Young people
Scenario_1_v4.mp4 from ASHM on Vimeo.
Judy - 26-year-old who identifies as female (she/her) attends an appointment for renewal of her contraceptive pill. The clinician is an older male GP. Judy has not had an STI screen in two years, and states she is in a monogamous relationship with her partner. The last STI screen was only for chlamydia and gonorrhoea from an endocervical swab which was negative. The GP offers Judy an STI screen.
Clinical indicator
- Young person (< 30 years old).
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions which highlights why an STI screen should be considered based on the information Judy has provided.
- Normalising – The asymptomatic nature of STIs, the ease of testing and the role of partners getting tested also.
- Role of assumptions – Assumptions could have resulted in Judy missing the opportunity for a routine STI screen. Instead normalising the asymptomatic nature of STIs and the right questioning e.g., ascertaining Judy’s last STI screen resulted in Judy having an STI screen also as part of her appointment.
Scenario_2_v2.mp4 from ASHM on Vimeo.
Joey– 23-year-old who identifies as male (he/him) and heterosexual attends clinic for travel vaccinations as travelling to Philippines for three-week holiday. Joey has not had an STI screen in several years, and only had sex with people with a vagina. Joey is in a hurry as he has another appointment to attend. The practice nurse administers Joey’s travel vaccinations.
Clinical indicator
- Young person (< 30 years old).
- Travellers and mobile workers
Key learnings and take away
- Normalising – Normalising STI screening as part of a ‘travel health’ consult.
- Normalising – The common belief that people will know they have an STI but in fact the majority of STIs are asymptomatic.
Fatemah - 28-year-old who identifies as female (she/her) who has migrated to Australia. Fatemah is married to Milad who identifies as male (he/him). She is attending her routine antenatal screening at 28 weeks. Milad is present during the consult. The pregnancy management has been straightforward to date, and her anatomy scan was normal. You offer Fatemeh a Syphilis test as part of her routine antenatal care.
Clinical indicator
- Young person (< 30 years old).
- Culturally and linguistically diverse people
- Pregnancy
Key learnings and take away
- Normalising – Normalising that syphilis screening is routine in pregnancy.
- English as a second language – Acknowledging that English is Fatemah’s second language and ensuring an interpreter was offered. Although Fatemah’s husband is present who might have sufficient English it is inappropriate to use family members to interpret.
- Role of assumptions – Not just assuming because Fatemah is there with her husband, she doesn’t need to be offered the test. Just because someone is there with their regular partner does not mean they aren't at risk.
Disclaimer
The purpose of this video is to model communication. For testing and treatment advice refer to the Australian STI Management Guidelines for Use in Primary Care and local guidelines.
Scenario_4_v1.mp4 from ASHM on Vimeo.
Lucy - 29 years old who identifies as female (she/her). She is an Aboriginal woman from a remote community. Lucy has come for her annual health check. Lucy has a regular male partner. She has requested to see a female GP. English is Lucy’s second language. You take her observations, which are all normal. You see that she is due for a cervical screen test and offers this. During the pelvic exam you see a tiny sore on her vulva.
Clinical indicator
- Young person (< 30 years old).
- Aboriginal and Torres Strait Islander
- Regional/Remote community
- Genital lesion
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions to determine what tests need to be performed.
- Normalising – Normalising sexual health check-ups are just like any other routine check-up
- Role of assumptions – Just because Lucy was responding in English, she had listed this was her second language therefore it is good practice to ensure a patient does not need an interpreter
- Sexual history taking in a culturally appropriate way – Lucy asked specifically to see a female clinician as its central to Aboriginal culture to separate men's and women's business. So if this is a viable option always offer this when seeing patients who identify as Aboriginal as it may assist in the patient feeling more comfortable and therefore willing to disclose information of clinical relevance.
