Controlling HIV in Indigenous Australians

Molecular epidemiology of Neisseria gonorrhoeae using multi-antigen sequence typing and pulse-field gel electrophoresis in highly endemic Western Australian populations

Background

The remote and indigenous populations of Western Australia (WA) have one of the highest notification rates of gonorrhoea in the world. Despite this, the low rate of antimicrobial resistance in Neisseria gonorrhoeae from these regions permits the use of amoxycillin as empirical therapy. We describe the first molecular epidemiological study of gonococci isolated from this population using two different typing platforms.

Methods

Pulse-field gel electrophoresis (PFGE), Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST) and antimicrobial susceptibility tests were performed on 128 consecutive N. gonorrhoeae isolates cultured between January 2011 and December 2013. To highlight clusters isolates were evaluated based on their tbpB sequence types.

Results

No predominant NG-MAST or PFGE types were found. A total of 67 distinct PFGE pulsotypes were identified amongst the 128 isolates in this study with 20 PFGE pulsotypes representing 78 isolates. A total of 59 NG-MAST sequence types were found, represented by 45 porB alleles and 28 tbpB alleles with 13 tbpB genomogroups from 45 NG-MAST sequence types. TbpB genomogroup 29, represented by 45 isolates, was by far the most common genomogroup overall.

Conclusions

Results from this study suggest that gonococcal epidemiology in WA is quite different between remote regions and major population centres and, in some cases, geographically restricted. It is likely that isolates originating from endemic regions of WA mostly represent independent, small sexual networks with an infrequent interchange between other communities and regions. Given the high rate of antimicrobial resistance elsewhere in Australia, ongoing surveillance is essential to ensure the enduring efficacy of amoxycillin empiric use in the remote regions of WA.

Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia

BACKGROUND

Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non-Aboriginal people; was this the case for HIV infection in pregnancy?

AIMS

To compare the management and outcomes of pregnancy in Aboriginal and non-Aboriginal HIV-positive women in Western Australia (WA).

METHODS

A retrospective study of all pregnancies delivered in WA to HIV-infected women from 1991 until 2005. Managed pregnancies were compared in Aboriginal and non-Aboriginal women. Outcome measures were HIV status of the babies, birthweight, rates of caesarean delivery and perinatal mortality.

RESULTS

Fifty-six pregnancies occurred in 41 HIV-infected women resulting in 54 live births. Of the 41 women, 16 (39%) were Aboriginal. In regard to birthweight, perinatal mortality, rates of caesarean section and rates of HIV perinatal transmission, there was no significant difference between babies born to Aboriginal and those born to non-Aboriginal mothers. In contrast, of the eight pregnancies, with no contact with the multidisciplinary team, five babies (63%) were infected with HIV (2% vs 63%P = 0.001). There was no case of perinatal HIV infection in 22 pregnancies of the Aboriginal women that received care through the multidisciplinary team; perinatally acquired HIV occurred in the first pregnancy of one of these women before she was aware of her status when she was not managed by the team.

CONCLUSIONS

Similar outcomes can be achieved in both HIV-positive Aboriginal and non-Aboriginal women, through intensive, culturally appropriate, multidisciplinary care and without elective caesarean delivery.

Aboriginal women's stories of sexually transmissible infection transmission and condom use in remote central Australia

Background: Sexually transmissible infection (STI) rates are persistently high in central Australia, creating conditions for a potential HIV pandemic in the area. There is a shortage of qualitative research examining the underlying factors affecting STI transmission in this region. The present study investigates Aboriginal women’s current levels of knowledge regarding STI and their transmission, perception of risk for STI, patterns of condom use, access to condoms and experiences of condom negotiation with their partners. It also explores the sociocultural context of their sexual health. Methods: The present study used qualitative methods with a semistructured questionnaire. Twenty-four women aged 18–35 years from one remote central-Australian Aboriginal community were recruited. Results: The results revealed poor understandings of STI transmission, limited access to condoms and low levels of condom use despite a high perception of risk to STI. They also identified specific issues facing these women regarding the sociocultural context of their condom use, their access to condoms and the transmission of STI. The perceived effects of alcohol abuse, infidelity, sexual assault and shame on the acquisition of STI were significant issues for the women. Conclusion: This research has identified an urgent need for further qualitative research into the sociocultural factors that facilitate the spread of STI among Aboriginal people of remote central Australia. Implications include the need to increase their knowledge regarding STI and STI transmission, to increase women’s access to condoms and to incorporate the teaching of skills to deal with sexual assault and violence into sexual-health education.