Sexual health crisis: Syphilis epidemic rages as doctors sound alarm on rising HIV rates

EXCLUSIVE: Since 2011 a syphilis epidemic has swept across northern Australia, spreading across multiple states and hitting Indigenous communities hard. Figures obtained by NITV News show the rate of infections is rising fast. Now, stretched health services are warning a rise in HIV cases could be the next epidemic to hit the region.

By Robert Burton-Bradley  Source: NITV News. 20 Oct 2017

Indigenous Australia is in the grip of a serious health crisis as skyrocketing rates of syphilis have seen five babies die and hundreds of new cases appear. Now, rates of HIV are on the rise too. Doctors and health professionals working on the frontline have said more resources are urgently needed to stop the outbreak which is now in its seventh year.

Professor James Ward from the South Australian Health and Medical Research Institute told NITV News the situation was all the more concerning because it was preventable.

“We had a very good opportunity to eliminate it, we missed it, and now we're in this situation,” he said. “It is unacceptable in this day and age to have any congenital death related to an STI in a country like Australia, where we’ve got very good testing and very good treatment for these STIs.”

“If this had occurred in non-Aboriginal communities there would have been a national outcry.”

Figures obtained by NITV News reveal that as of August this year, Queensland has had almost 1000 cases of syphilis among its Indigenous population since the outbreak began there in 2011. The Northern Territory has seen a dramatic rise in infections more than doubling from 229 cases last year to 588 cases since 2013. Western Australia has had 134 cases since 2014, mainly in the Kimberley region, and the now the epidemic has spread to South Australia, which has had 26 cases since late last year. In most cases, the victims are under 29-years-old. There have been five cases of babies dying after being born with congenital syphilis and an unknown number of babies born with congenital abnormalities.

Cairns is the epicentre of the epidemic with the highest number of cases. Cairns Sexual Health Service Director, Dr Darren Russell, said he has never seen a syphilis outbreak like this before.

“It is concerning. We don’t know where it will end up, but it’s worse than it ever has been and the rates around the country are increasing, not decreasing,” he told NITV News. "We’ve seen is this incredible resurgence of syphilis and now we are seeing HIV where we have never seen it before. There is real concern."

“Cairns and surrounds is really the main area of concern. In North Queensland itself, up to August 2017, there have been 941 cases and five deaths of babies from congenital syphilis.”

“There is a lot of work going on to try and prevent further deaths, but it is very difficult when you have so many cases and you tend to get syphilis in young sexually active people.”

map of syphilis outbreak in northern Australia

A map of the syphilis outbreak in northern Australia.

Dr Russell said part of the problem is that in some communities the outbreak has become firmly entrenched.

“Initially, you can talk about an epidemic where an infection gets into a community and then what happens after a time is the infection can become endemic, more established in that community – that’s probably what is going on now in the Cairns area and the top end of the Northern Territory, and possibly even Townsville too”," he said. He warns of rising HIV notifications in and around Cairns, which he says could be linked to the syphilis epidemic. Now, there has been a spike in HIV infections, particularly in the Indigenous population, says Dr Russell.

“The syphilis epidemic started in 2011 and there was always a concern that HIV could piggyback on that because HIV and syphilis tend to go together,” he said. “Around Australia, HIV notifications in Indigenous people used to be about the same as non-Indigenous people, but they are now twice the rate and it looks like they are continuing to increase."

In Cairns, it is up to 50 per cent of infections, said Russell. "I don’t think we know at this stage if it is too late"

A public health alert sent to Queensland health workers last month warned the rising rates of HIV are tied to the syphilis outbreak and that a majority of the cases are among younger Indigenous people, under 40 years of age.

It came after an emergency HIV roundtable of around 80 clinicians and community leaders to discuss the crisis in Cairns earlier this week.

Professor Ward, a sexual health expert, who attended the conference as a speaker said the number of Indigenous HIV infections is not huge, but warns that could change unless extra resources are brought in.

