Role Advisors in Promoting Better Sexual Health - Essay Example

Running Head: Role of Sexual Health Advisors in promoting better Sexual Health Role of Sexual Health Advisors Abstract The paper examines the role of sexual health workers in promoting higher levels of sexual health in high risk groups like the prisons. Introduction Public health is defined as the actions taken collectively to ensure overall health of the society. The public health workers which are the main workforce of any public health system now focuses on a holistic approach to health encompassing the mental state in addition to the physical well being of an individual. The emergence of STI and HIV on pandemic proportions in our society has led the public health agencies to take a closer look on the sexual health of the individuals (Williams 2006). Sexual health is defined as a state of physical, emotional, mental and social well-being in relation to ones own sexuality. This paper focuses on the role of sexual health workers who work at various forays to ensure a high state of sexual health in the society. It begins with the health belief systems and models incorporated in public health systems and later goes on to explain the epidemiology of sexually transmitted infections (STI) including the HIV. The paper elucidates the importance of partner notification as an important method in arresting the spread of this epidemic. In the end the paper examines the challenges faced by sexual health workers in performing their role in various situations; focusing on their role in a high risk group of a male prison. Health Belief System and Health Models Every individual have their own set of beliefs as regards their state of health. To make any appreciable change to the overall health condition it is imperative to have the will and motivation to do so. Every individual has a perceived notion about his or her present condition of health. If an individual is suffering from a disease then his level of education about his condition, his cultural background and various other factors dictate his perceived notion. The development of beliefs is subjected to social religious and cultural reasons. An individual's action is driven by his desire to avoid illness and his belief that a certain action would be beneficial to avoid illness. A study on young Kenyan men reveals that abstinence and use of condoms as best prevention methods for contracting STI while the older men believed in fidelity as the better alternative. It is imperative to view the health beliefs in the light of cultural back ground and education levels. Sexuality mostly remains a taboo subject and hence its discussion elusive in many societies. Many times safe sexual practices are ignored in wake of such beliefs. This poses significant impediment in promoting better sexual health. Sexual health workers need to understand these impediments and barriers (such as reduced sensation with condom use) and attempt to eliminate them. The Health Models are used to promote public health and are used by sexual health workers to reach out to the target groups. They need to work closely with high risk groups in their own environments and encourage them to adapt safer sexual practices. Motivating the target group members to come forward for testing and treatment of their problems are always the first few challenging steps that need to be taken by these workers. Four models have been proposed by (Rhodes 1991) for health promotion. These models give different approaches to carry out the outreach work. The Information giving model lays emphasis on making information available to a large section of the target group helping them make an informed choice and decisions. It is important that the health workers are able to give detailed information about the causes, effects, symptoms, testing and treatment facilities available for STI. The next model is the Empowerment Model which emphasizes the requirement of self control and self motivation as important factors for promotion of good health. Health workers should instill these facets in the target group and motivate them to adopt safe sexual practices. Use of condoms and practicing abstinence through self control are some examples of this approach. The Community Action Model focuses on group behavior and the effect on individuals. The example setting amongst the members of the same group helps others to emulate. This technique helps the health workers to bring out new members to cooperate with them and accept the community norm. It is easier then to ask the new members to also adopt safe sexual practices help in partner notification and other such activities. The last model is the Radical Political Model which focuses on the legal, social and economic factors of health progression. Radical changes are required to the existing deep rooted social norms of stigmatization of persons suffering from STI. There is a need to combat the isolation and the ostracism faced by the patients. On the legal front changes are required in the law to help health workers in their quest for better sexual health, for example all individuals suffering from HIV need to notify their partners or legality of prostitution etc are some issues that need to be handled with utmost care. Epidemiology of Sexually Transmitted Infections Epidemiology is defined as the study of the various factors causing the disease its spread and its control. Sexually transmitted diseases are mostly spread due to unprotected sexual activity with an infected partner. The causative agent of the infection could be a virus, bacteria or a