The Current Health Promotion Activities Associated with the Sexual Health - Essay Example

Analyses of the Current Health Promotion Activities Associated with Sexual Heath By [Full 6 April [Lecturer’s and Number] Abstract Sexual health can be defined as “the integration of the somatic, emotional, intellectual and social aspects of sexually being in ways that are positively enriching and that enhance personality, communication and love” (WHO Expert Group 1975). It can also be defined as: “state of physical, emotional, mental and social wellbeing related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled” (Technical Consultation on Sexual Health in January 2002). Reproductive and sexual health and well-being are vital if people are to have a safe, responsible, and satisfying sexual lives. Good sexual health is important to both individuals and society. It is, therefore, important to have the right support and services to promote good sexual health. Sexual health requires a positive approach to human sexuality and understanding of the intricate factors that shape human sexual behaviour (Fogel 1990). These factors affect whether the expression of sexuality leads to sexual health and well-being or to sexual behaviours that put people at risk or make them vulnerable to sexual and reproductive ill-health. Health programme managers, policy-makers and care providers, need to understand and promote the potentially positive role sexuality can play in people’s lives and to build health services that can promote sexually healthy societies. Sexual Health Problem The level of concern related to sexual health among health care professionals, the Government and the public is presently high. This has been as a result of growing rates of infection, the arrival of the HIV epidemic in the 1980s, confirmation of heightened risk taking and often inadequate control of infections. Common conditions now include Chlamydia, non-specific urethritis and wart virus infections, but almost all sexually transmitted infections (STIs) are becoming more common (Stokes 1997). The frequency of visits to branches of genitourinary medicine (GUM) in England has doubled over the last decade and now stands at over a million a year, see figure 1 below. Diagnoses of genital Chlamydia also virtually doubled up during the 1990s, with a major marked increase in men and women aged less than 20. Current surveys of women indicate Chlamydia infection rates of up to 12% and there are more reports of outbreaks of syphilis3. The total of HIV infections newly diagnosed in 2000 was the peak since reporting began. Burtney (2004) reviewed studies which showed that there had been an increment in engagement in risky sexual behaviour and that there was still unawareness about the potential consequences. The typical age at which people start engaging in sexual intercourse is now 17. Four decades ago it was 21 for women and 20 for men. Between 33% and 50% of young people do not use contraception at first intercourse. Over 25% of 14–15 year olds hold the opinion that the contraceptive pill safeguards against infection. In 1999 most people questioned in a national study did not know what Chlamydia was (Watson 2000). Many sexual infections have enduring impacts on an individual’s health. Chlamydia, as well as some genital wart infections, is associated with cervical cancer. If left untreated, Chlamydia can cause pelvic inflammatory disease which consequently leads to ectopic pregnancy and infertility. New Attendances at GUM Clinics. England, 1960–1999 Number* of newly reported HIV infections in England by year of diagnosis (data to end March 2001) Sexual Health Promotion Activities These activities can be classified under the several different results of undertaking each of them, namely: better prevention, better service provision, and better commissioning. 1. Better Prevention Burtney (2004) stated five activities for Health Promotion that can be undertaken to achieve better prevention are as outlined below. • Building healthy public policy that promotes sexual health at local and national levels and addresses inequalities – the strategy sets out a range of public health measures to reduce the spread of HIV and other STIs; • Establishing environments that are supportive of sexual health – the strategy emphasises the importance of sexual ill-health and the need to reduce stigma associated with HIV and STIs; • Enhancing personal and social skills regarding sex, sexuality and sexual health – the better information and knowledge that the strategy encourages will help people to develop skills and make informed choices; • Ensuring that all services, which promote sexual health, build upon the evidence base and develop professionals’ skills, knowledge and positive attitudes through education and training – better professional education and training are central to the strategy, and it describes a programme of action for more evidence-based practice. • Strengthening community action in setting priorities, making decisions, planning strategies and implementing