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Ending the STI stigma

I recently had the privilege of listening to Rory O’Neill, aka Panti Bliss, talking about his experiences around the diagnosis and treatment of HIV infection. He described receiving the diagnosis from his GP.

Recently, a patient who attends the GUIDE Clinic in St James’s Hospital, Dublin, asked me if I had received the reports that she had ‘consented’ for them to send. It made me wonder whether the patients who don’t consent either attend St James’s for all their primary care needs, or just don’t tell their GP about their diagnosis or medications they might be on.

In November 2015, Minister for Health Leo Varadkar launched Ireland’s first National Sexual Health Strategy and Action Plan 2015-2020, which said that “sexual health services should and will be delivered to the individual in the least complex, most efficient way”, and “some individuals will elect to travel away from their local service in order to protect their anonymity or may choose to attend private services. Individual choice and preference should be acknowledged in the further development of sexual health services”.

I agree we need to reach out to ‘higher-risk’ groups and that there is a need for specialist input into services, but I am concerned that we are heading towards an increasingly isolated and fragmented service.

I am not sure either that we are removing the stigma by giving the message that for every other health concern you ‘go to your GP’, but if you suspect a sexually transmitted or blood borne one you should go elsewhere

I am not sure either that we are removing the stigma by giving the message that for every other health concern you ‘go to your GP’, but if you suspect a sexually-transmitted or blood-borne one, you should go elsewhere. In regard to anonymity, a GP surgery is probably the only place you might be at for any multitude of reasons; does the same apply to specialised clinics? Confidentiality is intrinsic to everything GPs and their staff do.

In December 2005, a report by the Health Protection Surveillance Centre advised that clinical STI services, including assessment, management, treatment and counselling, should be provided free of charge to patients at the point of access, whether the service is provided in primary care or in an STI clinic, with remuneration for GPs who provide this service. It hasn’t happened. 

The Chlamydia Screening in Ireland Pilot Study reported that young people’s preference was for STI testing in a primary care setting — general practice, family planning clinic or student health service by a doctor or nurse. Their policy brief, published May 2012, recommended that GPs should be supported by having good access to labs that provide timely testing and feedback and have support from community sexual health advisers. If they exist, I haven’t met one.

STIs particularly Chlamydia are on the increase particularly in those aged between 15 and 19 years; not surprising, as according to the Irish Health Behaviours in School Children ( HBSC) Study 2014, 31 per cent of 15-17-year-old boys and 21 per cent of 15-17-year-old girls are sexually active and do not always use condoms.

A lot of GPs and their practice nurses already provide sexual health services, demonstrated by the fact that 1,730 cases of chlamydia, 373 cases of gonorrhoea, 231 cases of herpes simplex and 53 cases of syphilis were notified by GPs in 2014 (CIDR).

The ICGP and Irish Association of Sexual and Reproductive Health Care Professionals (IASRHP) provide excellent courses which are well attended.

In the UK, the Faculty of the Royal College of Obstetricians and Gynaecologists recently launched their own vision: Better care, a better future: a new vision for sexual and reproductive healthcare. It focuses on establishing clear referral pathways between services so that care can be integrated around the needs of the individual. General practice in particular is acknowledged to have a pivotal role to play in promoting high-quality SRH.

Patients may like the idea of online screening and may receive ‘money off’ inducements from their health insurer, but are they really receiving a comprehensive service?

Despite the aforesaid recommendations, the HSE has still not yet resourced GPs to provide any aspect of sexual healthcare. People either have to pay, or those outside the main cities travel long distances to a HSE-run clinic, usually based in a hospital that only runs once or twice monthly, to avail of a ‘free service’; not very practical for school-going students.

Hopefully Dr Miriam Daly’s presence as ICGP representative on the National Sexual Health Strategy Steering Group and the long-awaited new GP GMS contract will recognise the role that GPs and practice nurses can play and it will be resourced and supported appropriately.

Patients will then be able to choose to avail of their sexual healthcare, along with their other care, in their surgery up the road and we can leave stigma out of it altogether.

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