parasite. There are various types of STI which can easily spread through contact with the mucous membranes covering the penis and the vulva. The major symptoms of STI are as genital discharge, pain when urinating, genital swelling and inflammation, however there are STI such as Chlamydia, which could be symptom less for a long time. The risk of contracting a STI can be minimized by undertaking regular check ups of oneself and their partners. Decreasing the number of casual partners and insisting on having protected sex are also certain ways to ensure sexual well being. Use of condoms and dental dams are some effective measures that can be taken while indulging in oral and penetrative sex. An important method to keep the endemic of STI in check is knowledge and information about the ill effects of these infections. Due to social stigmatization of these infections it is mostly difficult to talk about them and hence ignorance fuels the spread of STI in a big way. Certain common STI are syphilis gonorrhea Chlamydia Hepatitis B and HIV or AIDS. All these present themselves in a variety of symptoms and forms. These are discussed in greater details in the succeeding paragraphs. Syphilis is caused by a bacterial infection. It can extend throughout the body and even affect the heart, brain and nervous system of a person. If left untreated it can lead to serious health conditions. The first signs of the infection are sores. These sores can occur on the penis in men and in and around the vagina in women. If these sores are not treated the infection could travel into the blood stream and then cause a rash, mostly on palms of the hands and the soles of the feet accompanied by fever, sore throat and swelling of lymph nodes. The infection from the blood stream can then also spread to brain, heart, spine etc. Chances of acquiring the HIV also increases manifolds due to the presence of these open sores. Syphilis can present itself with very mild or no signs of infection often resulting in people neglecting this condition. The only way to be sure is by having a blood test. Sexually active persons at any age should be aware of its symptoms and carry out regular checks to ensure early detection and treatment. Chlamydia is one of the most commonly reported STI. It is transmitted mostly by direct contact with an infected sex partner. A women infected with it can have serious health problems as it affects the cervix and the urethra, with vaginal discharge. If left untreated it can even cause infertility in extreme cases. As the symptoms are mostly silent a lot of under reporting takes place. As chlamydia is easily transmitted by oral or anal sex homosexual men are at high risk from this infection. A larger number of sex partners increases the chances of acquiring this infection many folds. People suffering from Chlamydia generally do not project many symptoms and even if they occur, they usually appear within 1 to 3 weeks after exposure. The common symptoms in men are rectal pain, discharge, or bleeding. Annual screening of high risk groups' persons proves an effective way in combating this STI. If detected early Chlamydia can be easily treated with antibiotics Gonorrhea is a STI that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and in the urethra mouth, throat, eyes, and anus in women and men. Gonorrhea like other STI is spread through contact with the penis, vagina, mouth, or anus. Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. In men, gonorrhea can cause epididymitis, a sore condition of the testicles that if left untreated can lead to infertility. In severe cases there can be green discharge from penis accompanied with burning sensations during urination, the infection can also spread to blood where it can be life threatening. Acquired Immune Deficiency Syndrome (AIDS) was first reported in 1981 in USA when it affected some homosexual men. It was only in 1983 that the cause of AIDS was identified as the human immunodeficiency virus or the HIV. There are two types of HIV the HIV 1 and HIV 2 these are slow viruses and attack the immune system of an individual (Murphy 2000). These replicate themselves in large numbers inside the cells. The virus spreads due to sexual contact with an infected person or coming into contact with blood and other body fluids of an infected individual. Sharing of needles mostly by drug users is also another common way that propagates HIV infection. The infection affects the immune system of the body by reducing the count of CD4+T cells which have the ability to fight infection in the body. Certain drugs have been found to be effective against the virus but its high cost is a major deterrent for its widespread use. A large percentage of HIV positive cases are present in economically poor countries which lack basic infrastructure to combat this pandemic. These people who are infected with HIV do not get access to enough information for prevention of this infection. HIV is easily preventable by use of condoms, keeping a single partner for sex and not sharing of needles, razors, tooth brushes and injections etc. The infection manifests itself with tremendous weight loss. The later stages affect the neurological system thereby impairing intellect and motor performance in an individual. This leads to depression and anxiety, the social alienation also adds to worsening of this condition. HIV can be best managed by spreading information about its prevention, and better understanding of the situation. Counseling and compassion plays an integral part to keep the balance of the mental state of the patient. The infection is