This year’s ATSIHAW is themed ‘You and me can stop HIV’ and the focus is on taking personal responsibility, and helping others, to end the spread of once-deadly disease.

ATSIHAW is designed to get people talking about HIV, to raise awareness of prevention methods, and testing and treatment options and to slow the rate of new infections to zero.

ATSIHAW leads into World AIDS Day on 1 st December 

These 4 article from Page 12 and 13  NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

” Since we started collecting HIV data among Aboriginal and Torres Strait Islander people in the early 1990s rates of diagnosis have been similar or lower than for non-Indigenous people. It’s been one of the good news stories of Aboriginal health for over two decades. But is this all at risk?

Aboriginal people are at higher risk of HIV because of high rates of other STIs, because of increasing injecting drug use within communities including sharing of injection equipment between people, lower health literacy regarding HIV, less access to primary health care and HIV specialist services “

A/Prof James Ward South Australian Health and Medical Research Institute Adelaide : Dr David Johnson, Public Health Medical Officer, Aboriginal Health Council of South Australia :Dr Salenna Elliott, Public Health Registrar, Aboriginal Health Council of South Australia

 “Hepatitis C is a virus that affects the liver. It is thought that 95% of the Hep C in Australia is acquired through sharing of injecting equipment or other equipment that transfers blood from one person to another, such as for tattooing.

Aboriginal and Torres Strait Islander people are overrepresented in hep C diagnoses in Australia, with an estimated 20,000-30,000 diagnoses in our population.  Without treatment hep C damages the liver, and can result in cancer and death. ”

A/Prof James Ward Head Infectious Diseases Research Aboriginal Health South Australian Health and Medical Research Institute :

See Article 4 below

Each year data are reported for all HIV diagnoses made in the previous year. This data are based on people reporting how they think they acquired HIV, e.g. via heterosexual sex, male-to-male sex, mother to child transmission, sharing injecting drug equipment. Data are also collected on Aboriginal and Torres Strait Islander status.

Over the last five years a worrying trend has emerged: HIV rates are stabilising in the non-Indigenous Australian-born population, while rates are increasing for our population. The rate of HIV diagnosis among Aboriginal and Torres Strait Islander people is now for the first time ever more than double the non-Indigenous rate.

There are also important differences in how HIV is transmitted, with more cases among Aboriginal people attributed to heterosexual sex and injecting drug use.

In the past five years:

• 21% of cases in the Aboriginal population were attributed to heterosexual sex, compared to 14% amongst non-Indigenous people
• 16% of cases among Aboriginal people were attributed to injecting drug use compared to 3% of cases in the non-Indigenous population .
• 58% of new cases in the Aboriginal population were attributed to anal sex between men, compared to 80% among non-Indigenous people

These rising rates and different transmission patterns are of concern. At the global level we have seen that HIV can escalate quickly once it takes hold in marginalised populations such as Indigenous peoples, people who inject drugs, sex workers and prisoners.

This has happened among Canada’s First Nations peoples and in Saskatchewan, clinicians and communities are calling for a state of emergency to be declared because of rapidly escalating HIV rates.  Factors that place our communities at risk of an HIV epidemic include the high prevalence  of other sexually transmissible infections (STIs) that increase risk of HIV transmission, limited access to sexual health services, education  and prevention programs (particularly in regional and remote communities) and

HIV-related stigma and shame. For us to turn about the clear divergence in HIV rates between our population and the non-Indigenous we must act now.

While community education and awareness, condoms and safe sex are still the mainstay of HIV prevention – as are clean needles and syringes, detox services and drug rehabilitation for people who inject drugs – the use of HIV treatment medications is also now a major component of prevention strategies. We need to understand these new prevention tools and work out how to ensure their benefits reach our communities.

Treatment as prevention – the game-changer

Advances in HIV treatment medications mean that it’s now possible for someone with HIV to live as long as the person next to them who doesn’t. Modern treatments also mean that the amount of HIV in the blood of a person with HIV can be reduced to an undetectable level.

This is not a cure, but a person with an undetectable viral load is virtually non-infectious. At a community wide level, the more people with HIV who reach an undetectable viral load the less chance there is for people to acquire HIV.  This is called ‘treatment as prevention’.

A drug to prevent HIV

There’s also now a pill that can protect against HIV. Called Pre-Exposure Prophylaxis or PrEP for short,  PrEP involves HIV-negative people taking an HIV treatment antiretroviral drug before risk exposure, for example before having sex, to protect against contracting HIV. PrEP is only recommended for people most at risk of HIV – including men who have anal sex with men, and HIV-negative men or women with an HIV-positive partner.

Don’t forget PEP

Post exposure prophylaxis is a tablet you take after a high risk exposure to HIV. PEP works by preventing HIV entering the lymph system- but only if it is given within 72 hours after the exposure. PEP is available at most hospital Emergency departments and at sexual health services nationally.

