NACCHO Aboriginal Health #HIV #ATSIHAW #WorldAIDSDay :Minister @KenWyattMP speech at launch ” Together, you and me can stop HIV “

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 ” High quality health care must be accessible and appropriate for the needs of Aboriginal and Torres Strait Islander peoples. We have to acknowledge that those with HIV may experience additional barriers in accessing health care which relate to stigma and shame.

Racism is one of the social and cultural determinants of health for Aboriginal and Torres Strait Islander peoples. Racism is part of a vicious circle that contributes to low levels of access to health services by Indigenous Australians and causes psychological distress.

I consider it a huge step forward to have racism recognised within the National Aboriginal and Torres Strait Islander Health Implementation Plan

Together we will build the capacity of the Indigenous community controlled health sector and make a real impact on the HIV rates among Aboriginal and Torres Strait Islander peoples.

The Assistant Minister for Health and Aged Care, The Hon Ken Wyatt AM, MP spoke at Parliament House, Canberra, to launch National Aboriginal and Torres Strait Islander HIV Awareness Week.

Photo above Ken Wyatt, NACCHO CEO Pat Turner, James Ward , Mark Saunders and Professor Gracelyn Smallwood 

PDF printable version of Together, you and me can stop HIV – PDF 270 KB

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Good morning.

Before I begin I want to acknowledge the Traditional Custodians of the land on which we meet the Ngunnawal and Ngambri peoples and pay my respects to Elders past, present and future. I also acknowledge other Aboriginal and Torres Strait Islander peoples here this morning.

I want to thank the Aboriginal and Torres Strait Islander HIV Awareness Week Organising Committee for inviting me to speak this morning. It’s good to be here with Minister Sussan Ley and Senator Dean Smith.

We are here today because HIV continues to be a serious health concern for Aboriginal and Torres Strait Islander peoples. The rate of HIV among Aboriginal and Torres Strait Islander peoples is more than twice as high than it is for the Australian-born, non-Indigenous population, increasing to more than three times higher for those aged over 35 years. We know that access to HIV testing and treatment remains an issue for Aboriginal and Torres Strait Islander peoples for a wide range of reasons.

I welcome the Health Minister’s announcement this morning that $485,000 in funding will go to the South Australian Health and Medical Research Institute to find out why our young Indigenous people are still at an increased risk of blood borne viruses and STIs.

High quality health care must be accessible and appropriate for the needs of Aboriginal and Torres Strait Islander peoples. We have to acknowledge that those with HIV may experience additional barriers in accessing health care which relate to stigma and shame.

Racism is one of the social and cultural determinants of health for Aboriginal and Torres Strait Islander peoples. Racism is part of a vicious circle that contributes to low levels of access to health services by Indigenous Australians and causes psychological distress. And it is this distress that can contribute to negative coping behaviours such as injecting drug use or just being too ashamed to talk about their health concerns, or ask to be tested for STIs, or access condoms and clean needles.

To make real progress, we need to work together and eliminate discriminatory and stigmatising behaviour wherever and whenever we see it. We must call it out.

We need to provide our people—young and old—with an environment where they can talk about important issues such as their health or sexuality. And they need to do this without the fear of losing the support of, or connection with, their community. Aboriginal and Torres Strait Islander peoples also need to feel culturally safe in the mainstream health system.

I am proud of our close relationship with, and continued support for, community controlled health services, their peak bodies in every state and territory and the National Community Controlled Health Organisation. Aboriginal community controlled health services deliver holistic, culturally competent and safe primary health care and is a model for all health services as they strive to improve health outcomes for Aboriginal and Torres Strait Islander peoples.

An appropriately trained health workforce helps build the cultural competence of mainstream primary health care services. It also supports the ongoing viability of Indigenous specific health services, particularly those delivered through Aboriginal community controlled health services.

To improve access to culturally safe, high quality health care for Aboriginal and Torres Strait Islander peoples, the Government continues to invest in the Aboriginal community controlled sector.

In 2015-16, the Government provided funding to three additional community controlled health services to deliver comprehensive primary health care:

    • Moorundi Aboriginal Community Controlled Health Service in SA—a newly established service.
    • Tamworth Aboriginal Medical Service in NSW, now an independent organisation.
    • And the Werin Aboriginal Corporation Medical Centre in NSW, also now an independent organisation.

The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, was released last year. This important Plan guides our strategies, actions and deliverables to maximise health benefits for Indigenous Australians.

