• An image from a syphilis awareness campaign. (Supplied)
EXCLUSIVE: Since 2011 a syphilis epidemic has swept across northern Australia, spreading across multiple states and hitting Indigenous communities hard. Figures obtained by NITV News show the rate of infections is rising fast. Now, stretched health services are warning a rise in HIV cases could be the next epidemic to hit the region.
By
Robert Burton-Bradley

Source:
NITV News
20 Oct 2017 - 4:46 PM  UPDATED 20 Oct 2017 - 4:46 PM

Indigenous Australia is in the grip of a serious health crisis as skyrocketing rates of syphilis have seen five babies die and hundreds of new cases appear. Now, rates of HIV are on the rise too.

Doctors and health professionals working on the frontline have said more resources are urgently needed to stop the outbreak which is now in its seventh year.

Professor James Ward from the South Australian Health and Medical Research Institute told NITV News the situation was all the more concerning because it was preventable.

“We had a very good opportunity to eliminate it, we missed it, and now we're in this situation,” he said.

“It is unacceptable in this day and age to have any congenital death related to an STI in a country like Australia, where we’ve got very good testing and very good treatment for these STIs.”

“If this had occurred in non-Aboriginal communities there would have been a national outcry.”

Figures obtained by NITV News reveal that as of August this year, Queensland has had almost 1000 cases of syphilis among its Indigenous population since the outbreak began there in 2011. The Northern Territory has seen a dramatic rise in infections more than doubling from 229 cases last year to 588 cases since 2013. Western Australia has had 134 cases since 2014, mainly in the Kimberley region, and the now the epidemic has spread to South Australia, which has had 26 cases since late last year.

In most cases, the victims are under 29-years-old. There have been five cases of babies dying after being born with congenital syphilis and an unknown number of babies born with congenital abnormalities.

Cairns is the epicentre of the epidemic with the highest number of cases. Cairns Sexual Health Service Director, Dr Darren Russell, said he has never seen a syphilis outbreak like this before.

“It is concerning. We don’t know where it will end up, but it’s worse than it ever has been and the rates around the country are increasing, not decreasing,” he told NITV News.

"We’ve seen is this incredible resurgence of syphilis and now we are seeing HIV where we have never seen it before. There is real concern."

“Cairns and surrounds is really the main area of concern. In North Queensland itself, up to August 2017, there have been 941 cases and five deaths of babies from congenital syphilis.”

“There is a lot of work going on to try and prevent further deaths, but it is very difficult when you have so many cases and you tend to get syphilis in young sexually active people.”

A map of the syphilis outbreak in northern Australia.

Dr Russell said part of the problem is that in some communities the outbreak has become firmly entrenched.

“Initially, you can talk about an epidemic where an infection gets into a community and then what happens after a time is the infection can become endemic, more established in that community – that’s probably what is going on now in the Cairns area and the top end of the Northern Territory, and possibly even Townsville too”," he said.

He warns of rising HIV notifications in and around Cairns, which he says could be linked to the syphilis epidemic. Now, there has been a spike in HIV infections, particularly in the Indigenous population, says Dr Russell.

“The syphilis epidemic started in 2011 and there was always a concern that HIV could piggyback on that because HIV and syphilis tend to go together,” he said.

“Around Australia, HIV notifications in Indigenous people used to be about the same as non-Indigenous people, but they are now twice the rate and it looks like they are continuing to increase."

In Cairns, it is up to 50 per cent of infections, said Russell.

"I don’t think we know at this stage if it is too late"

A public health alert sent to Queensland health workers last month warned the rising rates of HIV are tied to the syphilis outbreak and that a majority of the cases are among younger Indigenous people, under 40 years of age.

It came after an emergency HIV roundtable of around 80 clinicians and community leaders to discuss the crisis in Cairns earlier this week.

Professor Ward, a sexual health expert, who attended the conference as a speaker said the number of Indigenous HIV infections is not huge, but warns that could change unless extra resources are brought in.

“It used to be relatively stable. We’d have say 20 (Indigenous) cases a year nationally, we’re almost double that now, perhaps, even more, when you look at the most recent data, and that’s very problematic because once it reaches a tipping point, it will move into an endemic state and I think now is the time to put lots of effort into preventing HIV."

The other issue, said Dr Russell, is that diseases like syphilis and HIV can be sleeper infections and people could be unaware for lengthy periods of time they have been exposed, and in turn, pass it on to others.

“One of the problems is we don’t know what we don’t know, there will be individuals who haven’t been diagnosed yet, and if they are not aware they have HIV, then onward transmissions will continue."

“I think we have always been concerned in Australia that there would be an epidemic of HIV in the Indigenous community and we’d almost eliminated infectious syphilis a few years ago – what we’ve seen is this incredible resurgence of syphilis and now we are seeing HIV where we have never seen it before. There is real concern at this stage and we don’t know where the HIV epidemic is going to go, whether it will continue or be brought under control."

How did this happen?

A decade ago, syphilis in Queensland was on track to being eradicated, but then in 2010, the number of cases diagnosed started drastically increasing. By 2011, it was being called an epidemic.

