"Let's not talk about sex": Reconsidering the public health approach to sexually transmissible infections in remote indigenous populations in Australia

• Sexually transmissible infections (STIs) are hyperendemic in some remote Indigenous populations in Australia. • Screening programs have had some success in reducing the prevalence of STIs in specific populations, but there has been little overall improvement in the past 10 years. • We question the usefulness of current practice and urge consideration of a new and radical approach. • Instead of a "screen, treat and contact trace" strategy, we suggest adopting the same approach as currently accepted for trachoma control: populations reaching a threshold prevalence for a set of marker STIs (identified through sentinel surveillance) should be offered a treatment program aimed at the entire sexually active population. • We also recommend a parallel program of health promotion and "life skills" education and outline the arguments for such a departure from currently accepted public health policy.