Regional teams working to 'Close the Gap' in sexually transmitted infections
The Western Australian Aboriginal Sexual Health and Blood-borne Virus Strategy provides a framework for reducing sexually transmitted infection (STI) and blood-borne virus (BBV) transmission in Aboriginal people in Western Australia. Regional sexual health teams were established in 2004 in the Midwest, Pilbara, Kimberley and Goldfields regions to assist with implementing comprehensive STI and BBV control programs.
Improvements in STI and BBV control in Aboriginal people in WA over the past decade include:
- acknowledgement by Aboriginal communities and state and national governments that the gap in STI and BBV roles between Aboriginal and non-Aboriginal people needs to be closed. This has been followed up with a significant investment of resources and political support towards STI and BBV control
- improved workforce capacity through the provision of clinical guidelines and the establishment of monthly teleconferences and twice yearly face-to-face updates supported by the Sexual Health and Blood-borne Virus Program
- improved availability of health promotion resources, school-based education resources and small grants to support regional teams
- the routine provision of quarterly data, including laboratory testing data, by the Communicable Disease Control Directorate
- improvements in laboratory diagnostic tests for chlamydia and gonorrhea that have improved their sensitivity and rendered them less affected by transport delays
- improved partnership building through regional planning (although not consistent throughout all regions)
- the creation of an enabling, evidence-based policy environment with the development of the Second WA Aboriginal STI and BBV Strategy 2010-2014
- achievement of good control of syphilis, hepatitis B and C, and HIV, shown by stable or falling notification rates.
Despite these achievements, considerable disparities remain between Aboriginal and non-Aboriginal people in relation to STI and BBV control.
Epidemiological trends, 2003 to 2012
Over the past decade, chlamydia notifications for all West Australians have tripled. This is considered to be the result of improved sensitivity of diagnostic tests and increased transmission in the community. Although the number of notifications for non-Aboriginal people was consistently higher than for Aboriginal people, the chlamydia age-standardised rates (ASRs) in Aboriginal people was higher than in non-Aboriginal people. Notifications are increasing in both groups, but more rapidly in the non-Aboriginal group, hence a decrease in Aboriginal to non-Aboriginal ASR ratios between 2003 (16:1) and 2011 (4:1) (Figure 1).
Figure 1 – Age-standardised rate of chlamydia notifications by Aboriginality and Aboriginal:non-Aboriginal rate ratio, WA, 2003 to 2012
Aboriginal people have consistently had higher gonorrhea notification rates than non-Aboriginal people. Although the Aboriginal to non-Aboriginal rate ratio has been decreasing since 2010, it remains very high (28:1 in 2012) and is due to notification rates increasing more rapidly in the non-Aboriginal group, rather than any significant gains being made in the Aboriginal population (Figure 2).
Figure 2 – Age-standardised rate of gonorrhoea notifications by Aboriginality and Aboriginal:non-Aboriginal rate ratio, WA, 2003 to 2012
Aboriginal infectious syphilis rates have remained low and stable since 2010 following an outbreak in 2008 among Aboriginal people in the Pilbara (Figure 3). This outbreak was rapidly brought under control and by 2009 infectious syphilis notifications among Aboriginal people had returned to baseline low levels.
Figure 3 – Age-standardised rate of infectious syphilis notifications by Aboriginality and Aboriginal:non-Aboriginal rate ratio, WA, 2003 to 2012
Aboriginal people have consistently had higher hepatitis C ASRs than non-Aboriginal people. The majority of hepatitis C cases among Aboriginal people were detected through routine voluntary blood-borne virus testing in correctional facilities. High rates of imprisonment and access to needle and syringe programs are significant barriers to hepatitis C control in Aboriginal populations. Hepatitis C treatment uptake is also poor among Aboriginal people.
View the public health publication The Epidemiology of Notifiable Sexually Transmitted Infections and Blood-Borne Viruses in Western Australia 2012 (PDF 1.27MB) for more detailed information.
Where to from here?
In late 2014, the Communicable Disease Control Directorate will host a statewide forum on Aboriginal sexual health and BBVs to mark the regional sexual health teams' tenth anniversary and start the development of the next WA Aboriginal Sexual Health and Blood-borne Virus Strategy due in 2015.
Aboriginal leaders, Aboriginal community-controlled health organisations and representatives from the departments of Health, Child Protection and Corrective Services will be invited to review the successes and challenges of the past 10 years and discuss ways of taking a collaborative approach for the coming decade in reducing STI and BBV infections in WA Aboriginal people.
Accessible primary heath care remains a central element to the public health response to STIs and BBVs in Aboriginal communities. Health literacy, hepatitis B and HPV vaccination, adult heath checks, STI and BBV testing and treatment, a skilled workforce and overcoming the stigma and discrimination associated with STIs and BBVs underpin CDCD's programs.
WA Health offers a range of resources and training opportunities to assist general practitioners, practice nurses and Aboriginal health workers working in Aboriginal sexual health and BBV control including:
- free, online training (external site) in STI and BBV clinical management (accredited for medical and nursing professional development programs
- up-to-date information on the STI clinical management in primary health care
- culturally-appropriate patient education resources.