I consider it a huge step forward to have racism recognised within the Implementation Plan. This is the critical issue that must be addressed to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples. And this is why Aboriginal and Torres Strait Islander culture is at the centre of the Implementation Plan.

I see the theme of this event, ‘Together, You and Me Can Stop HIV’ as a call to action. Working in partnership with Aboriginal and Torres Strait Islander peoples is critical to addressing poor health outcomes of Indigenous Australians. It is only through working together as true partners— the fundamental and guiding principle—of the Implementation Plan that we will achieve success.

Already we are seeing real progress against the deliverables in the Implementation Plan. The next stage of the Plan is to address health system effectiveness and the social and cultural determinants of health such as racial discrimination.

This Plan will also increase engagement and involvement with other Australian Government agencies, state, territory and local governments, the Aboriginal community controlled sector, the non-government sector and the corporate/private sector. This broader engagement base will provide the mechanism for significant improvements in Indigenous health outcomes, including the reduction of sexually transmissible infections and blood-borne viruses such as HIV.

Finally, to reiterate comments made by the Prime Minister, it is critical that the Government continues its policy of doing things with, and not to, Aboriginal and Torres Strait Islander peoples.

I am confident that by working with all our partners in developing and implementing actions, we will Close the Gap in health outcomes for Indigenous Australians because Closing the Gap is everybody’s business.

I recognise there is a lot of work to be done, but we must all recognise that respect of diversity and respect of cultures must be embedded into the way that all services are run. This is fundamental to improving health outcomes for Aboriginal and Torres Strait Islander peoples.

Together we will build the capacity of the Indigenous community controlled health sector and make a real impact on the HIV rates among Aboriginal and Torres Strait Islander peoples.

NACCHO Aboriginal #SexyHealth #ATSIHAW : Minister @KenWyattMP launches Aboriginal and Torres Strait Islander #HIV Awareness Week

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We have to acknowledge that those with HIV in Indigenous communities may experience additional barriers to health care which relate to stigma, shame and racism. To make real progress and combat the spread of HIV we need to work together,

“We need to eliminate discriminatory and stigmatising behaviour wherever, and whenever, we see it so people can seek the treatment they need without the fear of negative consequences.”

Assistant Minister Ken Wyatt announcing funding of $485,000  at ATSIHAW launch with Pat Turner, James Ward , Mark Saunders pictured below

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Picture above NACCHO CEO Pat Turner launching the new website  http://www.atsihiv.org.au at Parliament House this Morning

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NACCHO Aboriginal #SexyHealth #ATSIHAW : Aboriginal and Torres Strait Islander #HIV Awareness Week

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

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Funding to conduct a survey to better understand why young Aboriginal and Torres Strait Islander people are at increased risk of blood borne viruses (BBV) and sexually transmissible infections (STI) was announced today.

The Minister for Health and Aged Care Sussan Ley, MP and the Assistant Minister for Health and Aged Care Ken Wyatt AM, MP announced the funding at the launch of National Aboriginal and Torres Strait Islander HIV Awareness Week.

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“While Australia has maintained one of the lowest HIV rates in the world it is still present and we need to do more,” Ms Ley said.

According to the Kirby Institute’s Annual Surveillance Report, the rate of HIV among Aboriginal and Torres Strait Islander people in 2015 is more than two times higher than the Australian-born, non-Indigenous population, with rates nearly three times higher for those aged over 35 years.

“While huge inroads have been made to prevent the spread of HIV, we need to ensure that Aboriginal and Torres Strait Islander people have timely access to scientific advances in treatment and diagnosis, as well as access to best practice management of HIV that is culturally safe,” Ms Ley said.

“This is why the Australian Government will provide funding of $485,000 to the South Australian Health and Medical Research Institute to conduct a second GOANNA Survey to gain a better understanding of why our young Aboriginal and Torres Strait Islander people are at increased risk of STI.”

The Australian Government remains committed to providing better public health programs that are responsive to the needs of Aboriginal and Torres Strait Islander peoples through targeted initiatives including Closing the Gap, the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 and the BBV and STIs Strategy.

aids-video Watch video here

Or check out the new website http://www.atsihiv.org.au

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NACCHO Aboriginal #SexyHealth #ATSIHAW : Aboriginal and Torres Strait Islander #HIV Awareness Week

 

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 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.

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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.

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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.