“It used to be relatively stable. We’d have say 20 (Indigenous) cases a year nationally, we’re almost double that now, perhaps, even more, when you look at the most recent data, and that’s very problematic because once it reaches a tipping point, it will move into an endemic state and I think now is the time to put lots of effort into preventing HIV."

The other issue, said Dr Russell, is that diseases like syphilis and HIV can be sleeper infections and people could be unaware for lengthy periods of time they have been exposed, and in turn, pass it on to others.

“One of the problems is we don’t know what we don’t know, there will be individuals who haven’t been diagnosed yet, and if they are not aware they have HIV, then onward transmissions will continue."

“I think we have always been concerned in Australia that there would be an epidemic of HIV in the Indigenous community and we’d almost eliminated infectious syphilis a few years ago – what we’ve seen is this incredible resurgence of syphilis and now we are seeing HIV where we have never seen it before. There is real concern at this stage and we don’t know where the HIV epidemic is going to go, whether it will continue or be brought under control."

How did this happen?

A decade ago, syphilis in Queensland was on track to being eradicated, but then in 2010, the number of cases diagnosed started drastically increasing. By 2011, it was being called an epidemic. By 2014 it had spread into the Northern Territory, before moving into the Kimberley region of WA and reaching South Australia last year. Many of the cases are in remote Indigenous communities.

Indigenous Australians are six times more likely to catch syphilis than the non-Indigenous population. Staggeringly, this increases to 132 times higher in remote areas. Rates of HIV infection are twice as high for Indigenous people than the rest of the population.

“These things take you by surprise, there is no way of pre-empting some of this kind of outbreaks but a fast response is really necessary.”

Dr Russell warns that HIV is now looming as a follow up threat. He points to Canada’s experience, where Indigenous people account for as much as 11 per cent of new HIV infections, despite making up just 4.3 per cent of the total population.

“We appear to be heading in that direction,” he warned.

Dr Mark Wenitong, Public Health Medical Advisor at the Apunipima Cape York Health Council, said a large part of the blame resides with the drastic cuts to public health spending made by the incoming government of former Queensland Premier Campbell Newman in early 2012, and a failure by health services to recognise the threat early on.

"Very unfortunate that five women have lost their babies but there have been a number of other babies born with congenital syphilis abnormalities which is problematic and why we are desperate to get message out there for that target age group." said Professor James Ward.

“The thing is there were resources going into North Queensland through the health department, but after the election, that got cut a fair bit, and from the perspective of primary health care, that really did leave a hole in education. Screening and particularly sexual health teams, that has definitely had an impact,” he said.

Dr Wenitong said this compounded the already large challenges health providers face in the Indigenous community in an area like Cape York.

“There are limited resources because everything is a priority in Aboriginal communities because of the prevalence of a lot of different illnesses,” he said.

Dr Russell said previous outbreaks of STI’s like HIV had largely bypassed these communities, meaning that some were caught off guard.

“It’s a whole range of things. You have a population that is quite marginalized and disadvantaged, has poor access to health care, you’ve also got a group in whom traditionally there hasn’t been a lot of HIV, so the health services aren’t really geared up for thinking about HIV and testing for it.”

Dr Wenitong conceded the outbreak had now spread beyond the control of some health providers.

“These things take you by surprise, there is no way of pre-empting some of this kind of outbreaks but a fast response is really necessary.”

“I think one of the things we feel is a bit of a sense of failure in a way, that things like syphilis which is preventable and controllable, that that got away from us across the Top End of Australia.

What is being done

In response to growing calls for action, the Government has committed more resources, says Liberal senator Dean Smith, who is chair of the Chair of the Parliamentary Liaison Group for HIV/AIDS, Blood Borne Viruses and Sexually Transmitted Infections.

“The evidence of the alarming disparity in the rates of STIs between Indigenous and non-Indigenous Australians is very credible.

