Aboriginal and Torres Strait Islander people
In Aboriginal and Torres Strait Islander communities, effective health care service delivery of any kind requires practitioners to be aware both of the uniqueness of each client, Indigenous cultural context generally and also the cultural diversity that exists within the Aboriginal and Torres Strait Islander communities. This is especially the case with issues of sexual health and contact tracing. For this reason, generalisations about how to work within these distinctive cultural frameworks are difficult to make.
Rather than seeking to provide guidance to workers on issues of contact tracing by providing ‘national’ guidelines, a flexible approach that respects the rights and dignity of clients through cultural sensitivity is recommended. Workers in the field should endeavor to establish local partnerships and relationships that can provide effective feedback and guidance on how to proceed. These partnerships are based on trust and respect within the local community and need to be built up over time. Key to establishing such relationships are the roles played by Aboriginal primary health services in general and Aboriginal health workers in particular. These workers and organisations have established expertise in the delivery of Indigenous health care. They can provide local-level advice on particularly difficult and sensitive issues such as contact tracing. It is recommended that contact tracing be conducted in partnership with a local Indigenous health care worker and that contact tracing is part of an overall prevention and care package. Of particular importance will be the question of who does the actual contact tracing. As well as the issue of gender concordance, there are other issues such as kinship relationships, use of multiple identifiers (nicknames), multiple itinerant addresses and the consequences of diagnosis to the client that need to be taken into account. Care should be taken in all circumstances to establish and maintain a rigorous approach to confidentiality.