A surveillance report in 2004 by the National Centre in HIV Epidemiology and Clinical Research shows that there are much higher rates of notification among indigenous populations compared to non-indigenous people. Bacterial STIs like C. Trachomatis and N. Gonorrhoeae among males in central Australia have shown a prevalence of 20.9%, which is very concerning. In Western Australia, there is a higher rate of HIV infections among indigenous people compared to non-indigenous people. HIV transmission among the indigenous is mostly heterosexually transmitted, with indigenous females 18 times more likely to contract the virus than non-indigenous females.
In response to these figures, attention has been devoted to improving and monitoring the sexual health of the indigenous population. The Indigenous Sexual Health and Well-Being Project in South Australia, is implemented for that purpose in the South Australian region with the collaboration of other organizations. Significant efforts have been observed within the Project during the years 2001 and 2002. Partnership with the South Australian Sexual Health Advisory Committee and the provision of sexual health training and education are part of the extensive efforts to curb STIs. These steps are certainly necessary to gain the upper hand in STI control, alongside better access to diagnosis and treatment.
Despite an increased awareness of the importance of reducing the incidence of STIs on the government’s part, some socio-cultural issues may be hindering progress. There has been a debate over whether sexual practices or the inadequacy of sexual health services best explains the high incidence of STIs among aboriginal communities. Listed below are some risk factors identified for incident STIs among the indigenous community:
- Age (especially the 15- 19 year old age group)
- Alcohol abuse
- Petrol sniffing
- Previous STI history
Age and previous STI history were strong predictors of both incident Gonorrhoea and Chlamydia infections. Alcohol abuse and petrol sniffing, interestingly, were strong predictors of gonorrhoea infection only. In general, it seems that there is a linkage between substance abuse and the occurrence of STIs. Perhaps this can provide clues for future strategies of ensuring good sexual health among the aboriginal communities.
In addition to the risk factors mentioned, indigenous populations in rural areas are hampered by poverty, inadequate housing, low income and poor standards of living. Basic knowledge about STIs is deficient among aboriginal communities. Indigenous patients usually only seek professional help when genital symptoms are obvious.
During a study to determine the prevalence of STIs in northern Australia, indigenous women living in remote areas were encouraged to attend well-women checks and screening procedures. However, only 9.2% of women attended, and this was because they had symptoms. Other issues which the indigenous community has to deal with include the lack of high school education, uncommon contraceptive use and the use of sex as an exchange for favours.
A comparison of the sexual practices of the indigenous and non-indigenous populations has shown that partner changes among indigenous Australians are not higher than those among non-indigenous Australians. Thus, it is likely that the higher incidence of STIs among the indigenous population is largely due to lack of access to health services and treatment.
Suggestions for improving visitation to sexual health clinics include management improvements such as discreet clinic signs, private entrances, assistance with transport to the clinics, the use of false names during clinic registrations and the coding of histories and test requests. Same-sex Aboriginal sexual health staff are also preferred, together with greater access to sexual health services. This study also indicates that privacy, fear of stigma and the sensitivity of sexual health issues should be considered during the planning of a sexual health strategy for this population. Mainstream services are less effective among indigenous populations as these services are not designed for stigmatised issues nor for marginalized populations.
While reaching out to the indigenous communities may be difficult and implementation of strategies could be difficult to sustain, let us not forget that the basic human right of health access is compelling enough to dictate that we meet these challenges. According to the World Health Organization (WHO), the health of indigenous populations in the world differs greatly from that of their non-indigenous counterparts. They continue to be marginalized in terms of health, economics and standards of living. Hopefully, with extensive planning and research, not only will the sexual health of these indigenous populations gradually improve, but so will their quality of life in general.
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