“I am aware that over the last four years, $15 million has been spent on a variety of specific STI and BBV prevention and education activities across northern Australia, including  trialling “point-of-care” testing for certain diseases and surveying the sexual health and lifestyle behaviours of Aboriginal and Torres Islander communities,” he tells NITV News.

He said everyone needs to be worried by the current crisis and urged his own Government to do more.

“As an immediate action, I firmly believe there must be a stronger response from the Federal Government and that it must take a more proactive leadership role in coordinating the activities of State and Territory Governments on the issue."

Indigenous Health Minister Ken Wyatt said the government was aware of the problem and is taking steps to combat the spread of syphilis and HIV.

“In August, I raised the syphilis issue with the Australian Health Ministers’ Advisory Council’s (AHMAC) Australian Health Protection Principal Committee (AHPPC), which is currently intensifying the national response to the current outbreak, including short-term actions to reduce infection,” Minister Wyatt told NITV News in a statement.

“A governance group has been established and will report on the proposed action plan to the Health Minister and myself in December 2017. The response will also focus on a long-term and sustainable response to combating other blood-borne viruses and sexually transmitted infections.

“The Commonwealth continues to fund targeted activities and a national network of approximately 140 Aboriginal Community Controlled Health Services (ACCHSs) and around 40 other providers to deliver comprehensive, culturally appropriate primary health care services, including sexual health and maternal health services."

A new awareness campaign called Young Deadly and Syphilis Free has been rolled out over the last few months targeting Indigenous communities and urging regular resting and treatment of infections.

This week, the Queensland Government announced an expansion of the number of places for people to PrEP (Pre-Exposure Prophylaxis) a medication that can dramatically reduce the risk of HIV transmission in HIV negative people.

Queensland Health Minister, Cameron Dick, acknowledged working with communities would be crucial in combating the further spread of the outbreak.

“If we are to achieve our shared goal of the virtual elimination of HIV in Queensland by 2020, we must reach out to Aboriginal and Torres Strait Islander people in every community.”

A spokesman for Queensland Health said the government was committing $15.8 million over three years to support the actions of the North Queensland Aboriginal and Torres Strait Islander Sexually Transmissible Infections Action Plan 2016-2021, in addition to millions being spent more broadly on sexual health.

Despite the promises of increased resourcing, the problem, more than seven years after the first outbreak in Queensland, remains for the time being.

Professor Ward said he believed the slow response was in part because the affected population was Indigenous.

“If this had occurred in non-Aboriginal communities there would have been a national outcry.”

Dr Russell from Cairns Sexual Health says it may already be too late to resolve the outbreak anytime soon.

“That’s the million dollar question. I don’t think we know at this stage if it is too late, but clearly, there are worrying signs and it is certainly not controlled at this stage."

Second World Indigenous Peoples’ Conference on Viral Hepatitis: Anchorage Consensus Statement 2017

2017 is the 10th Anniversary of the Declaration of the Rights of Indigenous Peoples. Delegates at the 2nd World Indigenous Peoples’ Conference on Viral Hepatitis, held in Anchorage, Alaska from 8-9 August, seized the opportunity to develop a powerful consensus statement which calls on nation-states and governments to commit to eliminating viral hepatitis among Indigenous Peoples and Tribal Communities WORLDWIDE by 2030.

Anchorage Consensus Statement 2017

As delegates at the 2nd World Indigenous Peoples’ Conference on Viral Hepatitis held in Anchorage, Alaska, who are committed to effective action on viral hepatitis in indigenous and tribal communities, we declare the following:

We SEEK the ELIMINATION of avoidable mortality from people living with viral hepatitis, and the ELIMINATION of viral hepatitis from Indigenous Peoples and Tribal Communities WORLDWIDE by 2030.

We REQUIRE OUR nation-states and governments to make special provision in health and funding policies to achieve elimination of viral hepatitis from Indigenous Peoples and Tribal Communities by 2030.

We RECOGNISE and SUPPORT the desire of Indigenous Peoples and Tribal Communities to determine our futures and to receive culturally effective services which reduce the impact and eliminate viral hepatitis.

