How HIV Disproportionately Affects Aboriginal and Torres Strait Islander People
Atomo Diagnostics would like to acknowledge that we operate on the traditional lands of the Gadigal and Wangal peoples of the Eora Nation. We pay our respect to Elders both past, present, and future.
Warning: This article contains themes and events that may disturb some readers. Reader discretion is advised.
The first week of July each year represents a period of immense significance in Australian culture. The first Sunday in July marks the beginning of NAIDOC Week, the week of the National Aborigines and Islanders Day Observance Committee’s celebration and recognition of the history, culture, and achievements of Aboriginal and Torres Strait Islander people. The origins of the National Aborigines and Islanders Day Observance Committee can be traced as far back as the 1920s, where Indigenous Australians sought to increase awareness in the wider Australian community of the treatment and stigmatisation experienced by Aboriginal and Torres Strait Islander Australians.
The arrival of European settlers and subsequent colonisation of Australia in the late 1700s resulted in an unprecedented disruption to the way of life of the world’s longest-continuing culture and civilisation. Researchers estimate that approximately 10,000 Aboriginal lives were lost over 403 separate massacres during what has come to be known as The Frontier Wars.[i] Furthermore, thousands of Indigenous children were forcibly removed from their families by welfare bodies, governments and churches to be raised in institutions, fostered out and even adopted by non-Indigenous families.[ii] These Stolen Generations have created a substantial degree of intergenerational trauma among Indigenous individuals and communities alike.
While many of the atrocities experienced by Indigenous Australians over the course of recent history have been acknowledged, and attempts have been made to rectify them, there remain clear disparities in the lives and experiences of First Nations Peoples and non-Indigenous Australian born people. Indigenous Australians still to this day experience substantial discrimination in social and cultural settings, employment, education, incarceration rates and, perhaps most significantly, health.
For example, there remains an estimated 17-year difference in the life expectancy of Indigenous and non-Indigenous Australians.[iii] In all age groups below 65 years, the age-specific death rate for Indigenous Australians is at least twice that of non-Indigenous Australians.[iv] In addition to this, inequalities in access to and condition of housing and primary healthcare services for Indigenous Australians lags significantly behind that of non-Indigenous Australians.[v]
One of the main areas in which statistical discrepancies between Indigenous and non-Indigenous Australians is most significant is in the sexual health and sexually transmitted infection space. Data from 2017 indicated substantially higher notification rates for Indigenous populations than non-Indigenous populations for each of Chlamydia (1194 vs. 427 per 100,000 people), gonorrhoea (627 vs. 96 per 100,000 people) and infectious syphilis (102.5 vs 15.5 per 100,000 people).[vi] This discrepancy extends further to HIV. The rate of diagnosis of HIV infection in 2019 in indigenous people of 3.3 per 100,00 was higher than Australian born non-Indigenous peoples at 2.8 per 100,000.[vii] This is a gap that has been widening since 2013 despite targeted efforts to both increase testing among these communities and implement prevention strategies such as condoms usage, biomedical prevention, safety agreements, risk reduction and harm minimisation strategies.[viii]
HIV Notification Rate Per 100,000 Australian-Born Population, 2008-2017, By Indigenous Status. Source: The Kirby Institute (2018).
Of the 4,289 positive HIV diagnoses in Australia in the period from 2015 to 2019, 173 were attributed to Indigenous people. Unlike positive infections within non-indigenous demographics, a lesser proportion of cases occurring among men who have sex with men (61% for Indigenous infections vs 73% for non-Indigenous infections) was noted. Conversely, a higher proportion of cases were attributed to heterosexual contact (19% for Indigenous infections vs. 11% for non-Indigenous infections) and injecting drug use (20% for Indigenous infections vs. 3% for non-Indigenous infections).[ix] These numbers are somewhat similar during the five-year period from 2013-2017 as outlined in the graph below.
HIV Notification Exposure Category, 2013-2017, By Indigenous Status. Source: The Kirby Institute (2018).
Furthermore, there are several barriers obstructing diagnosis. Structural and social factors including but not limited to late or non-diagnosis, sub-standard testing, insufficient uptake of medical interventions and negative stigma regarding HIV have been reported.[x] Other determinants include the aforementioned discrepancy in access to clinical services due to physical, financial, and cultural reasons; as well as sub-standard housing, limited access to transportation, and lower levels of both education and employment. The stresses experienced often result in a situation whereby personal health may be de-prioritised.
