New data released last week highlights a growing divergence in HIV infection rates among different at-risk communities.
Data from the Kirby Institute shows some staggering trends—while HIV infection rates have stayed steady across the broader Australian population, they have doubled for indigenous communities over the past five years.
These numbers present a significant challenge for HIV prevention strategies, one we must address now before the spread worsens.
HIV prevention continues to focus on men who have sex with men (MSM), concentrated in Australia’s big cities. Since the outbreak of the disease in the 1980s, gay men in particular have banded together on the issue, creating community responses focused around sexual health campaigns, drug access and distribution, and more recently the introduction of PrEP.
This was, and remains, the right response. Over the long run, strategies targeted at MSM have significantly reduced HIV infections, and have reduced the prevalence of AIDs to the point where it is no longer considered a major public health issue in Australia. MSM remain one of the most at-risk groups of infection, and any attempt to eliminate HIV infections will require more work with this cohort.
What this recent data suggests, however, is a potential ‘new front’ in the fight against HIV; a front that is very different from the battle within MSM communities. Growing infection rates among indigenous communities are significantly different to that of most MSM groups. While the majority of infection rates in Australia remain due to sexual contact between men, infections among indigenous communities include a higher proportion being due to heterosexual contact and drug use. Infections are also are largely occurring in remote and rural communities; areas that have largely missed out on community health campaigns, and the preventative medical services that follow.
This represents a major challenge. Tackling HIV for these communities is very different from campaigns focusing on MSM. As one example, The South Australian Health and Medical Research Institute's Aboriginal health advisor - Associate Professor James Ward - spoke of the challenge of introducing PrEP to remote indigenous communities:
"Given that there's a high morbidity already in the community and lots of medications already being taken for people who are quite unwell ... trying to conceptualise how someone in the Aboriginal community might take a drug to prevent them getting an illness has some contentious issues and is something we need to work through".
What Ward is highlighting is that the campaigns targeted at MSM in big cities are unlikely to work in rural and remote indigenous communities, and that these communities require unique strategies and campaigns to tackle their specific needs.
This work is, of course, already being done by many people. The NSW health promotion organisation ACON, for example, has a number of specific projects focused on indigenous communities, recently rolling out an Aboriginal gay men’s HIV testing campaign. Earlier this year, the out former former Rugby League player Casey Conway was announced as the front man for a sexual health campaign in the Northern Territory, targeting both gay and indigenous communities. The campaign is part of the broader work of the Northern Territory AIDs and Hepatitis Council designed to provide “culturally appropriate education and health promotion resources for Aboriginal people.”
However, what this data highlights is the difficulty of much of this work. Many of these campaigns are still focused around MSM, despite growing numbers of non-MSM infection rates in indigenous communities. There are clear challenges in regards to reaching remote communities, ones which have not been successfully dealt with as of yet. This is not intended as a criticism but instead as a mark of the challenges of this ‘new front’.
The recent data from the Kirby Institute has highlighted a new challenge in our battle to eventually eliminate HIV infections. While the majority of HIV infections remain among MSM in large urban areas, the growing numbers of infections within indigenous communities is a cause of concern. This requires not a rethink but the development of new strategies. This must occur now before the spread becomes any worse.