Young, Deadly and Syphilis free is an aspect if the Young Deadly and Free campaign focused on improving STI infection rates amongst young Aboriginal and Torres Strait Islander people living in remote Australian communities. The outcomes are to:

• Increase age specific syphilis testing among young people in remote communities affected by the syphilis outbreak
• Increase awareness  and understanding of syphilis, its transmission, testing and outcomes among young people
• Improve awareness of the syphilis outbreak among clinicians and understandings of syphilis testing for remote clinicians

The components of the campaign include a media strategy involving television commercials, radio advertisements and other media; supporting posters and multi-media education materials; a social media campaign for peer to peer delivery of key messages about syphilis, and; a health service engagement strategy towards testing promotion. The media strategy also includes messaging local languages and Kriol.

Using analytics for Facebook, the platform where the majority of resource sharing is taking place, it is apparent that the videos developed for the campaign are having the most reach. This is followed by image-based resources. It is difficult to measure the extent of links being shared as Facebook's analytics do not prioritise accounting for these. Instagram is being used although currently the account only has 54 followers.

Unfortunately, getting info to really remote areas is still proving difficult.

Moving forward, the campaign is investigating the use of online ambassadors who would be paid to guide others in their social networks towards information.

To develop the literacy capabilities of clinical service providers, an electronic newsletter sent via email is sent fortnightly to over 350 health service staff. These act as reminders about campaign services, the outcomes of the campaign, key messages and stories from health services highlighting strategies for testing On average, about 38% of these are opened which is on par with other forms of electronic newsletter clinicians may receive. .

 

Young Deadly and Free is a culturally responsive campaign, targeted to combat the prevalence of STIs amonst Aboriginal and Torres Strait Islander youth. The campaign has been developed by the Aboriginal Health Team at the South Australian Medical Research Institute. The rationale for the campaign is based on increasing rates of STIs experienced by Aboriginal and Torres Strait Island people and strategies toward providing appropriate educational tools. Recent findings from the Kirby Report released 6 November 2017, indicates a 33% increase in diagnoses of HIV amongst Aboriginal and Torres Strait Island people between 2011 and 2016. In Aboriginal and Torres Strait Islander communities, young people and women feature prominently in STI infection data. 

Young Deadly and Free is an attempt to enhance the knowledge, awareness and skills surrounding sexual health literacy, with a focus on Aboriginal and Torres Strait Islanders aged between 16 and 29, living in remote and very remote Australia. The components of the campaign include:

• Clinician resources
• Animations, infographics and fact sheets for young people
• People of influence resources
• Peer education

In terms of Clinician resources, the campaign has developed a resource audit to help clinics ascertain the things that work and find gaps in service provision. As well, new knowledge-bases have been built to help clinicians feel more confident in their approaches to testing for opportunistic infections and skills in talking to young people about blood-borne viruses. Resources for young people have been developed for visual appeal and utilise forms of communication that young Aboriginal and Torres Strait Islander can relate to. Enlisting people of influence within communities enables strength-based ways of sharing knowledge within communities. Peer education strategies pay young Aboriginal and Torres Strait Islander youth to facilitate peer education programs, with between 4 and 8 sixteen to twenty-four year olds facilitating at different sites throughout Australia.

http://youngdeadlyfree.org.au/

Day 2 Morning Session.

Good morning folks, welcome back. The sun is shining, its still a bit cold in Canberra but you wouldn't recognise the place. I started the morning with the Opening plenary for the Sexual Health Conference, some fantastic speakers with valuable insights. Prof. Kit Fairley from Melbourne Sexual Health Centre was a highlight (fantastic speaker) as was Prof. Gracelyn Smallwood speaking on Indigenous HIV and sexual health with her career highlights numerous. Not just an informative session but also very entertaining. Wonderful speakers.

Our last speaker for the morning was Dr Ayden Scheim from the University of California speaking on Trans Rights, sexual health and HIV, referring to the studies, or lack thereof, in regards to Trans people in HIV and Sexual Health research. This as another area where work needs to be done and the way in which we as clinicians or researchers attend this will greatly impact on our ability to be proactive and effective. If I say something from personal and professional experience, work with us, not on us.

I will get off my high horse now and am currently sitting in the next session with Leah Williams, a Nurse Practioner from Perth Hospital speaking on the REACH Programme where maintaining clinical contact with at risk patients more likely to not be presenting.

Normally where referred patients would be discharged from care after two missed appointments, the Immunology clinic sought a change in the structure of clinic visits which is REACH. Candidates were identified as living in metropolitan area, with a detectable viral load and who would avoid or miss clinical appointments.

A cohort of 108 patients was found for the programme, consisting of 65% men, 32% women and 3% people identifying as trans. The research found that the most hard to reach people were Australian and not  born overseas. Interestingly a number of these people were identified as attending the clinic weekly despite no appointments, an indicator that people felt safe to be within this clinical area and with staff. Collaborating with other services, such as Emergency Department presentations by REACH clients being notified to the clinic and staff being able to take the opportunity to engage with the client.

