Human papillomavirus vaccination and genital warts in young Indigenous Australians: national sentinel surveillance data

The known The Australian HPV vaccination program has led to significant declines in a number of HPV-related conditions, including diagnoses of genital warts in young women and heterosexual men at sexual health clinics.

The new We found marked declines in the proportions of young Indigenous women and men attending sexual health clinics for the first time who were diagnosed with genital warts following introduction of the HPV vaccination program, similar to declines among non-Indigenous young women and men.

The implications Sustained high HPV vaccine coverage rates and monitoring are needed to close the gap between Indigenous and non-Indigenous Australians in the rates of cervical and other HPV-related cancers in older women.

The Australian national human papillomavirus (HPV) vaccination program commenced in April 2007. Free vaccination was provided to 12–13-year-old girls in schools; this was supplemented by a 3-year catch-up program for 13–18-year-old girls in schools and for 18–26-year-old women through family doctors in July 2007.1 In 2013, boys were added to the program, providing free HPV vaccination to 12–13-year-old boys in schools and, for 2 years, a catch-up program for 14–15-year-old boys. Australia uses the quadrivalent HPV vaccine (Gardasil), protecting against HPV types 6 and 11, which cause ano-genital warts, and HPV types 16 and 18, which cause cancer.2,3

The Australian HPV vaccination program has had very promising results. High coverage rates among vaccine-eligible girls have been achieved, 73% receiving all three doses in 2010.4 Significant reductions in the prevalence of HPV-related conditions have been seen; diagnoses of genital warts in young women and heterosexual men at sexual health clinics,5,6 inpatient treatment of genital warts at private hospitals,7 hospital admissions for genital warts,8 the prevalence in young women of HPV types targeted by the quadrivalent vaccine,9,10 and the incidence of high grade cervical abnormalities11 have all declined.

Measuring the impact of the HPV vaccination program in Aboriginal and/or Torres Strait Islander (Indigenous) people is important because cervical cancer rates among Indigenous women are twice as high as among non-Indigenous women.12 Similar findings have been reported overseas; a meta-analysis of data from 35 studies found that indigenous women had elevated risks of invasive cervical cancer and related mortality (pooled risk ratios, 1.72 and 3.45 respectively).13 Indigenous Australians experience poorer outcomes than non-Indigenous people for a range of conditions,14 including some sexually transmissible infections (STIs).15–17 In response to these inequities, the Australian Government initiated the Closing the Gap program in 2008,18 followed in 2014 by the Fourth National Aboriginal and Torres Strait Islander Blood-borne Viruses and STI Strategy, 2014–2017, which includes the aim of achieving high rates of HPV vaccination.19

Despite their disproportionately high rates of cervical cancer, there is a lack of information on HPV vaccination and its impact, including on the prevalence of genital warts, in indigenous populations around the world. A recent systematic review20 did not find any studies that reported the effect of HPV vaccination programs in indigenous populations. The aim of our study was therefore to examine the effect of the HPV vaccination program on diagnoses of genital warts in Indigenous Australians, and to compare this with data for non-Indigenous Australians.

Methods

Routinely collected de-identified data were collated from 39 clinics in the Genital Warts Surveillance Network (http://kirby.unsw.edu.au/projects/genital-warts-surveillance-network). The network, including 47% of all sexual health clinics in Australia, was established in 2008 to measure the effects of the Australian HPV vaccination program on the prevalence of genital warts. The participating clinics, all of which have computerised medical records systems, are the largest such clinics by patient volume, accounting for more than 90% of all sexual health clinic consultations in Australia. Patient demographic and behavioural data (age, sex, Indigenous status, country of birth, sex of their sexual partners) and data on the clinical diagnosis of genital warts were collated.

Data analysis

Australian-born patients who attended one of the clinics for the first time between January 2004 and December 2014 were included in the study. Analysis was restricted to Australian-born patients because the HPV vaccine is available free of charge only to Australian permanent residents and citizens (residency status is not routinely collected at clinics), and to first visits to exclude patients with recurrent genital warts diagnoses. Patients of unknown Indigenous status were excluded. Men who reported having sex only with men or with both men and women in the past 12 months were classified as men who have sex with men (MSM), and men who reported having sex only with women as heterosexual.