As we celebrate the 10th Anniversary of the Declaration on the Rights of Indigenous Peoples, we AFFIRM our commitment to Indigenous rights and URGE nation-states and governments to facilitate further progress.

To maintain momentum, it is critical that an Indigenous-led working group be formed and supported to drive international action on eliminating Viral Hepatitis in Indigenous Peoples; recognising how Indigenous Peoples are organised, and designed to ensure those with the greatest needs are served first.

9 August 2017 – Anchorage, Alaska, USA

In developing this statement, we have taken regard to the following PRINCIPLES:

  • Diversity exists within Indigenous peoples and tribal communities;
  • Viral hepatitis is impacted by the intergenerational trauma experienced by Indigenous peoples;
  • Viral hepatitis is everybody’s responsibility, yet Indigenous peoples must lead the change;
  • Indigenous leaders, scientists, researchers, philanthropists, academics, people in industry, and Indigenous peoples’ living with viral hepatitis – working together under Indigenous peoples’ leadership;
  • Indigenous peoples’ self-determination and empowerment of Indigenous peoples and communities to control their relationship with viral hepatitis;
  • Privileging and prioritising indigenous peoples’ responses by integrating, weaving, and incorporating cultural and traditional knowledges, worldviews, and culturally resonant, strength-based practices;
  • Freedom from racism, discrimination and stigma;
  • Health equity for all Indigenous peoples;
  • Respecting and protecting Indigenous peoples’ lands, habitats and communities;
  • Creating opportunities for sharing Indigenous peoples’ expertise on health and supporting Indigenous models of hepatitis care and treatment.


  • develop a template to enable indigenous peoples regionally to report on reducing avoidable death and making progress toward elimination of viral hepatitis;
  • develop national, indigenous-specific targets within strategies to ELIMINATE viral hepatitis;
  • on the path to ELIMINATION, commit to a reduction in the incidence, prevalence and burden of viral hepatitis in Indigenous populations;
  • encourage, facilitate and fund indigenous youth attendance to meetings and workshops;
  • improve access for indigenous peoples to quality healthcare across all levels of the healthcare system;
  • incorporate indigenous knowledges and customs in viral hepatitis health education (including through Indigenous educators);
  • develop and implement Indigenous models of viral hepatitis care and treatment;
  • respond to the viral hepatitis needs of indigenous peoples in prison;
  • on the path to ELIMINATION, promote harm reduction as a strategy for reducing the burden of viral hepatitis in indigenous peoples;
  • on the path to ELIMINATION, improve surveillance, data collection, reporting and monitoring of viral hepatitis in Indigenous communities;
  • encourage, facilitate and fund (indigenous controlled) research in viral hepatitis;
  • support international meetings and workshops to address viral hepatitis in indigenous peoples.

Dr G. Yunupingu’s legacy: it’s time to get rid of chronic hepatitis B in Indigenous Australia

News of the tragic death of Dr G. Yunupingu last week in Darwin at only 46 years of age has again highlighted the unacceptable gap in life expectancy between Aboriginal and Torres Strait Islanders and other Australians. Yunupingu had been living with chronic hepatitis B since early in life, and experienced complications of this condition including liver and kidney disease.

Hepatitis B infections, which can lead to liver disease and cancer, are unacceptably high in Indigenous Australians. In Northern Australia, 10-20% of the Indigenous population is infected with the virus. Eliminating the impact of this infection in Indigenous Australians would make a substantial contribution to closing the gap in life expectancy.

Hepatitis B in Indigenous Australia

Hepatitis B is the most prevalent form of viral hepatitis worldwide. It’s also the leading cause of liver cancer. Interestingly, hepatitis B used to be known as the “Australia Antigen” as it was first discovered in Australian Aboriginal people in the 1960s.

Hepatitis B is around ten times more prevalent in Indigenous communities than in the rest of Australia. Of the nearly 240,000 Australians estimated to be living with chronic hepatitis B, over 20,000 are thought to be Indigenous people. New infections with hepatitis B remain three times as common in Indigenous people as in non-Indigenous Australians.