For us to turn around rising HIV rates among Aboriginal people we need:

1. Enhanced community education and awareness about HIV and sexual health at both national and local level, such as Aboriginal and Torres Strait Islander HIV Awareness Week which has just completed its third year of activities
2. Continued promotion of safe sex and safe injecting, with improved community access to condoms, testing and treatment for STIs, Needle and syringe programs
3. Capacity for referrals to appropriate drug treatment services
4. Appropriate testing for HIV in Aboriginal primary care services for people at risk of HIV, including people who have a recent other STI diagnosis
5. Enhanced early diagnosis and treatment rates, and education regarding the personal and community benefits of treatment as prevention.
6. Community education on HIV, including on ‘treatment as prevention’, PrEP and to address HIV-related stigma and shame.

The cure for HIV is still a long way off, so we all need to do our bit to ensure HIV doesn’t take hold in our communities.

We acknowledge Ms Linda Forbes, of SAHMRI (proof read articles on Pages 12/13 ).

STI rates remain unacceptably high in our communitites

A/Prof James Ward Head Infectious Diseases and Sarah Betts STI Coordinator Aboriginal Health Council of South Australia

Rates of common sexually transmissible infections (STIs) among our communities remain grossly disproportionate to rates among non-Indigenous Australians.

In the policy and programming context, it could be said that in the scheme of things, persisting high rates of STIs are alarming but not requiring more urgent attention than other areas of Aboriginal health, such as diabetes, cardiovascular and child and maternal health-but should it be that way?

The failure to address high rates of STIs in has immediate and long-term implications for our communities. Poor outcomes in pregnancy, shame and stigma, interpersonal violence as an outcome of STI transmission, infertility and a much higher chance that HIV will be transmitted are just some of these. Those most affected are young people, and the more remote a young Aboriginal person’s community, the more likely they are to have not just one STI but multiple STIs. Young people in our remote communities face many challenges – let’s at least act to reduce the pervasive risk of STIs.

The main STIs

Let’s take a look at some of the most common infections:

• Chlamydia is the most common STI in Australia, affecting both Aboriginal and non-Indigenous Australians, predominantly in the age group 15-25 years. Rates among Aboriginal people are between 3 and 5 times that of the non-Indigenous population, whether in cities, regional and remote areas. Chlamydia rarely has symptoms. It is easily tested for and treated with a one-off dose of antibiotics. If not detected and treated chlamydia can cause pelvic inflammatory disease and other serious complications in women, including poor outcomes in pregnancy.
• Gonorrhoeae and syphilis disproportionately affect young Aboriginal people, particularly in remote and isolated communities. Rates of gonorrhoeae are 30 times higher for the Aboriginal population compared to the non-Indigenous population; and syphilis rates are five times higher. An outbreak of syphilis that started in 2011 and has spread across northern and central Australian remote communities has us way out of reach of once was thought to be possible; eliminating syphilis from our communities. Both STIs can cause major issues in pregnancy, including loss of the baby, and babies can be born with both infections. Both conditions are relatively easy tested for and treated with antibiotics.
• Trichomonas is another STI very prevalent among Aboriginal and Torres Strait Islander people. In remote communities we have found that around 25% of women found to have trichomonas. Untreated Trichomonas can cause premature birth and low birth weight and of course facilitate HIV transmission

Upping STI testing and treatment rates

So testing and treating STIs is straightforward if they’re diagnosed early, but the consequences of failing to detect and treat infections are huge. We need to understand what’s stopping people getting tested. Shame and stigma obviously play a part, including for young people – how can we get to the point that young people in our communities see sexual health checks as a normal part of living a healthy life?  How can we ensure that babies aren’t born with STIs?

The work happening at the individual health service and NACCHO affiliate level as well as in mainstream, is great. But we need to intensify our focus on:

1. Developing innovative community education and awareness to make sure young people are aware of these STIs and the need to test
2. Equipping young people with skills and tools to prevent STIs
3. Ensuring we are all aware that STIs often don’t have symptoms but are easily tested for and cured
4. Ensuring our health services are offering regular testing as per clinical guidelines
5. Normalising STI testing, including by making sure that that STI testing is offered as part of Adult Health Assessments, particularly for young people between 16 and 29 years.
6. At a broader systemic level I believe an additional two national KPIs would be beneficial for raising the profile of this issue, in addition to a special PIP for full STI and BBV testing and elevation of STI testing in the Adult health check.

We have been working hard in research, trying to make sense of why STIs are still so common and to develop strategies bring down these unacceptably high rates. But much more work is required. The recent defunding of 20 or so Aboriginal sexual health worker positions in NSW should not even have been.

Hyper-vigilance is needed. Let’s all get onto this together – our young people have the right to enjoy full and healthy sexual relationships with their loved ones now and into the future.