The study period was divided into a pre-vaccination period (2004–2007) and a vaccination period (2008–2014). All data from 2007 were included in the pre-vaccination period. The proportion of patients diagnosed with genital warts was calculated by dividing the number of new diagnoses by the number of patients seen, and the relative percentage change in proportion over time was calculated.

The pattern of change in diagnoses was described using univariate Poisson regression models, with the number of diagnoses as the outcome and the calendar year as the independent variable. Results are presented as average annual trends (average annual proportional change in rates; eg, for 10% average increase, average annual trend = 1.10). Models were separately fitted for the pre-vaccination and vaccination periods; the pre-vaccination period was assessed to identify any changes related to factors other than vaccination. Model fit was assessed in Pearson χ² tests and by visually comparing it with the observed proportions (online Appendix, figures 1–3).

The average difference between the pre-vaccination and vaccination periods in the proportions of patients diagnosed with genital warts was analysed in univariate Poisson models, with the number of diagnoses as the outcome and the vaccination period as the binary independent variable. Results are presented as summary rate ratios (SRRs).

The magnitude of the difference between Indigenous and non-Indigenous people in rate change was quantified in a bivariate Poisson model, using the number of diagnoses as the outcome, including an interaction term for Indigenous status and year. Results are presented as the ratio of the SRRs for diagnoses in non-Indigenous and Indigenous people to account for potential differences in patient numbers by vaccination period for each group.

A sensitivity analysis that excluded the 2007 data was conducted with the same methods to allow a wash-in period for the intervention. Results were qualitatively compared with those of the primary analyses to assess any reduction in the proportion of diagnoses during 2007 associated with vaccinations during the second half of 2007.

Analyses for three age groups were conducted: people under 21 (all women in this age group were eligible to receive free HPV vaccination, but boys aged 12–15 years were only eligible to receive it from early 2013), people aged 21–30 years (most women in this age group were eligible to receive free HPV vaccination, and all women by the end of the study period), and those over 30 (few women in this age group were eligible to receive free HPV vaccination). No men over 21 had been eligible for free vaccination at any time. Analyses for MSM were not stratified by age because of the small number of observations.

All analyses were conducted in Stata 13.1 (StataCorp).

Ethics approval

Ethics approval for the study was provided by the Aboriginal Health and Medical Research Council (reference, 1099/15), the St Vincent’s Hospital Sydney Human Research Ethics Committee (reference, 08/051), by the state-based human research ethics committees, and by the governance offices overseeing each participating clinic.

Results

A total of 220 761 Australian-born patients were seen at the participating sexual health clinics for the first time between 2004 and 2014. 5162 records (2.3%) were excluded because information on Indigenous status was missing; of the remaining 215 599 patients, 15 638 (7.3%) identified themselves as Indigenous and 91 689 (42.5%) were women. The median age of the 215 599 patients was 27 years (interquartile range [IQR], 21–36 years); the median age of the Indigenous patients was 22 years (IQR, 18–32 years).

Women

The rates of diagnosis of genital warts were consistently lower for Indigenous women than non-Indigenous women in each age group (Box 1; online Appendix, table 1).

Average annual trend

There was no trend in annual diagnosis rates for the pre-vaccination period. During the vaccination period, the annual diagnosis rate declined for both Aboriginal and non-Aboriginal women aged 30 years or less, but not for women over 30 (Box 2).

Vaccination v pre-vaccination periods

The average annual rates of diagnosis declined significantly between the pre-vaccination and vaccination periods for both Indigenous (SRR for Indigenous women under 21, 0.12; 95% confidence interval [CI], 0.07–0.21; P < 0.001; for 21–30-year-old women, 0.41; 95% CI, 0.27–0.61 P < 0.001) and non-Indigenous women under 30 years of age (SRR for non-Indigenous women under 21, 0.21; 95% CI, 0.19–0.24; P < 0.001; for 21–30-year-old women, 0.43; 95% CI, 0.40–0.46; P < 0.001) (Box 2).

Ratio of SRRs

The reduction in the proportion of clinic patients diagnosed with genital warts associated with the vaccination period was similar for Indigenous and non-Indigenous women, and the fall was significantly greater only for Indigenous women under 21 (SRR ratio, 1.72; 95% CI, 1.72–2.91; P = 0.043) (Box 2).

Heterosexual men

The rates of diagnosis of genital warts were consistently lower for Indigenous men than Australian-born non-Indigenous men in each age group (Box 3; online Appendix, table 2).

