Ward James, Costello-Czok Michael, Willis Jon, Saunders Mark, Shannon Cindy
AIDS Educ Prev. 2014 Jun;26(3):267-79. doi: 10.1521/aeap.2014.26.3.267.
Indigenous people globally remain resilient yet vulnerable to the threats of HIV. Although Australian Aboriginal and Torres Strait Islander peoples experience the worst health status of any identifiable group in Australia, with a standardized morbidity rate three times that of non-Indigenous Australians, the Australian response to HIV has resulted in relatively low and stable rates of HIV infection among Australia's Indigenous peoples. This paper examines the reasons for the success of HIV prevention efforts. These include early recognition by Indigenous peoples of the potential effect that HIV could have on their communities; the supply of health hardware (needle and syringe programs and condoms); the development and implementation of culturally-appropriate health promotion messages such as the internationally-recognized Condoman campaign; the inclusion of dedicated Aboriginal and Torres Strait Islander Sexual Health Workers in communities; and an inclusive policy and partnership approach. Furthermore, the efforts of peak Aboriginal health organizations including NACCHO and its member services and Indigenous programs in peak mainstream organizations like AFAO and its member organizations, have all contributed to prevention success. Efforts need to be maintained however to ensure an escalated epidemic does not occur, particularly among heterosexual people, especially women, and people who inject drugs. New ideas are required as we enter a new era of HIV prevention within the context of the new paradigm of treatment as prevention, and getting to zero new infections.
全球范围内的原住民在面对艾滋病毒威胁时,依然坚韧却也易受伤害。尽管澳大利亚原住民和托雷斯海峡岛民的健康状况在澳大利亚所有可识别群体中最为糟糕,其标准化发病率是非原住民澳大利亚人的三倍,但澳大利亚对艾滋病毒的应对措施使得该国原住民中的艾滋病毒感染率相对较低且稳定。本文探讨了艾滋病毒预防工作取得成功的原因。这些原因包括原住民对艾滋病毒可能对其社区产生的潜在影响的早期认识;卫生用品(针头和注射器项目以及避孕套)的供应;制定并实施符合文化特点的健康促进信息,如国际认可的“安全套侠”运动;在社区中纳入专门的原住民和托雷斯海峡岛民性健康工作者;以及采取包容性的政策和伙伴关系方法。此外,包括全国原住民社区控制卫生组织(NACCHO)及其成员服务机构在内的主要原住民健康组织,以及诸如澳大利亚艾滋病组织联盟(AFAO)及其成员组织等主流组织中的原住民项目所做的努力,都对预防工作的成功起到了推动作用。然而,仍需持续努力以确保不会出现疫情升级的情况,尤其是在异性恋人群中,特别是女性以及注射吸毒者当中。随着我们在“治疗即预防”这一新范式以及实现零新增感染的背景下进入艾滋病毒预防的新时代,需要有新的理念。