Aboriginal and Torres Strait Islander People

Overview

  • Disproportionate rates of STI diagnosis (chlamydia, gonorrhoeainfectious syphilis and hepatitis B) occur among Aboriginal and Torres Strait Islander people, particularly in remote and very remote communities.
  • Rates of diagnosis of chlamydia and hepatitis C are high, particularly among Aboriginal and Torres Strait Islander people living in urban and regional areas.
  • People who live in urban settings, who have a sexual network connection to remote communities, are also at an increased risk of infection.
  • Trichomoniasis is endemic in Aboriginal and Torres Strait Islander populations in regional/remote areas.
  • Although rates of HIV are similar to the non-Indigenous population, high rates of untreated STIs enhance HIV transmission, making this group potentially vulnerable to HIV.

Testing advice

In addition, testing for trichomoniasis and hepatitis C is recommended in this population.

InfectionConsideration
Chlamydia Consider 
self-collection of samples for testing.
Gonorrhoea Consider
self-collection of samples for testing.

If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites.
Trichomoniasis Consider
self-collection of samples for testing.
Hepatitis B Vaccinate if not immune. Vaccination is free in most states/territories for sexual/household contacts.
Hepatitis C Offer testing if history of injecting drug use, incarceration or unsafe tattoos. Repeat test if patient exposed within 6 month window period.

If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.
Syphilis If clinical suspicion of syphilis, refer to the syphilis  guideline.
HIV Repeat test if patient exposed within previous 12 weeks (window period).
NAAT – Nucleic Acid Amplification Test

Specimen collection

Clinician collected
Self-collection 

Self-collection of specimens is acceptable and can be helpful in situations where the person is uncomfortable with the clinician collecting the sample directly or where consultation times are limited.

Clinical indicators for testing

  • Offer testing opportunistically when seeing Aboriginal and Torres Strait Islander people who are asymptomatic, especially young people aged 15-30 years (or from age of first sexual exposure up to 34 years if from remote and very remote areas).
  • Other Aboriginal and/or Torres Strait Islander people to prioritise for testing include people who inject drugs (PWID); people who have history of/current incarcerationmen who have sex with men (MSM), sistergirls and transgender people; people living with HIV (PLWHIV), and people with hepatitis B or hepatitis C.
  • Always test and offer examination when presence of symptoms – discharge, dysuria, pelvic/low abdominal pain, post-coital or intermenstrual bleeding, dyspareunia or genital lesions.
  • Consider offering cervical screening to females undergoing examination.
  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations

  • MBS item 715 - Aboriginal and Torres Strait Islander People’s Health Assessments for Children, Adults and Older People may be used.
  • Offer Aboriginal clients the option of having an Aboriginal Health Worker present during part/all of the consultation.
  • Contact tracing is important and best undertaken when appropriate and culturally sensitive support services are readily available to both the index case and contacts.

Follow up

If test results are positive, refer to STI management section for advice on:

Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Vaccinate for hepatitis B
  • Discuss and activate reminders for regular screening tests according to risk, especially if their behaviors indicate the need for more frequent screening.

Auditable outcomes

  • 100% of Aboriginal and Torres Strait Islander people are identified at registration.
  • 90% of Aboriginal and Torres Strait Islander people are screened according to these guidelines.
  • 100% of Aboriginal and Torres Strait Islander people aged 16-34 are offered an annual STI check.

References

  1. Australian Government, Department of Health. MBS Health Assessments Items 701, 703, 705, 707, 715 and 10986. Canberra: Commonwealth of Australia, 2013. Available online [Accessed November, 2013].
  2. NSW Department of Health, NSW HIV/AIDS, Sexually Transmissible Infections and Hepatitis C Strategies: Implementation Plan for Aboriginal People 2006-2009. Sydney: Department of Health, 2007.
  3. Sexual Health and Blood Borne Virus Unit Centre for Disease Control. NT Guidelines for the Management of Sexually Transmitted Infections in the Primary Health Care setting, 3rd ed. Darwin: NT Government, 2012. Accessed online [Accessed November, 2013].
Last Updated: Tuesday, 22 March 2016