As was discussed at the AIDS 2014 Indigenous Pre-Conference in Sydney, it is time to urgently step up the pace on HIV response targets so that the First Peoples of Australia don't get left behind.
The statistics make for grim reading: the proportion of newly diagnosed HIV cases amongst people who inject drugs is four times higher in Aboriginal and Torres Strait Islander peoples than in non-Indigenous Australians; rates of HIV among Aboriginal and Torres Strait Islander women are four times that of non-Indigenous women; there is a far higher diagnosis rate of HIV reported among Aboriginal and Torres Strait Islander people at a younger age than in the non-Indigenous population.
According to James Ward, Associate Professor in Indigenous Health at the Baker IDI Heart & Diabetes Institute, Melbourne, such statistics have “grave implications” for the First Peoples of Australia. Ward co-convened the International Indigenous Pre-Conference on HIV & AIDS held in Sydney a couple of days prior to the International AIDS Conference itself in Melbourne.
The Pre-Conference (entitled “Our Story, Our Time, Our Future”) gave Aboriginal and Torres Strait Islander people most at risk from HIV — gay men, injecting drug users, brotherboys, sistergirls and women — a chance to share their stories. It also launched the Eora Action Plan — the aim of which is to reverse the above statistics by adopting more ambitious targets in response to HIV in Aboriginal and Torres Strait Islander communities. (The Eora Action Plan is so called because the Eora Nation lived in the Sydney basin, home to generations of Aboriginal and Torres Strait Islander peoples long before Australian settlement.)
Australia’s historical response to HIV was to adopt a participatory partnership approach — an approach that has drawn much praise worldwide. Even so, Ward believes government and community organisations need to urgently raise the game so as to avoid a sharp escalation of HIV among Australia’s Indigenous population. Ward is concerned that HIV among Aboriginal and Torres Strait Islander peoples could mirror the pattern experienced by Canada’s First Peoples, who in 2013 made up 4% of the total population but accounted for 23% of cases of HIV.
Among the goals laid out in the Eora Action Plan are: a commitment to reduce the number of newly diagnosed HIV cases
within the Indigenous community by 50%; an aim to reduce the rates of other STIs by 50%; calls for antiretroviral drugs to be made available, accessible and correctly utilised by 80% of Aboriginal and Torres Strait Islander peoples living with HIV; and a pledge to eliminate stigma and discrimination within the Indigenous community — particularly towards gay men, people who inject drugs and sex workers.
One of biggest concerns for the Indigenous community is the high rate of STIs, especially among young people. According to the Kirby Institute, notification rates of chlamydia in 2012 were four times higher among Aboriginal and Torres Strait Islander peoples than the non-Indigenous population; syphilis was five times higher; and gonorrhoea 21 times higher. “If HIV enters these communities,” said Ward, “it would rapidly escalate because of the prevalence of these STIs.”
Injecting drug use (IDU) is another worry. IDU accounts for almost 60% of Canada’s HIV diagnosis among the country’s First Peoples. “All the signs are there that we could come down the same path as Canada,” said Ward. “Now is the time to address this area.”
And time is of the essence: the First Peoples of Australia, said Ward, are at a crossroads. “Over the last few years, numbers have increased and the differential between the Indigenous and non-Indigenous [HIV] rate has increased,” he said. “We can either scale up our actions to reduce the risk of HIV, or continue along the same path and allow HIV to take hold in our communities."