Antenatal screening for sexually transmitted infections in remote Australia

Our relationships, our values, our culture - Aboriginal young men's perspectives about sex, relationships and gender stereotypes in Australia

Studies of Aboriginal young people have often followed a deficit approach depicting them as 'risky' and in need of help. In contrast, this study took a strengths-based approach and focussed on what Aboriginal young people value, how they stay safe and how their culture impacts their lives. 16 Aboriginal men aged 16 to 24 years were interviewed in Sydney, Australia. We examined Aboriginal young men's perspectives about relationships, sex and gender. Interviews were conducted by young Aboriginal men in 2019 and 2020. Overall, four features of positive sexual and romantic relationships were discussed: (1) love, connection and support; (2) enjoyment and fun; (3) responsibility, safety and consent; and 4) honesty, respect and trust. Additionally, three topics related to gender roles: (1) becoming a man; (2) sex as a masculine achievement; and (3) inequality and gender stereotypes. Our study suggests that Aboriginal young men are exploring sexual and romantic relationships, and although they value enjoyment and fun, they are aware of broader issues such as consent and respect. The young men acknowledged gender stereotypes faced by young women. Our results could be used by future school safe sex education programmes to better meet the needs of Aboriginal young men.

Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.

Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities? A mixed-methods study

Gender disparities in testing rates for sexually transmitted infections (STIs) have been identified as one potential factor sustaining high rates of STIs and repeat infections in the Northern Territory of Australia, especially in remote Indigenous communities. The study aimed to investigate the reasons for these disparities utilising a mixed-method study design. We conducted an audit on client information at a remote community health clinic, focus-group discussions with young men in the same community and interviews with experienced remote area clinicians. The clinic audit found a significantly higher proportion of female residents of the community than males visited the clinic (72.8 versus 55.3%, p < 0.005). Women were also more likely to be tested for STIs than men when visiting the clinic (49.7 versus 40.3%, p = 0.015). Major barriers to men's seeking STI testing included a sense of shame from being seen visiting the clinic by women, men's lack of understanding of STIs and the need for testing, and inadequate access to male clinicians. Increasing men's access to healthcare and STI testing requires offering testing at a gender-sensitive and separate locations, and community-based sexual health promotion to increase knowledge of STIs.

Responding to Australia's National Hepatitis B Strategy 2010-13: gaps in knowledge and practice in relation to Indigenous Australians

The Australian National Hepatitis B Strategy 2010-13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001-May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.

Improvement in antenatal testing for sexually transmissible infections and blood-borne viruses in Western Australian hospitals, 2007 to 2010

Objective Antenatal testing for specified sexually transmissible infections (STIs) and blood-borne viruses (BBVs) is recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). In 2007, the Department of Health, Western Australia (DoHWA) issued an operational directive (OD) recommending universal testing for chlamydia and additional testing for women in the STI endemic regions of Western Australia (WA). To assess adherence to these guidelines, seven WA public hospitals were audited. Design and setting: Demographic details and testing information of the last 200 women who gave birth immediately before 30 June 2007 (baseline audit) and 30 June 2010 (follow-up audit) were obtained from each hospital’s antenatal records. Results: Data from 2718 women who delivered at ≥36 weeks’ gestation were analysed (baselinen = 1353; follow-upn = 1365). Testing at the first antenatal visit in accordance with the guidelines improved over time (RANZCOG: 68–74%; χ2-test = 13.96, d.f. = 1, P < 0.001; DoHWA OD: 12–40%; χ2-test = 279.71, d.f. = 1, P < 0.001). Retesting at 28–36 weeks’ gestation in the STI endemic regions improved for chlamydia (3–10%; χ2-test = 17.40, d.f. = 1, P < 0.001) and gonorrhoea (3–7%; χ2-test = 6.62, d.f. = 1, P < 0.05), but not for syphilis or HIV. Chlamydia prevalence was 3% and 8% among nonAboriginal and Aboriginal women, respectively. Conclusion: The proportion of women delivering in WA public hospitals who had antenatal STI and BBV tests improved after publication and promotion of the OD.

Cervical smear participation and prevalence of sexually transmitted infections in women attending a community-controlled Indigenous health service in North Queensland

OBJECTIVE

To increase Pap smear participation and to assess the prevalence of sexually transmitted infection (STI) in urban Indigenous women in Townsville.

DESIGN

Convenience sample of women attending Townsville Aboriginal and Islanders Health Services (TAIHS) for health care participating in the Trichomonas vaginalis (TV) project, coordinated by an Aboriginal Health Worker (AHW) trained in women's health and cervical screening.

PARTICIPANTS

198 women, aged 20-69 years of age, attending TAIHS between March 2002 and 31 January 2004.

MAIN OUTCOME MEASURES

Pap smear participation and prevalence of STIs.

