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ENHANCING SEXUAL WELLBEING IN SCOTLAND- A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: ANALYSIS OF NON-WRITTEN CONSULTATION EVIDENCE ON THE DRAFT SEXUAL HEALTH AND RELATIONSHIPS STRATEGY
CHAPTER SIX THE ROLE OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES
6.1 The draft strategy states that lifelong learning about relationships and sexual health must be complemented by accessible, confidential and appropriate clinical services. The strategy notes that there are many examples of good and innovative sexual health services across Scotland, but that there are also wide variations in terms of availability, quality and choice and a number of challenges that limit the impact of these services. To address these challenges it recommends the integration of sexual health services across each NHS Board area. |
Implementing an integrated tiered approach
6.2 The draft strategy recommends that each NHS Board should develop a tiered service approach by integrating sexual health services across a range of disciplines and specialities. A tiered service approach should provide more flexible, consistent and co-ordinated clinical services facilitating patient choice of sexual health service providers either through direct provision or referral arrangements. |
6.3 A fundamental principle of the strategy is that every person should have a choice when accessing sexual health services and be able to self-refer to all such services. Participants suggested that people value choice and ease and speed of access to services in terms of waiting times.
"We need centres where there are doctors available all the time, where no appointments are needed. Referral to specialists can take another two weeks, but we need a service that is able to respond. People [with HIV] can be really quite ill and the situation can escalate quickly" (African women group).
"My GP does have open sessions [where you don't need an appointment] - we need this in more places and people need to know about them" (African women group).
"There should be better resources so infected people can get seen quickly. The services already in existence need to be promoted better. Kids don't know that GUM clinics exist, unless they visit their doctor" (SCF participant).
6.4 Embarrassment and stigma are major barriers to the use of sexual health services and all services need to address the issues that prevent people from going for help. The need for different service options and for the development of culturally competent services has been discussed in
Chapter 4.
Specific actions to reduce Sexually Transmitted Infections (STIs)
6.5 There are a number of recommendations in the draft strategy on the use and distribution of condoms, specifically to reduce the spread of STIs. The draft strategy recommends that health promotion activities should include skills development in the use of condoms and be reinforced by professionals in both learning and clinical services. NHS Boards should also ensure that a range of condoms and lubricants are regularly supplied free of charge to outlets and services targeted at high-risk groups and as part of outreach work. At present, in some services contraception is available free of charge for women, and where this is the case, the draft strategy recommends that condoms should also be freely available to both men and women. It also recommends that condoms should be available on prescription for males and dental dams for females throughout the course of their detention in young offender institutions and adult prisons. The Scottish Executive are also encouraged to fund the availability of the chlamydia postal testing kits developed by Healthy Respect to all NHS Boards if the evaluation evidence supports this in order to encourage early diagnosis and treatment and to minimise onward transmission among those aged under 25. |
6.6 The use of barrier contraception has been discussed in
Chapters 2 and
4 in relation to a media campaign, stigma and practical barriers to wider condom use. Many of the issues raised there are relevant here too and some additional comments were made about the desirability of condoms being more freely available, although not all the recommendations were commented on by participants.
"Condoms should be available free. Resources are needed to cover this. Family Planning Clinics do provide condoms, but there can be a huge stigma attached to them, and some people don't want to be seen going in there. This is especially true in smaller rural areas, where you will most likely know the staff of the clinic personally" (SCF participant).
"Condoms are too expensive in the UK" (African men group).
"Condoms can be hard to get hold of. They are very expensive in the shops, but few people seem to appreciate they are free from Family Planning Clinics" (SCF participant).
"Condoms need to be made very accessible wherever young people are. A condom drawer in a youth club, for example. London gay bars have bowls of condoms on the counter. Ask young people themselves where and how they would like to get access to condoms" (SCF participant).
"You can walk into any gay bar and you'll find condoms all over the place. If you walk into a straight bar there's none - well they'll be in the machine in the toilets. There should be a bowl somewhere - you should be able to pick up half a dozen of what you want without having to go to ask someone for them" (Working men group).
"People aren't aware that condoms can be obtained free at Family Planning Clinics. The 'C-Card' scheme in the Lothians also means people can get them free, and not just bog-standard ones either" (SCF participant).
