HIV/AIDS and Sexual and Reproductive Health

The sexual health of young people remains a concern, with 75 percent of all Sexually Transmitted Infections (STIs) in Australia occurring in young people [1] and increasing rates of diagnoses of STIs of young people aged 15 to 29. [2] Aboriginal and Torres Strait Islander people continue to have much higher rates of infection for STIs other than HIV. [3] The increasing rates of STIs in young people can be attributed to a low level of awareness of STIs due to poor sexual education and an unwillingness to seek information about this sensitive issue. This had lead to a low proportion of youths practicing safe sex and accessing testing and treatment sexual health services. As such, the Committee on the Rights of the Child has recommended in their Concluding Observations that Australia:

  • Intensify efforts to provide adolescents with sex education and information on reproductive health; and
  • Improve accessibility to contraception, counselling, and confidential health services particularly amongst Aboriginal and socioeconomically disadvantaged communities.
  • Article 17: A child’s right to have access to information and materials from a diverse range of national and international sources, especially those aimed at promoting his or her social, spiritual and moral well-being and physical and mental health
  • Article 24: Children have a right to access the highest attainable standard, facilities and treatment of health. It should be ensured that no child can be deprived of this right

Positive Developments

NATIONAL: Launch of Central Australian Aboriginal Congress’ new Indigenous youth sexual health education resource package

On 13 June 2013, the Central Australian Aboriginal Congress (CAAC) launched a new Indigenous youth sexual health education resource as part of their Community Health Education Program (CHEP), which providesawareness and education about sexual health to local schools. [4] The resource package, launched in Alice Springs, will include manuals that complement the training provided and enable teachers to feel well prepared and confident in educating young people about sexual health. CHEP will benefit through fun and interactive learning activities.

NATIONAL: CSIRO report finds that Australian sexual health clinics are attracting priority populations

A study conducted by the CSIRO has found that Australian sexual health clinics are fulfilling their mandate required by the Second National Sexually Transmissible Infections Strategy 2010-2013 (National STI Strategy). The National STI Strategy classifies ‘priority populations’ as young people, Aboriginal and Torres Strait Islander people, men who have sex with men and sex workers, [5] with the study confirming that sexual health clinics are attracting higher proportions of priority populations than the rest of the public. [6] Whilst general practitioners are responsible for most of the sexual health care provided in Australia, sexual health clinics are frequently preferred for their specialist expertise, confidentiality and targeted programs. [7]

NSW: It’s your choice, have a voice: rights, respect, responsibility and Staying Strong: Act Connect Survive campaigns

It’s your choice, have a voice: rights, respect, responsibility is a campaign run by the Aboriginal Health and Medical Research Council (AH&MRC). Funded by the NSW Ministry of Health, the creative arts based campaign saw its first phase implemented in August and September 2011. Phase 2 was welcomed with Deadly Days festivals on 4 and 6 September 2012, along with 12 week long workshops in NSW earlier this year. [8] The campaign which uses Facebook as a key media source, aims to help empower and educate young Aboriginal people aged 12-19 years old regarding their choices about their sexual health, alcohol and drugs, and runs events such as hip-hop and music workshops. [9] Ron Jackson, an Aboriginal education officer, attributed the positive response to the campaign to the ease with which the participants could relate to it. This is due to the activities being taught by young people. He commented, “the kids are just totally engaged.” [10]

The campaign itself has reached 4000 young people. Through the inclusion of Facebook, the campaign has also been able to interact with many Aboriginal people who did not participate in the activities; they were able to ‘like’ the page and view the content uploaded. [11] Dina Saulo, AH&MRC Project Officer cited the campaign’s Facebook page as, “a key reason why it was so successful,” [12] particularly as Aboriginal people are well represented on social media sites. Saulo also described it as being, “a great way to let people know where and when the next workshop was going to be.” [13] Following an evaluation in 2012, the campaign was deemed to have met all key performance indicators and funding was renewed for two extra years. [14]
AH&MRC also ran another campaign in 2013, Staying Strong: Act Connect Survive, which worked towards young Aboriginal people’s knowledge about drug use and blood-borne viruses.

