Day 4- Thursday 17/11/2016 - A.Prof. James. WARD - ABSTI Health

 Aboriginal & Torres Strait Islander Health (ABSTI) – HIV & STI’s in the Australian ABSTI health context.

 Presented by A.Prof. James WARD and Prof. Gracelyn Smallwood and other eminent panellist discussed these contemporary health issues with Australia’s ABSTI people.

 HIV – double the rate of Non- Aboriginal people

                   With 60 % - Men that have sex with Men (MSM)

                             20% - Injecting drug users

                             20% - Heterosexual     

                                                                                                                                                               Please note that  -  20 % of HIV Diagnosis are Women and 12% live in remote and rural & communities.                                                                                                                                                                                                                                                       33% late diagnosis with 21 % having advanced HIV. In the general Population – 90% are diagnosed.

MEDICATION and adherence and co-morbidities are a huge burden.                               Mental Health/ depression – 12% report feeling depressed, with 9.6% of the general population report this.

The social determinates of health – ABSTI have poorer general health with unique challenges in addressing ABSTI HIV care and treatment. Medication burden.             Complex health.

 the effects of ongoing racism and discrimination.

 Feel “SHAME” and their spirits is low.

 Stigma from HIV.                                                                                                                                                                             Need to trust clinicians and respect for clients confidentially is utmost important.  

Needle Syringe Program (NSP) – 

ICE/Crystal has become a big issue.  

We can’t wait for an outbreak to occur, so we need to increase access to NSP services, such as in outreach programs.  

 Health and Community Partners/organisation to work with the community needs, in culturally appropriate ways, including not driving it (program & service health delivery) with experts  without consulting, involvement & input from respected key community stakeholders.

Partner’s organisations needs to ask local people to teach cultural norms. 

PANEL DISCUSSION –

90 % of the general population know HIV Status

80% of the ABSTI know their status (20% don’t!).

Reduced life expectancy (estimates 20 years compared to non-aboriginal Australia people).

need a grass roots approach, need to empower the local people by using their knowledge and expertise about their own local communities and support solutions at local levels.

Funding been cut by Governments with 75 % of Funding is going to non-grass roots, such as University Research & government bureaucracy.  

3% population in jail, 

food prices are increasing in local and remote communities 

Poor sanitation

No jobs, lack of career pathways

Cairns Doctors advised that the syphilis epidemic came first, then linked with HIV.  

Recently 1 female and 4 males (MSM) aged from 18-25 years HIV +                                  young mobile, homelessness (is a major barrier), couch surfing, staying with Aunties, not taking medication as forgets due to constant moving. Finances - Centrelink – cut off.

 Aboriginal Medical Service (AMS) – Aboriginal controlled services across Australia -      there can be an issue of taking blood in ABSTI Peoples.                                                          Non-Aboriginal Health care workers need to provide better cultural translations -           explanations as to why blood is needed (MEDICALLY) to be taken.

With young people there is a better acceptance of outreach programs that deliver rapid testing for Syphilis.  

Issues in screening STI’s in prisons

Aboriginal Community Health Workers – not getting paid and recognised properly.

Some Clinicians can be uncomfortable offering a HIV Test.

Clinicians needs to be flexible in care delivery. Work to ‘hold confidence’ with Clients.

How can Services be friendlier to ABSTI Peoples?

Building good working and trusting relationships is everything. Keeping rapport and people engaged.

Service providers need to become more effective!

Burden of disease/s, reluctant in accessing care, complex family dynamics, isolation.

Family worries, social issues, turning up for appointments and reminders.

Shame aspect – needs to be taken out of HIV. Of not having housing, which prevents people from becoming stable and stay on treatment.

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