"Some school pupils held a discussion on contraception, and agreed that the school should make condoms and the morning after pill available to students. Their views were not welcomed by the authorities, nor were they acted on. There is evidence around that suggests school condom programmes can be very effective" (SCF participant).
"Critics believe that schools want to chuck condoms around without providing any back-up message" (SCF participant).
6.7 All the young participants agreed that access to free condoms was important and that there should be no obstacles to accessing free condoms. Their experience was that the availability of free condoms varies widely across local areas. The most important issue to them relating to the distribution of condoms was being able to access them easily and without embarrassment. They were aware of the sensitivities surrounding access to condoms and their suggestions for expanding access to condoms took these into account.
6.8 Access to condoms through vending machines is an expensive option, particularly for young people. Local GP clinics present problems of access and anonymity. Having to buy condoms means that young people do not use them, both because of the financial cost and embarrassment of having to ask for them over the shop counter.
"If you're a kid and you have to pay for them you just won't use them" (Young gay men/care leavers group).
"I'm quite lucky, I live across the road from a centre that gives them out" (Young gay men/care leavers group).
"If you can just go into a shop and grab a handful without going up to the counter it's a lot more comfortable" (Young gay men/care leavers group).
6.9 Some young participants believed that they should be given out in schools even though most anticipated that parents would complain about this.
"Some parents would say it's encouraging young people to have sex. At least they would be encouraging them to have safe sex" (Young fathers group).
6.10 However, others were concerned that it would be embarrassing for some young people to receive condoms at school. All the young mothers agreed that distributing C-cards at school would be a good idea since this scheme gives young people a choice about obtaining condoms and an opportunity to obtain condoms free of charge.
6.11 Further suggestions for distributing condoms were that they could be distributed with nightclub flyers and available in a wide range of locations such as clinics, a drop-in centre located within school, in the school nurse's office, in toilets within bars, pubs and clubs, in newsagents and in off-licences.
6.12 Anticipating concerns about condoms being obtained by younger children and young people, some participants explained that younger people only took free condoms to play around with as balloons, which meant they got used to handling them. Other participants emphasised that seeking condoms should be recognised as part of young people's natural curiosity and that it should not be assumed that young people seeking access to condoms or information about sexual health were having sex or even that they were thinking about it. They stated that this assumption was both inaccurate and a barrier to young people preparing themselves for that part of their lives.
6.13 Whilst greater access to condoms is broadly welcomed, some participants raise concerns about the legal implications.
"Workers with under 16's are afraid to give out condoms because of legal implications" (SCF participant).
"The law says you can't have sex if you are under 16. Youth workers face legal comebacks if found giving condoms to under 16's. I don't necessarily want to see the age of consent lowered, but people under 16 need to be supported" (SCF participant).
6.14 As discussed in
Chapters 2 and
3 there is also a sense that in some cases what is needed are information and communication skills development, rather than the provision of condoms.
"Outreach work is going on with under 16s. Experiences of [youth work] has been that it is more effective to arm young people with information, rather than condoms" (SCF participant).
6.15 The LGBT outreach group made the point that it is difficult for a voluntary service to offer outreach support to prisons. Given this, the recommendation that condoms and dental dams should be available on prescription in young offender institutions and adult prisons would be an appropriate way to reach such populations.
6.16 Peer education may also be a valuable in this respect, particularly for high-risk groups and as part of outreach work. Sex worker participants described their role in peer education for each other and for their clients and the frank knowledge that they exhibit is more widely applicable for those in wider society that have casual sexual encounters.
"This is where the peer education comes in again, if you learn how to put a condom on right - that it's the right size according to the guy, make sure you use plenty of lubrication, then it minimises the chance of a burst. It's all knowledge you've got to learn" (Sex worker interview).
"I also tell my clients how to put a condom on - if they go with another girl. Don't use an oral condom for sex because they're very thin and could burst and stuff like that" (Sex worker interview).
"We've been told how to put a condom on with your teeth! - so that basically if a guy refuses to put a condom on you can just do it - without him really knowing. Personally I wouldn't do that because there can be a thing of violence if he finds out you're using a condom and he's asked not to" (Sex worker interview).