them to achieve better sexual health – the strategy sets out targeted work aimed at reducing inequalities in sexual health and encourages more involvement of local people. Embarrassment, previous negative experiences and worries about confidentiality become substantial barriers when carrying out activities aimed at promoting sexual well-being. Embarrassment is especially tough to overcome when inquiry into sexual matters becomes necessary (Yzer 2000). Most people opt to keep their questions to themselves and hence go on living in ignorance of proper sexual health preventive measures. Previous negative experiences when employing a preventive measure can also deter the health promotion activities aimed at better prevention. For instance, pregnancy occurrence after use of condoms can lead one to believe that condoms are ineffective whereas they are effective. 2. Better Service Provision One of this strategy’s most important aims is to develop sexual health services around patients’ needs (Schubotz et al. 2004). Doing that successfully means: • Increasing uptake by providing a choice of easily available services; • focusing services on local needs through effective commissioning; • giving staff the education and training they need to work together and provide an integrated service; • giving all service providers clear descriptions of their tasks, roles, skills and interrelationships; • giving people better information about local services; • reaching an understanding between commissioners and providers about the sexual health characteristics of the local community, including information on morbidity, services, resources and activity; and • setting local targets for improvements in services. Social exclusion, language, cultural difficulties and homophobia make the barriers of negative attitudes and expectations harder to cross. This deters the effort put into health promotion activities to reach minority groups such as homosexuals and transsexuals. There are also obvious and particular service access problems for prisoners (Yzer 2000). 3. Better Commissioning The effective implementation of the strategy hinges on good local planning and commissioning of services (French 2009). Good planning helps to make sure that: • Medical, nursing and other health and social care staff can work together in new ways and across traditional boundaries; • HIV and STI prevention is more consistent and effective; and • Both commissioners and providers broaden their focus and work in partnership. Planners and providers must be aware of the difficulties that specific groups face in accessing services and ensure that services meet their needs. This would guarantee that the barriers aforementioned are overcome in order to create a level field of access to health services and information that is specific to an individual’s needs (Yzer 2000). Success of Sexual Health Activities Howser (2013) stated that the success of past and on-going sexual health promotion activities is judged on the basis of the targets of the health promotion strategy currently undergoing implementation. 92% of 11 to 16 year olds should not have experienced sexual intercourse by 2013; Baseline: 89% of 11 to 16 year olds reported they had not experienced sexual intercourse in 2003 (Young Persons Behaviour & Attitude Survey). Note: Teenage Pregnancy and Parenthood Strategy 2000-2007 set a target that 75% of teenagers should not have experienced sexual intercourse by age of 16. A reduction of 25% in the rate of births to teenage mothers under 17 years of age by 2013; Baseline: 3.1 births per 1000 females aged less than 17 years 2003-2005. Note: Compatible with PSA 8 target of 40% reduction by 2010, on the 1998-2000 baseline rate of 4.1 births per 1,000 females. The percentage reductions for the 2010 and 2013 targets contrast because altered baselines have been used. by March 2008, all patients evaluated as being clinically urgent to access specialist Genito-Urinary Medicine/Sexual Health services within two working days; Note: This is one of the suggestions arising from the review of sexual health and GUM services which was embarked on in 2006 by the four Health and Social Services Boards, and the target is on-going. A reduction of 25% in the number of new episodes of gonorrhoea by 2013. Baseline: 182 cases in 2005. Source: KC60 statistical return. Note: This target was agreed following discussion with regional experts from GUM services and the Health Protection Agency. The numbers of new cases of Gonorrhoea is considered a good proxy measure of sexual ill health in the population and usage of GUM services. Interagency Cooperation in Sexual Health Promotion Activities This is a fundamental necessity in enacting the strategy for nationwide sexual health promotion (Fogel 1990). No single organization can adequately cater for the entirety of the United Kingdom hence interagency cooperation is the order of the day, more often than not. This is especially true of the Department of Health which is actively cooperating with agencies such as Community