There has been a noticeable shift in recent years concerning the rate of HIV infection in Indigenous people based on residential area. While the rate of positive diagnoses in urban areas has been gradually trending downwards, whereas regional and remote areas have been increasing over time.[xi] This shows that, while education and clinical support for HIV is progressing well in urban centres, there are still concerns in regional and remote communities around Australia.
HIV Notification Rate Per 100,000 In Aboriginal and Torres Strait Islander People, 2008-2017, By Area of Residence. Source: The Kirby Institute (2018).
With the lifting of restrictions on the sale and promotion of HIV self-test kits in December of 2021, there now exists an opportunity to provide critical support for HIV diagnosis to remote and regional communities across Australia where access to sexual health clinics is limited relative to urban areas. HIV self-tests also help to address the negative stigma-related reasoning behind either hesitancy or outright avoidance of testing and treatment for HIV. For more information on how HIV testing is helping to eliminate new cases of HIV in Australia, check out our earlier blog post.
At Atomo, we are extremely proud to be able to contribute to the combined effort of governments and industry bodies to end the transmission of HIV in Australia by 2030. Atomo’s HIV Self Test is currently the only HIV self-test approved for use in Australia. The test is discreet, accurate and easy to use and can be comfortably undertaken by any individual within the privacy of their own home. The test can be shipped discreetly to any part of Australia and can be ordered online at www.atomohivtest.com.au
Once again, Atomo would like to both recognise and celebrate the extraordinary achievements of Aboriginal and Torres Strait Islander people during this year’s NAIDOC Week. We are proud to play a small part in the ongoing efforts to narrow the discrepancies in healthcare between Indigenous and non-Indigenous Australians.
References
[i] Brennan, B. & Wellauer, K. 2022, More evidence of ‘genocidal killings’ of Aboriginal people in frontier times, University of Newcastle research reveals, ABC, viewed 30 June 2022, <https://www.abc.net.au/news/2022-03-16/aboriginal-people-genocidal-killings-massacre-map-nt-wa/100913106>.
[ii] Australian Institute of Aboriginal and Torres Strait Islander Studies, 2022, The Stolen Generations, AIATSIS, viewed 30 June 2022, <https://aiatsis.gov.au/explore/stolen-generations>.
[iii] Australian Institute of Health and Welfare and Australian Bureau of Statistics, 2005, ‘The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples’, ABS no. 4704.0, Commonwealth of Australia, Canberra, p148.
[iv] ibid., p.151.
[v] Royal Australasian College of Physicians, Inequity and Health, 2005, A Call to Action - Addressing Health and Socioeconomic Inequality in Australia – Policy Statement 2005, RACP, Canberra, p3.
[vi] Bell S., Aggleton P., Ward J., Murray W., Silver B., Lockyer A., Ferguson T., Fairley CK., Whiley D., Ryder N., Donovan B., Guy R., Kaldor J. & Maher L., 2020, ‘Young Aboriginal people's engagement with STI testing in the Northern Territory, Australia’, BMC Public Health, vol. 6, iss.20(1):459.
[vii] Ward, J., Gilles, M. & Russel, D., 2021, HIV infection in Aboriginal and Torres Strait Islander people, ASHM, viewed 1 July 2022, < https://hivmanagement.ashm.org.au/hiv-infection-in-aboriginal-and-torres-strait-islander-people/#:~:text=Of%20the%204%2C289%20HIV%20diagnoses,peoples%20(2.8%20per%20100%2C000)>.
[viii] Delhomme, F., Baiocchi, M., Bradfield, L., Brown, K., Draper, A., Leha, J., Moffitt, T., Smith, J., Sparks, M., Wimbis, J., Ward, J., 2019, ‘HIV in the NSW Aboriginal and Torres Strait Islander population’, ACON, Sydney, p.9.
[ix] Ward, J., Gilles, M. & Russel, D., 2021, HIV infection in Aboriginal and Torres Strait Islander people, ASHM, viewed 1 July 2022, < https://hivmanagement.ashm.org.au/hiv-infection-in-aboriginal-and-torres-strait-islander-people/#:~:text=Of%20the%204%2C289%20HIV%20diagnoses,peoples%20(2.8%20per%20100%2C000)>.
[x] Ward JS, Hawke K, Guy RJ. Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209:56.
[xi] Naruka, E., King, J., McGregor, S., McManus, H. & Guy, R., 2018, Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strat Islander people, The Kirby Institute for infection and immunity in society, Sydney.