Average annual trend

There was an increase in annual diagnosis rates during the pre-vaccination period for both Indigenous and non-Indigenous men under 21 (each P < 0.05), but no statistically significant change for those aged 21–30 years, nor for Indigenous men over 30. There was, however, a decline in rate for non-Indigenous men over 30 during this period (P = 0.001). During the vaccination period, there was no change in diagnosis rates among younger Indigenous men but a decline in those over 30 (P = 0.04). There was a decline in diagnosis rates among all non-Indigenous men, with the greatest decline among those under 21 (P < 0.001) (Box 2).

Vaccination v pre-vaccination periods

The average annual rates of diagnosis were statistically significantly lower during the vaccination period than the pre-vaccination period for younger Indigenous men (SRR for Indigenous men under 21, 0.25; 95% CI, 0.12–0.49; P < 0.001; for 21–30-year-old men, 0.56; 95% CI, 0.35–0.90; P = 0.016), but not for those over 30; the reductions were significantly lower for all non-Indigenous men (SRR for non-Indigenous men under 21, 0.33; 95% CI, 0.28–0.39; P < 0.001; for 21–30-year-old men, 0.60; 95% CI, 0.56–0.63; P < 0.001; for those over 30, 0.83; 95% CI, 0.78–0.89; P < 0.001) (Box 2).

Ratio of SRRs

The level of change in the proportion of clinic patients diagnosed with genital warts associated with the vaccination period was similar for Indigenous and non-Indigenous men in all age groups (Box 2).

Men who have sex with men

The rates of diagnosis of genital warts were similar for Indigenous and non-Indigenous MSM (Box 4; online Appendix, table 3).

Average annual trends

There was no trend in the diagnosis rates for Indigenous or non-Indigenous MSM during the pre-vaccination period. Similar reductions in rate were measured in both groups during the vaccination period, but the change was not statistically significant for Indigenous MSM (Box 2).

Vaccination v pre-vaccination periods

There was no significant change in the average annual rate of diagnosis for Indigenous MSM (SRR, 0.74; 95% CI, 0.40–1.36; P = 0.33), but the rate declined significantly among non-Indigenous MSM (SRR, 0.64; 95% CI, 0.59–0.70; P < 0.001) (Box 2).

Ratio of SRRs

The reduction in the proportion of MSM diagnosed with genital warts associated with the vaccination period was not significantly different for Indigenous and non-Indigenous men (Box 2).

Sensitivity analysis

The results of the sensitivity analysis were qualitatively similar to those of the primary analysis. Trend results were attenuated by the reduced time frame and need to be interpreted with caution, but there was no significant downward trend in rate during the pre-vaccination period. SRRs were similar to those in the primary analysis, but were influenced slightly by the reduced time frame (online Appendix, tables 4 and 5).

Discussion

We found that there have been marked declines since the introduction of the national HPV vaccination program in the proportions of Indigenous and non-Indigenous women under 21 attending sexual health clinics for the first time who are diagnosed with genital warts. The decline for Indigenous women under 21 was higher than for non-Indigenous women of the same age. Marked decreases were also found for young Indigenous heterosexual men and non-Indigenous heterosexual men of all ages. The decline in heterosexual men is probably due to herd protection, as it is too early to expect any substantial direct effect of the vaccination of boys. The declines in the proportions of diagnoses in older Indigenous men were not statistically significant, probably because of the small number of patients in this group (online Appendix, table 2).

The reductions in the proportions of Indigenous and non-Indigenous young people attending sexual health clinics diagnosed with genital warts are remarkable; in recent times, very few interventions have achieved such dramatic declines in an STI, with the exception of donovanosis.16 While the number of genital warts diagnoses has been declining since 2007, those of chlamydia has been increasing. Data from the Australian Collaboration of Coordinated Enhanced Sentinel Surveillance study, which includes the same clinics as our study, reported that the proportion of Indigenous women attending these clinics who were chlamydia-positive had risen from 14.4% in 2006 to 19.8% in 2011 (for trend, P = 0.01); the rate in young Indigenous men was stable (2006, 15.8%; 2011, 16.2%; P = 0.23).21

We found no significant difference between the rates of decline in genital wart diagnoses in Indigenous and non-Indigenous women — except among those under 21, for whom the decline was greater among Indigenous women — nor between those for Indigenous and non-Indigenous heterosexual men or MSM. In contrast, data from the HPV vaccination catch-up program for Indigenous women in Queensland and Northern Territory indicated that coverage rates were lower among Indigenous women than non-Indigenous women in Queensland, particularly for the third dose; in the Northern Territory in 2011, however, completion rates for the three doses were similar for the two populations.22 The clinics included in our study included only a subset of Indigenous people in each state and territory, so it is possible that some differences may have been masked.