The chance of developing chronic hepatitis B depends on an individual’s age at the time of infection. Around 90% of those who were exposed as infants develop chronic hepatitis B, but only 5% of those who were exposed as adults will develop chronic infection. Most people living with chronic hepatitis B were infected as young children – often, through mother-to-child transmission at the time of birth. This is why vaccination during infancy is particularly important.

The prevalence of chronic (long-term) hepatitis B in Indigenous Australians varies significantly between regions. It is most prevalent in remote areas of Australia, with the Northern Territory having the highest prevalence of any Australian jurisdiction. Around 1.8% of the NT population live with the disease.

The prevalence of hepatitis B and other communicable diseases such as skin infections and influenza in Indigenous communities is intensified by the social, economic, environmental and political situation in which Indigenous Australians find themselves.

Liver disease

In some people, chronic hepatitis B can cause severe liver scarring (cirrhosis) or liver cancer. Less commonly, hepatitis B can damage other parts of the body, including the kidneys and blood vessels.

Chronic liver disease contributes significantly to the Indigenous life expectancy gap. Liver cancer is the fastest-increasing cause of cancer deaths in Australia. In 2016, it was the sixth-most-common cause of cancer deaths. However, for Indigenous people it is the second-most-common cause of cancer-related death after lung cancer.

Compared to non-Indigenous Australians living in the NT, the rate of death due to liver cancer is six times greater in Indigenous Australians.

Cure is rare with liver cancer, and most Indigenous Australians die within a few months of being diagnosed. In the NT, a range of factors contribute to the unequal burden of liver cancer in Indigenous Australians, but hepatitis B is the most important cause.

Hepatitis B vaccine is one way

A safe, effective vaccine for hepatitis B has been provided for all infants in Australia since 2000 – and in the Northern Territory since 1990. As a result, new hepatitis B infections in children born since 2000, as well as those who received adolescent catch-up vaccination from 1998 onwards, have fallen markedly.

However, funded hepatitis B vaccine for Indigenous adults is available only in some states and territories. This limits access for Indigenous people who remain at much higher risk of infection. A recent study suggested a funded catch-up vaccination program for Indigenous adults could rapidly eliminate disparity in hepatitis B incidence.

Vaccination has no effect for those who already have chronic hepatitis B. It is believed over 90,000 Australians living with hepatitis B have never been diagnosed and are unaware of their infection. Only 15% of those infected are receiving treatment or monitoring for their condition.

Unlike hepatitis C, hepatitis B is not yet curable, but current treatments are very well tolerated and effective at preventing liver disease and liver cancer. The profound lack of access to treatment and care among Indigenous people contributes to the disproportionate impact of hepatitis B on this population.

Other ways to reduce infections

An example of innovative care has been operating in Dr G. Yunupingu’s home community of Galiwin’ku for over five years. Under the management of Miwatj Health, an Aboriginal community-controlled health organisation, a hepatitis specialist visits regularly three to four times per year.

The specialist brings necessary diagnostic equipment and effectively provides a “one-stop shop” for individuals living with hepatitis B in Galiwin’ku. Just as importantly, a local healthcare practitioner champions the cause of hepatitis B treatment and elimination. Those infected are contacted and encouraged to see the specialist team.

Several other regions in the world with large Indigenous populations and high hepatitis B prevalence, such as Alaska and New Zealand, have developed programs to test most of the population and identify those with hepatitis B infections. Affected individuals are offered regular follow-up and care to prevent cirrhosis and liver cancer.

When delivering such care to Indigenous communities, it’s essential to develop trust and ensure culturally appropriate approaches. Also important is partnering with communities and their health workers to develop new ways of building awareness of hepatitis B as an important health issue.

With comprehensive public health initiatives, long-term commitment to funding and policy – including significant workforce development to ensure as many people as possible are tested and appropriately followed up – the impact of hepatitis B on Indigenous communities can be eliminated.

