Men's Business and women's business: Indigenous sexual Health

For Indigenous Australians, sexual health is closely linked to wellbeing, which is itself a cultural, emotional, and spiritual experience. The need for a culturally sensitive conceptual framework for managing Aboriginal health was first recognised in 1989, in the National Aboriginal Health Strategy (National Aboriginal Health Strategy Working Party 1989). This also underpinned the National Indigenous Australians’ Sexual Health Strategy, written in 1997 in response to concern about the potential impact of HIV on Aboriginal and Torres Strait Islander communities (ANCARD Working Party of Indigenous Australian’ Sexual Health 1997). History
demonstrated the profound effect that such infections can have on Indigenous populations. Among the many devastating diseases that Europeans brought to Australia were venereal diseases. Syphilis and gonorrhoea spread rapidly through the Aboriginal populations, causing high levels or mortality and infertility (Broome 1994). By 1840, syphilis was widespread in the southeastern states and was spreading ahead of the frontier (Dowling 1997).

Indigenous Australians, particularly those living in remote communities, continue to suffer from disproportionately high levels of STIs (Burns et al 2004, Saggers et al, 2005; Stark 2007, Ward 2011, Kirby Institute 2012). For example, in 2007, the STI rates among NT’s Indigenous youth aged 15-24 were up to 120 times higher than their non-Indigenous counterparts (NT GOV 2008). These levels of infection have been a
focus of concern by state, territory and federal governments since the advent of HIV/AIDS (Rowse 1996). Indigenous populations were defined as being ‘high risk’ of the disease (Burns et al 2004) and were, and continue to be, subjected to a range of interventions to combat STIs in general, and HIV/AIDS in particular. Unlike other population groups, such as the gay community (Lupton 1994), there has been very little attention paid to the implications and the potential stigma of Aboriginal groups being defined in such a way. Rather, the emphasis has been, with some exceptions, on the development of public health interventions, screening and contract tracing, where considerations of informed consent, counselling, and ensuring confidentiality appeared in some cases to have been overridden by the sense of crisis (Nangala 1992).

The predicted epidemic of AIDS in Aboriginal populations has not eventuated, although it still remains a frightening possibility. Rates of HIV infection in the Indigenous populations remain similar to those in the non-Aboriginal populations (Ward et al, 2010, Kirby Institute 2012), although there are major differences in the way that HIV is acquired with more cases attributed to heterosexual contact and injecting drug use (Ward et al 2010). Rates of other STIs, with the exception of Donanvanosis (Kirby Institute 2012) have proved to be resistant to improvement, despite the range of public health interventions. This chapter will examine the barriers to improvement in sexual health in Aboriginal communities, by examining the role of public health, the potential for effective education and the need for a sound understanding of people’s beliefs about the causes of illness and their understanding of sex and relationships.