Archives of Sexual Behavior

, Volume 46, Issue 7, pp 2145–2156 | Cite as

Development of a Risk Algorithm to Better Target STI Testing and Treatment Among Australian Aboriginal and Torres Strait Islander People

  • Handan WandEmail author
  • Joanne Bryant
  • Marian Pitts
  • Dea Delaney-Thiele
  • John M. Kaldor
  • Heather Worth
  • James Ward
Original Paper


Identifying and targeting those at greatest risk will likely play a significant role in developing the most efficient and cost-effective sexually transmissible infections (STI) prevention programs. We aimed to develop a risk prediction algorithm to identify those who are at increased risk of STI. A cohort (N = 2320) of young sexually active Aboriginal and Torres Strait Islander people (hereafter referred to as Aboriginal people) were included in this study. The primary outcomes were self-reported high-risk sexual behaviors and past STI diagnosis. In developing a risk algorithm, our study population was randomly assigned to either a development (67%) or an internal validation data set (33%). Logistic regression models were used to create a risk prediction algorithm from the development data set for males and females separately. In the risk prediction models, older age, methamphetamine, ecstasy, and cannabis use, and frequent alcohol intake were all consistently associated with high-risk sexual behaviors as well as with a past STI diagnosis; identifying as gay/bisexual was one of the strongest factors among males. Those who had never tested for STIs, 52% (males) and 66% (females), had a risk score >15, and prevalence of undiagnosed STI was estimated between 30 and 40%. Since universal STI screening is not cost-effective, nor practical in many settings, targeted screening strategies remain a crucial and effective approach to managing STIs among young Aboriginal people. Risk prediction tools such as the one developed in this study may help in prioritizing screening for STIs among those most at risk.


Sexual risk behaviors Sexually transmitted infections Aboriginal and Torres Strait Islander Indigenous Australians Risk prediction 



We would like to acknowledge each State and Territory Health Department for the contribution of both in-kind and cash contributions to this project. The project was coordinated by NACCHO and the state and territory-based affiliate organizations who agreed to participate and be a strategic partner in the research. Particular thanks to the survey coordinators based within these organizations who were responsible for the coordination of logistics and data collection in their respective jurisdiction.


This project was funded by the Australian Research Council Linkage Grant # LP0991274.

Authors Contribution

JW was the principle investigator of the GOANNA study. HW and JW developed the study concept. HW analyzed the data. JW and HW drafted the initial manuscript. JW, JK, HW, JB, MP, and DT were investigators and participated in the design of the study as well as commented on the final draft. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interest.

Ethical Approval

The project received ethical approval from Aboriginal Human Research Ethics Committees in relevant jurisdictions and the University of New South Wales and La Trobe University Human Research Ethics Committees. Participants were also provided with consent forms with contact details of the relevant research ethics committee(s) should anything in the survey cause distress. Survey collectors verbally confirmed that participants were aged 16–29 years and identified as Aboriginal and/or Torres Strait Islander and ensured that they consented to participation.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Handan Wand
    • 1
    Email author
  • Joanne Bryant
    • 2
  • Marian Pitts
    • 3
  • Dea Delaney-Thiele
    • 4
  • John M. Kaldor
    • 1
  • Heather Worth
    • 5
  • James Ward
    • 6
  1. 1.Kirby InstituteUniversity of New South WalesKensingtonAustralia
  2. 2.Centre for Social Research in HealthUniversity of New South WalesKensingtonAustralia
  3. 3.Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneAustralia
  4. 4.Aboriginal Medical Service Western SydneyMount DruittAustralia
  5. 5.School of Public Health and Community MedicineUniversity of New South WalesKensingtonAustralia
  6. 6.South Australian Health and Medical Research InstituteAdelaideAustralia

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