"Men who have sex with men but are married men can't take condoms home so need them on site" (LGBT outreach group).
6.17 Much of the earlier discussions, including the comments on the quality of sex education in schools underline the need to discuss condoms and encourage skills development in their use, but also the need to tackle the wider social and cultural reluctance to use condoms. This suggests that greater access to condoms will not be sufficient without a wider media campaign to promote their use.
6.18 In relation to HIV testing, a further recommendation of the strategy is that HIV testing should be offered to all Genitourinary Medicine (GUM) clinic attendees not known to be HIV infected who present with a new STI. Such offers would be made in the context of the HIV test being presented as a routine, recommended test. |
6.19 Whilst only a few participants responded directly on this specific recommendation, some of their comments suggest that this will need to be sensitively handled. There are issues about whether the routine offer of an HIV test may be interpreted as making racist assumptions and a need to ensure that people are aware of their entitlement to treatment, without fear of the consequences for their immigration status.
"If you go for something else, even a non-sexual health issue, the first thing they want to do is an HIV test" (African men group).
"They think if they're [HIV] positive they'll be sent back home. This is the main reason. This message has to be clear - that if they are positive, they will be treated for free and not sent home" (African men group).
6.20 Making HIV tests routine or 'normal' will also have to address the fear and reluctance to be tested amongst those that may be in high risk groups, borne of the continuing stigma around HIV/AIDS and fear amongst some groups that they may not be entitled to treatment in the UK.
"Testing is not likely if you're not sick, because of the stigma" (African men group).
"Some of them are afraid of the HIV test - they don't want to know. Media messages about HIV don't help" (African men group).
"People may fear they have it, but they're not diagnosed, then they have a phobia - they don't want to be tested" (African men group).
6.21 The African women felt that it was always better to know if you are HIV positive and some participants expressed a dislike of the practice of not revealing the results of some HIV tests.
"Anonymous blood tests - they don't tell you the results! If people aren't told they can't benefit from the treatment. The Government is just establishing the facts, but not helping the people" (African men group).
6.22 Knowing your HIV positive status is, of course, no guarantee of the practice of safer sex.
"Some men know they are HIV positive, but go ahead and have sex without protection" (African men group).
6.23 Handling HIV testing is a challenging area for the development of cultural competence amongst staff.
"There wasone case where someone interpreted an HIV positive result as a 'good thing'. This was because the Doctor presented the positive test result as 'the best piece of news you'll ever get', because of the [medical] view that it is better to know the result because then treatment can begin" (LGBT outreach group).
6.24 In the context of the proposal that HIV tests should become routine at GUM clinics, there are clearly issues about how professionals deliver the outcome of tests and how they deal with clients where the danger of misunderstanding is very great. Such a proposal will also need to address concerns about anonymity and the reluctance to use GUM clinics, particularly amongst high risk groups.
"My experience of GUM clinic is that they persist in asking for your name and date of birth, but people don't want to give this information" (African men group).
6.25 Peer education and counselling may be appropriate in helping to overcome some of these barriers to testing and treatment.
"You could use HIV positive people - as peers in GUM clinics" (African men group).
6.26 Voluntary services are also important in supporting those who are HIV positive, particularly in providing a culturally sensitive service.
"Voluntary services helps so much. There are problems when people are referred to the hospitals - it's probably because of colour" (African men group).
6.27 The strategy also recommends that all HIV patients have access within their main clinic to at least Tier Four sexual health services. |
6.28 Whilst Tier Four covers many of the current services in specialist GUM clinics, only at Tier Five are the specialist services of HIV treatment and care included. There were no comments on this recommendation by participants.
6.29 In relation to measures to reduce STIs, there is substantial agreement that greater access to free condoms is important for both men and women, but it is clear that this will not be sufficient without a wider media campaign to promote their use. There is also a need to promote awareness of the need to use condoms for oral and anal sex and health promotion activities to promote skills development in the use of condoms, perhaps through peer education reinforced by professionals in learning and clinical settings. The difficulties in offering outreach support to prisons and young offenders institutions suggests that these populations should not be excluded from wider measures to protect sexual health. There were no direct comments on the proposal to fund wider availability of chlamydia postal testing kits, which perhaps is a reflection of the evident lack of knowledge about STIs more generally.
