National Aboriginal and Torres Strait Islander Sexual Health

Executive summary

The purpose of this report is to look at the sexual health strategy for the Aborigine and Torres Strait Islander indigenous groups of Australia as well as the aspect of health care planning in the strategy. These indigenous groups are faced with poor health and lack or proper health care facilities which make them vulnerable to contracting diseases such as HIV, blood borne viruses and sexually transmitted diseases. The Aborigines and the Torres Strait Islander communities have a higher risk of contracting sexually transmitted diseases, blood borne viruses and HIV when compared to the rest of the Australian population

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The National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008 is developed to deal with the sexual health issues that affect these indigenous groups. Its identifies four important areas which are HIV, blood borne virus infections, the number of people infections that occur in the indigenous communities, their ability to access diagnosis and treatment facilities, and the capacity of the health sector to provide proper services to the Aborigines and Torres Strait Islander communities that are infected with HIV, STIs and blood borne viruses.

The main goal of developing the strategy is to reduce the number of people infected with HIV, STIs and BBV (Blood borne viruses) that belong to the Aborigine and Torres Strait Islander Communities. The purpose of developing the strategy is to cover the gap of inequality in healthcare services for members in these communities. It also seeks to ensure that members of these communities are able to access treatment facilities that are equipped with qualified and trained staffs that are able to offer proper health care services.

Introduction

The Aboriginal community in Australia and the Torres Strait Islander group are viewed to have serious health issues in the whole of Australia. These groups also face health disparities when compared to the health care services that Australian citizens receive. These disparities are evident in the form of the high number of diseases that affect Aborigines and the Strait Islander community such as heart diseases, diabetes and pneumonia. Because of their poor health status and inability to get proper heath services, these groups are have an increased vulnerability to sexually transmitted diseases (Commonwealth of Australia, 2008).

According to data collected from the National Centre for HIV Epidemiology and Clinical Research (NCHECR) in 2005, the rate of diagnosis for HIV increased from 4 percent in 2001 to 5.8 percent in 2004 for the Aboriginal and Torres Strait Islander population. The rate of Hepatitis C infections in indigenous communities found in the Southern, Western and Northern territories of Australia is more than double that of the non indigenous population. The main sexually transmittable diseases identified by NCHECR (2005) are syphilis, gonorrhoea and Chlamydia.

The main focus of the strategy is on the Aboriginal community and the Torres Strait Islander community and the number of sexually transmitted infections in these communities. These groups form the original inhabitants of the Australian continent and they account for 2.7 percent of the Australian population. The Torres Strait Islanders originated from the Torres Strait Islands that are located at the tip of the northern part of Queensland. The aborigines were seen originate from various parts of the Australian continent (AIHW, 2006).

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According to Michael Moore, the CEO of Public Health Association of Australia (PHAA), the Aborigine and Torres Strait Islander communities face the worst health services and outcomes of any of the cultural communities found in Australia. He notes that it is important to understand what are the underlying issues that lead to poor health in these communities and what techniques can be used to improve healthcare services. The Minister of Indigenous Health, Hon Warren Snowdon, notes that more needs to be done to improve the healthcare system for indigenous communities. The minister notes that there are inequalities facing Indigenous Australians when it comes to healthcare but the government is involved in initiatives to deal with these inequalities (PHAA, 2010).

Evaluation of the Strategy

In understanding the strategy, the concept of healthcare planning needs to be highlighted. Planning is important for the health sector because the demand for better services is constantly increasing. Factors such as technological innovations, ageing and increasing utilisation of health care services place some impact on the healthcare sector. The goals for health care planning should be directed towards achieving quality health care, easy access to health care facilities, having a healthy population, and better value for quality health services (NSW Health, 2005).

