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Sullivan RP, Bukulatjpi SM, Binks P, Hosking K, Nundhirribala P, Vintour-Cesar E, McKinnon M, Gurruwiwi G, Green A, Davis JS, Davies J. "They feel shame sometime, but that is why we need to talk to them…we need to tell them how important it is not to feel shame": Hepatitis B related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce. Arch Public Health 2024; 82:151. [PMID: 39261962 PMCID: PMC11389596 DOI: 10.1186/s13690-024-01389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The Aboriginal health workforce has unique insights given their healthcare experience and interactions with their communities. The aims of this project were to explore their perceptions of hepatitis B related shame and ways to improve hepatitis B care in Aboriginal and Torres Strait Islander communities of Northern Territory's Top End, Australia. METHODS We conducted a qualitative study with guidance from the Menzies School of Health Research Infectious Diseases Indigenous Reference Group. The Aboriginal health workforce was asked to participate in semi-structured interviews exploring hepatitis B related shame and ways to improve hepatitis B care. Qualitative data were evaluated using reflexive thematic analysis. RESULTS There were fifteen semi-structured interviews with participants representing eight different communities. The experience of shame was reported by the Aboriginal health workforce to be common for individuals diagnosed with hepatitis B and comprised feelings of fear related to transmitting the virus, to being isolated, and to being at fault. Shame was mediated by poor health literacy, communication, the lack of culturally safe spaces and was perpetuated by intersecting stereotypes. Improvements in care can be achieved by utilising the Aboriginal health workforce more effectively, improving communication and the availability of culturally safe spaces, emphasising community connection, and reframing hepatitis B as a chronic condition. CONCLUSIONS Hepatitis B related shame was an important issue and impactful in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory. There were many facets to shame in these communities and it was mediated by several factors. The Aboriginal health workforce has emphasised several pathways to improve care and diminish the impact of shame, such as improving communication and the availability of culturally safe spaces.
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Affiliation(s)
- Richard P Sullivan
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia.
- Department of Infectious Diseases and Immunology, St George and Sutherland Hospital, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales (NSW), Australia.
| | | | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Kelly Hosking
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Population and Primary Health Care, Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | | | - Emily Vintour-Cesar
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Melita McKinnon
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - George Gurruwiwi
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
| | - Anna Green
- University of Southern Queensland, Toowoomba, Queensland, Australia
- University of Technology Sydney, Sydney, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Infection Research Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Jane Davies
- Menzies School of Health Research, Charles Darwin University, Northern Territory (NT), Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, NT, Australia
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Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24:553. [PMID: 38693527 PMCID: PMC11062015 DOI: 10.1186/s12913-024-10796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
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Affiliation(s)
- Stephen Harfield
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia.
- School of Public Health, University of Queensland, Herston, Australia.
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Tara Purcell
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Eliza Schioldann
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Odette Pearson
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Peter Azzopardi
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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McCormack H, Wand H, Bourne C, Ward J, Bradley C, Mak D, Guy R. Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis. Sex Health 2023; 20:488-496. [PMID: 37690512 DOI: 10.1071/sh23107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16-29years in Aboriginal Community Controlled Health Services between 2018 and 2020. METHODS Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. RESULTS Of the 13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20-24years (OR 1.2, 95% CI 1.1-1.4) and 25-29years (OR 1.1, 95% CI 1.0-1.2) compared to 16-19years and patients residing in very remote (OR 4.2, 95% CI 3.7-4.8), remote (OR 2.4, 95% CI 2.1-2.8), and regional areas (OR 2.5, 95% CI 2.2-2.8) compared to metropolitan areas. There was no association with patient sex. CONCLUSIONS Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women.
