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|City||Perth, Western Australia|
|University||University of Western Australia|
|Thesis type||Master of Public Health|
Background: In the past decade HIV notification rates have declined in many developed countries. However, infections among certain minority groups, such as American Natives and Aboriginal Canadians have increased. This trend has not been apparent in Aboriginal Australians, although national figures may not reflect the epidemiology in Western Australia (WA).
Aim: To describe the epidemiology of HIV infection in Aboriginal and non-Aboriginal WA residents.
Method: Descriptive analysis of population-based surveillance data reported to the Department of Health Western Australia from 1983 to 2002.
Results: There were 1,060 WA residents notified with HIV infection in this 20-year period. From a peak of 95 cases in 1986, the number of cases notified annually declined until 1997, and then remained relatively stable with an annual average of 41 notifications, before increasing in 2002 by 25% to 51 cases. While males comprised the majority of HIV notifications overall (944, 89%), the proportion of female cases increased over time from 4% in 1983 - 1987 to 21% in 1998 - 2002 (p less than 0.01).
Overall, average annual HIV notification rates (AANR) decreased from 3.8 cases per 100,000 person-years (py) in 1988 - 1992 to 2.2 cases per 100,000 py (p less than 0.01) in 1998 - 2002. For the corresponding periods, AANR decreased in males (7.1/100,000 to 3.4/100,000 py; p less than 0.01), and increased in females (0.6/100,000 to 0.9/100,000 py; p less than 0.01). The proportion of heterosexually acquired infections increased from 3% during 1983 - 1987 to 40% during 1998 - 2002 (p less than 0.001). The proportion of HIV notifications in Aboriginal people increased from 1% of cases in 1983 - 1987 to 15% of cases in 1998 - 2002 (p less than 0.001). In the same periods, the AANR in Aboriginal people increased eight-fold from 1.3 to 9.8 cases per 100,000 py (p less than 0.001). The latter rate was five times higher than in non-Aboriginal people, whose AANR had decreased from 3.9 to 1.9 per 100,000 py (p less than 0.001) for the same periods.
Of all non-Aboriginal cases, 92% were males and 73% had acquired HIV through homosexual contact. In contrast, 47% of Aboriginal cases were males and only 20% of cases were homosexually acquired.
Conclusion: There are differences in the epidemiology of HIV infection in the non-Aboriginal population of WA, consistent with national and international trends. However, in recent years, an increase in the notification rate and proportion of HIV cases in the WA Aboriginal population, among whom HIV is more likely to be heterosexually acquired, and more common in females. These data indicate a need for review of prevention strategies targeting the Aboriginal community.
Australian Indigenous HealthInfoNet abstract