NSW: Release of the NSW HIV Strategy 2012-2015

On 1 December 2012, the NSW Ministry of Health released its NSW HIV Strategy 2012-2015, with a goal to virtually eliminate HIV transmission in NSW by 2020. [15] This ambitious first of its kind plan [16] will work towards reducing transmission in the gay community by 60 per cent.

NSW: First pop-up rapid HIV testing site

From 27 November 2013 to 1 December 2013, Australia’s first pop-up rapid HIV testing site was run in Taylor Square, Darlinghurst, offering simple on-the-spot tests that provided results within half an hour. The caravan was manned by trained staff from South Easter Sydney Local Health District and ACON. The innovative approach has resulted in plans to run a similar pop-up testing in Oxford Street ahead of the 2014 Gay and Lesbian Mardi Gras. [17]

QLD: Release of the Queensland HIV Strategy 2013-2015 and founding of the HIV Foundation Queensland

On 5 September 2013, the Queensland HIV Strategy 2013-2015 was jointly released by the Queensland Department of Health and the Ministerial Advisory Committee on HIV/AIDS (MAC HIV/AIDS), with the aim of a 50 per cent reduction in HIV transmission by the end of 2015. [18] The framework’s targets include increasing HIV testing and treatment, increasing awareness and implementing a preventative approach. [19]

On 1 December 2013, the new HIV Foundation Queensland, an organisation dedicated to fighting HIV/AIDS, came into existence. It will be aiding the E.N.D.H.I.V campaign and the Chairman Dr Darren Russell has concluded that the foundation’s more flexible and autonomous role means they are able to do “edgier” [20] things that are “less constrained by government.” [21] The establishment of the foundation also means that it will be in a better position to raise funds for the E.N.D.H.I.V. campaign, whilst providing advice to the government, and facilitating and promoting research. [22]

QLD: Implementation of free rapid HIV testing

From 3 June 2013, the Queensland Department of Health made new free rapid HIV tests available in order to increase voluntary testing as part of the Queensland HIV Strategy. By 1 December 2013, stock was gradually rolled out across Queensland communities. This makes Queensland the first state to have free rapid HIV testing as part of regular clinical practice. The cost of the twenty minute finger-prick test is covered by the MAC HIV/AIDS and encourages at-risk people previously hesitant to undergo current GP tests to be tested earlier. [23] As at the end of November 2013, it had been reported that the rapid tests had already reached 500 untested and most at-risk Queensland residents. [24]

In November 2013, Queensland’s Health Minister, Lawrence Springborg, also announced plans to open an after-hours, peer-based HIV testing clinic in early 2014. [25] The clinic, which will be hosted by Queensland Positive People, will be run by Community HIV Education and Prevention Officers. The free, rapid HIV tests will also be available at nominated GP clinics that are most frequently visited by at-risk people.

VIC: Implementation of free rapid HIV testing

In January 2013, the Victorian government announced their plans to offer Australia’s first rapid HIV testing. The community-based pilot aims to get more people tested and treated sooner via a walk-in service, with results provided within 20 minutes. The Victorian Health Minister, David Davis, hopes that, “by providing affordable, accessible, convenient rapid HIV testing, we can reduce a number of barriers to testing – such as the need to return for results – and provide an incentive to frequent testing by getting results in 20 minutes or less.” [26] Victorian AIDS Council executive director Matt Dixon has also emphasised the importance of rapid testing, agreeing that, “if more guys are getting tested more frequently, we’ll be picking up those new infections before they are transmitted on to another person.” [27] The finger-prick blood test was approved by the Therapeutic Goods Administration in December 2012.

In August 2013, Australia’s first shop front rapid HIV testing site, PRONTO, in Fitzroy, Victoria, was launched. [28] The opening of PRONTO follows a $1.2 million investment by the Victorian government, with the site being run by the Burnet Institute and the Victorian AIDS Council/Gay Men’s Health Centre. It is hoped PRONTO will provide an “alternative option” [29] for testing that is simple and eliminates stigma often associated with testing.