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Affiliation(s)
- Heather McCormack
- Kirby Institute, UNSW, Sydney, NSW, Australia; and NSW STI Programs Unit, Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Handan Wand
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Christopher Bourne
- Kirby Institute, UNSW, Sydney, NSW, Australia; and NSW STI Programs Unit, Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia; and Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Qld, Australia
| | - Clare Bradley
- UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, Qld, Australia
| | - Donna Mak
- Department of Health, East Perth, WA, Australia; and School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, NSW, Australia
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Sao SS, Yu R, Abboud S, Barre-Quick M, Deshmukh S, Wang R, Coleman JS. Utilizing Digital Health Technology to Increase Sexual Health Care Access: Youth Preferences on Self-Collect, Mail-In Sexually Transmitted Infection Testing in a High Sexually Transmitted Infection Prevalence Area. J Adolesc Health 2023; 73:1002-1009. [PMID: 37676195 PMCID: PMC10935575 DOI: 10.1016/j.jadohealth.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE The COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address barriers to in-person STI testing, particularly for youth, who bear a disproportionate burden of STIs. This study sought to obtain youth input on the development of a free self-collect, mail-in STI testing program. METHODS Focus group discussions (n = 5, 45-60 minutes each) were conducted with 28 youth ages 14-19 years old living in Baltimore, Maryland. Focus group discussions were based on a conceptual framework of patient-centered health-care access, and a prototype online program was discussed. Transcribed data were coded thematically. Memos were written to synthesize findings and identify representative quotes. RESULTS Participants noted existing barriers to in-person STI testing barriers including individual-level (e.g., lack of knowledge), interpersonal-level (e.g., stigma), and structural-level (e.g., financial). Although participants expressed concerns about self-collect, mail-in STI testing (e.g., accuracy of self-swabbing), there was overall acceptance of the program, and many felt it would address current barriers to testing. Opportunities to improve the testing program included all four steps of testing process: kit ordering, receipt of the kit and swabbing, post-testing experience, and communication of results and treatment. Specifically, participants desired expanded shipping options to schools, and mail drop-off points such as lockers and local convenience stores; more transparency about testing and treatment; and hearing directly from health-care providers to assuage any concerns. DISCUSSION Self-collect, mail-in STI testing was favorable among youth, and could be a viable option for increasing youth access to STI testing.
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Affiliation(s)
- Saumya S Sao
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Ruoxi Yu
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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McCormack H, Wand H, Newman CE, Bourne C, Kennedy C, Guy R. Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation. JMIR Med Inform 2023; 11:e51387. [PMID: 38032729 PMCID: PMC10722379 DOI: 10.2196/51387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. OBJECTIVE We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. METHODS We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. RESULTS Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. CONCLUSIONS This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.
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Affiliation(s)
- Heather McCormack
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Christy E Newman
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Christopher Bourne
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | | | - Rebecca Guy
- Kirby Institute, University of New South Wales, Kensington, Australia
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Martin T, McIntyre S, Waight E, Baynam G, Watson L, Langdon K, Woolfenden S, Smithers‐Sheedy H, Sherwood J. Prevalence and trends for Aboriginal and Torres Strait Islander children living with cerebral palsy: A birds-eye view. Dev Med Child Neurol 2023; 65:1475-1485. [PMID: 37147854 PMCID: PMC10952932 DOI: 10.1111/dmcn.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/07/2023]
Abstract
AIM To provide a birds-eye view of the trends of cerebral palsy (CP) for Australian Aboriginal and Torres Strait Islander children and young adults. METHOD Data were obtained for this population-based observational study from the Australian Cerebral Palsy Register (ACPR), birth years 1995 to 2014. The Indigenous status of children was classified by maternal Aboriginal and Torres Strait Islander or non-Indigenous status. Descriptive statistics were calculated for socio-demographic and clinical characteristics. Prenatal/perinatal and post-neonatal birth prevalence was calculated per 1000 live births and per 10 000 live births respectively, and Poisson regression used to assess trends. RESULTS Data from the ACPR were available for 514 Aboriginal and Torres Strait Islander individuals with CP. Most children could walk independently (56%) and lived in urban or regional areas (72%). One in five children lived in socioeconomically disadvantaged remote/very remote areas. The birth prevalence of prenatal/perinatal CP declined after the mid-2000s from a high of 4.8 (95% confidence interval 3.2-7.0) to 1.9 per 1000 live births (95% confidence interval 1.1-3.2) (2013-2014), with marked declines observed for term births and teenage mothers. INTERPRETATION The birth prevalence of CP in Aboriginal and Torres Strait Islander children in Australia declined between the mid-2000s and 2013 to 2014. This birds-eye view provides key stakeholders with new knowledge to advocate for sustainable funding for accessible, culturally safe, antenatal and CP services. WHAT THIS PAPER ADDS Birth prevalence of cerebral palsy (CP) is beginning to decline for Aboriginal and Torres Strait Islanders. Recent CP birth prevalence for Aboriginal and Torres Strait Islanders is 1.9 per 1000 live births. Most children with CP live in more populated areas rather than remote or very remote areas. One in five Aboriginal and Torres Strait Islander children with CP live in socioeconomically disadvantaged remote areas.
