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Sexually transmittedinfections in CentralAustralia – time forconcerted actionFigure 2: Nationwide chlamydia notifications over 5years by year and State/TerritoryAhmed S. Latif, Kirsty S. SmithTristate STI/HIV Project, CDC, Sexual Health and BloodBorne Viruses UnitIntroductionSexually transmitted infections (STIs) are an importantpublic health problem not only because they can causeserious short term and long term complications butalso because they facilitate the transmission of humanimmunodeficiency virus (HIV) infection. Indigenouscommunities in Central Australia continue to experiencehigh rates of STIs including chlamydial infection,gonorrhoea, syphilis, trichomoniasis and genital herpes.Interventions for STI control in the region in the lastdecade have focussed on primary and secondaryprevention of infection through screening and casefinding and have had limited effect. An examinationof the national notification rates of chlamydial andgonococcal infection reveals extremely high annualisedinfection rates in the Northern Territory (NT). While ratesof infection of chlamydia and gonorrhoea in the rest ofAustralia are 200 per 100,000 or less, rates in the NTare more than three times greater 1 (Figures 1 and 2).Recognising the association between STIs and HIVtransmission, the World Health Organisation advises thatSTI management and control should form an integralpart of AIDS/HIV control programs globally 2 .Prevalence of STIs in the Central Australian CrossborderregionWithin the NT, STI rates are higher in the Alice Springsregion and most STI notifications in this region are fromindigenous communities in the area and from AliceSprings itself. 3, 4 The annual community based STI screenconducted over a 6-week period in 2005 revealed thatof 721 men aged between 14 and 35 years screened,119 (16.5%) had chlamydia and/or gonorrhoea and/orsyphilis, and of 808 women in the same age range, 177(21.9%) had an STI (Table 1).Table 1: Results of STI Screening in 2005 in remotecommunities in the Central Australian region of NTFigure 1: Nationwide gonorrhoea notifications over 5years by year and State/TerritoryThe trend of infection in NT communities is shown inFigure 3. It is noted that high rates of infection persistover the period of five years. The distribution of infectionthroughout the NT is not even. Higher rates of between25 and 33% occur in some remote communities and insome urban areas. STI control interventions includingSTI screening and treatment have been in place forsome years now in the Central Australian region.Rates of infection in the entire cross-border area arehigh, however control interventions have been moresuccessful in some areas than others. In WesternAustralia trends appear to be reducing gradually over theyears (Figure 4). Over the last 5 years In South Australiaa slight upward trend is noted, the rates of chlamydialand gonococcal infection previous to the period shownwere considerably higher (Figure 5).32
Figure 3:Trends in chlamydial and gonococcal infection inthe NT south of the Barkly tablelands – Summaryof crude prevalence rates obtained during annualcommunity-based STI screening of young personsover a 5-year periodFigure 2:Trends in chlamydial and gonococcal infection in theNgaanyatjaara Lands in WA over 5 years (Source:Tangey A. Report on STI Screen 2004. Sexual andreproductive health program. Ngaanyatjarra HealthService 6 .)Figure 5:Trends in chlamydial and gonococcal infection in theAnangu Pitjantjatjara Lands in northern SA – Resultsof annual STI Screening of young persons 2001-2005(Source: Nganampa Health Council. Annual Report2005 7 )*Prevalence rates (%) of infection prior to 2001 inthe Anangu Pitjantjatjara Lands in northern SA wereconsiderably higher:DiscussionThe tri-state cross-border region of Central Australiaexperiences high rates of chlamydial and gonococcalinfection. Infection rates persist at high levels despiteintensive coordinated control initiatives. There aremarked variations in prevalence rates geographicallyand in the NT it has been noted that extremely highrates of infection occur in some communities. Howeverit is encouraging to note that rates in the western andsouthern regions of Central Australia have decreasedover a period of time.A number of factors may be responsible for thedifference in rates between the NT and the WA and SAregions. Most notably, the health services in the WA andSA regions of central Australia are community controlled.The ownership of health care provision may have asignificant impact on the acceptability and effectivenessof services. It has been noted that during the annualSTI screen, the coverage rates of screening of thetarget groups over the years have been much betterin WA and SA when compared with those achieved inNT communities. The maintenance of population listsis prioritised enabling more accurate data analysis;testing for STIs opportunistically is an initiative that isencouraged and fully incorporated within the healthdelivery system in WA and SA and hence more personsconsidered to belong to high risk groups are offered STIscreening when they are seen at health facilities. Partnernotification and treatment are followed up rigorously,culturally appropriate education is promoted and finally,the community-controlled Nganampa and Ngaanyatjarrahealth services experience less staff turnover and enjoya more stable long term staffing situation. The mobilityof indigenous persons between remote communitiesand between communities and town is high 5 , and thisoften leads to poorer coverage rates particularly in theNT, during the annual targeted STI screen.Future directionWith the alarmingly high rates of STIs in indigenouscommunities the risk of becoming infected withoutengaging in “high-risk” behaviour is very high. In someareas one in every three young women and one in everyfour young men are infected, therefore any person whohas sex in such communities is at risk of becominginfected. With these prevalence rates it is absolutelyessential that early effective treatment be given toanyone at risk for infection and to consider presumptivetreatment of asymptomatic persons.The general lack of education of indigenous personsneeds to be addressed. The level of literacy andnumeracy is low and hence innovative educationalmethods need to be developed and used. These includethe participatory education methods developed for outof-schoolyouth.33
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