Abebe - an international student from Ethiopia, 24-year-old who identifies as male (he/him/they) and has been sexually active for the last five years. Abebe’s appointment is by telehealth. About three months ago, he started exploring his sexuality and has had sex with a few male partners (if asked for more detail – 4/5 partners, both insertive and receptive anal and oral sex, infrequent condom use). Abebe is feeling confused and uncertain about his sexuality and would never have felt comfortable exploring it further while living with his parents in Ethiopia. He is worried about anyone in his family finding out, particularly his father. Abebe has no significant medical history but has been feeling a little anxious lately. Abebe has never smoked cigarettes but has been experimenting with some recreational drugs since coming to Australia. He drinks alcohol with friends on weekends (4-5 drinks per occasion) and has tried some MDMA. These occasions are also when he started to experiment having sex with men. Harm reduction education is provided regarding drug use and linked into community organisation for ongoing support.
Clinical indicator
- Young person (< 30 years old).
- Culturally and linguistically diverse people
- MSM
- People who use drugs
Key learnings and take away
- English as a second language - Despite Abebe appearing he could understand and speak English quite confidently from the start of the consult the clinician still confirmed the need for an interpreter.
- Role of assumptions – This consult is a very comprehensive and detailed consult in terms of addressing any of Abebe’s assumptions about HIV, STIs and risks associated with condomless sex. This also assisted in the clinician in ascertaining all information required to perform a comprehensive sexual history.
Angus - 28-year-old who identifies as male (he/him) who has recently tested positive to gonorrhoea and is returning to your clinic to receive his diagnosis and treatment. Angus identifies as heterosexual and is married with two children. Angus and his partner Olivia (32-year-old who identifies as female). Upon being told about his diagnosis Angus says on occasion has sex with male partners and notes Olivia is not aware of this. You discuss contact tracing options with Angus.
Clinical indicator
- Young person (< 30 years old).
- STI diagnosis
- MSM
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions to determine what tests need to be performed.
- Role of assumptions – Without the right questioning in this scenario and an assumption being made about Angus being married it may have resulted in him not having the additional tests or not having a full understanding of his risk profile.
- Role of assumptions – If assumed Angus was only having sex with his wife and no further history taking occurred this would have also missed an opportunity to discuss PEP and PrEP with him.
- Patient linkage to community support services – Angus would be a patient you might think about linking with community support services for men who have sex with men that may not identify as homosexual an example of such a service is GAMMA (Gay and Married Men’s Association NSW).
Scenario_8_v2.mp4 from ASHM on Vimeo.
Jenny - 19-year-old who identifies as female (she/her) attending the university clinic for the first-time requesting contraception advice. When asked, Jenny states that she has not seen a GP or nurse for a general check-up in 3 years and does not want to go back to her family GP due to privacy concerns. You notice self-harm scars on her arms and that she avoids eye contact when speaking to you. Upon further questioning, Jenny discloses at a recent party she was sexually assaulted by a close family friend.
Clinical indicator
- Young person (< 30 years old).
- Sexual assault
Key learnings and take away
- Normalising/role of assumptions – The clinician asks Jenny the purpose of using contraception as not all people use contraception for the prevention of pregnancy. By doing this it assisted the clinician to lead into sexual history taking questions and normalising this line of questioning as part of the consult.
- Respectful history taking – This consult reveals the client has been sexually assaulted. The way in which the clinician ascertained this information was respectful hence resulted in the client disclosing what happened.
Scenario_10_v2.mp4 from ASHM on Vimeo.
Milo - 18-year-old who identifies as non-binary (they/them). Milo attends their local sexual health centre for the first time and has indicated that they prefer not to disclose their sex at birth on the intake form. Milo is asexual, however, on occasion, is sexually active with their long-term partner Gianna (19-year-old who identifies as non-binary; unknown sex assigned at birth). Milo is shy and provides short responses when questioned.
Clinical indicator
- Young person (< 30 years old).
Key learnings and take away
- Importance of inclusive language – from the start of this consult the clinician has acknowledged Milo did not disclose their sex and uses inclusive language and questioning to ascertain Milo’s preferred names for body parts and genitals.
- Respectful and inclusive sexual health history taking – By the clinician confirming with the client at the start preferred terminology for body parts and genitals a respect and inclusive sexual history was able to be obtained. This is a simple way to build rapport with a client to assist in normalising sexual history taking and the kinds of questions that are going to be asked.