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Affiliation(s)
- Tanya Martin
- School of Nursing and MidwiferyThe University of SydneyCamperdownNew South WalesAustralia
| | - Sarah McIntyre
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Emma Waight
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Gareth Baynam
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | - Linda Watson
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Susan Woolfenden
- Discipline of Paediatrics, School of Clinical MedicineUNSW SydneySydneyNew South WalesAustralia
- Sydney Institute of Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Hayley Smithers‐Sheedy
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Juanita Sherwood
- Jumbunna Institute for Indigenous Education and ResearchUniversity of Technology SydneySydneyNew South WalesAustralia
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Cama E, Beadman K, Beadman M, Walker M, Treloar C. Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework. Harm Reduct J 2023; 20:154. [PMID: 37864220 PMCID: PMC10588043 DOI: 10.1186/s12954-023-00889-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance. METHODS Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program. RESULTS Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available. CONCLUSIONS The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
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Cardwell ET, Ludwick T, Fairley C, Bourne C, Chang S, Hocking JS, Kong FYS. Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis. J Med Internet Res 2023; 25:e45695. [PMID: 37738083 PMCID: PMC10559186 DOI: 10.2196/45695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. OBJECTIVE We aim to systematically identify and assess web-based STI/HIV testing services available in Australia. METHODS A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. RESULTS Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days). CONCLUSIONS This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests.
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Affiliation(s)
- Ethan Trey Cardwell
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Teralynn Ludwick
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Fabian Y S Kong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Taflan P, Simpson PL, Wilson M, Jones J, Donovan B, Amin J, Nathan S, Butler T. Sexually transmissible infections (STI) and HIV testing and diagnosis among Aboriginal and non-Aboriginal adolescents in contact with the Australian justice system: a cross-sectional study. Sex Health 2023; 20:303-314. [PMID: 37344218 DOI: 10.1071/sh23028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It is unclear what factors are associated with sexually transmissible infections (STI) and HIV testing and diagnosis among justice-involved adolescents, and if these differ for Aboriginal or Torres Strait Islander peoples. METHODS A cross-sectional survey of 465 justice-involved adolescents (aged 14-17years) from Australia was conducted between 2016 and 2018. Participants were asked about sexual behaviours, STI/HIV knowledge, and prior STI diagnoses and testing. RESULTS Approximately 38% (n =130) of those sexually active had ever been screened for STI/HIV and 17.8% (n =23) had been diagnosed with an STI. No participant reported living with HIV. For Aboriginal participants, being male (aOR 3.6, 95% CI 1.3-10.1) and having under three sexual partners in the past 12months (aOR 3.1, 95% CI 1.2-8.0) was associated with never having had an STI/HIV test. For non-Aboriginal participants, being male (aOR 2.7, 95%CI 1.2-5.7), single (aOR 2.4, 95% CI 1.2-4.9), attending school (aOR 2.4, 95% CI 1.1-5.1), not having sought sexual health information (aOR 2.8, 95% CI 1.4-5.8), and having a lower STI/HIV knowledge score (aOR 2.3, 95% CI 1.1-5.0) were associated with never having had an STI/HIV test. Factors associated with STI diagnosis were non-heterosexual sexual orientation (aOR 5.6, 95% CI 1.1-28.2), transactional sex (aOR 11.2, 95% CI 3.0-41.3), and having sought sexual health information (aOR 3.5, 95% CI 1.0-12.5). CONCLUSIONS Males, particularly Aboriginal male adolescents, should be engaged with sexual health promotion and testing services as soon as they come into contact with the justice system. Approaches should consider different cultural, gender and sexual orientations.