 

NACCHO Aboriginal health : #AIHW #AustraliasHealth2016 : What are the health experts saying about the report ?

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” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.

Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.

Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.

However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.

The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.

This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “

AHHA Chief Executive Alison Verhoeven

Download the report here australias-health-2016

 #AIHW and Minister Sussan Ley press releases from launch #AustraliasHealth2016 report

Life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade

The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.

The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.

The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.

The gap for women was slightly lower at 9.5 years.

Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.

The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.

Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.

Indigenous sobriety rate higher than non-Indigenous Australians

While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.

The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.

However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.

This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.

Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.

This was 10 per cent more than their non-Indigenous counterparts.

Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.

Reports below from the Conversation

According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).


A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively. AIHW

The single leading cause of death in Australia is coronary heart disease, followed by:

Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:


Burden of disease, by disease group, Australia, 2011 AIHW

Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.

The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):


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Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.


Lifestyle choices

Fron Jackson-Webb, Health + Medicine Editor, The Conversation

The good news is Australians are less likely to smoke and drink at risky levels than in the past.

Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).


AIHW

The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.


AIHW

Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).

Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).

The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.

Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.

Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.

Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.

Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.

Proportion of the burden attributable to the top five risk factors


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Preventing chronic disease

Rob Moodie, Professor of Public Health, University of Melbourne

This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.

If we took prevention and health promotion far more seriously, we could do a lot better.

The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.


Further reading: Focus on prevention to control the growing health budget


Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.

However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.

We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.

Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.


Inequities

Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University

Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.

Deaths by socioeconomic group: 1 = lowest; 5 = highest


AIHW

The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.


Further reading: Want to improve the nation’s health? Start by reducing inequalities and improving living conditions


Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.

Compared with the non-Indigenous population, Indigenous Australians are:

  • 3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
  • five times as likely to have end-stage kidney disease
  • twice as likely to die from an injury
  • twice as likely to have heart disease.

Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.


AIHW

The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.

Coverage with private health insurance and government health-care cards


AIHW

Cost of care

Professor Stephen Duckett, Director of the Health Program at Grattan Institute

Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.

Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.

But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.

Informed commentators have generally rejected the unsustainability claim, some labelling it a “myth”, while others take a more nuanced view.

Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.


Annual growth rates in health expenditure AIHW

This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.

Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.

Health expenditure by area (adjusted for inflation)


AIHW

Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.

This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.

NACCHO Aboriginal Health Newspaper Next AGM Edition

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NACCHO coverage #NTElections #Aboriginal Health #DonDaleKids Policy document RACP

NT

#Aboriginal Health

” In the Northern Territory, as elsewhere in Australia, Aboriginal and Torres Strait Islander people disproportionately experience poor health – much of which stems from SDoH factors. Concerted action must be taken by the incoming government to address these.

For instance, overcrowded housing for Indigenous people is a major problem in the Northern Territory and contributes to increased rates of infectious diseases. It is associated with the spread of ear and eye diseases, skin infections, respiratory infection, and streptococcal infections causing rheumatic fever and rheumatic heart disease.

Education and literacy are strongly associated with lifestyle choices and health literacy. The incoming government must prioritise strategies which improve access to education and increase educational participation for Aboriginal and Torres Strait Islander people across the Northern Territory, including early childhood education. “

The RACP’s Northern Territory Committee

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#DondaleKids

“As in other Australian states and territories, Aboriginal and Torres Strait Islander youth and adolescents are hugely overrepresented in the Northern Territory justice system.

The special needs of these young people need to be considered. This should include the involvement of the Aboriginal Community Controlled Health sector in the provision of culturally specific and safe care. Culturally appropriate services and support programs are also needed post juvenile justice incarceration.

We welcome the Royal Commission into Child Protection and Youth Detention Systems of the Northern Territory; however we are calling for the Terms of Reference to be broadened to cover health. It is also crucial that all those who have been victims of any abuse receive immediate support and treatment for physical and mental health issues.

The disproportionate number of Indigenous young people in detention makes it essential that formal processes and mechanisms are put in place to facilitate the participation of Aboriginal and Torres Strait individuals and communities in the work of the Royal Commission and the overhaul of the Northern Territory’s incarceration culture.

The RACP’s Northern Territory Committee

Download this policy document

NT time-for-action-on-health-policy-nt-federal-election-statement-2016

INDIGENOUS AFFAIRS

The CLP abolished the Aboriginal Affairs portfolio, but reinstated it in 2015, has set public service Aboriginal employment targets and had pledged to invest more in remote housing, with a $1.65 billion program to build 240 houses a year for eight years in remote communities. Labor has pledged to give communities greater control over local government, education and training, health, childcare and justice, as well as promising a $1.1 billion 10-year remote housing program.

