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Objective: To evaluate the impact of a program to improve access to, and delivery of, diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities., Design: Analysis of cross-sectional data from annual age-based screening., Setting: Six remote Aboriginal communities and three homelands on the Anangu Pitjantjatjara Lands in the far north-west of South Australia, 1996-1998., Participants: All Aboriginal people aged 12-40 years listed on the Nganampa Health Council population register as resident on the Anangu Pitjantjatjara Lands., Main Outcome Measures: Prevalence of gonorrhoea and chlamydial infection, determined by urine polymerase chain reaction tests., Results: The prevalence of gonorrhoea in people aged 12-40 years almost halved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P < 0.001). The fall in prevalence of gonorrhoea was comparable and statistically significant in both men and women. Prevalence of chlamydial infection also fell, from 8.8% in men and 9.1% in women in 1996 to 7.2% in both men and women in 1998, but this decline was not statistically significant (test for trend: P = 0.174)., Conclusion: This study documents a rapid reduction in prevalence of gonorrhoea, probably reflecting reduced duration of infectiousness due to advances in diagnosis, increased testing activity and reduced interval to treatment rather than behaviour change. These results demonstrate that, in remote communities, even with a highly mobile population, it is possible to implement effective control activities for sexually transmitted diseases.

Background and Methods: Despite a concentration of risk factors for HIV transmission, many remote Aboriginal communities in central Australia have a low uptake of HIV testing. We studied the uptake of HIV testing in six clinics in remote Aboriginal communities following the introduction of voluntary confidential testing to assess the impact of the intervention and to determine if the program was reaching people most at risk of HIV infection and transmission., Setting: The study was conducted by Nganampa Health Council, an Aboriginal-controlled health service on the Anangu Pitjantjatjara Lands in the far north-west of South Australia., Results: Since the introduction of confidential coded testing in August 1994 the number of HIV tests provided through the remote clinics has increased from 83 tests/year to 592 tests/year. In the 12-month audit period (August 1, 1995, to July 31, 1996) 62.7% of women aged 20-24 years, 44.6% of people aged 12-40 years and 24% of the total population had an HIV test. Fifty per cent of tests were accounted for by the 15-25 year age groups and 60% of tests related to an STD consult., Discussion: This study shows that a high uptake of HIV testing in high-risk groups can be achieved in remote Aboriginal communities where a high level of confidentiality is maintained.