Health care planning is meant to lead to an improvement in service delivery and the health of the general population. The main process of planning involves identifying the problem that requires specific attention, gathering and analysing the relevant data, formulating and evaluating outcomes that will be used to address the issues, selecting the best option and then developing appropriate strategies that will be used in the implementation process. The strategies undergo monitoring and review to determine whether there is need for improvements and whether there are any emerging issues in the plan (NSW Health, 2005). Green and Kreuter (2005) describe health promotion activities as the planning activities that combine politics, education and organizational actions to meet the health needs of individuals, groups or identified communities such as the Aborigine and Torres Strait Islander communities. The National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008 is viewed as a health promotion strategy because it highlights the aspects such as primary prevention activities, diagnosis and treatment facilities as well as the support and care of people infected with HIV, BBV or STIs. The involvement of indigenous groups in the strategy is seen as vital and a prerequisite to the successful implementation of the plan.

A model that can be used in the health promotion of the strategy is the proceed model developed by Green (Green and Kreuter 2005). The model begins by first conducting a social assessment about the quality of life of the indigenous groups as well as considering epidemiological assessments that look at the causes of health problems, genetics, environment and lifestyles of people in these communities. After conducting the social and epidemiological assessment, the next step will involve conducting an ecological and educational assessment that will look at the predisposing, reinforcing and enabling factors for the health promotion plan.

An analysis is thereafter conducted on the political, administrative and policy assessment and their usefulness to the health promotion strategy. Political policies and administration are aspects that will be covered by the government particularly the Department of Health. After the analysis, prevention strategies are developed and implemented. The process undergoes some evaluation to measure the impacts and outcomes of the strategies and whether they have achieved the set out objectives and goals. The outcomes are measured to provide some feedback that will determine whether the strategy has to undergo further improvements (Green and Kreuter 2005).

Organizational Commitment and Performance Indicators of the Strategy

The commitment of the government of Australia to reducing the number of HIV, STI and BBV infections in the indigenous communities is evidenced by the amount of money it allocated to meet the health expenses that might arise from establishing diagnosis and treatment facilities for these indigenous communities. The amount of money the government allocated to the Department of Health and ageing to meet indigenous health care needs in the 2008-2009 budget was $513.8 million. This amount was increased in the 2009- 2010 budget to $614.3 million (Department of Health and Ageing, 2010).

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Other organizational commitments are prevention strategies that have been incorporated to reduce the rate of infections in these indigenous communities (CoA 2008). Educational programs have been included as part of the strategy to increase awareness of diseases to these groups as well as screening facilities that will test the HIV, STI and BBV infections. Immunisation programs have also been established by the Australian Government to deal with the high levels of hepatitis B infections. Policies have also been formulated by the government with regards to HIV testing and diagnosis. Such policies include the ANCARD/IGCARD HIV testing policy formulated in 1998 by the Commonwealth of Australia. This policy provides the guidelines for HIV testing for the general Australian community but a review will see the guidelines considering the diagnosis and testing needs of the Aborigine and Torres Strait Islander communities (Commonwealth of Australia, 2005).

The Australian government has also committed itself to a 5 to10 year plan that will see the recruitment and retention of competent health care staff that will be trained to address the needs of Aborigines and Torres Strait Islander communities. The purpose of the plan will be to increase the number indigenous people working in heath professions, improve their training and careers, develop the needs of other health staff that work with indigenous communities and ensure there is accountability by the government to meet these objectives (Commonwealth of Australia, 2005).

Performance indicators for the strategy will be to look at the number of sexual health subcommittees that have been established in each jurisdiction, look at the number of strategic partnerships that have been formed with various government, private and health sector organizations with the Aborigine and Torres Strait Islander health group organization, establish the number of diagnosis and treatment centres that have been set up to deal with HIV, BBV and STI, analyse the accessibility of these facilities by members from these indigenous groups, look at the number of employees who have bee trained and recruited to work in indigenous communities (CoA, 2005).

The main gap in health care planning activities is inequality services. Despite the main focus of the strategy being to address sexual healthcare for the indigenous communities, the general healthcare of these groups is still poor when compared to the non-indigenous Australian population. There is general inequality of healthcare services because people from these groups are seen to be of a lower social status and are therefore unable to afford better healthcare services.

