Introduction Australia has a widely dispersed network of public sexual health services that see large numbers of people at risk of genital Chlamydia trachomatis infection. ACCESS was established to monitor chlamydia testing and positivity rates nationally and to assist the interpretation of chlamydia diagnoses reported through passive surveillance. We report on chlamydia testing and positivity in Aboriginal and Torres Strait Islander (hereafter Aboriginal) people attending 18 sexual health services participating in ACCESS between 2006 and 2011.

Methods Using line-listed data, we analysed Aboriginal status reporting, testing rates based on first visits and chlamydia positivity in those tested. Outcomes were stratified by age group, sex, and year of attendance and were compared with non-Indigenous clients using a chi-square test and multivariate logistic regression (p < 0.05).

Results From 2006 to 2011, 7,103 (4.2%) Aboriginal people and 161,626 (95.8%) non-Indigenous people attended participating sexual health services for an initial visit. Of the Aboriginal people 5,280 (74%) were tested for chlamydia. The positivity rates in Aboriginal people were 17.0% in women (23.3% in 15–19 year olds and 18.9% in 20–24 year olds) and 17.3% in men (20.2% in 15–19 year olds and 24.3% in 20–24 year olds). There were increasing trends seen in chlamydia positivity in Aboriginal and Torres Strait Islander females and non-Indigenous males and females between 2006 and 2011 (p-trend < 0.01). On multivariate analysis, positivity was associated with younger age, being heterosexual and living in Queensland in both Aboriginal men and women. In addition, in Aboriginal men, positivity was associated with not living in a remote area, and not having sex overseas; and in Aboriginal women, it was associated with attending in 2010 or 2011.

Conclusion The high Chlamydia positivity rates and increases over time highlight the need for enhanced prevention and screening programmes in Aboriginal people in Australia.