HIV notifications in Aboriginal and Torres Strait Islander people are increasing, mainly in men, mainly in Qld, particularly in regional settings. Transmission risks are different - higher IDU and heterosexual transmission than amongst non-Indigenous individuals.
Prof Russell spoke specifically about the FNQ outbreak that commenced in Cairns in 2014, and now included about 30 new diagnoses. Coinfections with syphilis is common (known concurrent / preceding syphilis outbreak in the area), and there have been 5 deaths due to congenital syphilis. This in itself is staggering. Mainly young men (2 women). Mainly MSM though not gay-identifying. Only sporadic IDU use has been reported. New cases include Cape York, Torres Strait and NT.
Various measures that could be considered with regard to prevention were considered -systemically in this talk by this experienced HIV clinician who has been based in Cairns now for many years.
- Condom use (Fagan et al 2010, self reported behaviours suggest similar rates of condom use amongst this group to others, but younger sexual debut, more sexual partners. Unlikely to be able to significantly increase.
- Test and Treat - low level of HIV testing overall in this group.'Nth QLD STI Action Plan' covers syphilis but not really HIV; Good testing of male prisoners in Cairns, reasonable antenatally for women. Adult and young peoples health checks now include HIV testing. Consider - point of care testing (ALere Determine accessibility)
- TasP - the presenter considers this is the most likely strategy to reduce onward transmission but costly, logistics etc.
A Recent audit found significant numbers at high risk of onward HIV transmission in need of case mx and extra support. Significant need for individualised management. Leaks from the Treatment cascade are myriad/multiple - shame/stigma, as well as more mundane issues like money/transport availability, poor hosing, low health literacy, alcohol and drug use. Furthermore this is generally a highly mobile population.
- PrEP - Pessimism was expressed for this as a strategy in this group, despite 3% prevalence amongst the 2000 on PrEP in QLD. (4% population indigenous). However most in SE Qld.Pessimism because of low health literacy, most don't identify as gay; more engagement and culturally appropriate PrEP promotion is needed. On-demand PrEP or long-actin PrEP may be more appropriate in this target group.
- Health promotion is urgently required- but some ideas are circulating/in development.
The importance of knowing your epidemic is illustrated dramatically here.