HIV and AIDS Prevention strategy (CHAPS) and the FORWARD (Foundation for Women’s Health Research and Development) organisation (French 2009). The FORWARD organization works in tandem with the department of health to mobilise professionals from various disciplines to meet the needs of women and girls affected by female genital mutilation (FGM). This is sometimes known as female circumcision and is illegal, unacceptable, and a violation of the human rights of the young girls (usually aged between four and ten) who suffer it. According to French (2009), such joint effort has raised the awareness of local services concerning FGM and has created support for community initiatives aimed at stopping this practice. The downside to such interagency cooperation is that it is usually government-initiated. Seldom does an independent health promotion agency get the government support it may require by simply requesting it. The formalities involved take time and thus allow issues which require swift action, to fester and develop into mammoths that the requested support can no longer handle (Watson 2000). Behaviour Change Models In the 1950s, the Health belief model was developed. It holds true that health behaviour is a result of an individual’s socio-demographic attributes, knowledge and attitudes (Fogel 1990). This model postulates that a person essentially holds the following beliefs in order to be able to alter their behaviour: 1. Apparent vulnerability to a specific health issue (“am I at risk for HIV?”) 2. Apparent gravity of the condition (“how serious is AIDS; how hard would my life be if I got it?”) 3. Assurance in the efficiency of the new conduct (“condoms are effective against HIV transmission”) 4. Signals to action (“witnessing the death or illness of a friend or relative due to AIDS”) 5. Observed benefits of preventive action (“if I start using condoms, I can avoid HIV infection”) 6. Barriers to taking action (“I don’t like using condoms”). In this model, encouraging action to alter behaviour comprises shifting individual private principles. Individuals consider the benefits against the observed costs and obstacles to change. For any change to occur, benefits must outweigh costs. With respect to HIV, involvements often aim at discernment of risk, beliefs in severity of AIDS (“there is no cure”), beliefs in effectiveness of condom use and benefits of condom use or delaying onset of sexual relations (Watson 2000). Determinants of Sexual Health Health in the broadest sense includes: access to quality health and social care services; confidence and self-esteem; a sense of belonging within a community; and a sense of physical and emotional wellbeing (French 2009). The degree to which we live in good health is affected by an assortment of factors, several of which are distributed unevenly within the population. These factors, known as determinants of health, include the following: socio-economic circumstances; education; employment opportunities; lifestyle choices; decent housing; cultural norms /health beliefs; access to quality health services; access to leisure amenities; exposure to adverse physical conditions; community networks; genetic/ biological factors; access to affordable, reliable transport; and a sense of control over own life (Schubotz 2002). The topic of variations in health came to nationwide distinction in the 1980s after the publication of the Black Report. This established the gradient of mortality from social class I to V, both for total deaths across age and gender groups and for a wide range of specific causes of death (Fogel 1990). There is now growing evidence that many forms of social shortcoming result in the circumstances in which people’s sexual health experience is negatively affected (Burtney 2004). In scrutinizing data relating to sexual health status and key determinants of health in the UK, it is important to note that majority of the factors influencing health lie further than the National Health Service (NHS) (Howser 2013). The environment in which we live is also a main determinant of health and wellbeing. It affects local economics and lifestyle choices and also therefore impacts on social networks (Fogel 1990). References Burtney, E. 2004, Young people and sexual health: individual, social and policy contexts, Palgrave McMillan Publishers: Basingstoke, Hampshire. Fogel, C. I. 1990, Sexual Health Promotion, W. B. Saunders: St. Louis, Missouri. French, K. 2009, Sexual Health, Blackwell Publishers: Oxford, UK. Howser, S. 2013, Sexual health: understanding your body’s changes, Rosen Central: New York. Schubotz, D., Simpson, A., Rolston, B. 2002. Towards Better Sexual Health: A survey of sexual attitudes and lifestyles of young people in Northern Ireland, University of Ulster. Yzer, M.C, Siero, F.W, and Buunk, B.P. 2000. Can public campaigns effectively change psychological determinants of safer sex? An evaluation of three Dutch Campaigns. Health Education Research: June 15 (3): 339-52 Watson, J. 2000, Researching health promotion, Routledge: London Read More