SA: Release of the Sexually Transmissible Infections Plan 2012-2015

In 2012, the South Australian Department for Health and Ageing released the state’s first sexually transmissible infections plan. The three year plan will target priority populations, with young people the key priority group in South Australia. [30] Some of the plan’s objectives include working towards improving access to STI testing services, particularly through primary health care, as well as providing free STI services. [31]

SA: Evaluation of the Focus Schools Program and Aboriginal Focus Schools Program

In South Australia, SHine SA, a non-government sexual health agency, has been running their Focus Schools Program since 2003. The program which is now formally supported in 114 South Australian government schools, [32] provides free professional staff development, intensive training and resource materials for teachers, and a comprehensive Year 8 to 10 curriculum. [33] SHine SA has also adapted this project to cater for Aboriginal youth. As part of the Yarning On program, the Aboriginal Focus Schools Program has been working with 17 South Australian communities, with training occurring in 19 Aboriginal schools. [34] The initiation of the Aboriginal Focus Schools Program has also resulted in Aboriginal-specific resources being produced. [35]

In 2012, a research project commissioned by SHine SA evaluated teachers’ responses to the program and found that 97% of teachers approved of the curriculum as the content was, “relevant, age-appropriate, up to date, well-structured, comprehensive, engaging and practical.” [36] This resulted in more than 90% intensively teaching the curriculum’s key components. [37] The evaluation also found that there was overwhelming support for implementing the curriculum as teachers believed students “needed to know” [38] it in order to make “good decisions” [39] and that it was their right to be sexually healthy. [40]

Developments Requiring Attention

NATIONAL: Utilising the internet and social media to educate young people about sexual health

A theme prevalent throughout the sexual health education community has been a call for better and increased use of the internet and social media in educating young people. A study published in 2013 revealed that the vast majority of health organisations in Australia had not yet begun effectively using social media networks for youth-targeted, health promotion. It also recognised that despite their lower level of trust in the media, young people are more likely to access sexual health information through this source, with the study’s participants agreeing their most common access point was a Google search. The study’s participants also stated that if an online forum on which they could anonymously post their questions to be answered by a health professional was created, they would use it. The study’s participants emphasised the inclusion of humour as a must when communicating a sexual health message, citing humour as being able to overcome any sexual health stigmas and that if a message was too serious, it might not be spread. The study also found the importance of having a static central website for any campaign. A resource sheet released by the Closing the Gap Clearinghouse has warned however, that employing mainstream social marketing strategies cannot ensure reaching or influencing Indigenous communities, [41] which perhaps builds on from the historical distrust many Indigenous Australians have towards ‘mainstream’ health services. [42] The Closing the Gap Clearinghouse instead advised, based on international evidence, that social marketing campaigns be ethnic and age-specific, be informed by research and theory and include messages that empower youth. [43]

NATIONAL: Improving sexual health education in schools

Despite sexual health education being available in Australian schools since the 1970s, a 2012 survey [44] has found that there is a lack of standards in the teaching of the national material. This is due to inconsistent and different curricula across the states and territories and the great variety in range and quality across schools. [45] The situation is further aggravated by the various ethical and religious frameworks that exist in regards to some private and faith-based schools, [46] in addition to those schools that completely do away with providing any sexual health education. [47] The survey emphasised the importance of the role of schools in the provision of sexual health education, citing that all of the young people surveyed thought sexual health education should be included in their schooling. [48] A study in 2011 came to a similar conclusion, finding that young people consider schools as their most trusted source for sexual health information. [49] In addition to identifying schools as a trustworthy source, young people also pointed to youth centres, youth health services and peer education models as being preferred ways to obtain reliable information. [50] Similarly, the delivery of sexual education outcomes is improved when schools engage external organisations and professionals who are dedicated to providing sexual health education. [51] Young people have also expressed their belief that sexual health education should be staggered throughout their schooling, [52] which is consistent with the earlier onset of puberty.

