ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Stronger than the sum of our parts: the importance of a multidisciplinary and integrated approach to sexual health
One of the things that the HIV/AIDS pandemic did was to bring sexuality and sexual health medicine into the fold.
Sexual behaviour is complex.
Disciplines from the laboratory services to the epidemiologist, psychologist, social worker or nurse.
There is a vast array of environmental factors that contribute to behaviour and risk taking that a multidisciplinary approach is well suited to untangle.
Evaluation of one-stop-shop models of sexual health service provision.
One-stop-shops offer the most efficient way to provide sexual health services.
We are good at collecting data on soft outcomes, like are patients happy with the service, were they treated with respect, was their confidentiality preserved, etc.
We are not good at collecting evidence on hard outcomes like reduction in teenage pregnancies, STI rates, or behaviour change etc.
MSM still prefer the GUM model of provision.
Heterosexual men prefer the one-stop-shop model because they feel that family-planning services are for women only, and they are distrusting of the confidentiality offered by General Practitioners.
Integrating services in one-stop-shops, e.g. HIV services introduced stigma and deterred women from attending.
Staff at one-stop-shops was mixed, with some staff feeling excited that they offer a good service, and others feeling there was less opportunity to specialise.
Are some services better off set apart from integrated sexual health services?
Integrating alcohol interventions into sexual health care.
There is a plethora of evidence to suggest that alcohol is probably the main predictor of unprotected sex and numbers of sexual partners.
Brief interventions has not demonstrated any significant reduction in alcohol consumed or sexual risk rates after 6 months suggesting this is not a cost effective approach.
Substance misuse and sex - chemsex.
Prolonged periods of often unprotected sexual activity, with multiple partners and multiple drugs.
A small number of studies show fairly intensive behaviour modification interventions can reduce chemsex behaviour.
PrEP is now another option.
Can we integrate these services into the one-stop-shop model or should we be referring off to more specialised services.
There is a strong rationale for school based sexual health clinics.
Takes services closer to one of our key service user groups.
There is little evidence whether they work or not.
There is some evidence of reduction of teenage pregnancy and chlamydia rates but the fact is it has not been looked at well.
In fact, there is little evidence that sex education reduces pregnancy or STI rates.
Abstinence only interventions were found to be completely ineffective.