behind the increase?

Doctors believe the increase in HIV infections in Cairns is linked to a syphilis epidemic, which has affected Indigenous communities across northern Australia for several years.

‘There are probably a few factors that are leading to this increase,’ Dr Russell says.

‘We have a syphilis epidemic across far north Queensland along with the Northern Territory and north-west Australia at the moment and we’re seeing a lot of syphilis where previously we had it almost under control.

‘Syphilis makes it much easier to acquire HIV so that could be one of the factors driving it.’

HIV infections by the numbers

The actual number of Indigenous HIV diagnoses each year remains small compared to the overall national figure.

In 2014, of the 1081 new cases of HIV around Australia, 33 involved Indigenous Australians.

Worryingly, the rate of HIV diagnosis among Aboriginal and Torres Strait Islander people is now higher than the rate for non-Indigenous Australians. In 2014 it was 5.9 per cent compared to 3.7 per cent.

The Kirby Institute reported in its 2015 Annual Surveillance Report that the HIV diagnosis rate in Aboriginal and Torres Strait Islander people has increased in the past five years and ‘requires a strengthened focus on prevention in this vulnerable population’.

The Kirby Institute also found that the rate of syphilis infection in the Aboriginal and Torres Strait Islander population in 2014 was four times higher than the rate in the non-Indigenous population.

According to Russell, the number of syphilis infections appears to have plateaued or decreased in some areas such as Cape York and Torres Strait but continues to rise in other northern regions, particularly among younger Indigenous Australians.

Syphilis rates remain a concern in the Top End of the Northern Territory, and are increasing in the Kimberley region of Western Australia. There is also a danger of the syphilis epidemic spreading to Indigenous communities in Central Australia.

The role of government

The federal government is under pressure to act to prevent a sexual health crisis. Russell has described the federal response to date as disappointing.

‘We have a Closing the Gap scheme that is really silent on the issue of sexual health and sexually transmitted infections, and yet one of the health factors that could really cause a huge amount of damage to Indigenous Australians is poor sexual health including syphilis and HIV,’ he says.

‘They’re not getting the priority that they should.

‘I’m not suggesting we de-prioritise other chronic health conditions, but we do need to have more focus federally, and more funding and support when it comes to sexual health and HIV.’

U And Me Can Stop HIV December 2015

Aboriginal and Torres Strait Islander HIV Awareness Week (ATSIHAW) is an annual program of events that seeks to raise awareness about the impact of HIV among Aboriginal and Torres Strait Islander people.

Although the inaugural event was only held twelve months ago, it is already well recognised as key event for raising awareness and mobilising action to address HIV among Aboriginal and Torres Strait Islander communities.

HIV diagnoses among the Aboriginal and Torres Strait Islander population is increasing, yet for many years now there has been little or no investment by governments targeted at enhancing our communities’ knowledge and awareness of HIV.

While the number of annual HIV diagnoses for Aboriginal and Torres Strait Islander people is fairly low at present (around 30 new diagnoses per year), in 2014 the notification rate of newly diagnosed HIV infection was 1.6 times higher for the Aboriginal and Torres Strait Islander population compared to the non Indigenous population (5.9 vs 3.7 per 100,000 in 2014).

The potential exists for HIV to escalate rapidly in the Aboriginal and Torres Strait Islander population – as has been the experience in other Indigenous populations globally. This potential is due to three main issues:

  • very high rates of other sexually transmissible infections (STIs) exist in many communities, and the presence of these increases the chances that HIV can be transmitted
  • increasing rates of injecting drug use – including increasing rates of methamphetamine (ice) use in Aboriginal communities, and
  • the close proximity of Papua New Guinea (PNG) to the Torres Strait Islands, and the mobility and interaction of PNG nationals and Torres Strait Islanders. PNG has the highest recorded rates of HIV in the Asia-Pacific region.

In the five year period 2010–2014, when comparing rates of new HIV infection among the Aboriginal and Torres Strait Islander population with the non- Indigenous Australian born population, a higher proportion of notifications were attributed to injecting drug use (16% vs 3%); heterosexual sex (20% vs 13%); and 22% vs 5% of new HIV diagnoses were among females.

Based on CD4+ cell counts at diagnosis, in 2014 a third (30%) of the new HIV diagnoses among the Aboriginal and Torres Strait Islander population were determined to be late.

ATSIHAW events

The 2015 ATSIHAW  launched at the Wuchopperen Aboriginal Health Service in Cairns on the 30 November.

Speakers included Assoc Professor James Ward, SAHMRI (South Australian Health and Medical Research Institute), Dr Mark Wenitong, Apunipima Cape York Aboriginal Health Council, HIV-positive speakers, and youth and elders from the Cairns region and community.

The launch was followed by a training day on Tuesday the 1 December for health service staff working in the Cairns region, to learn about updates on HIV diagnosis, risk factors, prevention strategies, treatment updates, care and management of people living with HIV and outbreak management – including privacy confidentiality stigma and discrimination.

On 2–3 December, ATSIHAW, in partnership with the HIV Foundation Queensland, ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) and the National Aboriginal Community Controlled Health Organisation, hosted a high level summit in Brisbane to discuss strategies and actions for moving forward an agenda that is urgently required.

The Summit, opened by the Queensland Health Minister, the Hon Cameron Dick MP, was held in recognition of the need to urgently address the fact that STIs and blood borne viruses are part of our communities’ overwhelming burden of disease, particularly:

  • for remote communities – STIs (chlamydia, gonorrhoea, syphilis and trichomonas), as well as hepatitis B
  • for urban and regional areas – hepatitis C and chlamydia
  • emerging HIV transmission risks from drugs such as methamphetamines (‘ice’) – both due to unsafe injecting and condomless sex.

During ATSIHAW, community events were held across Australia at over 30 Aboriginal Community Controlled Health Services in most jurisdictions and at other HIV organisations such as AIDS Councils, aimed at raising awareness of HIV in our communities.

ATSIHAW also recruited high profile Ambassadors to help spread the word about HIV in our communities and the roles all individuals can play in stopping HIV.

Our ATSIHAW Ambassadors include Prof Pat Anderson AM, Prof Kerry Arabena, Dr Marlene Kong, and Mr Dion Tatow, to name a few.

View profiles of some of our ATSIHAW Ambassadors


Associate Professor James Ward is Head, Infectious Diseases Research Aboriginal and Torres Strait Islander Health at South Australian Health and Medical Research Institute (SAHMRI) and a guest editor of HIV Australia.

 

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