managed medically by early detection and regular treatment. A large number of studies have predicted the future projections of the extent of this epidemic spread. However this is prevalent largely in American homosexuals. As there is no affordable treatment or vaccine for its prevention, the only hope in controlling the spread of this infection is to target the high risk groups and educating them with the prevention techniques. An effective way to carry out these proposals is to involve a large number of public health workers and public support groups. Partner Notification It is the act of informing the unaware sex partners and needle sharing partners of individuals found suffering or infected with any STI (Baguley 2005). Partner notification is a well established activity in public health departments. It is based on the principle that the partners of infected individuals be made aware of the exposure that they have been subjected to while having sex or sharing needles. There is a high possibility that this group would also be suffering from STI. After they are informed about the potential threats they are offered education, testing, counseling, and appropriate referrals. Partner notification is important for various reasons. It provides invaluable information counseling and testing to the individuals who require such assistance. This also prevents the propagation of infection chain. As the STI is often socially stigmatized in our societies and not talked about openly, the role of partner notification technique holds greater importance. The job of health worker is also very challenging in convincing and encouraging the partners of the infected clients to accept therapies preventing or delaying the one set of disease. However partner notification remains a voluntary action on the part of the infected person wherever it is not made mandatory under law for some special life threatening STI like the HIV. Confidentiality of the infected person and their partners is another issue that needs to be addressed while performing partner notification. It should be done with utmost care and sensitivity as there are always certain possibilities of back lash due to personal, social and cultural reasons. Various strategies are used to carry out partner notification. The basic is patient or client notification; here the patient takes the initiative to inform all his partners about their exposure and helping them to undergo tests and treatment. The other strategy remains where the patient is not willing or is not fully capable to carry out notification himself. In such cases a public health provider assists him in the notification process. Another possibility is to hand over medicines to the patient to administer it to their partners who avoid their trips to the clinics. All such strategies are to be personalized depending upon circumstances. In cases of HIV test coming positive it becomes all the more important to educate the patient about the importance of partner notification. A health worker needs to work very closely with such patients continuously motivating them to carry out complete partner notification. A health worker needs to provide full assistance to the patient in finding and gathering information to carry out partner notification. He is also responsible to ensure that the partners of the infected patient come forward for treatment and testing. The Public Health department also has the responsibility to ensure that partners who come forward are given full confidentiality and all testing and treatment facilities are made available to them. The medium used to carry out partner notification is also an area that needs detailed analysis. No clear evidence is available that a simple telephone call or an email is less effective but a personal call by the patient or the health provider goes a long way to ensure that a lot of psychological issues are handled. The effectiveness of these strategies was ascertained by certain studies that have been carried out. These studies that were held in different countries summarize that provider led notification and some mixed notification strategies work the best. Another facet that comes out from these studies is the feasibility and affordability of this technique in economically poor countries. Here the issue remains of allocation of resources for implementation of partner notification. Many studies concentrate on the effectiveness of this technique. These studies which may be conducted in developed countries may not be economically feasible in some backward nations where basic public health system does not exist. Although partner notification is an established way to control spread of sexually transmitted infections, its global implementation and feasibility needs to be further examined and studied. Role of Health advisor The role of a sexual health advisor is to support people with STI maintain a high standard of sexual health, and to arrest further transmission of STI. They are also responsible to assist medical staff in providing medical treatment to the people infected with STI A sexual health worker helps infected individuals with advice and information on how to cope with the infection its treatment and maintenance. They provide accurate information about STI in general and early detection of HIV. They give counseling to patients and help them understand their problems. Another important facet is to help individuals cope with the social isolation that they have to face. The sexual health worker would talk to the patient's partner and friends and make them understand the overall situation helping