Hepatitis B – improving access to vaccination, diagnosis and treatment

A/Prof Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis, Doherty Institute

Aboriginal people were among the first groups in who hepatitis B was discovered in the 1960s – which is why for a while the virus was known as ‘The Australia Antigen’.

The proportion of Aboriginal and Torres Strait Islander people living with chronic (long-term) hep B is around 10 times that of non-Indigenous people born in Australia. Of the 230,000 Australians estimated to be living with hep B, around 20,000 are thought to be Aboriginal or Torres Strait Islander people, and new infections with hep B are still occurring at 4 times the rate in Indigenous Australians.

Most people living with chronic hep B were infected as babies or young children, with infection being passed from mother to child or between young children. Someone infected as a baby has a 90% chance of going on to chronic hep B; while someone infected as an adult only has a 5% chance of going on to long term infection, but can still get very sick in the short term. In Australia, most infections in adults are caused through sexual contact with someone with hep B, or through unsafe injecting drug use.

Chronic hep B infection usually causes no symptoms and for most people will cause no long-term health problems – but for around 1 in 4 people living with hep B, the virus can cause severe liver scarring (cirrhosis) or liver cancer. We know that liver diseases are one of the important causes of the life expectancy gap experienced by Indigenous Australians – hep B is one of the conditions responsible for this. Recent evidence from research in the Northern Territory suggests that Aboriginal people have a unique strain of the hep B virus passed on over many years that could explain why hep B in some Indigenous people might have a more severe course.

Unlike the other STIs and BBVs, hep B can be prevented by a safe, effective vaccine which has been provided for all infants in Australia since 2000 (and in the Northern Territory since 1990). As a result, new hep B infections in children born since 2000 (and in those who received adolescent catch-up vaccination from 1998 onwards) have fallen substantially. However funded hepatitis B vaccine for Indigenous adults is available only in some states and territories, which limits access for Aboriginal and Torres Strait Islander people who remain at much higher risk of hep B infection. This inequality in access cannot continue.

For people who already have hep B infection, vaccination has no effect. We know many people living with hep B, including Indigenous people, have never been diagnosed. However being tested for hep B is easy – it’s a simple blood test which can tell whether someone has hep B, is immune through past infection or vaccination, or if a person needs vaccination. National guidelines suggest all Aboriginal and Torres Strait Islander adults whose hep B status isn’t known should be offered testing.

If someone is found to have hep B, they should receive counselling and household and sexual partners should be tested and vaccinated if not immune. Highly effective treatments for hep B are available in Australia that greatly reduce the chance of developing liver scarring or cancer, and involve taking a tablet once a day. However unlike for hep C, these are not cures – treatment needs to continue, often for many years. We know that in many areas of Australia where most people living with hep B are Indigenous people, treatment uptake is very low – this needs to be changed urgently. With better access to prevention, diagnosis and treatment, the burden of hep B on Indigenous health can be eliminated in coming years.

Hepatitis C – the bad news and the good

A/Prof James Ward Head Infectious Diseases Research Aboriginal Health South Australian Health and Medical Research Institute

Hepatitis C is a virus that affects the liver. It is thought that 95% of the Hep C in Australia is acquired through sharing of injecting equipment or other equipment that transfers blood from one person to another, such as for tattooing. Aboriginal and Torres Strait Islander people are overrepresented in hep C diagnoses in Australia, with an estimated 20,000-30,000 diagnoses in our population.  Without treatment hep C damages the liver, and can result in cancer and death.

The bad news is that over the last five years rates of hep C diagnoses have increased by 43% in our community, yet the in the non-Indigenous community have been stable. Particularly concerning are rates of diagnosis among people in the age group 15-24 years of age with rates 8 times higher than non-Indigenous people in the same age group.  This age group is concerning because it is most likely that these infections are new infections given the nature of Hepatitis C being transmitted primarily through injection drug use.  Also of concern because of the high and rising Indigenous incarceration rates is the proportion of people in Australian prisons who are diagnosed with hep C, with an estimated 50-65% of all prisoners diagnosed with Hep C.

The good news however is there is now a cure for Hep C

But there is great news about hep C treatment:

• There is now a cure for hep C. Daily tablets for 10-12 weeks are more than 90% effective of curing hep C
• The cost of these tablets is subsidised by the Government – a full script costs around $40
• Hep C treatment can be organised by Aboriginal Community Controlled Health Services or any GP practice.
• There are very few side effects from these new tablets that cure hep C.

In the first 6 months since the Australian Government approved this new medication for treating hep C almost 20,000 Australians have been cured. Of these we do not know how many Aboriginal and or Torres Strait Islander people have been cured but our suspicion is relatively low numbers.

Aboriginal and or Torres Strait Islander people who have been diagnosed with Hep C have the right to get the advantage of this major breakthrough in Hep C treatment. Now is the time to encourage someone you know who is living with hep C to take treatment for this condition.   The more people we can get cured of hep C the better the chances are of reducing new infections in the community.