Are we winning against STIs?

hiv-1903372_1280Image by Darwin Laganzon from Pixabay 

by Grant J Everett

Australia is a signatory to the United Nations’ Sustainable Development Goals, which means our country has agreed that sexual and reproductive health and their associated rights are central to achieving health and gender equity by 2030. According to Associate Professor Deborah Bateson, Medical Director of Family Planning NSW, this promise is composed of many parts. For instance, Australia is using a multi-pronged approach to combating STIs, and the numbers show that our tactics are having an effect. Since the introduction of the HPV vaccine in 2007, Australia has seen a significant decline in the spread of genital warts. Since 2007 there has been an enormous 92% drop in its contraction rate among females and males below the age of 21, putting us on course to be a global leader in the elimination of HPV-related diseases (Bateson, 2019). 

Falling through the cracks

Not everyone is experiencing the benefits of new vaccines and other treatments. Women from very remote regions and from the lowest socio-economic groups are far less likely to be screened for STIs, and the mortality rate among Aboriginal and Torres Strait Islander women is subsequently four times that of non-Indigenous women. STI-related diseases among Aboriginal and Torres Strait Islander people demands urgent attention. According to Professor Bateson: “Enhancing the availability of reliable, cost-effective, point-of-care STI tests is particularly relevant for regional and remote Australia. The significant burden of STI-related disease among Aboriginal and Torres Strait Islander people…demands urgent attention…new (HIV) diagnoses in the Aboriginal and Torres Strait Islander population increased by 41% compared with a decline of 12% in the non-Indigenous population between 2013 and 2016.” 

These vulnerable groups are also much less likely to have access to effective birth control, such as long acting reversible contraception like implants and intrauterine devices. While the use of long acting reversible contraception has sharply increased in Australia, we are still lagging behind other high income countries.

By the end of 2017, 36.9 million people were living with HIV worldwide. 21.7 million were receiving antiretroviral treatment. 

Pre-Exposure Prophylaxis (PrEP)

In the field of HIV infection, enhanced diagnosis methods and effective antiretroviral treatments have made a dent in new cases of the disease over the years. According to Professor Rebecca Guy, head of the Kirby Institute’s Surveillance, Evaluation and Research Program, there were 963 new cases of HIV in Australia in 2017, compared to 2,412 in 1987 (the peak of the epidemic), and there’s been a 7 per cent decline in HIV acquisition rates over the past 5 years. This is still a very high figure  given the enormous investment of work and money that has gone into preventive education, and there is yet to be a “magic bullet” for HIV. 

The recent listing of Pre-Exposure Prophylaxis (PrEP) on the Pharmaceutical Benefits Scheme (PBS) in April 2018 is projected to have a significant impact on the HIV epidemic. PrEP involves the regular use of HIV medications by HIV-negative people to prevent HIV acquisition. People at high risk of HIV are now eligible for PrEP under the PBS in Australia, including sexually active gay and bisexual men, the transgender community, heterosexual people with a HIV positive partner, as well as other high risk population groups. Research shows PrEP medication is highly effective at preventing HIV transmission, making it an important new tactic in HIV prevention, and alongside existing treatments and preventions PrEP will support Australia in ending HIV transmission for good.

PrEP is thought to have already reduced new infections over the last few years, particularly in men who have sex with men. However, there has been a decrease in consistent condom use among gay and bisexual men since the introduction of PrEP: “The decrease in consistent condom use…since the introduction of PrEP has (also) led to an increase in the burden of bacterial sexually transmissible infections.” (Bateson)

Chlamydia remains the most common STI, with three-quarters of cases occurring in young people aged 15–29. Most infections have no symptoms, but if left untreated can result in serious complications, including pelvic diseases and infertility. The rate of antibiotic-resistent gonorrhoea infections is also increasing. 

Take home message: if you are sexually active or planning on becoming sexually active, stopping the spread of STIs is your concern. Speak to your GP to learn how you can help. 

Sources and further reading: 

“Sexual, reproductive health and rights: how are we doing?” Cate Swannell, Med J Aust, 24th of March 2019

“The Guttmacher–Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?” Deborah J Bateson, Kirsten I Black and Shailendra Sawleshwarkar, Med J Aust,1st of April 2019

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