The concern surrounding the inconsistent nature of sexual health education in schools has resulted in multiple calls for improved, effective and mandatory approaches. Family Planning Queensland Director, Holly Brennan, has expressed her thoughts on children having free access to sexuality and relationship education, warning, “if children don’t receive sexuality education they are more at risk of sexual abuse, they are more at risk of unplanned pregnancies, they are more at risk of getting STDs”. [53] Youth Affairs Council of Western Australia CEO Craig Comrie, has also attributed the recent spike in STI cases to the lack of education. Family Planning Western Australia spokeswoman, Rebecca Smith, linked, “lack of education, lack of knowledge about contraception, lack of knowledge about STIs and pregnancy,” [54] to the current epidemic. Australian Medical Association (SA) President, Dr Patricia Montanaro, believes that the responsibility of providing sexual health education should extend beyond school, into the home environment. [55]

Also in need of immediate attention is the failure by the current sexual health programs in schools at addressing the needs of same-sex attracted and sex and gender questioning young people. [56] The 2012 AYAC and YEAH survey has recommended that content in the curriculum be respectful and inclusive of such identifying young people. [57] In the first national survey of Australian teachers who taught sexuality education, same-sex attraction was one of the topics identified by the teachers that they would like to be included. [58] However for many teachers, the topic of same-sex attraction was often avoided due to the lack of training and support provided. [59] This has also been the case for many other health and education practitioners such as youth workers, counsellors and nurses, who were generally not trained in youth sexuality education whilst studying at tertiary institutions. [60]

In light of the above findings and continued calls for more effective approaches, the Australian Curriculum, Assessment and Reporting Authority (ACARA) began conducting a review of the Health and Physical Education syllabi from pre-school to Year 10. In early-mid 2013, ACARA drafted the Foundation to Year 10 Australian Curriculum, with the revised version to be published in late 2013 and its implementation to occur in 2014, [61] although concern has still been raised at the omission of content relating to homophobic bullying and STIs. [62]

Areas Lacking Progress

NATIONAL: Lack of a comprehensive national sexual and reproductive health strategy

In 2008, Sexual Health and Family Planning Australia (SH&FPA) and the Australian Reproductive Health Alliance released a background paper, Time for a National Sexual and Reproductive Health Strategy, calling for the federal government to implement a comprehensive national sexual and reproductive health strategy. However, in the five years since the publication of the paper, the federal government is yet to act on this. Earlier in January 2013, SH&FPA reiterated its position in its pre-budget submission for the 2013-14 financial year. SH&FPA’s submission outlined Australia’s history of sexual and reproductive health policies and concluded that the existing policies are inconsistent with best practice as there is a lack of an integrated approach. [63] Whilst SH&FPA acknowledged that there were national strategies in place that focused on individual diseases such as the Sixth National HIV Strategy 2010-2013, Second National Sexually Transmissible Infections Strategy 2010-2013 and the National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy, it criticised these policies for not addressing sexual and reproductive health as a whole-of-sector issue as well as their failure to link interdependent strategies. [64] In drawing up a national strategy, SH&FPA has suggested that the government aim to support people in acquiring knowledge for good sexual and reproductive health and improve accessibility and affordability to sexual and reproductive health services. [65] It also recommended looking to best practice examples such as those from the Netherlands, where young people are comprehensively educated on sexual health in school and are able to easily access contraception at no or low cost. [66]

Also of national concern is the over-representation of people with disability being affected by sexual and reproductive ill-health. In May 2013, the Disability Special Interest Group within the SH&FPA released a report focusing on improving sexual and reproductive health for people with disability. The report notes the lack of mention of people with a disability in the Second National Transmissible Infections Strategy 2010-2013, [67] and also highlights the uncertainty surrounding disabled people and their sexual rights in light of the implementation of DisabilityCare Australia. [68] Noting that there is no consistent framework within Australia that addresses sexual and reproductive health rights for people with disability, [69] the report advises that policy and practice guidelines need to take into account these rights and the specific needs of people with disability in this area. [70]