FROM AAP Summary see below part 2

 First Aboriginal eye doctor Kris Rallah-Baker working at Sunrise health clinic at Mataranka in the Northern TerritoryPhoto: Michael Amendolia

Overview

The Royal Australasian College of Physicians (RACP) is committed to working with all political parties to inform the development of health policies that are evidence-based and grounded in clinical expertise, that focus on ensuring the provision of high quality accessible healthcare. The Northern Territory Committee of the RACP utilises the knowledge and expertise of Northern Territory based members to develop policy positions and proposals which prioritise the health of all Territorians.

The RACP’s Northern Territory Committee has identified a number of policy priorities for the incoming government, accompanied by recommendations for action. These include:

  • Measures to address health inequity and the social determinants of health, as means to improve health outcomes and reduce rates of preventable diseases;
  • Improving access to specialist medical care for Aboriginal and Torres Strait Islander people and supporting the vital services of the Aboriginal Community Controlled Health sector;
  • Banning the use of lead shot for hunting;
  • Improving the provision of health, psychological and social services to adolescents in the juvenile justice system to facilitate rehabilitation and help detainees develop lifelong healthy behaviours;
  • Immediately ending the dangerous policy of open speed zones;
  • Implementing effective, community-led measures to reduce the harms of alcohol, including better utilisation of Alcohol Action Initiatives; and
  • Facilitating the provision of specialist medical services in community-based settings.

 

The RACP urges the incoming government to adopt strong policies which put the health of Territorians first, in line with the recommendations contained in this document.

Social Determinants of Health

Health is a matter that calls for a whole-of-government approach. The evidence is clear, an individual’s health is not only shaped by lifestyle choices but also by a range of socioeconomic factors which individuals often do not have direct control over. These are commonly referred to as the Social Determinants of Health (SDoH) and include housing, early childhood experience, economic status, transport, built and social environments and access to resources.

The evidence to date shows that:

  • Diseases and illness are exacerbated and disparately distributed in direct relationship to inequities in society.
  • Addressing the SDoH will reduce the burden of avoidable disease, resulting in savings to the health system as well as economic growth and development.

If action was taken to address the determinants of health at all levels of government, it is estimated that 500,000 Australians could avoid incurring a chronic disease.2

Governments can influence the SDoH by adopting an approach to policy-making that places health as a key decision-making factor in all areas of policy. This approach, referred to as Health in All Policies (HiAP), consists of systematically taking into account the health and health-system implications of all policy decisions, by seeking synergies between policy portfolios and avoiding harmful health impacts, in order to improve population health and health equity.3

In the Northern Territory, as elsewhere in Australia, Aboriginal and Torres Strait Islander people disproportionately experience poor health – much of which stems from SDoH factors. Concerted action must be taken by the incoming government to address these.

For instance, overcrowded housing for Indigenous people is a major problem in the Northern Territory and contributes to increased rates of infectious diseases. It is associated with the spread of ear and eye diseases, skin infections, respiratory infection, and streptococcal infections causing rheumatic fever and rheumatic heart disease. Education and literacy are strongly associated with lifestyle choices and health literacy. The incoming government must prioritise strategies which improve access to education and increase educational participation for Aboriginal and Torres Strait Islander people across the Northern Territory, including early childhood education.

In addition to adopting a Health in All Policies approach, a strong focus on health prevention is required. The absence of a clearly defined preventive health strategy in Australia is deeply concerning, especially with chronic conditions such as heart disease, kidney disease, cancer and type II diabetes, accounting for accounting for 83 per cent of premature deaths (deaths among people aged less than 75 years) and 66 per cent of the burden of disease in Australia. Investment in preventive health improves the population’s health and is critical to the long-term sustainability of the Northern Territory healthcare system.

Preventive health measures must address key contributing factors to chronic diseases in Australia, including alcohol consumption, obesity, poor nutrition and tobacco use. In order to effectively manage the preventive health risks posed by lifestyle factors and associated diseases, a coordinated approach is required.

