HIV epidemiology in Aboriginal and Torres Strait Islander Peoples: Why is there a gap and how do we address it?

A report on Dr James Ward’s presentation on day 1 of the Conference.

Australia has seen a “relentless increase” in new HIV diagnoses in Aboriginal and Torres Strait Islander (ATSI) peoples, said Professor James Ward at the HIVAIDS Conference in Sydney today.

This increase lies on a background of a reduction of new HIV diagnoses in non-ATSI populations, and highlights the ongoing inequity in health outcomes for Aboriginal people in Australia. 

Ward’s passionate presentation emphasised the epidemiological differences in HIV rates between ATSI and non-ATSI populations, discussed reasons for the discrepancy and what we need to explore further to close the gap.

Ward estimated that 14% of ATSI people living with HIV are undiagnosed, compared to 8% in the general population. ATSI peoples diagnosed with HIV are more likely to be younger at the time of diagnosis and ¼ of all ATSI peoples with HIV are female. 1/3 of ATSI people with HIV will be diagnosed late, and there is low HIV testing rates in remote Aboriginal communities even in the presence of other sexually transmitted infections.

The drivers of this trend are multifactorial. Ward proposes that the slower progress in reaching Indigenous Communities with health promotion and new health interventions, even in the absence of risk behaviour, can open up new inequities in health outcomes. Oppression in its various forms: societal exclusion, sexual racism, and exceptionalism can result in weakened community networks and subsequently lower access to peer knowledge. Social determinants of health haven’t changed for Aboriginal and Torres Strait Islander peoples, but there has been an increase in intravenous drug use, and other sexually transmitted infections including syphilis and gonorrhoea.

Ward suggests we need to explore condom use, rates of unprotected anal intercourse and the role of alcohol and drug use in new diagnoses of HIV. We must question whether the knowledge and awareness of HIV in ATSI communities is decreasing, and increase access to testing in primary health care settings. We need to address ideas of fluidity of sexuality and gender reclamation in ATSI groups and work together in reducing stigma and shame of STIs in Aboriginal and Torres Strait Islander peoples. We need to increase uptake of new treatments and preventatives such as PrEP in ATSI communities. Targeted campaigns and engagement with multiple population groups, and a holistic and culturally safe model of care, are vital in addressing the epidemic and closing the gap.

Author bio:

Dr Douglas is a GP with a special interest in sexual and reproductive health. She has worked in Peru, London, Ireland and Australia and has extensive experience in sexually transmitted infections, cervical screening, unintended pregnancy and abortion care, and contraception. She is currently the Medical Director at SHQ (Family Planning Association of WA), a member of the WA Medical Board of Australia, the National Sexual Boundaries Notification Committee, and a forensic doctor with the Sexual Assault Referral Center (SARC).