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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