them to accept the infected patient. Although a sexual health worker has to fine tune his role to suit their patients requirements, a challenging task for them would be to fulfill their role while working amongst prisoners in a jail. The prisoners are a highly active, high risk group. Working in a male prison the health workers are faced with certain peculiar issues. The percentages of prisoners suffering from STI is on a higher side and regular checkups are required to pinpoint the individuals suffering from the infections. The majority of prisoners tend to be sexually active with free usage of drugs and multiple visits to commercial sex workers. Various surveys put such prisoners in high risk groups and health workers find it extremely demanding to work with such groups. Homosexuality is prevalent in such groups and various studies indicate that fairly large percentages of prisoners tend to be experimental in their sexual behaviors. Non usage of condoms poses a serious threat to this high risk group and aids the transmission of STI and HIV. Providing a high degree of health service inside prison is difficult due to funding issues and issues of logistics and security. The workers need regular check ups and treatment of their patients which may not always be possible due to their regulations in the prisons. The funding of the health care in prisons is a state owned activity, and that itself sometime is an issue to be handled. Long periods of isolation tend to adversely affect the mental stability of a lot of prisoners. A sexual health worker therefore has to educate all prisoners with the basic epidemiology of STI and HIV. There is a need to maintain extreme confidentiality amongst them regarding their state of physical and mental health. The worker handles the conversation with such prisoners with utmost care and encourage them to use condoms and sterilize needles being used for drug abuse or tattooing. The high risk group of prisoners forms a perfect group to whom some counseling and education can be imparted to. The prisoners tend to reflect on the past and absorb the inputs which they receive. Even the prison staff needs to be sensitized to handle prisoners in light of their infection. HIV testing and maintenance of confidentiality are more difficult to be implemented in prisoners scenario due to various issues of security and administration. There are issues to be handled between the health workers and the prison staff as the former wants to counsel the prisoners and expect a softer approach while the later tries and instill discipline which is important too. The sexual health workers have a socio medico approach to the overall well being of their patients. Key focus though remains on prevention of HIV and STI transmission the sexual health workers have a broader horizon to operate; it incorporates child abuse mental health, disaster preparedness etc. Conclusion The role of a sexual health worker is multi disciplinary in nature. A human approach is the best method of promoting good sexual health in high risk groups. A health worker needs to understand the social and cultural impediments preventing the target group in adopting safe sexual practices and always endeavor to remove them. Works Cited Erin Charles A., Bennett ,Rebecca (1999) HIV and AIDS: Testing, Screening, and Confidentiality Oxford University Press Novick,Lloyd F. Mays Glen P. ( 2005) Public Health Administration: Principles for Population-Based Management. Jones and Bartlett Publishers Kalipeni Ezekiel (2003) HIV and AIDS in Africa: Beyond EpidemiologyBlackwell Publishing Morisset, Richard, Kurstak Edouard (1986) Advances in Sexually Transmitted Diseases: Diagnosis and TreatmentVSP Handsfield H. Hunter (1987) Sexually Transmitted DiseasesSaunders Williams Carolyn F Masters, Nelson Kenrad E. (2006) Infectious Disease Epidemiology: Theory and PracticeBy Jones and Bartlett Publishers Murphy Siobhan M., Brook Gary, Birchall Martin A. (2000) HIV Infection and AIDSBy Elsevier Health Sciences Gail Mitchell H, Brookmeyer Ron (1994)AIDS Epidemiology: A Quantitative Approach Oxford University Press Timmreck Thomas C. ( 2002) An Introduction to Epidemiology Jones and Bartlett Publishers Heathe RGN. Wilson, MacAndrew Sue (2000) Sexual Health: Foundations for Practice Elsevier Health Sciences Baguley, Stephen Persad Rajendra, Kumar Sunil (2005) Key Topics in Sexual Health Taylor & Francis Fisher Dennis G., Needle Richard (1993) AIDS and Community-Based Drug Intervention Programs: Evaluation and Outreach Haworth Press Rhodes T, Holland J, Hartnoll R. (1991) Hard to reach or out of reach An evaluation of an innovative model of HIV outreach in health education. Tufnell Press, London Partner Notification http://www.health.ri.gov/hiv/notification.php World Health Organization, Management of patients with sexually transmitted diseases. Report from a WHO Study Group. WHO Technical Report Series 810. Geneva Epidemiology of STI http://www.sharonregional.com/WomensLibrary/young/your_body/gyne_health/std/index.htm Epidemiology of STI http://www.ucsf.edu/ 2006 United Kingdom National Guideline on the Sexual Health of People with HIV: Sexually Transmitted Infections http://www.bashh.org/guidelines/2006/sexual_health_hiv_0406.pdf Role of a health worker http://www.nhslothian.scot.nhs.uk/ourservices/gum/whatdo/role.asp Using the Internet for Partner Notification of Sexually Transmitted Diseases --- Los Angeles County, California, 2003 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5306a4.htm Health Belief Models http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/ Read More