Abstracts

Among Aboriginal people of Australia, diagnosis rates of sexually transmissible infections (STIs) are an example of the health disadvantage faced by this population. Diagnosis rates are between three and 50 fold higher than non-Indigenous Australians. Further there is a trend of divergence in HIV diagnosis rates, and in 2015 rates were more than double in the Aboriginal population than non-Indigenous rates. Despite much effort to reduce both incidence and prevalence of STIs in the Aboriginal population, there have been limited success. To contribute to addressing the gaps in research, this thesis examined both causes and impact of interventions to reduce STIs in this population. Chapter 1 is a review of STI epidemiology literature among Indigenous populations. Chapters 2 and 3 are papers from a national survey of 2,877 young Aboriginal people regarding sexual health. Chapter 2 describes the methods, implementation and demographics of the study. Chapter 3 is an analysis of this study, describing prevalence and correlates of participants who reported ever been diagnosed with an STI. Early sexual debut, inconsistent condom use and identifying as gay were significantly associated with a previous diagnosis. Chapter 4 describes Aboriginal peoples attendance, testing and positivity outcomes for chlamydia obtained from four primary health care settings. We found highest testing rates in sexual health clinics (80%) and lowest in general practice (5%) and higher positivity rates among Aboriginal people across all settings. Chapter 5 is an analysis of data from the STRIVE study, showing low rates of HIV testing (32%) conducted after a positive diagnosis for other STIs (n=15,260), demonstrating the need for improved clinical governance in this setting. Chapter 6 is a review paper assessing HIV prevention efforts among Aboriginal people in the first 25 years of the epidemic in Australia, and highlights the trajectory forward in prevention. The STRIVE Study Protocol is included in Chapter 7. This stepped wedge cluster randomised trial developed and implemented a sexual health quality improvement program in 68 remote communities with a primary outcome of reduced STI prevalence. Final results are currently being analysed. Finally Chapter 8 contains a number of recommendations directed at research, policy and programmatic levels that may address disparate rates of STIs and HIV in Aboriginal communities.Advisors/Committee Members: Donovan, Basil, Kirby Institute, Faculty of Medicine, UNSW, Kaldor, John, Kirby Institute, Faculty of Medicine, UNSW.