6.30 Participants comments suggest that HIV testing is a procedure that cannot readily be 'normalised' and proposals to make it routine (amongst GUM clinic attendees not known to be HIV infected who present with a new STI) will need to be sensitively handled to avoid the great potential for misunderstanding. They will need to address concerns about anonymity, racism where assumptions are made about people from Africa, fear of the disease itself and fears of the possible wider consequences of treatment for immigration status.
Supporting access to services
6.31 The draft strategy makes a number of recommendations to support access to services. These include service configuration, developing professional roles to respond flexibly to the tiered service approach, supporting access to services in rural areas, information, confidentiality and anonymity, anonymity of testing, contraception and termination and sexual dysfunction. 6.32 The draft strategy recommends that barriers that restrict the use of services are identified and addressed and that proposals are made to improve service access for all populations, including reviews of the needs of rural communities. It identifies staff attitudes and outlook as being an important factor, particularly for vulnerable groups including people from minority ethnic communities. Same-sex GPs and nurses are identified as having a positive influence on outcomes. Opening times, location, premises and perception of the service by users can also present barriers to service use. Many of these factors are related to stigma, embarrassment, concerns about confidentiality and anonymity and a lack of cultural competence of services, as discussed in
Chapter 4. The draft strategy recommends that all clinical services assess their current services against the clinical service values and principles identified in the strategy. These are that: Services should be sensitive, respectful, confidential, attractive, appropriate, flexible and user friendly and responsive to the needs of their local community including being culturally competent Services should be responsive to the specific needs of men and women of all ages and recognise the impact of gender stereotypes and behaviours Services should be provided in high quality premises which are accessible both geographically and in their opening times Services should focus on, and respond to, the needs of the individual and adopt a non judgemental approach to sexuality and sexual orientation Users should be involved actively in development planning and ongoing service feedback in general and as part of patient/public participation initiatives Services should promote empowerment, positive self esteem and self advocacy Services should offer support and information in making informed choices and developing fulfilling and healthy relationships Staff providing sexual and reproductive health services must be supported through the provision of appropriate training/continuing professional development and resources
6.33 The draft strategy also recommends that guidance should be developed on confidentiality and disclosure of information for use by all service users and for all relevant health, social care and education staff. All providers of sexual health advice, information, learning and services should prominently display their confidentiality approach in information booklets, on notice boards and in waiting areas. It also recommends that service providers should give clear information to users about their options when giving personal and identifiable information if confidentiality or anonymity are of concern. The draft strategy also makes a number of recommendations in relation to contraception and termination, however, no direct comments were made by research participants on these issues. |
6.34 The experience of service use by many of the research participants endorses the view that the challenges of overcoming the barriers to access to services are substantial. Restrictive opening times and the need to wait act as deterrents to accessing services. In addition there are issues about the fear of illness and treatment, in addition to a lack of anonymity and stigma.
"People think that HIV is the only STI, and they're scared of it. People don't want to go to the doctor in case they are given fatal news. If people won't go to their doctor, where will they go? GUM clinics could do with better opening times, perhaps at weekends" (SCF participant).
"Most ethnic minority men won't go to hospitals. They have preconceptions - that they'll have to wait, they won't be treated on time. Some of them are afraid of the HIV test - they don't want to know. Media messages about HIV don't help" (African men group).
"I hate going to the GUM. It's far too public for me. It's all very well as long as you go between the hours of 8-10 in the morning and you pick up a number and you eventually get called. I liked it when we had the [outreach] clinic. Everybody in here was in the same boat as me. Everybody was a prostitute. When we had it here it was great because I could come in and the nurse would joke. At the GUM you can feel people looking at you. They make you feel dirty" (Sex worker interview).
"HIV testing information should be completely confidential even with GP's then maybe more people would take the tests and take more care" (SCF participant).
6.35 The Poverty Alliance group participants felt that embarrassment would prevent many people using specialist services such as GUM clinics. However, there was some positive experience of using a GUM clinic amongst participants.
"The GUM clinic is quite a good idea. You're anonymous - you get a number. You don't have to give your personal details - that's a good way. You can be anonymous and no one needs to know your problems. You speak to the doctor and that's OK" (Working men group).
