Indigenous People | Rights, Vulnerability & Responses Session Code: WEAX03 Session Date: August, 6th 2008 Session Time: 16: :00 Session Room: Room 2 Presenter: Bev Greet | Program Manager, Aboriginal and Torres Strait Islander Health | Marie Stopes International Australia Prepared by: Scott Lockhart | NAPWA

Indigenous People | Rights UN Declaration on the Rights Of Indigenous Peoples | Article 23 Indigenous peoples have the right to determine and develop priorities and strategies for exercising their rights to development. In particular, indigenous peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions. Article Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services. 2. Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.

Human Rights and HIV/AIDS: Now more than ever | Law and Health Initiative Public Health Program, Open Society Institute UN High level meeting on HIV/AIDS (2006) reaffirms that | “the link between HIV/AIDS and marginalized, ‘different,’ or socially ‘deviant’ populations in the collective consciousness has been strong from the beginning. Hence the public health and human rights question: Which would be more effective – further repression of marginalized populations, or working with them in a way that respects their rights and dignity? Joanne Csete, 2005 “the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV/AIDS pandemic” And the “Realization of human rights and fundamental freedoms for all is essential to reduce vulnerability to HIV/AIDS”. -United Nations General Assembly Special Session on HIV/AIDS, Declaration of Commitment on HIV/AIDS, para. 58

Indigenous People | Vulnerability Indigenous Australia | Important differences between Indigenous people and the total population of newly diagnosed HIV infection over the ten-year period – in terms of age at diagnosis and exposure categories. The median age of diagnosis of HIV among Indigenous people was 30 years compared with almost 33 years for the total population. In contrast to the total population, for which less than 8% of diagnoses of HIV occurred in females, more than 31% of cases reported among Indigenous people occurred in females. Infection was acquired by heterosexual contact in 39% of cases among Indigenous people and in only 11% of cases among the total population. Male homosexual contact was responsible for 77% of cases in the total population and for 36% in the Indigenous population, and male homosexual contact with injecting drug use for 4% and almost 11% respectively. Injecting drug use without male homosexual contact was responsible for 4% of cases in the total population and for more than 12% in the Indigenous population. National Centre in HIV Epidemiology and Clinical Research (2004) 2004 annual surveillance report: HIV/AIDS, viral hepatitis and sexually ransmissible infections in Australia. Sydney: National Centre in HIV Epidemiology and Clinical Research

Indigenous People | Vulnerability Indigenous Australia | For rural and remote Indigenous communities, detection, prevention and treatment of HIV is dependent on social, cultural and geographical factors. Fear of breach of confidentiality is an issue in dealing with HIV/AIDS generally, not just with Indigenous people. There are cultural sensitivities surrounding the discussion of HIV prevention within Indigenous communities Resources that are culturally appropriate are important for achieving improved access to appropriate health care information for indigenous people. Community infrastructure is often limited and access to general health care, hospitals and specialist care may be restricted. Treatment of a patient within their community may not always be possible.

HIV Diagnosis, 2002 – 2006, by Aboriginal and Torres Strait Islander status and HIV exposure category | Aboriginal and Torres Strait IslanderNon-Indigenous Source: NCHECR Annual Surveillance via State and Territory health authorities

Indigenous People | Vulnerability Indigenous Australia | Unacceptably high rates of bacterial sexually transmitted infections are still being detected in a number of communities. The rate of newly diagnosed hepatitis C infection in Aboriginal and Torres Strait Islander population increased…whereas the rate remained stable in the non-indigenous population. Among Aboriginal and Torres Strait Islander people, the percentage of HIV infections attributed to injecting drug use increased from 5% in 1992 – 1998 to 18% 2002 – (Remains stable in non-indigenous population) …there is little information regarding the burden of disease within these jurisdictions that have the highest populations of Aboriginal and Torres Strait Islander people. Higher rates of some sexually transmitted infections and blood borne viruses occur among Aboriginal and Torres Strait Islander people than among non- indigenous people. This discrepancy has the potential to impact on already excess levels of morbidity and mortality experienced by Aboriginal and Torres Strait Islander people. Blood borne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: NCHECR Surveillance Report 2007