Once i the programme, REACH patients could turn up whenever they like, which was no different to many of their previous attendance. No appointments were made on the books and so no data on "Did Not Attend" was recorded, a huge plus to the clinics KPI's. Focus was on the presenting issues of the patient rather than making visits specifically HIV focused. Another important change was having clinic Administration staff aware of the clients being part of the REACH programme and no reason for a visit was necessary, another way of making clients feel welcome and the clinic appear more accessible.

The "Virtual Clinic" was one innovation of REACH where patient case files were reviewed weekly by a multidisciplinary team and any changes in care or needs were identified in order to facilitate the above changes and give appropriate patient care.Ensuring more support was avaialble to patients commencing new treatments early on and after diagnosis was identified as an effective strategy and client medications were also made available to be picked up from the clinic daily or weekly and use of webster packs to keep things simple and accessible again were effective changes.

In total, DNA rates were halved, patients were happy and were no longer discharged by the service and quality care was given to the patients. The take home message was that we make small tweaks ourselves to make things work becuase patients less likely to do so. Hahaha, so true.

Thanks for following me and looking forward to the second part of the day.

 

 

 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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A.Prof. James. WARD - Aboriginal Health Perspectives.

A Predicted divergence of what is happing in Aboriginal and Torres Straits Islanders community’s in relation to HIV and STI’s.

  

New diagnosis of HIV in remote communities due to young mobile population.

Risk Behaviours such as sharing NSP Equipment, with a background of increasing prevalence of STI’s.

 Failure to engage Treatment as Prevention (PrEP) as need to take other medication (pill burden) for multiple health conditions/comorbidity.

 10-24 years age group, increasing Chlamydia and Gonorrhoea -                                                                  This highlights the inequities and lack of access to care.

 

Hep C – mostly transmitted through injecting drug use (IDU).  

Hep C has increased 43 % in 2011 – 2015.  

It effects the youngest 15-24 years old.

Hep C has 8 times the incidence in Aboriginal people (than non-Aboriginal People).

 

Rural and Remote Communities – need more access to Aboriginal Primary healthcare for testing and treatment and treatment as prevention (PrEP).

HIV in Cairns, QLD – young Aboriginal & Torres Straits Islander men in 2014-2016 had 50 % increase in HIV. This also effects bi-sexual men and men that don't dentify as gay.

NO access to NSP. Difficulties in approach to NSP and harm minimisation.

(Treatment as Prevention) TASP.

Prof. Ward said that we could learn from Canada’s first nation’s people in Saskatchewan that have a background of unresolved grief & intergenerational trauma. 

Increased of IDU and STI’s = HIV !

We need to prevent an outbreak occurring in our rural and remote Aboriginal and Torres Strait Islander (ABSTI) Communities. Health services are already limited and they would also not be able to cope with a major outbreak occurs. This would devastating to these communities.

ABSTI – vulnerability of population.

Need to increase the workforce in meaning work and career options

Need timely surveillance data, to be able to respond quickly    

Medicare to cover costs

Need to advocate ‘outside and ‘raise our voices’ (to Governments and the Australian people to increase awareness and be able to act/prevent). Especially non-Aboriginal People need to stand up and raise their voices about concerns and issues of our ABSTI People.

Increase the current low testing rates for HIV.                                                                                                                                                             Use a diversity/combination of strategies include - strengthen Aboriginal and cultural appropriate Primary care.

 Currently on 32% of people with STI’s are offered HIV Test. This needs to be offered 100%.

 Community itself needs to be interested and engaged.

 

 

 

Professor Gracelyn Smallwood 'Aunty' delivered a highly emotional discussion about the realities faced by many Aboriginal People and Communities across Australia.

Most of the Closing the Gap money (75%) is not going to grassroots level of the people.

it is been swallowed up by university research, and provides jobs to non-aboriginal people.

Gracelyn said that poverty is widespread and needs to be cleaned up.

Many don't have running water and sanitation is poor. 

Food is marked up 200%

Most are unemployed and on Centrelink benefits.

ICE/ substance/drug use is high, including injection.

Concerns about HIV reaching remote and rural communities.

High rate of imprisonment  

Aboriginal Health & Community Services need culturally appropriate programs.

Non-Aboriginal people involved in programs deliver need to go into communities before and consult and talk with keys players/stakeholders and elders. 

Local grass root program delivery don't have to cost lots of money,                                                             such as the 'deadly program' and 'grog kills skills' delivered on a  shoe-string budget. 

Gracelyn talked about her us of the (world famous) Condom man.

This health promotion/prevention strategy was used successful and widely as a healthy alternative to the scary 'grim reaper' advertisements to assist combating HIV/AIDS. 

 Non-Aboriginal People need to speak out more and advocate for ABSTI People by keeping it on the agenda.

Australia needs to reconcile with the past and the ongoing injustices against Aboriginal and Torres Strait Islanders People's. 

