The health crisis we’re not talking about, but should be
1st April 2019
SBS Insight
EXPERT COMMENT: Doctors in far North QLD are fighting the greatest Australian HIV epidemic since the AIDS crisis, and until now they’ve been largely doing it alone.
The first recorded case of HIV in Australia was in Sydney in October 1982, and the first Australian death from AIDS occurred in Melbourne in July 1983. In the decades since those early days of the epidemic until quite recently Aboriginal and Torres Strait Islander Australians were at no greater risk of acquiring HIV than their non-Indigenous counterparts.
In 2012, though, something changed. Slowly at first, the rate of HIV diagnosis for First Australians started to rise. The diagnosis rate has now become almost twice that for Australian-born non-Indigenous people. And much of the increase can be attributed to an ongoing outbreak in north Queensland, predominantly in Cairns and in the Torres Strait, nestled up against Papua New Guinea in the steamy far north. We used to see one or two HIV diagnoses in Indigenous Australian in this area each year, but since 2014 there have been a total of 45 diagnoses, with two already this year.
So why has an outbreak occurred in the Far North? In 2011 a very large syphilis outbreak started in the Gulf Country of North-West Qld and rapidly spread north and east across to Cairns and has since caused infections in over 2500 Indigenous Australians in North Qld, the Northern Territory, Western Australia, and more recently in South Australia, including Adelaide. There have been 15 cases of congenital syphilis (affecting babies), with seven deaths, the latter all in North Qld. The same set of conditions that can cause the wildfire spread of a sexually transmissible infections such as syphilis can also cause HIV to spread. Many mobile young people, who – like young people everywhere – are sexually active, can carry the infection with them when they move around. Low health literacy among this young population, and low awareness among healthcare providers, mean that simple HIV testing may be rarely performed, and often happens too late to reduce onward spread of these conditions. A high level of stigma and shame regarding STIs, and especially HIV/AIDS, means that discussion is difficult for both the young person and for the doctor, nurse, or Indigenous Health Worker. And, worryingly, syphilis and other STIs make it much easier to acquire or pass on HIV.
In Cairns, the workload at our sexual health service has increased dramatically since the start of this outbreak in 2014. With regards to our HIV positive clients, nine per cent were Indigenous in 2012 – in 2018 that proportion had almost doubled to 16 per cent. HIV nowadays is a perfectly manageable, chronic health condition for which there are excellent and highly effective treatments. In many cases, one tablet a day – with almost no side-effects – can be taken by the person who has HIV and will lead to the amount of virus in their system reducing to undetectable levels within a matter of weeks. This means the person’s health generally stays good and damage to the immune system is minimised. In addition, such treatment renders it impossible to pass the virus on sexually. The difficulty, though, lies in diagnosing people in the first place, and then engaging them in care so that they prioritise this life-saving treatment in their lives. Unfortunately, that often does not occur for a variety of reasons, which includes a lack of staffing to follow up and support each person effectively.
However the Qld Government has recently given over $500,000 to produce a North Queensland HIV Action plan which will be completed by the end of June. This will then be used to map a way forward and will hopefully result in increased health promotion and HIV testing, better engagement of people into care and support, and a reduction in the stigma and shame associated with a positive HIV diagnosis.
This Action Plan couldn’t come soon enough, and while we are optimistic about the future, at present there is no dedicated funding to implement this plan. We are working hard to secure funding, but no one knows what the outcome will be. What we do know is that a major, ongoing outbreak of HIV infection would devastate communities in northern Australia, and this must not be allowed to happen.
By Darren Russell
https://www.sbs.com.au/news/insight/the-health-crisis-we-re-not-talking-about-but-should-be