The proportion of MSM diagnosed with genital warts declined significantly among non-Indigenous but not among Indigenous patients. MSM presumably do not benefit from the herd protection achieved by the HPV vaccination program, and the decline in the diagnosis rate among non-Indigenous MSM is probably explained by the increasing number of MSM seen at sexual health clinics in the past decade (Appendix, table 3). MSM have been encouraged to attend sexual health clinics more frequently for asymptomatic screening, whereas asymptomatic Indigenous men have always been a priority population.23

This study has several strengths. First, it is the first to examine trends in the diagnoses of genital warts in Indigenous people attending sexual health clinics. Second, these data come from a national surveillance network with wide geographic coverage. Third, retrospective data were available, so we could compare the number of diagnoses of genital warts during the vaccination and pre-vaccination periods. There are three main limitations to our study. First, it was an ecological study, and the falls in the proportions of clinic patients diagnosed with genital warts cannot be directly attributed to the HPV vaccination program. However, the sudden fall in diagnosis rates after its commencement and the dose–response relationship (that is, the number of diagnoses of genital warts fell as the number of people vaccinated increased) support a causal association. Second, the Indigenous patients included in our study are not representative of all Indigenous people because sexual health clinics see patients who are at higher risk of STIs than the general population;24 for some states a smaller proportion of Indigenous people was included, so that there may be local differences; and many Indigenous people receive health care from the Aboriginal and Community Controlled Health Services and other primary health services.25 Third, the numbers of patients in some groups were small, so that the 95% CIs for trends and SRRs were wide.

Current levels of HPV vaccination coverage among young Indigenous Australians of vaccine-eligible age are providing them with the same benefit as non-Indigenous Australians, closing the gap with respect to genital warts in young women. Older Indigenous women still have disproportionately high rates of cervical pathology and cancer, so that cervical cancer screening coverage for these women should be increased. Sustaining high HPV vaccination rates and monitoring coverage in Indigenous communities should also close the gap for cervical and other HPV-related cancers.

Box 1 –
Proportion of Indigenous and non-Indigenous Australian-born women diagnosed with genital warts at first visit to a sexual health clinic, 2004–2014*

* The vertical lines indicate the start of the HPV vaccination programs for girls (2007) and boys (2013).

Box 2 –
Average annual trends in the diagnosis of genital warts at 39 Australian sexual health clinics, with summary rate ratios (SRRs), 2004–2014

Sex

Age (years)

Indigenous status

Pre-vaccination period (2004–2007)

Vaccination period (2008–2014)

Vaccination v pre-vaccination

SRR ratio, non-Indigenous v Indigenous patients^‡

Average annual trend (95% CI)*

SRR (95% CI)^†

Women

12–20

Indigenous

1.18 (0.93–1.49)

0.16

0.69 (0.52–0.92)

0.010

0.12 (0.07–0.21)

< 0.001

non-Indigenous

1.04 (0.99–1.1)

0.14

0.69 (0.64–0.74)

< 0.001

0.21 (0.19–0.24)

< 0.001

1.72 (1.02–2.91)

0.043

21–30

Indigenous

0.87 (0.66–1.13)

0.30

0.84 (0.73–0.96)

0.010

0.41 (0.27–0.61)

< 0.001

non-Indigenous

1.01 (0.98–1.05)

0.45

0.80 (0.78–0.83)

< 0.001

0.43 (0.40–0.46)

< 0.001

1.05 (0.69–1.59)

0.83

> 30

Indigenous

1.01 (0.75–1.37)

0.94

1.07 (0.93–1.24)

0.33

0.84 (0.51–1.36)

0.47

non-Indigenous

1.03 (0.96–1.10)

0.40

0.98 (0.95–1.01)

0.14

1.05 (0.94–1.16)

0.39

1.25 (0.76–2.06)

