The sexual health status in Aboriginal and Torres Strait Islander (ATSI) communities is a hot topic among public health professionals in Australia, but rarely makes international news. I knew relatively little about Indigenous health before I moved to Australia and was shocked when I learned about the degree of health inequality between Indigenous and non-Indigenous Australians, especially since Australia has a nationalized healthcare system. To shed some light on this issue, I interviewed Australian sex and drug harm reduction educator Kat Byron about her extensive background working with ATSI communities on sexual health promotion.
Kate: How did you get started working in Indigenous sexual health?
Note: The “countries” listed below represent specific Aboriginal nations within Australia.
Kat: I guess I fell into sexual health. I was always the friend that was asked the tricky questions.
Ten years ago now, I started out as a youth peer educator in Biripi and Bunya country (Port Macquarie, northern NSW) then I moved to Larrikiah country (Darwin, NT) to train as a youth worker and later with the Northern Territory AIDS and Hepatitis Council as a youth peer educator in the needle and syringe program. I’ve recently started work based in Wurunderji country (Melbourne, VIC) to develop the capacity of Aboriginal health workers to start conversations about their community’s sexual health and harm reduction.
There was a steep learning curve to adapt to the different Aboriginal cultures and how to communicate sexual health messages, but I’ve learned to be flexible, listen to the community, and committing the time necessary to build trust.
Kate: Can you describe a bit about the current sexual health status in Aboriginal communities?
Kat: The rate of chlamydia in the Australian community is crazy. Chlamydia in Indigenous peoples is about three times higher than the general population. Around 80% of chlamydia cases in Indigenous and non-Indigenous Australians are in young people from 15 to 29 years old. Gonorrhea is the second-most common STI. In some rural and remote communities syphilis, donovanosis and trichomoniasis are bigger issues.
There is diversity between and within Aboriginal and Torres Strait Islander communities, with the majority of Indigenous peoples living in urban areas. A lack of access to culturally safe sexual health information, condoms, contraception, sexual health testing for urban, rural, and remote community has cooked up the perfect storm for STIs, especially the asymptomatic ones like chlamydia.
Sexual health in Aboriginal and Torres Strait Islander communities is part of a bigger, more holistic picture that encompasses physical, mental and cultural wellbeing. Colonization has had a direct impact on Indigenous sexual health, especially for aboriginal women. The rape and sexual abuse from non-Indigenous men that occurred when they first arrived in Australia forced syphilis and other STIs into their community.
Kate: Can you tell me more about how colonization has impacted their sexual health?
Kat: Factors that have lead to the current state of sexual health in Indigenous Australians include colonization, forced removal from kinship and family structures, removal from cultural knowledge of men’s and women’s (health and cultural) knowledge.
Older women and aunties would (and continue) to teach young women about their bodies, hygiene, menstruation, marriage and babies. The men had similar lessons.
There has always been a separation of men’s and women’s business and most mainstream sexual health campaigns don’t understand the need to adapt messages for Indigenous and other diverse communities. Sex and sexual health are, like in most communities, filled with shame and stigma.
Sistagirls, or Yimpininni, are people living as the third gender. Sistagirls had specific roles in family and culture in their communities until the missions came in and forced Christianity onto those communities. Sistagirls are similar to Samoan fa’afafine, Tongan fakaleiti or Native American two spirit peoples. Transgender people globally have poorer mental health outcomes, some Indigenous trans* people have an added layer of isolation, depression and suicide risk. Forced to assimilate to the gender binary, communities are now struggling to put sistagirls back into that special place within the community structure, until then the suicide rate of sistagirls will continue to be far higher than the Aboriginal average.
Kate: Can you tell me about any successful sexual health promotion initiatives for ATSI communities?
Kat: One of the best sexual health promotion initiatives developed with the Aboriginal community was a partnership between Marie Stopes International and the Victorian Aboriginal Community Controlled Health Organisation, which was a social marketing campaign for SNAKE condoms. SNAKE asked young Aboriginal and Torres Strait Islanders in Victoria how they want to receive sexual health messages and asked what are some key issues they have around sexual wellbeing. These include substance misuse, boredom, sexual abuse, unintentional/teen pregnancies, barriers to condom accessibility, lack of culturally appropriate sexual health education and sexual health services.
The program was shaped by the community and included peer educators, who also were community condom distributors, SNAKE branded condoms and community SNAKE festivals just to mention a few. Have you ever heard of a mainstream community festival sponsored by a condom brand? I know I haven’t, and this just shows that when it’s owned and run by the community, the response is so much better than a top down approach.
Kate: We hear a fair bit about ‘closing the gap’ in health outcomes between Indigenous and non-Indigenous communities in Australia. Are you hopeful that things are progressing toward that goal?
Kat: The close the gap campaign started in 2006 in response to the inaction of the government to address the 17-year gap in life expectancy between Indigenous and non Indigenous Australians.
The big five diseases are preventable, like cardiovascular disease, which is the single biggest killer of Indigenous Australians. Other health concerns include diabetes, respiratory diseases, musculoskeletal conditions, kidney disease and eye and ear problems. These are serious and complex health issues and from my perspective, it’s easy to see that sexual health and wellbeing issues get lost along the way.
When the mortality rate of most STIs is so low, we need to reframe the conversation around healthy families and strong communities. If we can build messages about chlamydia and infertility into a family context, we can start to get communities to get on board. The Aboriginal community controlled health sector is really proactive, with high rates of screening pregnant women as part of antenatal care and in the Victorian sector, over 98% immunisation rates for Hepatitis B in Aboriginal babies.
I’m hopeful that the life expectancy gap will close, but all tiers of government need to recognise the skills and abilities of the Aboriginal health and community workforce within Aboriginal communities and fund accordingly. The national apology to the stolen generations was one step forward, but the extension on the Northern Territory Emergency response and Stronger Futures legislation are many steps backwards in recognising sovereignty and the strength in Aboriginal communities. Funding going to non-Indigenous organisations to “fix” the problem, high consultancy fees to poke and prod around communities, more research on Aboriginal health, more pilot programs with little follow up holds Indigenous communities back.
The health of Aboriginal and Torres Strait Islanders declined the day the British invaded Australia. It has taken over 220 years for non-Indigenous people to recognise this. We really need to close the gap on inequality and eliminate racism and then the health issues will follow.
Follow us on Twitter @mysexprofessor or follow Kate, the interviewer @katecom. If you’d like to contact Kat, she’s on Twitter @kat_byron.