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Wilo Muwadda is a community activist supporting Aboriginal and Torres Strait Islander same sex attracted and gender diverse individuals and communities to self-determine pathways of equity and justice in Australia. He has over 30 years of community work and volunteer experience with HIV and AIDS within Indigenous communities of Australia (Photo by Louise Cooper).

For our NAIDOC Week issue of POSLINK Newsletter, Wilo explores lessons learned on Indigenous community management of HIV.

Aboriginal and Torres Strait Islander communities share the title of being Indigenous to Australia but we are not homogenous people. Environmental cultural ways and the historical impacts of colonisation on Indigenous people across Australia has resulted in a diversity of Aboriginal and Torres Strait peoples from urban, regional, remote, traditional and semi-traditional backgrounds.

Local, regional, state and national community-based networks support self-determination and work in collaboration with national strategies to culturally match Indigenous programs for health, education and employment. These programs are reliant on Indigenous networks that incorporate Indigenous ways of being, doing and knowing. However, they are also dependent on reliable funding to work and to grow into strong health, education and employment sectors. Unfortunately, history tells a story of funding cuts and government changes stifling the growth of these local and regional Indigenous programs. Attempts to reprogram these initiatives into state and national mainstream strategies have proven to be less effective in addressing culturally linked barriers to access and support.

In the 1990s, the introduction of highly effective treatments extended life for people living with HIV, however, there remained a range of health challenges for holistic wellbeing. During this period in North Queensland, Apunipima Cape York Health Council funded a program called the Northern Indigenous Sexual Health Workers Reference Group (NISHWRG). The group was made up of Indigenous sexual health workers from a wide range of health services from across northern Queensland, including Indigenous health promotion officers from the Queensland AIDS Council (QuAC) in Cairns in the early 2000s. I worked as an Indigenous health promotion officer for QuAC from 2001-07 and then manager of the state Indigenous program from 2007-10.

NISHWRG worked from a strong support base with endorsement from lndigenous community leaders, James Cook University, Tropical Health Cairns and the Office of Aboriginal and Torres Strait Islander Health. Most importantly, NSHWRG embedded Aboriginal and Torres Strait Islander philosophies into Indigenous sexual health strategies and programs. This process was guided by elders from communities to culturally match sexual health programs for Indigenous communities and often required a translation and transfer of Indigenous knowledge into national, state and regional sexual health strategies. This knowledge transfer also built the capacity of Indigenous leaders and community. This strategy had to sit within ethical and moral protocols of cultural women’s and men’s business as well as the empowerment of same sex attracted and gender diverse members of the community. It was a very complex and radical strategy to build community awareness and participation in preventing a HIV and STI epidemic as well as address stigma and discrimination.

NISWRG developed and implemented health promotion strategies that included resource development such as STI pamphlets that were easily accessed and understood by Aboriginal and Torres Strait Islander communities of Northern Queensland. They also provided sexual health education to high school students in state high schools and colleges. Support extended to being on hand to assist high school nurses and principals to create appropriate pathways to sexual health clinics where students could access sexual health and social and emotional wellbeing programs. Furthermore, QuAC ran conferences for at risk Indigenous populations with community-driven peer-based programs on sexuality, sex, identity and strategies for preventing infection.

During the mid-noughties Apunipima dropped the sexual health program and NISHWRG folded. The Indigenous project of QuAC and Indigenous sexual health workers of Cairns Sexual Health developed the Cairns Indigenous Sexual Health Workers Network (CISHWN) to continue the strategies developed and implemented by NISHWRG. This left a gap in a program that was Indigenous led and Indigenous driven. Embedding Indigenous philosophies was now institutionalised within non-Indigenous entities of state health and predominantly LGBTI led AIDS organisations. A cultural interface that saw a lack of capacity on both sides was weakened by the loss of Indigenous leadership provided through Apunipima. The ‘whole of community approach’ guided by NISHWRG lost support as a key partner within HIV management and prevention.

The interim response to the recent increases of HIV diagnoses within Indigenous communities lacks networks of Indigenous led local strategies that includes all stakeholder communities working in collaboration from a top down and a bottom up approach. Current representation structures have diminished Indigenous led inclusion instead of augmenting practices that worked through a continual network of Indigenous sexual health workers and community relationships. This has been further exacerbated by the lack of funding support for organisations such as the Anwernekenhe National HIV Alliance (ANA) to hold an equal national Indigenous representative position alongside government and non-government stakeholders to represent a community voice of affected populations and Indigenous people living with HIV.

The representation of at-risk Indigenous populations that include Injecting drug users, women, heterosexual men, same sex attracted men and gender diverse peoples and Indigenous people living with HIV to work in collaboration with Indigenous sexual health workers needs an informed national response. The empowerment of local, regional, state and national networks which is informed by international and national Indigenous peoples human rights frameworks and appropriate cultural methods and approaches, may very well show a reinvigorated ‘whole of community approach’.

The result will more than likely be an Indigenous informed HIV care and prevention model that works with community through Indigenous identified positions at all levels, in all stakeholder organisations, to address the emerging HIV and syphilis epidemics within the Aboriginal and Torres Strait Islander communities of Australia.

Read the full NAIDOC Week issue of POSLINK Newsletter for more voices of the Aboriginal and Torres Strait Islander community.