6.36 Even if confidentiality was guaranteed, the embarrassment at being known to have used certain services would been a barrier for some people, may delay or prevent them from using a service altogether.
"I've had experience of open discussion of private matters at GUM clinics. They don't understand that we're already stressed" (African women group).
"It took me forever to go in the first place. I had a gut feeling that I was positive but kept missing my appointments. And I am a medical person! I wonder about other people. I was thinking 'how can I go to a GUM clinic?'" (African women group).
6.37 Services that combine treatment for STIs with other sexual health services were considered by participants to be less stigmatising.
"If I'm worried about something, I go to the Family Planning Clinic. You're in a room, your name gets called. They don't know where you're going. It could be family planning - you could be going up for the pill. It's not so embarrassing as going to the GUM and sitting there" (Sex worker interview).
6.38 Other barriers are staff attitudes perhaps arising from pressure on services.
"Those ladies in reception are so cruel! They say 'you'll have to see whoever's free'. It's not working! I don't like it at all" (African women group).
6.39 The Poverty Alliance group also felt that staff in health services might have 'moralistic' attitudes towards some clients, particularly young people. They also felt that staff may not treat young people seriously if they presented themselves for treatment; that they would be
'treated like a child', in that they had been
'doing something they shouldn't have'.
6.40 There were also concerns that lack of knowledge about how the system works, discrimination, racism or cultural insensitivity means that not all users get the services they need.
"I've heard staff explain things to Scottish people, but we don't get explanations. The whole system has to be turned around. We need information on leaflets" (African women group).
6.41 The experience of Africans with HIV present a major challenge to the development of culturally competent services at all tiers.
"The problem with the GUM clinics is some of the people that work there. Even the counsellor was rather scared of talking to me. The people are not sufficient to address the issues - they don't have the information they need. But if you place it in mainstream services they will never get it" (African men group).
"You have to make the culture responsive to Africans. They see your colour -they think you've got it! [HIV]" (African men group).
"Everyone is more comfortable talking to their kind of people. We need more people in the services" (African women group).
"We need more people of colour to work in those places. It makes it more comfortable. At the GUM clinic, you don't see anyone of your colour there and that's scary!" (African men group).
"You do feel more comfortable talking in your own language. Otherwise you can't be sure you've really got your feelings across" (African women group).
6.42 Gender sensitive services may also be important to overcome embarrassment and recognise the needs of different faiths.
"Have you ever seen a male receptionist in the doctors surgery? It could be an issue if people want to walk in and get general health information. It's like buying condoms. Most chemists' front staff are female. The joke is you come out and you've got more toothbrushes than you'd ever need in your life. I'm not going to admit to someone of the opposite sex that I've got some sexually transmitted disease or whatever. There's just that embarrassment factor" (Working men group).
"Some Africans are Muslims and would want a same sex professional. People often do prefer this, but there are differences. We need to be given a choice - it's all about respect" (African women group).
6.43 It is evident that preferences for same sex professionals are not confined just to women or to a particular faith group, but are likely to be found within the broader population.
6.44 Those with HIV and others experiencing the poorest sexual ill health find inadequate service responses to their sexual health needs.
"If you're positive, you're just told to start using condoms and that's it. We need advice on pregnancy. We need guidelines on how to stop getting pregnant. They assume things - they don't go out of their way to tell you about other things. I don't know if they're frightened?" (African woman group).
"Being [HIV] positive doesn't mean you don't want kids. This is especially important for young women" (African woman group).
6.45 Some participants raised the concern that young people in particular would be unsure about the confidentiality of using GPs or other local services. The fear that medical staff would inform their parents was seen as a potential barrier. Linked to this issue, the question of the age gap between staff and younger clients was also raised. It was felt that young people would be less likely to use services if they were staffed by people who were significantly older then they were.
6.46 In addition to these practical barriers it was felt that young people, particularly from poorer communities, lack the self-confidence or the self-esteem to be able to access the services. Tackling this problem was seen as a role for the education system.
6.47 Embarrassment and lack of confidentiality were also identified by others alongside other kinds of barriers to sexual health including geography, access to services in rural areas and religious views.