The RACP calls on the incoming NT government to:

  • Adopt a ‘Health in All Policies’ approach to policy-making to place health as a key decision-making factor in all areas of policy which impact on individuals and communities’ health (i.e. housing, education, transport, built and social environments, etc.).
  • Develop a Northern Territory preventive health strategy which addresses and lowers the risk factors for preventable illnesses and diseases.
  • Support and contribute to the development and implementation of a national Australian Preventive Health Strategy.

Aboriginal and Torres Strait Islander Health

Data and experience shows that Aboriginal and Torres Strait Islander people access specialist services at a lower rate than needed, and they face many barriers in accessing specialist care – this is true whether they live in the city or in rural or remote areas.

For young Aboriginal and Torres Strait Islander people, access to sexual health information and services is critical. Concerted action is required to address the high levels of sexually transmitted infections (STIs) in Indigenous communities and to prevent increases in infection with blood borne viruses (BBVs). Aboriginal and Torres Strait Islander youth need to be empowered to promote and discuss good sexual health; supported to access timely, affordable and culturally appropriate sexual health services; with a target to reduce the incidence of STIs amongst Indigenous young people included in the Close the Gap objectives.

The RACP welcomed the launch of the Implementation Plan for The National Aboriginal and Torres Strait Islander Health Plan 2013-2023, with its recognition of the need for a national framework to improve access to specialist care that is needs-based, and initiated by and integrated with primary health care services. The RACP is committed to working with its partners to progress this work, including working with the NT government. It is vital that sufficient and sustained funding and resources are made available to drive this Implementation Plan, so that its aims become a reality.

Indigenous health leadership and authentic engagement of Aboriginal and Torres Strait Islander communities are crucial to achieving improved health outcomes. Service development and provision should be led by Aboriginal and Torres Strait Islander health organisations. The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, timely and culturally appropriate care to Aboriginal and Torres Strait Islander people, and must have long-term and secure funding to not only retain, but grow their capacity to do so.

The RACP calls on the incoming NT government to:

  • Allocate sufficient and secure long-term funding to progress the strategies and actions identified in the Implementation Plan that are the responsibility of the NT government.
  • Engage and consult with the RACP in order to utilise specialist expertise and clinical knowledge in overcoming barriers to accessing specialist care for Aboriginal and Torres Strait Islander people in the NT Time for Action on Health Policy: RACP Northern Territory Election Statement 2016 5
  • Implement specific strategies and initiatives to address the disproportionately high incidence of STIs and BBVs in Aboriginal and Torres Strait Islander communities.
  • Support the Aboriginal Community Controlled Health Sector to support the sector’s continued provision of Indigenous-led, culturally sensitive healthcare.
  • Build and support the Indigenous health workforce to grow their numbers and integration within multidisciplinary teams.

Banning use of lead shot for hunting

It is of significant concern that elevated lead levels have been found in over half of children tested in three Top End remote communities and in 20 per cent of adults. Updated guidelines from the National Health and Medical Research Council (NHMRC) of Australia recommend elevated levels be investigated and reduced. Inhalation or ingestion of lead can produce neurodevelopmental dysfunction in children, resulting in learning difficulties, and behavioural problems. Elevated lead levels can also contribute to dysfunction in cardiovascular, renal, neurological, and haematological systems in adults.

Lead shot used in guns remains a key source of lead exposure among populations where it is still commonly used; through directly ingesting game that has been hunted and therefore contaminated with lead shot, as well as handling lead ammunition (or playing with lead ammunition in the case of children), and consuming lead dust and particles.

For many Aboriginal and Torres Strait Islander populations, hunting and fishing yields continue to make up a considerable proportion of their diet. High consumption of game meat is also typical for many individual recreational and vocational hunters and their families.

Lead shot is banned for hunting waterfowl in the Northern Territory however Indigenous Australians hunting on Aboriginal-owned land are exempt from this legislation and therefore exempt from the protection it affords.

The RACP calls on the incoming NT government to:

  • Immediately ban lead shot for hunting in line with recommendations from the World Health Organisation and the National Health and Medical Research Council, and support appropriate access to alternatives.

Incarceration of adolescents

Significant improvements are needed within the juvenile justice system in the Northern Territory. The health and healthcare needs of young people in juvenile detention are rarely seen as a priority, despite the fact that these adolescents are among the most vulnerable in our community.

As in other Australian states and territories, Aboriginal and Torres Strait Islander youth and adolescents are hugely overrepresented in the Northern Territory justice system. The special needs of these young people need to be considered. This should include the involvement of the Aboriginal Community Controlled Health sector in the provision of culturally specific and safe care. Culturally appropriate services and support programs are also needed post juvenile justice incarceration.

