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Release peace: the magazine

Release peace: the magazine

Analysis & Background Stories on International Affairs

Why HIV Rates Remain High Among Australia's First Nations. And What Can be Done About it.

Article by: Ashton Harrison

This article was published as part of a collaboration with the School of Social Sciences of the University of New South Wales (UNSW).

This article was published as part of a collaboration with the School of Social Sciences of the University of New South Wales (UNSW).

HIV and its Potential Treatments

Human Immunodeficiency Virus (HIV) is a viral infection that attacks the immune system, weakening the body’s ability to fight off infections and diseases. If HIV is not diagnosed and treated, it can progress into Acquired Immunodeficiency Syndrome (AIDS), which if not effectively treated, can be fatal. Modern treatments for HIV are revolutionary. For example, pre-exposure prophylaxis (PREP) is a highly effective medicine taken to prevent HIV, and antiretroviral therapy (ART) treats HIV and makes it undetectable. Once undetectable, the infection becomes untransmittable. According to the Australian STI Management Guidelines, a lack of access to medical services and appropriate education, as opposed to any differing patterns in sexual behaviour or condom use has contributed to First Nations communities having a higher prevalence of new HIV diagnoses.

The Continued Impact of Colonisation on First Nations People’s Health

The inhabitation of First Nations people in mainland Australia spans over 65,000 years and their culture, history and knowledge are uniquely rich. After the first British settlement was established in 1788, massacres, disease and the forced removal of children caused the First Nations population across the continent to drop drastically. According to the Australian Bureau of Statistics, as of 2021, First Nations communities make up just 3.8% of Australia’s population. The continued effects of colonisation have also catalyzed higher rates of poverty, unemployment, and lower socioeconomic status for First Nations People. Additionally, generational trauma from the dispossession of land, the Stolen Generation, a stigmatisation by the majority society and  other factors have resulted in profound impacts. The Stolen Generation denotes the forced removal of First Nations children from their families between 1910 and 1970 as a result of government policies. The consequences of these practices are visible today with First Nations children remaining the highest population who are in out-of-home care.

Following Australia’s No’ referendum vote in October 2023, Indigenous peoples are neither recognised in the country’s constitution nor in an officially established body. A ‘Yes’ vote would have ensured them a “voice” to advise governments on the issues affecting their communities. This absence of First Nations perspectives within policymaking has led to limited interventions that would promote their physical and mental well-being. This in turn contributes to inadequate access to healthcare and lower educational attainment, fueling an increased vulnerability of contracting HIV and preventing AIDS.

Statistics of HIV Transmissions

Between 2011 and 2016, the rate of new HIV diagnoses among First Nations People increased from 3.6 to 6.3 per 100,000. Between 2016 and 2019 this saw an increase of 33%, whilst there was a decrease of 22% among the non-Indigenous population. Due to the COVID-19 pandemic and subsequent restrictions, 2020 saw a decline of 2.2 per 100,000. However, in 2021, HIV diagnosis rose again to 2.3 per 100,000 among First Nations People whilst non-Indigenous HIV notifications declined to 1.7 per 100,000. HIV rates have consistently remained elevated amongst First Nations communities.

The Bird’s Eye View

When comparing the holistic health and well-being of First Nations communities with that of the rest of Australia’s population, other stark disparities can be observed. For example, the prevalence of the burden of disease is 2.3 times higher for these communities than that of non-Indigenous people. Inadequate healthcare infrastructure and cultural barriers contribute to limited access to healthcare for rural First Nation communities, specifically regarding issues of privacy and location. According to the International Journal of Environmental Research and Public Health, “Aboriginal people are proportionally more likely to live in regional and remote areas, with 54% of Aboriginal Australians in NSW living outside of metropolitan areas.” – for those who unfamiliar with Australian states, NSW (New South Wales) is one of the more urbanised states in the nation, with its state capital Sydney. The article continues to say that: “Regional and remote areas receive less healthcare funding per capita, with very remote areas receiving less than a third of the funding of major cities.” The community’s reduced access to early support from healthcare services increases the risk of the infection’s progression to AIDS.

Barriers to Accessing Healthcare Services

To combat high levels of HIV, addressing barriers to testing is crucial, as early diagnosis improves treatment outcomes, prevents transmission, and eliminates the risk of AIDS. The heightened stigma surrounding all people with HIV remains prevalent, which discourages personal disclosure, treatment-seeking and even testing. This is exacerbated further for First Nations People due to complex social issues such as discrimination, inequalities in education and cultural disconnection. First Nations individuals experience high levels of shame and stigma when seeking HIV testing, diagnosis and treatment. Stigma and discrimination lead to self-shame, social isolation and reduced self-esteem. Moreover, testing and diagnosis may also be impacted by fear of HIV disclosure to healthcare professionals who are connected to the patient via family or community. The stress and shame of contracting HIV is known to contribute to the development and/or exacerbation of anxiety and depressive disorders.

Education and Cultural Awarenes

Insufficient knowledge of the history of First Nations people, limited reach in rural areas, and lack of cultural competence are just a few of the systemic barriers blocking the potential to achieve an appropriate level of education for Aboriginal students. This is further impacted by the inadequate level of funding for First Nation-led comprehensive prevention programs that could lower HIV transmission rates. These issues can be addressed through engagement with a culturally sensitive, competent curriculum as well as community involvement. Initiatives like these are essential to addressing the inequalities faced by First Nations communities and to combat HIV transmission, as it would allow open and respectful communication about sexual health, whilst integrating traditional knowledge and practices into HIV education and healthcare.

An Inclusive Approach

To address these barriers for First Nations communities in Australia, their self-determination is paramount when establishing appropriate community-based programs. Elevating the voices of these marginalised communities would contribute to successful community-led initiatives that incorporate culturally sensitive interventions. The construction of suitable educational resources on prevention such as PREP and treatment such as ART would also lower transmissions of HIV within the community. It is therefore essential for peak stakeholders both on an organisational level as well as on a government level to address these necessities to lower HIV transmission. This will strengthen a more holistic well-being, lower stigma and raise awareness of the persistent health disparities faced by the First Nations People of Australia.


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