This article was written by Benjamin Cowie, James Ward and Steven Tong and originally published in The Conversation.

Hepatitis C - PBS listing: 'Medical miracles welcome, but barriers to elimination remain'

Federal Government funding of a breakthrough antiviral medicine that can cure all forms of hepatitis C must be matched by a concerted effort to reconnect people living with the liver-destroying virus with clinical care.

Speaking on World Hepatitis Day (28 July), CEO of Hepatitis Australia Helen Tyrrell welcomed the Federal Health Minister’s announcement that the first pan-genotypic antiviral, Epclusa® would be PBS listed from 1 August. The new therapy is more than 90 per cent effective in achieving a cure within 12 weeks, regardless of hepatitis C genotype.

“Australians living with hepatitis C now have unprecedented access to curative therapies; however this is only the first step to eliminating hepatitis C as a public health threat in Australia,” Ms Tyrrell warned.

“Equipping health care professionals to feel confident engaging their patients in conversations about hepatitis C and the availability of cures must now become a focus,” she said.

“We must also communicate to those living with the condition that a life free from hepatitis C can be a reality.”

Epclusa (sofosbuvir 400 mg/velpatasvir 100 mg) is a pan-genotypic regimen for the treatment of adults with genotype 1-6 chronic hepatitis C virus infection. The therapy is used in combination with ribavirin in patients with cirrhosis.

New campaign to prevent syphilis in remote Indigenous communities

A new radio, television and social media campaign has been launched to help prevent the spread of syphilis in remote Indigenous communities.

There are now 1,400 diagnosed cases among young people across four states, after an outbreak six years ago.

The South Australian Health and Medical Research Institute hopes its community education and awareness program about the Sexually Transmitted Infection, will cut through.

Featured: Professor James Ward, SA Health and Medical Research Institute


New initiative to prevent the spread of syphilis in remote Indigenous communities

On Saturday, 1 July, the South Australian Health and Medical Research Institute’s (SAHMRI) Infection and Immunity Theme will launch a new multifaceted community education and awareness program in the fight against syphilis in remote Aboriginal and Torres Strait Islander communities.

The campaign, entitled ‘Young, Deadly, Syphilis Free’, will utilise mediums including two television commercials, social media, local radio and a new website to communicate to young Aboriginal and Torres Strait Islander people who live in remote communities the importance of being tested for syphilis, a sexually transmitted infection (STIs) that when left untreated, can have devastating effects.

Why is this campaign so important?

This project, funded by the Commonwealth Government Department of Health, has the ultimate objective of increasing testing rates among young Aboriginal people in the affected areas so that rates of syphilis are reduced in these communities.

Since 2011, there has been a sustained outbreak of infectious syphilis occurring in remote areas spanning northern, central and South Australia among Aboriginal and Torres Strait Islander people predominantly aged between 15 and 35 years. The accrued number of cases is now over 1,400 including four neonatal deaths and several other cases of congenital syphilis notified. Worryingly, syphilis continues to spread into new areas, and this needs to be stopped.

In addition to targeting young people, this campaign will have focus on healthcare services and providers, through the use of supporting resources and education materials, such as videos, posters and animations. Clinicians will play an important part in the success of this project and they are encouraged to consider talking more broadly about the syphilis outbreak among people of influence in their community to raise awareness.

Furthermore, the project will trial social media ambassadors, who will be young people from remote communities to help spread the campaign and its objectives.

Improving outcomes for young Aboriginal and Torres Strait Islander people

Associate Professor James Ward, Head of Infectious Disease Research - Aboriginal and Torres Strait Islander Health at SAHMRI said that education and awareness about syphilis transmission and its consequences is vital if we are to make a difference.

“This multifaceted approach to educate young people is well overdue,” Associate Professor Ward said.

“The resources that have been developed and focus tested with young people will go a very long way in improving outcomes in the community.”

Useful links:

TVC #1:
TVC #2: