ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Divergence in HIV rates within Aboriginal and Torres Strait Islander communities in Australia
A/Prof James Ward spoke about the divergence of HIV rates within Aboriginal and Torres Strait Islander (ATSI) communities.
HIV/AIDS in Australia has been a contained epidemic until now.
In 2015 Australia has seen the highest number of notifications in ATSI patients on record since the numbers have been monitored.
This is almost double what the Non-Indigenous notification rates are.
The majority of notifications are in men who have sex with men (MSM) at 51%, then the Heterosexual population is 21% with IV Drug Users at 16% of the notifications. (this was previously 3% in the 'early days')
Reminder that these figures are already 11 months old. Timely surveillance data is crucial.
The rate of notifications in Indigenous females is three times the rate of that of Non-Indigenous females.
This has been high in all regions, not just the urban and inner regional areas but now in the remote areas.
A/Prof James Ward mentioned there are a number of reasons why divergence is occurring but highlighted a few of the main reasons to be:
- a young, mobile population in more regional and remote communities
- risky practices such as sharing injecting equipment and the high prevalence of sexually transmitted infections (STI's)
-there is a lack of needle syringe programmes in the remote areas.
-failure to engage TasP (Treatment as Prevention) and PrEP (Pre-exposure prophylaxis) in the communities
-there is a high burden of disease and multiple co-morbid conditions in the Indigenous population and often these patients are on a number of other medications
He stressed the importance of being inclusive of all vulnerable populations when it comes to HIV.
The high prevalence of STI's in the 10-24 yr old age groups increases the risk of HIV transmission and poses an ongoing problem.
Previously there has been an increased focus on suicide prevention in this age group which is very important and needs to be ongoing , however, with the current Syphilis outbreak in Northern Australia and increase in HIV notifications more efforts need to be made to tackle this problem.
Unfortunately there is inequity in service delivery to these remote communities.
If we take a closer look at the Syphilis Outbreak in Northern Australia, the numbers of infectious syphilis diagnoses have risen exponentially.
Could we be dealing with a similar chart for the HIV increases in the near future? Are we prepared for this?
Using some figures from Cairns;
-prior to 2014 there were approximately 15 diagnoses of HIV with 1-2 cases reported in ATSI patients.
-from 2014-2016 the diagnoses of new cases in the ATSI population increased to 50% of the total number of cases.
Most of the cases recently have been in young men who identify as bisexual or heterosexual.
The recent high level summit report in Brisbane has highlighted what is deemed important in terms of tackling this problem in communities.
Workforce development is crucial. Downsizing in certain areas is disastrous as currently the Indigenous population is in the most vulnerable position regarding the HIV increases.
HIV needs to be managed in the Primary Care setting using the support from central public agencies to assist with management.
There needs to be outbreak management and community involvement at every level.
Some suggestions have been to make HIV testing within 30 days after a STI has been diagnosed a nKPI. (National Key Performance Indicator)
To make STI and BBV (Blood Borne Virus) testing compulsory linked to the Aboriginal and Torres Strait Islander Health Check. (Medicare Item 715)
To have Medicare Item numbers for STI/BBV testing.
Education with regards to health literacy is important together with rehabilitation programmes and opioid substitution therapy for IV drug users.
Post Exposure Prophylaxis (PEP)is misunderstood and the community do not know how or when to access this.
James Ward stressed that the community needs to be involved at the forefront of the efforts ,the community needs to be engaged.
I would hope that after attending this conference that all of us walk away with at least a few strategies to take back to our practices or organisations to help prevent HIV becoming an epidemic in the ATSI communities.
I found the presentation by A/Prof James Ward eye-opening and motivating.
We all have a responsibility to play in changing the course of the diverging HIV rates within the Indigenous population.