19. INFECTIOUS SYPHILIS ELIMINATION FOR ABORIGINAL PEOPLE IN NSW: CHALLENGES AND OPPORTUNITIES

Abstract

Elimination of syphilis within Aboriginal communities is one of the stated goals of the NSW Sexually Transmissible Infections Strategy 2006-2009. In 2007, a project was undertaken to inform strategy development to achieve the goal of elimination of infectious syphilis in Aboriginal communities.

Australian and international literature on elimination strategies for syphilis, STIs and other diseases was reviewed. Surveillance data were accessed through the National Notifiable Diseases Surveillance System and NSW Notifiable Disease Database and analysed to describe the current burden of disease. Key informants were consulted for advice on elimination strategies for infectious syphilis for Aboriginal people and possible barriers to the goal.

Infectious syphilis notifications for Aboriginal people have decreased significantly from 64% of all infectious syphilis cases in 1995 to 3% in 2006. For the rest of the population notifications have increased. Changes in male to female ratios and an increase in metropolitan notifications have been noted in recent years. Improvements in recording of Aboriginality information for infectious syphilis in NSW have allowed greater confidence in interpreting these trends. The role of accurate and complete surveillance information will play an important role in planning and directing the implementation of interventions to achieve the goal of syphilis elimination for Aboriginal people in NSW.

Challenges to the goal of elimination and the feasibility of a disease elimination strategy specific for Aboriginal people include issues of access to services for testing, diagnosis and treatment; cross-border mobility of Aboriginal people; prevalence of syphilis in the wider community; and continued access to accurate information. Lessons learned from international and Australian elimination strategies; burden of disease information; definition of elimination and target rates; challenges and strategies for achieving the goal of syphilis elimination and will be discussed.