We welcome the Royal Commission into Child Protection and Youth Detention Systems of the Northern Territory; however we are calling for the Terms of Reference to be broadened to cover health. It is also crucial that all those who have been victims of any abuse receive immediate support and treatment for physical and mental health issues.

The disproportionate number of Indigenous young people in detention makes it essential that formal processes and mechanisms are put in place to facilitate the participation of Aboriginal and Torres Strait individuals and communities in the work of the Royal Commission and the overhaul of the Northern Territory’s incarceration culture.

It is recognised that incarcerated adolescents are more likely to experience poorer health and life outcomes and disproportionately high levels of disadvantage over that of the general population, and it is increasingly recognised that their health needs are greater than adolescents in non-custodial settings.

Adolescence is a critical time in a person’s development, and it is imperative that juvenile detention provides opportunities for young offenders to rehabilitate and develop healthy behaviours for life. We acknowledge that the interactions between disadvantage, incarceration, poor health and well-being and life outcomes are complex, however this should not deter us from ensuring these young people are able to access the healthcare, support services and rehabilitation opportunities to support them to lead a healthy and productive future.

The RACP calls on the incoming NT government to:

  • Improve provision of health, psychological and social services to adolescents in the juvenile justice system, including a health screening within 24 hours of entry into detention.
  • Reduce reoffending and recidivism in the juvenile justice system and increase vocational productivity by addressing the social determinants of health through a “whole of Government” approach.
  • Improve the training of health professionals and others who work with adolescents in the juvenile justice system.

End Open Speed Zones

The open speed zone on the Stuart Highway puts hundreds of thousands of road users, tourists and local residents at risk each year. Northern Territory road users suffer a road safety record that is far worse than any other Australian state or territory. Its fatality rate is among the worst in the developed world – between February 2013 and March 2014, the fatality rate (17.79) was more than three times the national average of 5.11 deaths per 100,000 people.

These figures underscore a real and pressing need for the incoming government to commit to ending the policy of open speed zones in the interests of the health and safety of all Northern Territory road users and pedestrians. Road safety requires a comprehensive approach, and a vital element is missing when speed limits are not in place.

Since the reinstatement of open speed zones on the Stuart Highway in February 2014, the Northern Territory Committee of the RACP has consistently warned of the risks associated with open speed zones and advocated for an end to this dangerous policy. Speed is a relevant consideration in all road accidents. Higher speeds lead to a greater risk of a crash and a greater probability of serious injury if a crash occurs.

The RACP calls on the incoming NT government to:

  • Immediately abolish open speed zones on the Stuart Highway
  • Permanently end the policy of open speed zones across the Northern Territory
  • Show leadership and commit to road safety policies that focus on safeguarding the lives and health of all Northern Territory road users and pedestrians, in line with the principles of the National Road Safety Strategy 2011-2020.

Alcohol

The harms of alcohol are difficult to overstate. It is the world’s third largest risk factor for disease and eighth largest risk factor for deaths. It is a causal factor in more than 200 disease and injury conditions, and can lead to lifelong problems associated with Fetal Alcohol Spectrum Disorders (FASD).

The social and economic costs of alcohol to the Northern Territory are particularly high. National statistics have recorded the Northern Territory as having the highest per capita consumption of alcohol and the highest percentage of deaths attributable to alcohol. And while the epidemiology of FASD remains unclear due to a lack of standardised data, estimates suggest higher rates of FASD in the Northern Territory than the rest of Australia, particularly among Aboriginal and Torres Strait Islander children.

The RACP is particularly concerned about the harms of alcohol to children and young people, with the peak age for the onset of alcohol use disorders being only 18 years. The tendency of young people to combine drinking with high risk activities (such as drink driving) increases their risk of alcohol-related injury or illness, and in some cases can prove fatal. Risky drinking behaviours, combined with open speed limits (see above), creates conditions for further increases in the incidence of devastating road trauma and fatalities on Northern Territory roads.

The RACP calls on the incoming government to make better use of Alcohol Action Initiatives, as a potent tool for addressing the availability of alcohol while empowering local communities to restrict access to alcohol as they see fit. The previous Alcohol Management Plan (AMP) framework was shown to achieve stronger and more sustainable outcomes in reducing alcohol-related harms in communities where AMPs were locally driven and owned, and where supply measures were integrated with complementary demand and harm-reduction measures.