By 2014 it had spread into the Northern Territory, before moving into the Kimberley region of WA and reaching South Australia last year. Many of the cases are in remote Indigenous communities.

Indigenous Australians are six times more likely to catch syphilis than the non-Indigenous population. Staggeringly, this increases to 132 times higher in remote areas. Rates of HIV infection are twice as high for Indigenous people than the rest of the population.

“These things take you by surprise, there is no way of pre-empting some of this kind of outbreaks but a fast response is really necessary.”

Dr Russell warns that HIV is now looming as a follow up threat. He points to Canada’s experience, where Indigenous people account for as much as 11 per cent of new HIV infections, despite making up just 4.3 per cent of the total population.

“We appear to be heading in that direction,” he warned.

Dr Mark Wenitong, Public Health Medical Advisor at the Apunipima Cape York Health Council, said a large part of the blame resides with the drastic cuts to public health spending made by the incoming government of former Queensland Premier Campbell Newman in early 2012, and a failure by health services to recognise the threat early on.

“The thing is there were resources going into North Queensland through the health department, but after the election, that got cut a fair bit, and from the perspective of primary health care, that really did leave a hole in education. Screening and particularly sexual health teams, that has definitely had an impact,” he said.

Dr Wenitong said this compounded the already large challenges health providers face in the Indigenous community in an area like Cape York.

“There are limited resources because everything is a priority in Aboriginal communities because of the prevalence of a lot of different illnesses,” he said.

Dr Russell said previous outbreaks of STI’s like HIV had largely bypassed these communities, meaning that some were caught off guard.

“It’s a whole range of things. You have a population that is quite marginalized and disadvantaged, has poor access to health care, you’ve also got a group in whom traditionally there hasn’t been a lot of HIV, so the health services aren’t really geared up for thinking about HIV and testing for it.”  

Dr Wenitong conceded the outbreak had now spread beyond the control of some health providers.

“These things take you by surprise, there is no way of pre-empting some of this kind of outbreaks but a fast response is really necessary.”

“I think one of the things we feel is a bit of a sense of failure in a way, that things like syphilis which is preventable and controllable, that that got away from us across the Top End of Australia.

What is being done

In response to growing calls for action, the Government has committed more resources, says Liberal senator Dean Smith, who is chair of the Chair of the Parliamentary Liaison Group for HIV/AIDS, Blood Borne Viruses and Sexually Transmitted Infections.

“The evidence of the alarming disparity in the rates of STIs between Indigenous and non-Indigenous Australians is very credible.

“I am aware that over the last four years, $15 million has been spent on a variety of specific STI and BBV prevention and education activities across northern Australia, including  trialling “point-of-care” testing for certain diseases and surveying the sexual health and lifestyle behaviours of Aboriginal and Torres Islander communities,” he tells NITV News.

He said everyone needs to be worried by the current crisis and urged his own Government to do more.

“As an immediate action, I firmly believe there must be a stronger response from the Federal Government and that it must take a more proactive leadership role in coordinating the activities of State and Territory Governments on the issue."

Indigenous Health Minister Ken Wyatt said the government was aware of the problem and is taking steps to combat the spread of syphilis and HIV.

“In August, I raised the syphilis issue with the Australian Health Ministers’ Advisory Council’s (AHMAC) Australian Health Protection Principal Committee (AHPPC), which is currently intensifying the national response to the current outbreak, including short-term actions to reduce infection,” Minister Wyatt told NITV News in a statement.

“A governance group has been established and will report on the proposed action plan to the Health Minister and myself in December 2017. The response will also focus on a long-term and sustainable response to combating other blood-borne viruses and sexually transmitted infections.

“The Commonwealth continues to fund targeted activities and a national network of approximately 140 Aboriginal Community Controlled Health Services (ACCHSs) and around 40 other providers to deliver comprehensive, culturally appropriate primary health care services, including sexual health and maternal health services."

A new awareness campaign called Young Deadly and Syphilis Free has been rolled out over the last few months targeting Indigenous communities and urging regular resting and treatment of infections.

This week, the Queensland Government announced an expansion of the number of places for people to PrEP (Pre-Exposure Prophylaxis) a medication that can dramatically reduce the risk of HIV transmission in HIV negative people.

Queensland Health Minister, Cameron Dick, acknowledged working with communities would be crucial in combating the further spread of the outbreak.

“If we are to achieve our shared goal of the virtual elimination of HIV in Queensland by 2020, we must reach out to Aboriginal and Torres Strait Islander people in every community.”

A spokesman for Queensland Health said the government was committing $15.8 million over three years to support the actions of the North Queensland Aboriginal and Torres Strait Islander Sexually Transmissible Infections Action Plan 2016-2021, in addition to millions being spent more broadly on sexual health.

Despite the promises of increased resourcing, the problem, more than seven years after the first outbreak in Queensland, remains for the time being.

Professor Ward said he believed the slow response was in part because the affected population was Indigenous.

“If this had occurred in non-Aboriginal communities there would have been a national outcry.”

Dr Russell from Cairns Sexual Health says it may already be too late to resolve the outbreak anytime soon.

“That’s the million dollar question. I don’t think we know at this stage if it is too late, but clearly, there are worrying signs and it is certainly not controlled at this stage."