HIV diagnoses in indigenous peoples: comparison of Australia, Canada and New Zealand

Abstract

In industrial countries, a number of factors put indigenous peoples at increased risk of HIV infection. National surveillance data between 1999 and 2008 provided diagnoses for Aboriginal and Torres Strait Islanders (Australia), First Nations, Inuit and Métis (Canada excluding Ontario and Quebec) and Māori (New Zealand). Each country provided similar data for a non-indigenous comparison population. Direct standardisation used the 2001 Canadian Aboriginal male population for comparison of five-year diagnosis rates in 1999-2003 and 2004-2008. Using the general population as denominators, we report diagnosis ratios for presumed heterosexual transmission, men who have sex with men (MSM) and intravenous drug users (IDU). Age standardised HIV diagnosis rates in indigenous peoples in Canada in 2004-2008 (178.1 and 178.4/100 000 for men and women respectively) were higher than in Australia (48.5 and 12.9/100 000) and New Zealand (41.9 and 4.3/100 000). Higher HIV diagnosis rates related to heterosexual contact among Aboriginal peoples, especially women, in Canada confirm a widening epidemic beyond the conventional risk groups. This potential of a generalised epidemic requires urgent attention in Aboriginal communities; available evidence can inform policy and action by all stakeholders. Although less striking in Australia and New Zealand, these findings may be relevant to indigenous peoples in other countries.

Abuse of power in relationships and sexual health

“…HIV rates reported for Indigenous peoples in Canada are higher than those reported for Indigenous peoples in Australia and New Zealand (Shea et al, 2011). Within Canada, HIV rates reported for First Nations are higher than those reported for the general population (Archibald, Sutherland, Geduld, Sutherland, & Yan, 2003;Duncan et al, 2011;Spittal et al, 2007).…”

“…Within Canada, HIV rates reported for First Nations are higher than those reported for the general population (Archibald, Sutherland, Geduld, Sutherland, & Yan, 2003;Duncan et al, 2011;Spittal et al, 2007). The majority of reported HIV cases among First Nations are women (Cedar Project, Mehrabadi, et al, 2008;Shea et al, 2011), while the majority of reported HIV cases among the general population are men. These gender differences reflect differences in the HIV epidemic, which predominantly affects heterosexual and intravenous drug user subpopulations (Duncan et al, 2011) for First Nations and men-who-have-sex-with-men for the general population.…”

“…In that same period, Indigenous nations have experienced disparities in many social and health indicators (Adelson, 2005), including disproportionately high rates of human immunodeficiency virus (HIV) (Newman, Woodford, & Logie, 2012;Shea et al, 2011) and other sexually transmitted infections (STIs) (de Ravello, Everett Jones, Tulloch, Taylor, & Doshi, 2014;Eitle, Greene, & Eitle, 2015;Kaufman et al, 2007;Minichiello, Rahman, & Hussain, 2013;Winscott, Taylor, & Kenney, 2010).…”

“…These gender differences reflect differences in the HIV epidemic, which predominantly affects heterosexual and intravenous drug user subpopulations (Duncan et al, 2011) for First Nations and men-who-have-sex-with-men for the general population. The differences in affected populations suggest that gender and culture specific interventions are needed to prevent the HIV epidemic from widening (Shea et al, 2011).…”

So Far, So Good: Maintenance of Prevention Is Required to Stem HIV Incidence in Aboriginal and Torres Strait Islander Communities in Australia

“…In Canada, age standardized rates of HIV diagnosis among Canadian Aboriginal peoples have been reported at 3.9 times that of Indigenous Australians. The majority of these cases have occurred as a result of injecting drug use (Duncan et al, 2011;Shea et al, 2011;Wood et al, 2008) leading to long-standing concerns about HIV escalating among Indigenous people in Australia through injecting drug use.…”