The RACP encourages the incoming government to prioritise the implementation of proposed new Alcohol Action Initiatives, as a means for the Northern Territory to partner with the Commonwealth to empower local communities to tailor a suite of initiatives covering alcohol restriction as well as better treatment facilities and community education to reduce local alcohol-related harms.

The RACP notes that development of a Northern Territory Alcohol Action Plan is currently underway, with a whole of government response to FASD to be included in the plan. The RACP encourages the incoming government to utilise the RACP’s evidence-based Alcohol Policy in developing the plan and to consult with RACP Fellows to ensure physician expertise underpins strategies to reduce alcohol-related harm in the Northern Territory

The RACP calls on the incoming NT government to:

  • Take full advantage of the new Alcohol Action Initiatives to partner with the Commonwealth to facilitate locally owned and managed initiatives to reduce alcohol related harm through a combination of alcohol restriction measures, education and better addiction treatment facilities.
  • Increase funding for alcohol treatment services in order to reduce the incidence of alcohol use disorders
  • Increase funding to facilitate workforce development to address unmet demand for alcohol treatment services.

Integrated Care

For the growing number of Australians living with multiple, chronic health conditions, navigating the health system has become increasingly complex. This problem also impacts people with disability and mental health issues. The care of individuals with multiple health problems is often disjointed, with the patient’s different health conditions managed by different health professionals.

Fragmented health services delivery not only impacts the quality of patient care, but leads to inefficiencies, duplication and wastage across the health system. An approach to healthcare which places the patient at the centre is required to not only improve the management of patients with complex care needs, but ensure the Northern Territory healthcare system operates efficiently and effectively.

Of particular priority for the RACP is the need to support increased provision of specialist services in community-based settings, such as primary healthcare centres, community clinics, Aboriginal Medical Services, residential aged care facilities and people’s homes. Community-based settings allow patients with multiple, chronic or complex conditions to be seen in convenient location, and facilitate greater collaboration and coordination between the different health professionals involved in patient care.

The RACP calls on the incoming NT government to:

  • Engage and consult with the RACP in order to utilise specialist expertise and knowledge when developing integrated models of care for the NT, including any involvement in the Health Care Homes trial, to ensure a multidisciplinary approach is taken.
  • Implement policies that promote and support health professionals and service providers to work collaboratively.

WHAT THE TWO MAJOR PARTIES ARE FOCUSING ON FOR THE NT ELECTION: AAP Summary

COST OF LIVING

The CLP says it has reduced the cost of housing and petrol over its term, and increased family subsidies. It says it will continue to do so with more land release, will offer $500 study vouchers, and will work to reduce the cost of food in remote areas. Labor has accused the CLP of planning to sell off public utility PowerWater Corporation. Labor is offering up to $26,000 in stamp duty relief for home buyers, and will issue seniors with a $700 debit card every two years.

LAW AND ORDER

The CLP made its legislation to presume against bail for young property offenders an election issue. It’s also promising more CCTV camera funding. Meanwhile, Labor is focusing on early intervention, prevention and rehabilitation of young people, as well as promising more police on the streets. Both parties have pledged to close down the Don Dale centre and both have promised a new police station for Palmerston.

JOBS AND THE ECONOMY

Chief Minister Adam Giles has promised to create 24,000 jobs next term, a third of which would be in the onshore gas industry, and the rest across marine infrastructure development, tourism, horticulture, indigenous housing, aquaculture, construction and defence. Labor says it will repurpose $100 million from the current budget for infrastructure stimulus to create jobs.

INDIGENOUS AFFAIRS

The CLP abolished the Aboriginal Affairs portfolio, but reinstated it in 2015, has set public service Aboriginal employment targets and had pledged to invest more in remote housing, with a $1.65 billion program to build 240 houses a year for eight years in remote communities. Labor has pledged to give communities greater control over local government, education and training, health, childcare and justice, as well as promising a $1.1 billion 10-year remote housing program.

MINING AND THE ENVIRONMENT

The CLP says developing the onshore gas industry is key to a stable future and job security in the NT, while Labor says if elected it will institute an indefinite moratorium on fracking until the process is proven to be safe. The CLP will institute world’s best practice regulations in relation to mining and energy projects. Labor will follow a science-based and transparent water license process, will support indigenous rangers and environment groups, and will move to a 50/50 renewable energy target by 2030.

© AAP 2016

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.