Please read Gracelyn thesis which she addresses these multilevel issues in Australia's Indigenous People. http://www.atsiwlsnq.org.au/reports/Gracelyn_Smallwood_2011_thesis.pdf

Thankyou Aunty, your inspirational presentation. It was the highlight of the conference for me and together we can all individually and collectively help to improve the health and lives of Australians Aboriginal and Torres Strait Islanders People. 

 

 

 

Wednesday 16/11/2016

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.

 

 

 

 

 

 

 

Dr James Ward gave us a thought provoking opening speech outlining the recent increase (i.e. divergence) of HIV infection rates among Aboriginal and Torres Strait Islanders compared with the general population.  Here are the take home messages from the talk:

 

• initially rates of HIV infection were similar between Indigenous and TSI, but numbers are now increasing
• 2015 marked the highest rate of new diagnoses (n=38)
• new diagnoses of HIV are occurring in rural and remote areas, which has never been seen before
• why?
• background: young, more mobile, more regional
• risks: injecting equipment, high background of STIs
• success in non-indigenous diagnosis
• failure to engage with community
• how to improve?
• increasing workforce rather than downsizing
• timely surveillance data (absurd that we deal with 2015 data in Nov 2016)
• implementation of a national KPIs reportable for STIs by Aboriginal PHC
• change to AHC, make STI/BBV checks more mandatory
• Medicare items specific to BBV/STIs
• improved testing strategies
• only 32% of people with a positive STI screen had an HIV test within 30 days

 

I found the session a real eye opener and saw that there were plenty of areas that we could improve in. Simply increasing the rigor at which we conduct testing would seemingly make a big difference.

Associate Professor Rebecca Guy gave the Gallows Lecture.

The theme was new technologies for STI prevention and adult health checks with the target populations

- Aboriginal and Torres Straits Islanders People, 

- Gay men, 

- Mental health 

 

Resources and Notification of Partners. SMS technology is preferred. 

23% notified partner/s

Only 1/5 followed up in a clinic 

www.letthemknow.org.au

www.thedramadownunder.info

HOW is this going to change and effect my PRACTICE?

I will incorporate more IT into my clinical practice, as the Research has shown that clients and patients prefer SMS technology.  I have found this to be more effective approach in contacting those less engaged and harder to reach Clients, as it appears to be less intrusive means of contact & provides people the choice of when they want to make contact.

 

Other presentations on sexual health - Chlamydia 

Discussed health seeking behaviour. 

Focus on Adolescents

Low testing rates, 20 % people became re-infected in 1 year.

Issues are PID, infertility.

Gay men, increase risk HIV 

www.access-study.org

 

 

 

The afternoon symposium dedicated to Indigenous Health started with Associate Professor James Ward's summary of the STRIVE study.

 

The STRIVE study commenced in 2009 and was a randomised community trial with an intervention of a sexual health quality improvement program in 65 remote communities in northern and central Australia.

 

The primary aims of the STRIVE study were:

1. To determine whether targeted clinical review and support provided to health services can achieve substantive and sustained improvements in the provision of sexual health clinical services in remote Aboriginal communities

2. To determine whether the attainment of best practice levels in clinical activity can reduce the prevalence of STIs in these communities.

 

The results of the primary aims were discussed in today's presentation. The specifics of the quality improvement program were not discussed.

 

Results of aim 1: Improvements in the provision of sexual health clinical services

The study showed an improvement of testing rates and retesting after a positive result. The increased uptake of testing in men was more significant than testing in women. Some clinics were "high performer clinics" with 2.5x testing rates in men compared to the control group. The study took place over 3 years. Unfortunately, the increased testing rates were not sustained after the 1st year. The results also showed that only 30% of people with a positive STI result where offered/had a HIV test. Given the recent increase in HIV notifications in the Aboriginal and Torres Strait Islanders in the far north, this is alarming.

 

Results of aim 2: Prevalence of STIs in the community

The STRIVE study did complete prevalence data of chlamydia, gonorrhoea and trichomonas in the remote communities involved in the study. Unfortunately, I do not have that data to present here. Associate Professor Ward was obviously disappointed with the results that showed no change in prevalence over the length of the study. The next step in data analysis of the study is to see if the high performer clinics had a change in prevalence and try to determine factors which made these clinics high performing. Factors which seem to be associated with better results include: community-controlled clinics, availability of gender-based staff and more stable staffing.

 

The relative rolling door of staff in remote communities is one possible reason why the increased testing rates were not sustained over time. In fact, the lack of sustained results over the term of an intervention was mentioned in the next presentation by Barbara Nattabi.

 

Summary of the Indigenous Session

The session started with Assoc Prof James Ward presenting the notification rates of STIs in Aboriginal and Torres Strait Islanders in comparison to non-Indigenous people in Australia, rightly describing the difference in notifications as a human rights disaster. Unfortunately, there was no magic answer given for how to improve this during the afternoon. The afternoon finished with Professor Gracelyn Smallwood giving the history of her journey in sexual health and the growth and fame of Condoman. It was nice to end with a positive story and a reminder that a "bottom up approach" can be both cost effective and productive.