"You need to bring services to the people in rural areas. Geography is a real barrier to accessing services. There are problems reaching family planning services, contraception, relationship support" (SCF participant).
"We have to tell young people to go to the GUM clinic at the [hospital], where there are waiting lists to get seen. There should be better resources so infected people can get seen quickly. Services already in existence need to be promoted better. So many people can't access GUM clinics because of the geography - there are so few of them, often covering big areas" (SCF participant).
"Barriers to services are quite often geographical. If the one place in your community isn't appropriate, no-one will make use of it - lots of people don't want to be seen by friends or family going into certain buildings" (SCF participant).
"The Church has a very strong influence in the Highlands. People in the Highlands are in denial about issues such as rape and drug abuse and this is partly to do with the power of the church" (SCF participant).
6.48 The location of services can restrict access. If services are not available in local areas then some people may not feel comfortable accessing them. However the opposite might also be true.
"If specialist services are 'too local' some people may not wish to use them" (Poverty Alliance group).
6.49 These comments on existing service provision suggest major cultural change will be needed amongst service providers if service users are to have access to non-stigmatising services, appropriate to their needs. The challenges of overcoming the barriers to access to services are substantial. Concerns about confidentiality and anonymity are major barriers for all ages and populations. Embarrassment, stigma and prejudice prevent many people using specialist services such as GUM clinics. The development of cultural competence in all tiers of services will be a major challenge.
Information
6.50 To support access to services, the draft strategy recommends a review of existing service information, and where necessary revisions to make this available in a range of easy to read and accessible formats and where necessary in language and formats appropriate to local population needs. Information and health promotion materials should challenge, not reinforce or replicate stereotypes and reduce, not increase misinformation and discrimination. |
6.51 Participants welcomed the proposals for more information on sexual health issues and services and suggested that the voluntary sector has an important role in the provision of information.
"We need the ability to respond to any requests for information. Information about what STIs are out there, and how to avoid them. All information is needed on everything. We need to be confident that all agencies will have all information available - that means including information about failure of contraception to stop spread of STIs and pregnancies" (SCF participant).
"Access to information when required should be the key. The voluntary sector can provide this" (SCF participant).
"There is support for more information being made available. It's accepted that a variety of people will have a role to play - community venues and shops should be used to provide specific local information. There is support for local agencies working together to implement the strategy - [this should not be] Health Service driven - [but] the community and the community sector have a role to play" (SCF participant).
6.52 Participants also made suggestions about taking information to people in an active way and creating opportunities for discussion and dialogue on sexual health issues.
"You could try moving the sexual health clinic to the pub - this has worked in one area" (SCF participant).
"Information should be made available in all workplaces, about all health issues. This could also be done at access places for unemployed people" (SCF participant).
"More spaces are needed where people can come together and talk about sexual health and relationships, also to learn skills which will help them improve their own sexual health" (SCF participant).
"You could have a well facilitated 'space' in each community, appropriate in context, where discussion could take place and people could learn from each other. Cyberspace could be a possibility!" (SCF participant).
6.53 There were calls for information on a range of sexual health issues, including all STIs not just chlamydia or HIV. Difficulties of communication on sexual health issues means that older adults also need information targeted at their specific needs.
"We need info on the menopause - what to expect. We're not told by our mothers" (African women group).
"Erectile dysfunction is put down to age, drink, or some other thing that it's not talked about and your sex life just ends effectively" (Working men group).
6.54 There were also issues raised of targeting those who are 'hard to reach' or where there are literacy or language problems.
"[Information] will have to make sure that those who do not interact much with their community can be reached. Others who will need specific targeting include those with literacy problems and those with sight/reading problems" (SCF participant).
"Outreach work takes information materials to public sex environments, but we don't produce literature in other languages - it is a 'gap' in what we and health boards do. There are issues of paying for translation, but even so, some issues are difficult to put into other languages" (LGBT outreach group).
"Not all materials are wanted or appropriate for all groups. Materials should be targeted" (SCF participant).
6.55 There were suggestions about the use of IT to make information more widely available, but also some caution.
"What about making information more available through Internet? The community can access the Internet at local libraries. National youth websites need to give more information about what services are available [locally] -there is a central belt bias in web information. Any campaign will have to overcome this, and recognise that different areas have different needs" (SCF participant).