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Affiliation(s)
- Patricia Taflan
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Paul L Simpson
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Mandy Wilson
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Tony Butler
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
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10
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Landy R, Atkinson D, Ogilvie K, St. Denys R, Lund C, Worthington C. Assessing the acceptability of dried blood spot testing for HIV and STBBI among Métis people in a community driven pilot project in Alberta, Canada. BMC Health Serv Res 2022; 22:1496. [PMID: 36482470 PMCID: PMC9733141 DOI: 10.1186/s12913-022-08763-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little literature exists on culturally grounded approaches for addressing human immunodeficiency virus (HIV) and sexually transmitted and blood-borne infections (STBBI) among Métis people. The goal of this mixed-methods research was to explore the experiences of Métis community members participating in a dried blood spot testing (DBST) for HIV/STBBI pilot for Métis communities in Alberta, Canada, with the aim of assessing the acceptability of this testing method. METHODS Grounded in community-based and Indigenous research approaches and working in partnership with a Métis community-based organization, data collection included a survey and four gathering circles with Métis DBST recipients at one of two community events, and semi-structured interviews with three DBST providers. RESULTS Twenty-six of the 30 DBST recipients completed surveys, and 19 DBST recipients participated in gathering circles. Survey results suggest DBST is a highly acceptable STBBI testing method to Métis community members. Thematic analysis of gathering circle and interview transcripts revealed four broad themes related to the participants' experiences with DBST related to its acceptability (i. ease of DBST process, ii. overcoming logistical challenges associated with existing STBBI testing, iii. Reducing stigma through health role models and event-based, and iv. Métis-specific services). CONCLUSIONS These findings illustrate the potential for DBST to be part of a culturally grounded, Métis-specific response to HIV and STBBI.
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Affiliation(s)
- Rachel Landy
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Danielle Atkinson
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Kandace Ogilvie
- Shining Mountains Living Community Services, 4925 46 St, Red Deer, AB T4N 1N2 Canada
| | - Raye St. Denys
- Shining Mountains Living Community Services, 4925 46 St, Red Deer, AB T4N 1N2 Canada
| | - Carrielynn Lund
- Communities, Alliances and Networks, PO Box 2978, Fort Qu’Appelle, SK S0G1S0 Canada
| | - Catherine Worthington
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
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11
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D’Costa B, Lobo R, Sibosado A, Leavy JE, Crawford G, Ward J. Evaluation of the Young, Deadly, Syphilis Free multi-media campaign in remote Australia. PLoS One 2022; 17:e0273658. [PMID: 36084099 PMCID: PMC9462794 DOI: 10.1371/journal.pone.0273658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Since 2011, remote Australian Aboriginal and Torres Strait Islander communities have experienced an outbreak of infectious syphilis, with young people aged 15–29 years over-represented in notifications. The Young Deadly Syphilis Free multi-media campaign was implemented in 12 remote regions in four Australian jurisdictions over nine months from 2017–2018. Campaign components included television and radio advertisements, social media posts, and health promotion resources available via a dedicated website. The aim of this research was to evaluate the impacts (proximal, mediator, distal) of the Young Deadly Syphilis Free campaign for young Aboriginal people and health and community workers residing in remote campaign regions.
Methods
A cross-sectional (post-only) evaluation design was used. Data were collected through online surveys; metrics for social media (Facebook, Instagram) were also collected to determine campaign engagement via social media. A 22-item young people survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); along with intended behaviour and knowledge and attitudes (mediator variables). A 24-item health and community worker survey assessed campaign awareness, exposure, message recognition and diagnostics (proximal variables); and changes in professional practice (distal variable). Descriptive statistics summarised demographic characteristics and univariate analysis examined associations between key variables.
Results
Just over half (n = 25, 58%) of young people and three quarters (n = 36; 75%) of health and community workers were aware of the campaign. Recognition of key campaign messages was high for both participant groups (>64%), and television, Facebook, and website were the most common campaign exposure routes. Positive impacts on intended behaviour (young people) and professional practice (health and community workers) were also reported. Facebook was effective in engaging some young people in campaign content and was preferred by young people for accessing information.
Conclusion
The findings point to the value of utilising a multi-media campaign in raising awareness about syphilis among young Aboriginal people and health and community workers in remote Australian regions. A longer-term campaign that accommodates the diverse needs of Aboriginal young people from geographically remote communities would optimise campaign impacts and support behavioural change.