0.38

Men

12–20

Indigenous

1.73 (1.10–2.71)

0.017

0.78 (0.61–1.01)

0.057

0.25 (0.12–0.49)

< 0.001

non-Indigenous

1.14 (1.02–1.26)

0.019

0.71 (0.66–0.77)

< 0.001

0.33 (0.28–0.39)

< 0.001

1.34 (0.66–2.74)

0.42

21–30

Indigenous

1.33 (0.92–1.94)

0.13

1.02 (0.88–1.18)

0.80

0.56 (0.35–0.90)

0.016

non-Indigenous

1.01 (0.98–1.05)

0.47

0.83 (0.82–0.85)

< 0.001

0.60 (0.56–0.63)

< 0.001

1.06 (0.66–1.69)

0.82

> 30

Indigenous

1.22 (0.86–1.74)

0.26

0.88 (0.78–0.99)

0.040

0.67 (0.42–1.08)

0.10

non-Indigenous

0.93 (0.89–0.97)

0.001

0.97 (0.95–0.99)

0.008

0.83 (0.78–0.89)

< 0.001

1.24 (0.77–2.01)

0.38

MSM

All

Indigenous

0.77 (0.48–1.24)

0.28

0.88 (0.75–1.02)

0.09

0.74 (0.40–1.36)

0.33

non-Indigenous

0.96 (0.90–1.02)

0.205

0.88 (0.85–0.90)

< 0.001

0.64 (0.59–0.70)

< 0.001

0.87 (0.47–1.61)

0.66

MSM = men who have sex with men; SRR = summary rate ratio. * Average annual change in notification rate, based on univariate Poisson models with diagnoses as dependent variable and calendar year as independent variable. † Vaccination v pre-vaccination period SRR, based on univariate Poisson models with diagnoses as dependent variable and vaccination period as independent variable. ‡ Ratio of SRRs, based on Poisson models with diagnoses as dependent variable and with Indigenous status and vaccination period and associated interaction term as independent variables. Results may differ when calculated directly from table SRRs because of rounding.

Box 3 –
Proportion of Indigenous and non-Indigenous Australian-born men diagnosed with genital warts at first visit to a sexual health clinic, 2004–2014*

* The vertical lines indicate the start of the HPV vaccination programs for girls (2007) and boys (2013).

Box 4 –
Proportion of Indigenous and non-Indigenous Australian-born men who have sex with men diagnosed with genital warts at first visit to a sexual health clinic, 2004–2014*

* The vertical lines indicate the start of the HPV vaccination programs for girls (2007) and boys (2013).

The time is now to act on inequalities

PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY

An appropriate response from Australia and its new Health Minister to the health problems our country is confronting would start with a goal-based strategic approach to inequality and the injustice and health disadvantage that travels with it.

Many social and political analysts agree that inequality has manifested itself as an immense force in recent elections, including the vote on Brexit and the elevation of Donald Trump. The core temperature in the social volcano reached a critical level as workers’ wages froze while top executives received ever more millions. Now the volcano has erupted. A period of prolonged social unrest and loss of confidence in political structures is predicted.

At the World Economic Forum in Davos, Switzerland last month, inequality received unusual attention. The Forum is traditionally for high-flying business magnates, princes of the financial world and others who have benefited immensely from recent decades of global economic progress. But this year the glitterati, as they checked their ski bindings, nervously added inequality to their agenda. Inequality they ranked as “the most important trend likely to determine development across the world over the next decade”.

Now inequality may seem remote from us, our patients and the health of our communities but it may be closer than we think. Life expectancy and quality of health and life depend on life opportunities being relatively equal. Inequality is a powerful risk factor and as UK (nee Australian) epidemiologist Michael Marmot has shown and spoken forcefully in his 2016 ABC Boyer Lectures, can outweigh even smoking as a damage to health.

Hear the rumble in the mountain and be afraid

Voices urging health professionals to heed the rumbles deep in the mountain include those of Marmot and Flinders University’s Professor Fran Baum. And thank goodness that to an extent we have done so. The Aussie “fair go” has contained the avarice of economic fundamentalists who would turn the torch of unfettered market forces on everything. And so Australia retains Medicare, public education and social welfare programs that mitigate potential catastrophes and life-long loss of opportunity. With the exception of Indigenous health, our social gradients in life expectancy are not savage although far from top drawer compared, say, with Scandinavia.

What to do?

We can analyse the statistics and note the extent of inequality and its effects, but it is quite another to work out what we might do about it.

A recent article in the BMJ by Kate E Pickett and Richard G Wilkinson, epidemiologists at York University, reflected on the agitation on the Davos ski slopes. Inequality, they observed, “during the 20th century in most rich countries fell almost continuously from the 1930s to the 1970s but then increased dramatically from the 1980s”.

So presumably the deeply troubling levels of inequality that are driving current unrest can be undone. As John Kennedy observed, man-made problems are generally amenable to man-made solutions.

Pickett and Wilkinson remind us that the late Tony Atkinson, an economist and activist who spent his lifetime concerned about inequality, identified several actions relating to taxation and minimum wages that he calculated could help. So good minds have been at work.

Marmot has written extensively on what might be done about inequalities. His reports, built on a strong base of evidence, focus on six areas for action:

Give every child the best start in life;
Enable all children, young people and adults to maximise their capabilities and have control over their lives;
Create fair employment and good work for all;
Ensure healthy standard of living for all;
Create and develop healthy and sustainable places and communities; and
Strengthen the role and impact of ill-health prevention.

“Delivering these policy objectives,” he writes, “will require action by central and local government, the [national health authority], and the private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.”

Conceivably many of us can do a bit about several of these goals. A big challenge demands a big response and an imaginative and creative political push. It’s ages since we had a national health policy that made you stop and think with its depth and challenge. Let’s help make it happen.

Aboriginal and Torres Strait Islander People Have the Solutions to Close the Gap

AMA PRESIDENT DR MICHAEL GANNON

We continue to be handed myriad government reports on Indigenous affairs and hear well-meaning words spoken by our political leaders. But, in 2017, we still see governments fail to deliver on their commitments to improve the health and wellbeing of Aboriginal and Torres Strait Islander people.

The 9^th Closing the Gap report, handed down in Parliament House by Prime Minister Malcolm Turnbull on 14 February, reflects the inadequacy of government performance against their own commitment to close the gap in health and life expectancy between Indigenous and non-Indigenous Australians. Whilst there have been some encouraging gains in health and educational outcomes over recent years, the gap in health and life expectancy between Indigenous and non-Indigenous remains wide.

Discouragingly, only one of the Government’s seven Closing the Gap targets is on track to being met.How much longer do Aboriginal and Torres Strait Islander people in Australia have to live in disadvantage? How much longer do they need to be sicker and die younger than their non-Indigenous peers? Australia must and can do better.

Positive progress can be made if governments work directly with Aboriginal and Torres Strait Islander people, and better understand the approaches that work in their own communities. Aboriginal and Torres Strait Islander people have long called for, and continue to call for, structured engagement with governments and involvement in decision-making. The AMA recognises the importance of self-determination and fully supports Aboriginal and Torres Strait Islander people in wanting to take charge of their own lives.

Governments must recognise and value the knowledge and expertise that Aboriginal and Torres Strait Islander people have. They must understand that Indigenous people have the solutions and the expertise to deliver. This was made clear in the lead-up to the release of the Closing the Gap report, when Aboriginal and Torres Strait Islander leaders presented the Prime Minister with the Redfern Statement – a statement that calls on governments to better engage with Aboriginal and Torres Strait Islander Australians, and contains the solutions to improving health and life outcomes for Indigenous people.

The AMA considers that the current Parliament has an unprecedented opportunity to work closely with Indigenous people and meaningfully address the disadvantage that Aboriginal and Torres Strait Islander experience. The AMA urges the Government, opposition and minor parties to take note of the Redfern Statement and ramp up their efforts to achieve health equality for Aboriginal and Torres Strait Islander people and take further steps in building on existing platforms.

The AMA, along with many others working in Indigenous health, has been campaigning for long-term funding and commitments from government to improve the health and wellbeing of Aboriginal and Torres Strait Islander people. We will continue our advocacy to help achieve this goal.

We must find a way to celebrate Indigenous advancement where there is evidence of real improvement. Some gaps remain because of equivalent improvements in the health of non-Indigenous Australians. It is important to avoid a nihilism about Aboriginal and Torres Strait Islander affairs. We must never consign these issues to the ‘too hard’ basket and we risk that if we do not carefully appraise measures that are working and acknowledge them.

But having only one single Closing the Gap target on track is truly disheartening, and frustrating for Aboriginal and Torres Strait Islander people when their solutions are being ignored. It is imperative that the Prime Minister and his Government act urgently so that we can finally begin to see genuine improvements in health and life outcomes for Aboriginal and Torres Strait Islander Australians.

The AMA Indigenous Medical Scholarship Becomes Tax Deductible

The number of Aboriginal and Torres Strait Islander people attending university is sharply increasing; and more Indigenous people are choosing to study medicine.

There are now well over 200 Indigenous doctors practicing medicine across Australia, but barriers remain that prevent many Aboriginal and Torres Strait Islander people from completing a medical degree. Factors, such as cultural differences, racism, high expectations, financial hardship, and lack of academic support all play a role in preventing students from realising their dream of being a medical professional.

The AMA has a scheme in place to support more Indigenous students to pursue their dream of becoming a doctor – the Indigenous Medical Scholarship. Each year, the AMA offers a Scholarship to an eligible Aboriginal or Torres Strait Islander student, providing financial support for the full duration of a medical degree.

Since its inception in 1994, the Indigenous Medical Scholarship has helped more than 20 Indigenous men and women become doctors, many of whom may not have otherwise had the financial resources to study medicine. Despite this success, the AMA hopes to expand the number of Scholarships on offer each year to meet the increasing demand for the Indigenous Medical Scholarship. The number of applicants for the Indigenous Medical Scholarship is increasing each year, and we expect this this to increase even more in the future.

It can cost between $10,400 and $15,000 to attend one year of university to study medicine and students typically undertake four to six years to complete their degree to become a registered medical practitioner.

There is evidence that Aboriginal and Torres Strait Islander people have improved health outcomes when they are treated by Indigenous doctors and health professionals. Indigenous doctors have a unique ability to align their clinical and sociocultural skills to improve access to services, and provide culturally appropriate care for Aboriginal and Torres Strait Islander people. Yet, Aboriginal and Torres Strait Islander doctors comprise less than 1 per cent of the entire medical workforce.

The AMA is seeking contributions towards the Indigenous Medical Scholarship to increase our support for Indigenous medical students, and to help grow the Indigenous medical workforce. All contributions can be claimed as a tax deduction.

By supporting an Indigenous medical student throughout their medical training, you are positively contributing to improving health outcomes for Aboriginal and Torres Strait Islander people.

If you are interested in making a donation to the Indigenous Medical Scholarship, please contact Ms Sandra Riley at the AMA via email at indigenousscholarhip@ama.com.au or phone (02) 6270 5400.

Further information about the Indigenous Medical Scholarship can also be found online at: advocacy/indigenous-peoples-medical-scholarship.

The Scholarship was established in 1994 with a contribution from the Australian Government.

The AMA would like to acknowledge the contribution of the Reuben Pelerman Benevolent Foundation and also the late Beryl Jamieson’s wishes for donations towards the Scholarship

DONATE TO THE AMA’S INDIGENOUS MEDICAL SCHOLARSHIP TODAY!

Northern Territory Remote Aboriginal Investment: Oral Health Program—July 2012 to December 2015

This report presents analyses on oral health services provided to Aboriginal and Torres Strait Islander children and adolescents in the Northern Territory under the National Partnership Agreement on Northern Territory Remote Aboriginal Investment. From July 2012 to December 2015, there was generally an increase in the number of Indigenous children and adolescents who received full-mouth fluoride varnish applications, fissure sealant applications, and clinical services. A long-term analysis shows that the proportion of service recipients with experience of tooth decay decreased for most age groups between 2009 and 2015, with the greatest decrease—from 73% to 42%—seen in those aged 1–3.

Northern Territory Remote Aboriginal Investment: Ear and Hearing Health Program—July 2012 to June 2016

This report presents data on the Indigenous children and young people who participated in the audiology, ear, nose and throat (ENT) teleotology and Clinical Nurse Specialist (CNS) services delivered under the National Partnership Agreement on Northern Territory Remote Aboriginal Investment. During 2012–16, 9,221 outreach audiology services were provided to 5,357 children and young people, and 3,799 ENT teleotology services to 2,434 children and young people. A total of 2,612 children participated in the CNS services and presented for 3,085 visits. Of the children and young people who received audiology services in 2015–16, 31% had a hearing impairment.

Incidence of insulin-treated diabetes in Australia, 2015

This fact sheet provides the latest available national data on new cases of insulin-treated diabetes in Australia.It shows that in 2015 there were 28,775 people who began using insulin to treat their diabetes in Australia—63% had type 2 diabetes, 26% had gestational diabetes, 9% had type 1 diabetes and 2% had other forms of diabetes or their diabetes status was unknown.The fact sheet is accompanied by a dynamic data display, which provides data on insulin-treated diabetes by age at first insulin use, Indigenous status, remoteness, SEIFA and state/territory.

Child protection Australia 2015–16

During 2015–16, 162,175 (30.2 per 1,000) Australian children received child protection services (investigation, care and protection order and/or were in out-of-home care). Aboriginal and Torres Strait Islander children were 7 times as likely as non-Indigenous children to have received child protection services. This report also showed that children from geographically remote areas were more likely to be the subject of a substantiation, or be in out-of-home care than those from major cities.

Q&A: Darren Hartnett, 2016 AMA Indigenous Peoples’ Medical Scholarship winner

Image: Former AMA President, Professor Brian Owler, presenting the scholarship to Darren Harnett at this year’s AMA National Conference.

Darren Hartnett is the recipient of the 2016 AMA Indigenous Peoples’ Medical Scholarship. The third year medical student, from the University of Newcastle, spoke to doctorportal about the scholarship, and what it means to be an Indigenous man studying medicine and soon to be working as a medical practitioner.

What’s your background, and what made you decide that you wanted to study medicine?

I have been a registered nurse since the early 90s. I have been working in intensive care, coronary care and emergency departments throughout that time, and found that I wanted to do more, hence the progression in to Medicine

What was your path to medicine?

Apart from Nursing, I enrolled into the pre-medicine course at the University of NSW to see initially if I had the ability to take on study. Also, at the same time, I enrolled in a refresher courses for biology and chemistry to brush up on the basics.

What area of medicine interests you the most?

I still really enjoy critical care, such as intensive care, emergency and anaesthetics, and see myself in those roles in the future if I am lucky enough to be accepted into those areas. In saying that, I also really enjoy the rural areas as well, so a combination of the two would be perfect for me in the future.

How did the AMA Indigenous Peoples’ Medical Scholarship help you in your studies?

Enormously! While studying medicine, I have had to work to support myself. The scholarship has lightened the load in that respect, and enabled me to focus more on studying. It enabled me to travel to Broken Hill and Menindee this year to spend time in a remote area where the indigenous population is higher to see what effect distance had on specialist treatment. Some of the cultural experiences that I had I will never forget; it was very special.

What advice would you give other Aboriginal and Torres Strait Islander students who are thinking of studying medicine?

Do it! Even if it’s just inquiring about attending a pre-medicine program to see what it’s like, or to actually enrol in a pre-medicine course. All it takes is a phone call or an email to get started.

What has your experience been of being an Indigenous doctor so far? Are there any unique challenges or advantages?

It has been very positive. The support I have been given from the staff at the Wollotuka Institute at the University of Newcastle has been fantastic. From tutoring to mentoring programs, there is always someone there for you if you need a hand. As for challenges, I think the biggest challenge is settling in to the first year, and finding a routine that suits you. After that, it’s great.

How do you think your perspective or your path to medicine has differed as an Indigenous man?

I tend not to look at treating people as individuals, but more as the treating of a community. I always look at how my actions could influence a community in a positive way with regard to healthcare. We are slowly ‘closing the gap’, but now I just want to get out there to do my bit to make a difference.

Applications for the 2017 AMA Indigenous Peoples’ Medical Scholarship close January 31, 2017. Click here for more information.

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Healthy Futures—Aboriginal Community Controlled Health Services Report Card 2016

This report card provides information from about 140 Aboriginal Community Controlled Health Services (ACCHS) providing care to Aboriginal and Torres Strait Islander Australians. During 2014–15 these services saw about 275,000 Indigenous clients who received almost 2.5 million episodes of care.About 228,700 Indigenous Australians were regular clients of ACCHSs, where they received maternal and child health services, chronic disease risk factor prevention, and management services. This report card shows rises in the proportion of clients receiving appropriate processes of care for 10 of the 16 relevant indicators.