WA: Call for more sexual health clinics

Despite the CSIRO’s report on sexual health clinics fulfilling their mandate, [71] recently there has been a call for more sexual health clinics for young people to be opened in Western Australia. [72] Currently there is only one dedicated youth-specific sexual health clinic, Quarry Health Centre, in Western Australia, and there is a waiting list, which is especially concerning given the state has the highest number of young people with STIs. [73]

  • ACARA continue reviewing and implementing the national Health and Physical Education curriculum and ensure that the needs of same-sex attracted and sex and gender questioning young people are addressed by the curriculum.
  • Tertiary education institutions revise qualification requirements to include mandatory training of pre-service primary and secondary teacher candidates in sexual health education.
  • The Federal Government consider developing and implementing a comprehensive national sexual and reproductive health strategy that adopts best practice and interlinks interdependent strategies. The national strategy should also take into account the sexual and reproductive health rights and needs of people with disability.
  • Western Australian government open additional youth-specific sexual health clinics to aid the backlog of cases and work towards reducing the high rates of young people with sexually transmitted infections.
  1. Maia Giordano and Alischa Ross, ‘Let’s Talk About Sex: Young People’s views on sex and sexual health information in Australia’ (Joint Report, Australian Youth Affairs Coalition and Youth Empowerment Against HIV/AIDS, June 2012) 6
  2., accessed 27 November 2013
  3. Ibid.
  4. Central Australian Aboriginal Congress, ‘Resource gives new life to sexual health education for Indigenous youth’ (Media Release, 13 June 2013)  (accessed 2 December 2013).
  5. Australian Government, Department of Health and Ageing, Second National Sexually Transmissible Infections Strategy 2010-2013 (2010) 13.
  6. Ali Hammad et al, ‘Are Australian sexual health clinics attracting priority populations?’(2013) 10(6) Sexual Health 456, 456.
  7. Ibid.
  8. Aboriginal Health & Medical Research Council of New South Wales, It’s Your Choice! Have Voice! Rights, Respect and Responsibility – Phase 2 Aboriginal Health & Medical Research Council of New South Wales  (accessed 27 November 2013).
  9. NACCHO, NACCHO Aboriginal sexual health: Spreading positive sexual health messages with Facebook (22 February 2013) NACCHO Aboriginal Health News Alerts  (accessed 2 December 2013).
  10. Charlotte King, Dareton comes alive for hip hop workshops (9 August 2011) ABC  (accessed 2 December 2013).
  11. NACCHO, above n9.
  12. Ibid.
  13. Ibid.
  14. Ibid.
  15. New South Wales Ministry of Health, NSW HIV Strategy 2012-2015 (2012) 2.
  16. SBS, NSW sets targets to reduce HIV rates (26 August 2013) SBS  (accessed 10 December 2013).
  17. Jillian Skinner MP, ‘Australian-First as Rapid Testing for HIV Pops Up in Darlinghurst’ (Media Release, 26 November 2013) 1  (accessed 9 December 2013).
  18. Queensland Government Department of Health, Queensland HIV Strategy 2013-2015 (2013) 1 (accessed 9 December 2013).
  19. Ibid.
  20. Miles Heffernan, New HIV prevention body for Queensland (14 November 2013) star observer (accessed 9 December 2013).
  21. Ibid.
  22. The Honourable Lawrence Springborg, Minister for Health, ‘New HIV Foundation Queensland to help END HIV’ (Media Statement, 3 November 2013) (accessed 9 December 2013).
  23. Queensland Government Department of Health, ‘New free HIV test gives faster results’ (Media Statement, 7 May 2013) 1  (accessed 9 December 2013).
  24. The Honourable Lawrence Springborg, Minister for Health, ‘Improved services for HIV testing’ (Media Statement, 26 November 2013)  (accessed 10 December 2013).
  25. Ibid.