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Affiliation(s)
- Belinda D’Costa
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Roanna Lobo
- Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Amanda Sibosado
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Justine E. Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gemma Crawford
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- UQ Poche Centre for Indigenous Health, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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12
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Bryant J, Bolt R, Botfield JR, Martin K, Doyle M, Murphy D, Graham S, Newman CE, Bell S, Treloar C, Browne AJ, Aggleton P. Beyond deficit: 'strengths-based approaches' in Indigenous health research. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1405-1421. [PMID: 34145599 DOI: 10.1111/1467-9566.13311] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/11/2021] [Accepted: 05/14/2021] [Indexed: 05/12/2023]
Abstract
Health research concerning Indigenous peoples has been strongly characterised by deficit discourse-a 'mode of thinking' that is overly focused on risk behaviours and problems. Strengths-based approaches offer a different perspective by promoting a set of values that recognise the capacities and capabilities of Indigenous peoples. In this article, we seek to understand the conceptual basis of strengths-based approaches as currently presented in health research. We propose that three main approaches exist: 'resilience' approaches concerned with the personal skills of individuals; 'social-ecological' approaches, which focus on the individual, community and structural aspects of a person's environment; and 'sociocultural' approaches, which view 'strengths' as social relations, collective identities and practices. We suggest that neither 'resilience' nor 'social-ecological' approaches sufficiently problematise deficit discourse because they remain largely informed by Western concepts of individualised rationality and, as a result, rest on logics that support notions of absence and deficit. In contrast, sociocultural approaches tend to view 'strengths' not as qualities possessed by individuals, but as the structure and character of social relations, collective practices and identities. As such, they are better able to capture Indigenous ways of knowing and being and provide a stronger basis on which to build meaningful interventions.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Reuben Bolt
- Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Jessica R Botfield
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Kacey Martin
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michael Doyle
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, New South Wales, Australia
| | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Simon Graham
- Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Queensland, Australia
- School of Public Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Gender and Global Health, Institute for Global Health, UCL, London, UK
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13
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Ubrihien A, Gwynne K, Lewis DA. Enabling culturally safe sexual health services in western Sydney: a protocol to improve STI treatment outcomes for Aboriginal young people. Pilot Feasibility Stud 2021; 7:106. [PMID: 33985588 PMCID: PMC8117628 DOI: 10.1186/s40814-021-00847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background Aboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services. Methods This qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed. Discussion This study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations. Trial registration The study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16).
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Affiliation(s)
- Ashley Ubrihien
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
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Bell S, Aggleton P, Lockyer A, Ferguson T, Murray W, Silver B, Kaldor J, Maher L, Ward J. Working with Aboriginal young people in sexual health research: a peer research methodology in remote Australia. QUALITATIVE HEALTH RESEARCH 2021; 31:16-28. [PMID: 33012220 PMCID: PMC7750674 DOI: 10.1177/1049732320961348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done "on" rather than "with" or "by" them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involving Aboriginal young people as researchers, advisors, and participants in a qualitative sexual health study in one remote setting in the Northern Territory, Australia. We document the methodology, while critically reflecting on its benefits and limitations as a decolonizing method. Findings confirm the importance of enabling Aboriginal young people to play a central role in research with other young people about their own sexual health. Future priorities include developing more enduring forms of coinvestigation with Aboriginal young people beyond data collection during single studies, and support for young researchers to gain formal qualifications to enhance future employability.
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Affiliation(s)
| | - Peter Aggleton
- UNSW Sydney, Sydney, New South
Wales, Australia
- The Australian National
University, Canberra, Australia
- University College London, London,
United Kingdom
| | - Andrew Lockyer
- Central Australian Aboriginal
Congress Aboriginal Corporation, Alice Springs, Australia
| | - Tellisa Ferguson
- Central Australian Aboriginal
Congress Aboriginal Corporation, Alice Springs, Australia
| | - Walbira Murray
- Central Australian Aboriginal
Congress Aboriginal Corporation, Alice Springs, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal
Congress Aboriginal Corporation, Alice Springs, Australia
| | - John Kaldor
- UNSW Sydney, Sydney, New South
Wales, Australia
| | - Lisa Maher
- UNSW Sydney, Sydney, New South
Wales, Australia
- Burnet Institute, Melbourne,
Australia
| | - James Ward
- University of Queensland,
Brisbane, Queensland, Australia
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