Community sexual health advisor: a response to the national strategy for sexual health and HIV
Community sexual health advisor: a response to the national strategy for sexual health and HIV |
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Key words: community, needs assessment, sexual health strategy, schools.
Introduction
Since the publication of the National Strategy for Sexual Health and HIV in 2001, (1) local sexual health strategy groups have identified areas in need of improvement in order to meet the national targets. The Hambleton and Richmondshire Primary Care Trust has drawn up a provisional model for the delivery of local sexual health services that will be presented to the Professional Executive Committee in September 2004. A baseline review of the existing services highlighted the needs in the service, and as a result the post of Community Sexual Health Advisor was created.
Possible roles- support and training
This is a new and exciting post, which I took up at the beginning of May 2004. My background is in nursing. During the last eight years, I have worked as senior nurse in the Genito-urinary Medicine department at Scarborough Hospital, England and as the lead for a nurse-led family planning clinic at Pickering, North Yorkshire. One of the main problems in the General Practitioners' practices with regards to sexual health, is the lack of provision for partner notification (2). My role will be to support general practice and the family planning services by providing effective partner notification, as well as offering training to members of staff. This will be on issues of confidentiality, sexually transmitted infections, and HIV screening. The Primary Care Development team have identified practices where there is a possibility of offering an enhanced level of service, and my role will be to support them in this.
Counselling and out-reach
A gap has also been identified in the provision of counselling pre termination of pregnancy. This is for those who want counselling before their clinic appointment, and also after the termination. Part of my remit will be to provide counselling to whose who require more help in making their decision than can be offered in the routine settings of general practice or family planning.
There has always been a challenge of a core group of "hard to reach" people who need health services. In order to meet the needs of these vulnerable and hard to reach groups, I will be working in the Northallerton prison and the Shared Care Treatment Clinic. I am in the process of setting up an outreach Genito-Urinary Medicine service for the prison, (shortly to be taken over by the Primary Care Trust), which will be nurse-led and with referrals made to the prison doctor. My input into the Shared Care Treatment Clinic will be based on sexual health advice and harm minimisation.
A rural population such as this in North Yorkshire, England will benefit from this developing post. The main function of which, essentially, will be to enable standardisation of care in the community. This will be for those who do not access the Genito-Urinary Medicine clinic, and to support services outside the hospital setting that are offering sexual health screening. In this role I shall endeavour to be a useful link between sexual health services in the community whilst maintaining my clinical skills through my work in the Genito-Urinary Medicine clinic.
Although this post is new and challenging, it is not without its obstacles! Firstly, the geographical area alone poses a problem with distance to be covered, not just for myself but also for colleagues who find travelling to workshops and meetings difficult to fit into their busy schedule. Secondly, as with anything new there is a certain element of change. Whilst this may be perceived as threatening, as yet I have experienced only enthusiasm and support, (with just a hint of scepticism from a minority of GPs!). Thirdly, the advent of a Health Advisor carrying out Partner Notification, (PN) in the community will result in more people attending for screening and treatment. Whilst this is the aim of the sexual health strategy in preventing the spread of infection, it will have a knock on effect on the GUM clinic and surgeries in terms of caseload.
In contrast however, the benefits of having a Health Advisor in the community are considerable. First and foremost, standardising and supporting sexual health services outside of GU clinic increases access to a specialised service for people who are unable to attend a GU clinic. In my role I will be able to facilitate health promotion in areas most needed, namely, schools and colleges. Here I can work in conjunction with the school nurses and youth workers to provide an extra dimension to their sexual health needs, at the same time linking in with the aims of the teenage pregnancy strategy. Other areas include the prison, the shared care treatment clinic, the termination clinic, family planning, and anyone diagnosed with a sexually transmitted infection.
As the post develops within its broad remit, there is the risk that it becomes perceived as an “all singing, all dancing” service! I have no doubt that audit will provide the evidence needed for expansion.
References:
1. Department of Health. The national strategy for sexual health and HIV. London: Department of Health, 2001.
2. Tayal SC, Opaneye AA. Sexual health and HIV strategy: a survey of general practitioners on Teesside and North Yorkshire, England. Sexual Health Matters. 2003; 4(4): 63-65.
©2004 Sexual Health Matters. Published Quarterly by Express
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