"More use could be made of technology to provide information, as this affords more privacy and allows young people to get confidential advice and support" (SCF participant).
"You could look at direct learning through correspondence for some things, like getting family planning information to families. Websites could be used. However, access issues remain for many people to get on the Internet. It is also hard to check and monitor quality of information on the Internet" (SCF participant).
6.56 There was recognition of the fear that greater provision of information will promote sexual activity amongst young people, however, it was suggested that this was not always the case.
"Adults are afraid that if young people have good information about something that it will encourage them to do it - but that is not the case" (SCF participant).
6.57 Amongst young participants, issues of trust and confidentiality are important influences on how they wish to receive information on sexual health issues and services. No one option emerged as the best source of information on sexual health.
6.58 Text messaging brings issues of cost and trusting the source of information: "y
ou don't know who you're talking to, it could be anybody" (Young women group). Telephone helplines bring similar issues and those of a lack of privacy in using the telephone. Reactions to the use of the web were also mixed. The enthusiasts felt that young people need information and guidance as to which sites are reliable. Access to the web is problematic both at home and at school. School based access can be restricted to particular classes and schools operate a content filter that does not allow the viewing of websites with a sexual content.
6.59 Leaflets were a popular option amongst the young participants, although they were not considered helpful by all. Leaflets could be made more accessible by being stocked in the local library, in toilets and put through young people's letterboxes, in order that young people could obtain them anonymously. Leaflets need to be well designed, should not have too much text and should be interesting to read. The young participants also suggested that cartoons work well.
6.60 The young mothers participants believed there was a particular need for written information aimed at young parents. They believed that presentation was important, singling out a publication produced by a retail chemist on pregnancy and parenthood as well-designed and easy to read. They had suggestions for improvement, such as brighter colours, which would make this publication more appealing to teenage parents. These young women's experience was that information leaflets aimed at parents had tended to be directed at older parents and had failed to engage with the realities of their own experience.
"You get pictures of families with two point four children and fathers, smiling, but that's not real. It's not reality. It's not day to day life" (Young mothers group).
6.61 The young fathers believed that leaflets were unhelpful as a source of information on sexual health since they could lead to confusion and further unanswered questions. They said that it is crucial to have someone to talk to.
"You can end up thinking you have everything and then no one to talk to" (Young fathers group).
6.62 Nevertheless, many young participants most valued face-to-face, one-to-one contact in a supportive environment as a less intimidating way in which to obtain information about sexual health. They cited nurses or health workers, GPs or someone at a drop-in centre as good sources of information. Confidentiality again is the key influence on whom participants would speak to about sexual health;
"anybody that has the specific confidentiality policy as part of their job [would be OK to talk to]" (Young mothers group)
. However, other young participants preferred to obtain information about sexual health through parents, a partner or friends rather than through professionals.
6.63 These findings demonstrate that there is a need for an approach to the provision of information on sexual health and services informed by the needs and views of the target audiences. The findings support the recommendation to ensure information is provided in a wide range of accessible formats and caution against the tendency to assume that the use of IT is a particularly appropriate way to reach young people.
Reaching those in need of sexual health services
6.64 The draft strategy makes a number of recommendations in relation to reaching those in need of sexual health services. These are aimed at promoting consistency in the practice of partner notification, the development of comprehensive services for the treatment of those who have been subjected to sexual assault or rape and the development of practitioner and child protection guidance, training and parent education on female genital mutilation (FGM). |
6.65 Whilst there were only a few comments on these issues amongst research participants, the inconsistent links between service providers and police regarding the treatment and management of rape and sexual violence was acknowledged as a further barrier to receiving appropriate sexual and reproductive health services.
"There is also not enough support and information from the police on violence against women. Domestic disputes are still being ignored because the police just don't want to get involved" (SCF participant).
6.66 The draft strategy recognises that there should be further research to establish how many young girls in Scotland have undergone FGM or how many women have long term health problems associated with FGM. Again, this issue was not discussed directly, but the African women said that more information is needed on the needs of African children in Scotland, including information on their HIV status.
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