RESULTS

Pap smear participation among eligible women at TAIHS increased from 20.9% pre TV project to 28.6% during the project and 35.6% in the 12 months post completion of the TV project (p<0.0001), an increase of 70.3%. Of 196 smears performed during the study, 20 (10.6%, 95% CI 6.2-15) were abnormal; abnormality was more common in non-Indigenous 8/50 (16.0%) than in Indigenous women 12/139 (8.6%), but did not reach significance (p=0.180). The prevalence of Chlamydia trachomatis was low, with no differences between the Indigenous and non-Indigenous groups, and highest in younger women: 6/44 (13.6%) in women less than 25 years; Trichomonas vaginalis was more common in the Indigenous group.

CONCLUSION

An AHW trained to perform and advocating for Pap smear participation has significantly increased the smear participation at TAIHS. The overall prevalence of STI was low.

The Elimination of Congenital Syphilis: A Comparison of the Proposed World Health Organization Action Plan for the Elimination of Congenital Syphilis With Existing National Maternal and Congenital Syphilis Policies

BACKGROUND AND OBJECTIVES

Building upon a critical assessment of national policies, programs, and treatment options, the World Health Organization (WHO) recently developed an action plan for the elimination of congenital syphilis (CS). The objective of the review was to identify areas of commonality or divergence between the national strategies and the WHO plan, thereby helping to target the development of national-level policies in light of the forthcoming recommendations of the proposed WHO action plan to eliminate CS.

STUDY DESIGN

The 4 strategic pillars of the proposed WHO action plan were used as a comparative framework to examine the policy, programmatic, and monitoring components of a sample of 14 existing national-level congenital or maternal control policies. The countries were chosen to represent a range of resource and prevalence levels.

RESULTS

The majority of countries do not meet every element proposed in the WHO action plan. Political commitment (pillar 1) across the 14 countries is varied. CS elimination goals were rare but all had universal screening. Linkages to appropriate case management services were identified in 11 countries, although a national governing body was not generally evident. Efforts to increase and improve access to care (pillar 2) were noted in 8 countries with recommendations to ensure all pregnant women were screened and treated. Low-resource settings have formed international partnerships. Guidelines for the diagnosis and treatment of pregnant women and partners (pillar 3) found in high-resource settings were lacking in low-resource and high CS prevalence countries. Surveillance programs were active in 10 countries while comprehensive details on monitoring and evaluation (pillar 4) components including proxy CS indicators were unavailable for nearly all.

CONCLUSIONS

The elimination of CS can be achieved through the implementation of a series of proven measures but requires technical support, funding, and a commitment among political forces, health officials, and the public to prevent and treat all CS cases and help countries reach their Millennium Development Goals. Stronger partnerships with clearly defined responsibilities should be developed among agencies responsible for national STI control, HIV/AIDS control, and Making Pregnancy Safer initiatives to ensure the universal coverage of CS control interventions.

Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia

OBJECTIVE

To assess the prevalence of sexually transmitted infections (STI) in a cohort of pregnant urban Indigenous women and association of STI with preterm birth, low birthweight birth and perinatal mortality.

DESIGN

Prospective intervention program in a cohort of women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003 incorporating routine screening for chlamydia, gonorrhoea, trichomoniasis, hepatitis B and syphilis.

SETTING

Townsville is a provincial urban centre with a regional Indigenous population of over 16 000.

PARTICIPANTS

Four hundred and fifty-six pregnant women who were screened for bacterial STI and other viral infections.

MAIN OUTCOME MEASURES

Prevalence of STI, associated risk factors and perinatal outcomes.

RESULTS

Of the 456 women, 403 (88.4%) were screened for chlamydia, gonorrhoea and trichomonas and 432 (94.7%) were screened for syphilis. A total of 92 cases of STI (20.2%, 95% CI 16.5-23.9) were detected, with 21 concurrent infection(s). The overall prevalence of chlamydia was 14.4%, gonorrhoea 6.1%, trichomoniasis 7.2% and infectious syphilis 2.5%. Predictors for STI were young age, harmful/hazardous alcohol use and unwanted pregnancy. Low birthweight and perinatal death were significantly associated with the presence of STI and infectious syphilis during pregnancy.

CONCLUSION

The prevalence of STI among pregnant women in this urban Indigenous community is high, suggesting that screening for STI should be included in all antenatal care protocols for Indigenous women in Australia. Strategies to reach the whole Indigenous community of child-bearing age, especially those aged less than 25 years, are needed to improve perinatal outcome.

The prevalence of genital Chlamydia trachomatis in Australia 1997 - 2004: a systematic review

Objectives: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004. Methods: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups. Results: 40 studies of 50 populations and 40587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4–4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4–8.6%) and 8.7% (95% CI 7.9–9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1–1.9%) and 1.4% (95% CI 0.9–2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0–3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9–6.4%) for adolescents and young adults, 3.3% (95% CI 2.8–3.9%) for sex workers, and 1.6% (95% CI 1.2–2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems. Conclusions: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.