Part 1. What is sexual health? Part 2. Why STI Priority Population Groups? Part 3. The framework of a phone call Part 4. Managing difficult calls Triage Course Overview
May 26, 2015
Part 1. What is sexual health?
Part 2. Why STI Priority Population Groups?
Part 3. The framework of a phone call
Part 4. Managing difficult calls
Triage Course Overview
Part 2. Why STI Priority Population Groups?
Learning Objectives
At the end of the session you will be able to:
Explain why certain groups of people are more at risk of STIs
Describe some STI symptoms
Decide who should attend a sexual health clinic and who should be referred to a GPIdentify priority
populations in your local area who may access your clinic
Key Points
Some groups
of people
are more
vulnerable to STIs than
others.
People who are
more vulnerable to STIs
are considere
d a priority
for access to Sexual
Health Services.
Targeting priority groups helps with more
effective allocatio
n of health
resources.
Targeting
priority groups is a key strategy
in preventing the spread of STIs.
Some people may
belong to
more than one
priority group.
The NSW Sexually Transmissible Infections Strategy 2006-2009 (NSW Health) gives priority to the following groups because they are more vulnerable to STIs.
Aboriginal People
Men who have sex with men
Sex Workers
People with HIV / AIDS
Young people and heterosexuals with recent partner change are a large priority group and some services may lack the capacity to see all clients in these groups. It may be necessary to ensure those most vulnerable to STIs within these groups are prioritised. This issues is discussed further in part 3.
Aboriginal people are a priority for sexual health services because of:
Lack of access to primary health care services
A higher percentage of the Aboriginal population are young (Median age 21 compared with 39 for non-Aboriginal people; ABS 2006).1
Notifications of STI rates are higher among Aboriginal people
Many Aboriginal people move from community to community
Aboriginal people have a lower than average health outcome, because of a range of social and economic factors.
Men who have sex with men (MSM)
MSM are a priority for sexual health services because of:
Higher rates of STIs2
Having an STI increases the risk of HIV infection2
Certain sexual practices may place them at increased risk of STIs
Clustering of gay communities may facilitate the spread of STIs2
Homophobia may impede access to services2
Sexual health education relevant to same-sex attracted youth is generally not covered in school2
Sex Workers
•sex workers are considered a priority because they have a high number of sexual encounters.2
While the prevalence of HIV and STIs
among Australian female sex workers remains one of the
lowest in the world;3
•sex workers remain a priority population to ensure that achievements to date are sustained.2
Sex workers have a very high rate of condom use and
undertake frequent sexual health check
ups;4
Sex workers are a priority group for STI services because:
Sex Workers
Overseas-born may be less likely to practise safe sex owing to:
Greater pressure to practice unprotected sex 2
Isolation from peer support and information services 2
Isolation within working environments which do not routinely insist on protected sex2
Reduced skills and knowledge in negotiating protected sex particularly for overseas born workers who lack English speaking skills2
Lack of access to condoms and lubricant2
Sex Workers
Street based may also be at higher risk of STIs due to:
Greater pressure to practice unprotected sex5
Greater difficulty accessing health care services for preventive health care 5
Illicit injecting drug use 5
Inconsistent access to condoms and lubricant 5
Sex Workers
Male sex workers may also be at higher risk of STIs due to:
Higher incidence of STIs among MSM5
High rates of illicit drug use 5
Inconsistent condom use with non paying partners 5
People who inject drugs
Poorer health outcome across a range of indicators
Poorer access to health services especially primary health
Behaviours associated with injecting drug use places them at higher risk for STIs
People who inject drugs are a priority for SHS because they have:
Street outreach conducted in Melbourne revealed a high prevalence of infections and risk behaviours among people who inject drugs5
The Australian Study of Health and Relationships reported men and women who injected drugs were more likely to have had an STI 6
People who inject drugs
There is also evidence that:
People with HIV
People with HIV are considered a priorityFor sexual health services because of:
Higher prevalence of STIs among gay and other homosexually active men with HIV
STIs have a greater impact on the health of people with HIV
The presence of STIs increases the risk of HIV transmission
STIs may present with unusual features and be less responsive to treatment in people with HIV
Young People
They have higher reported rates of STIs
They change partners more frequently
Approximately 41% of young men and 61% of young women are sexually active4
Limited finances or not having their own Medicare card can make it difficult to access health care
Young people, aged 25 and under are considered a priority population because:
attending school
being homeless
using illicit drugs
beginning sexual experience
having multiple sexual partners
being Aboriginal
being same sex attracted
being culturally and linguistically diverse
having a mental illness
A range of approaches will be needed to address the different issues young people face. Consider how the issues identified below will affect how vulnerable a young person is to STIs.
Heterosexuals with recent partner change
Reported by the Australian Study of Health and Relationships5
Age Group
% Male % Female
Sex with 2 or more people in the previous year *
16 -59 13% 7%
More than one sexual partner ** 16-59 5% 3%
As the risk of STIs increases with the number of sexual partners this group is also a priority within the STI strategy. Because of the size of this group sexual health services may not beable to prioritise this group or may have to prioritise only those withinthis group who are most at risk of STIs.
* More common for under 30 years olds** Among those who were in a regular relationship for more than one year
Heterosexuals with recent partner change
The period between first sexual experience and settling down with one partner has increased over the past few decades as cohabitation has become more acceptable 5
This has greatly increased the need for awareness of STI risks and prevention among the majority of heterosexuals
Heterosexuals with recent partner change
Starting new relationships
After a casual
relationship
At the end of a
relationship
As most STIs have no symptoms, people should be encouraged to have an STI check.
Encouraging regular sexual health check-ups is important for this priority group particularly when -
Heterosexuals with recent partner change
It may be more appropriate for people who want a ‘routine’ sexual health check to be referred to a GP practice, family planning clinic or women's’ health clinic, unless their circumstances indicate they maybe a higher priority
People with symptoms or a contact of STI
Pain when passing urine
An unusual discharge from the penis or vagina
Sores, lumps or rashes in the genital or anal area
Any pain or bleeding associated with sex
Any testicular pain (men)
Any pelvic pain (women)
Anyone who experiences the following symptoms should be considered a higher priority
People with symptoms or a contact of STI
Sometimes callers may be unsure of these STI signs. It is better to be cautious and refer them into the clinic than refer out
It is impossible and unwise to diagnose people over the phone, despite that they may ask you what it could be
Anyone who is a sexual contact of gonorrhoea, chlamydia, syphilis, HIV, hepatitis A or B is also a priority
The ‘3-7-3’ rule shown below, indicates how soon an appointment should be provided.
3 days - HIV nPEP post exposure prophylaxis can only be given for any * high risk exposure to HIV occurring within the last 3 days.If unsure about their risk, refer to a nurse for assessment.
7 days - After this time Chlamydia and Gonorrhoea can be tested conclusively.
3 months - After this time HIV, hepatitis and Syphilis can be tested conclusively.
*Unprotected anal intercourse in MSM or unprotected vaginal intercourse in women with a known HIV infected partners is generally considered a high risk exposure.
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