Indigenous People | Vulnerability Indigenous Australia | Although Australia is one of the healthiest populations in the developed world, it has failed to make substantial improvements in health for Aboriginal and Torres Strait Islander populations. Life expectancy for Aboriginal and Torres Strait Islander peoples is some 20 years for males and 19 years for females - below that of other Australians. Within Aboriginal and Torres Strait Islander communities there is significantly higher prevalence of disease such as diabetes, hypertension and a range of communicable diseases (ABS). Morrissey 2003 concluded that, indigenous Australians are, on average, extremely poor compared to the Australian population. However, the indigenous mortality gap remains “out of all proportion to the income gap” Morrissey argues that “poverty is not an infection or an environmental contaminant, but a social process”. Social factors such as access to adequate income, education and employment combine with health risk factors such as; lack of housing, adequate nutrition and a pervasiveness of loss and grief and other factors such as; a lack of basic environmental health infrastructure including; adequate sanitation, water supplies and appropriate housing. Australian Health Ministers’ Advisory Council’s Standing Committee on Aboriginal and Torres Strait Islander Health Working Party (Comprising the Northern Territory, Queensland and South Australia, March 2004

AIDS incidence, 1995 – 2004, by Indigenous status and year | Source: State and Territory health authorities

Indigenous People | Responses Australian response | The health system, overall, does not provide the same level of care to treat illness for Aboriginal and Torres Strait Islander Peoples and is so culturally inappropriate or inadequately resourced that their needs cannot be met. Barriers include: Poor linkages and co-ordination across the health care system Socio-economic barriers (cost of health care and, treatments) Poor access and distribution of services Health care provider attitudes and practice and communication issues Cultural and identity A younger and more mobile population Shame and historical factors associated with treatment for sexually transmitted infections Australian Health Ministers’ Advisory Council’s Standing Committee on Aboriginal and Torres Strait Islander Health Working Party (Comprising the Northern Territory, Queensland and South Australia, March 2004

Indigenous People | Responses Australian response | Australian Indigenous HealthInfoNet details a number of HIV/AIDS interventions – suggesting that: Interventions should be integrated into health education programs as high risk behaviours can increase susceptibility to HIV/AIDS. Building networks and partnerships in the area of HIV/AIDS is essential for successful outcomes The inclusion of indigenous workers and peers is important for successful program outcomes consultation and planning as well as the implementation of culturally-appropriate strategies

Indigenous People | Responses Background: The ‘Positive Aboriginal and Torres Strait Islander Network’ (PATSIN) was formalised in June 2003 at a meeting in Adelaide. Its Associate Membership with NAPWA was endorsed by a Special Resolution of the NAPWA membership in Cairns in October PATSIN is the formalization of a supportive Aboriginal and Torres Strait Islander HIV positive network that has existed as long as the epidemic in Australia. Rationale PATSIN recognizes the diversity of the lived experience of Aboriginal and Torres Strait Islander people and undertakes to provide culturally valid representation, advocacy, peer support and information sharing among all Aboriginal and Torres Strait Islander HIV+ people. PATSIN Vision Statement: Aboriginal & Torres Strait Islander HIV positive peoples, providing representation and advocating on behalf of Aboriginal & Torres Strait Islander HIV positive peoples.

Indigenous People | Responses Terms of Reference: PATSIN seeks to do its work through a consensus-orientated process where discussion continues until everybody is satisfied with the result - not just the majority. PATSIN: Advocates for HIV positive Aboriginal and Torres Strait islander people Represents HIV positive Aboriginal and Torres Strait islander people: locally nationally and globally. Promotes culturally valid care & support with Aboriginal and Torres Strait Islander peoples and communities. Promotes equitable access to current treatment and treatments information. Promotes and develops Aboriginal and Torres Strait Islander peer support networks. Promotes and works to the development of culturally valid resources and education for Aboriginal and Torres Strait Islander people. Works in a collaborative and cooperative manner with key stakeholders to develop and strengthen partnerships and networks. Empowers HIV positive Aboriginal and Torres Strait Islander people to non- violent action toward equity and justice.

Indigenous People | Responses