  26. Denis Napthine, Premier of Victoria, ‘Australian-first rapid testing HIV trial in Victoria’ (Media Release, 13 January 2013)  ( accessed 9 December 2013)
  27. Farrah Tomazin, ‘Victoria first to offer rapid HIV testing’, The Age Victoria (online), 13 January 2013 (accessed 9 December 2013).
  28. Victoria Government, Department of Health, PRONTO – new rapid HIV testing site (14 August 2013) News & Events (accessed 9 December 2013).
  29. Ibid.
  30. South Australian Department for Health and Ageing, Sexually Transmissible Infections Actio Plan 2012-2015 (2012) 6 (accessed 10 December 2013).
  31. Ibid.
  32. SHine SA, Focus on relationships and better sexual health education newsletter 2013 (2013) 1.
  33. SHine SA, Focus schools SHine SA (accessed 9 December 2013).
  34. SHine SA, above n30, 12.
  35. Ibid.
  36. Bruce Johnson, ‘They need to know…A report on teachers’ use of the South Australian Relationships and Sexual Health Curriculum’ (Evaluation report, University of South Australia, 2012) 6.
  37. Ibid.
  38. Ibid. 45.
  39. Ibid.
  40. Ibid.
  41. Australian Government, Closing the Gap Clearinghouse, Education programs for Indigenous Australians about sexually transmitted infections and bloodborne viruses (May 2012) 1 (accessed 9 December 2013).
  42. Ibid, 2.
  43. Ibid, 5.
  44. Giordano and Ross, above n1.
  45. Ibid, 38-39.
  46. Ibid, 39.
  47. Kim Lyell, Call to make sex education mandatory in Qld schools (30 August 2013) ABC (accessed 4 December 2013).
  48. Giordano and Ross, above n1, 6.
  49. Grahame Brown, Anne Sorenson and Janina Hildebrand, ‘How they got it and how they wanted it: marginalised young people’s perspectives on their experiences of sexual health education.’ (2011).
  50. Giordano and Ross, above n1, 40.
  51. Ibid, 39.
  52. Ibid. 22.
  53. Lyell, above n52.
  54. Chloe Papas, Lack of sexual health education leads to unsafe behaviour (28 June 2013) ABC Perth (accessed 4 December 2013).
  55. Katrina Stokes, SA children as young as 12 with chlamydia as more people test positive for sexually transmitted diseases The Advertiser NEWS (accessed 4 December 2013).
  56. James May, ‘Averting a Sexual Health Crisis Among Young People’ (2013) 11(1) HIV Australia (accessed b2 December 2013).
  57. Giordano and Ross, above n1, 8.
  58. Sexuality Education in Australian Secondary Schools 2010, 24. Data for the study was collected through two techniques, one through a representative random sample, in which schools were randomly selected and the eligible teachers within asked to respond to the survey, the other through a snowballing technique, in which teachers were directly invited by mail to respond to the survey. Overall 328 educators were involved in the survey.
  59. Ibid, p27.
  60. Papas, above n59.
  61. ACARA, Health and Physical Education (HPE) ACARA (accessed 2 December 2013).
  62. 702 ABC Sydney, ‘Proposed sex education syllabus criticised’ (website, 7 August 2013) <> (accessed 28 January 2014).
  63. Sexual Health & Family Planning Australia, Submission to the Department of Treasury, Sexual Health and Family Planning Australia Pre-Budget Submission for 2013-14 Financial Year, 30 January 2013, 3.
  64. Ibid, 4.
  65. Public Health Association of Australia Inc, Sexual Health & Family Planning Australia and Australian Reproductive Health Alliance, Time for a National Sexual and Reproductive Health Strategy for Australia (Background Paper, February 2008)20.
  66. Ibid, 17.
  67. Sexual Health & Family Planning Australia Disability Special Interest Group, Improving Sexual and Reproductive Health for People with Disability, (Report, May 2013) 4.
  68. Ibid, 3.
  69. Ibid, 8.
  70. Ibid.
  71. Australian Government Department of Health and Ageing, above n5.
  72. Cathy O’Leary, Call for more youth sexual health clinics (16 October 2013) The West Australian health+MEDICINE (accessed 4 December 2013).
  73. Ibid.
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