Strengths and Weaknesses of the Strategy

The major strength of the strategy is that it has focused on the indigenous Aborigine and Torres Strait islander communities in Australia. This is because these groups of people are categorised to experience the poorest health in Australia despite the continent boasting of having a world class health system and one of the healthiest populations in the world. The poor health of indigenous groups is attributed to factors such as low incomes, lower educational levels and high cases of unemployment among the Aborigine and Torres Strait Islanders which have led them to engage in high health risk behaviours such as drug use, smoking and alcoholism (CoA, 2006).

According to NCHECR (2009) the highest rates of new HIV diagnosis were confirmed to occur in the indigenous communities with the factors that contributed to the high rates of HIV, STI and BBV infections being identified as shortages of clinical staff, lack of accessibility to health services, the social-economic disadvantages experienced by these communities, stigmatization of people with HIV and STI infections. 50 percent of new diagnoses were calculated from the population rates of newly diagnosed BBV, HIV and STI infections in the indigenous communities, information that was gathered from the Australian Bureau of Statistics (2008) estimates of the Aboriginal and Torres Strait Islander Australian community.

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The limitations of the strategy with relation to healthcare planning are that there are hierarchical level problems that are caused by the high levels of complexity in healthcare systems. Healthcare planning is also seen to be a complex activity to the people concerned because it involves analyzing a lot of information that is subjective and that eventually requires a reorganization of the healthcare systems. Healthcare planning also requires high policy formulation and implementation procedures which creates a situation where a lot of politicization is placed on policy formulation. The policies end up being misinterpreted and implemented in an inconsistent way (Kuhn et al, 2007). Another limitation is that the interaction, collaboration and interaction efforts that are necessary to ensure that the strategy is successful to the indigenous groups might lead to a defragmentation of existing policies on healthcare. This in turn will lead to misinterpreting the set goals and objectives of the strategy. The strategy might also place a lot of expectations on the Aborigine and Torres Strait Islander communities who will see the implementation of the strategy as the end of their health problems. The strategy will also place a lot of pressure on health workers and the health sector in general which will see their workloads increasing once it’s implemented (Kuhn et al, 2007).

Recommendations

To improve sexual health care to the indigenous communities, there should first be an awareness of the cultural diversity of these groups to people in the health care sector so as to ensure they provide culturally appropriate health care, the health care sector should also consider making the health services to the Aborigines and Torres Strait Islander people more responsive to their particular needs especially when it comes to the diagnosis and treatment of sexually transmitted infections and HIV, the government of Australia should combine its efforts with the non-governmental agencies, private sector companies and the Aborigine, Torres Strait Islander health sector to ensure these communities receive improved and better health care services and facilities.

References

Australian Bureau of Statistics (2008). Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians. Canberra, Australia: Australian Bureau of Statistics.

Australian Institute of Health and Welfare (AIHW) (2006) Indigenous Australians. Web.

Commonwealth of Australia (CoA) (2005). National Aboriginal and Torres Strait Islander sexual health and blood borne virus strategy. Canberra, Australia: Department of Health and Ageing.

Commonwealth of Australia (CoA) (2006). Aboriginal and Torres Strait Islander health performance framework. Canberra: Department of Health and Ageing.

Commonwealth of Australia (CoA) (2008). Aboriginal and Torres Strait Islander health performance framework. Canberra: Department of Health and Ageing.

Department of Health and Ageing (2010) Australian health and ageing system: the concise expenditure fact book. Canberra: Economic and Statistical Analysis Branch.

Green, L.W., & Kreuter, M.W. (2005) Health Promotion planning: an educational and ecological approach. 4th Edition. St.Louis: McGraw- Hill.

Kuhn, K.A., Warren, J.R. & Leong, T.Y. (2007) MEDINFO 2007: proceedings of the 12th world congress on health, Volume 1. Amsterdam, Netherlands: IOS Press.

National Centre in HIV Epidemiology and Clinical Research (NCHECR) (2005). HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report. Web.

National Centre in HIV Epidemiology and Clinical Research (NCHECR) (2009). Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report. NSW: University of New South Wales.

NSW Health (2005) Area healthcare services plans- NSW health guide for development. Web.

Public Health Association of Australia (PHAA) (2010) Indigenous health: challenges and breakthroughs. Web.

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