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This research aims to improve understanding and surveillance of syphilis in rural and remote communities in Northern NSW. While simultaneously, examining the factors involved and the experiences of people with an STI in accessing health care. Preliminary findings will be discussed which includes the difficulties and issues related to research in rural areas. Syphilis notifications over a ten year period from 1994 to 2004 in Northern NSW were extracted from NSW Health Notifiable Diseases Database for the geographic area covered by the Hunter New England Area Health Service, Northern Area. This study uses the Index of Relative Socioeconomic Disadvantage developed by the Australian Bureau of Statistics. The sample consisted of 254 notifications for the Hunter New England Northern Area over the 10 year period. Preliminary results show that notifications were highest in the most disadvantaged areas with high levels of advantage associated with lower numbers of notifications for syphilis <1 year duration. Reported rates of syphilis declined from 1996 until 2001 when the trend began to reverse. People aged between 15-29 years had a prevalence proportion of 5.2 per 1,000 population compared to 0.8 for those over the age of 30 years. The reported rate of infection is higher among women than men. Questions raised from this analysis will be explored in further detail in in-depth interviews with approx 40-60 people. The study reveals there a number of differentials in the notification of syphilis. The implications of this study for policy and practice highlights that people under the age of 30 years and those from disadvantaged areas require …