Mw3301
Learning outcome one
Critically discuss the concepts of health and evaluate their influence on sexual health.
The world health organisation defines health as ‘a state of complete physical, social and mental
well=being not only the absence of disease and illness. (WHO, 1948) this concept by the Who is
consistent with the biopsychosocial model of health which encompasses all determinants such as
mental health, social, physical which is different from the traditional medical model of health which
emphasis the importance of clinical intervention not the importance of individual responsibility for their
own health and well-being (Bolton, D, Gillett G, 2019). however, a state of complete well-being is
dependent on how an individual may view their own situation for example it does not recognise
individuals living with chronic health issues such as diabetes or HIV prthps as healthy (Huber et al, 2011).
Living with HIV by this definition you would be classed an unhealthy and a state of ill-being, although
many people live with HIV and with the help of antiretroviral drugs (ART) and support from services such
as The Terrance Higgins Trust adapt take responsibility and lead in their belief that they are healthy and
well. Even though individuals who are unaware of the definitions of health and may not feel it relevant
to them it has an impact in on health policies and legislation, research including research into sexual
health (Gagnon etal, 1973). Health is complicated and depends on the beliefs of health by professionals
and society, also by determinants such as education, individual's choice of lifestyle and quality
healthcare, (Noack et al, 1987). Ill health effects good sexual health and is one of the vital aspects of
individuals health and well-being along with components such ass mental health, physiological health,
socially /culturally and spirituality (Field et al, 2013). A feeling of well-being enables individuals to form
positive sexual relationships and meaningfully contribute to society however wellbeing can be hard to
measure due to the objectivity of it (Foresight Mental Capital and Wellbeing project, 2008). Poor sexual
health can lead to long-term consequences and become detrimental to other areas of a person's
wellbeing such as a diagnosis of HIV or Genital Herpes can cause anxiety and distress causing ill mental
health also (Department of health, 2013). A healthy sexual health life relies on the ability for individuals
to access information about safe sex, sexuality, and risks, it should be an environment that promotes
sexual health. Most adults are sexually active, and poor sexual health can lead to unintended
pregnancies and STIs. supporting individuals cultural background and belief systems and sexual
orientation is a vital part of supporting individual's sexual health holistically (NICE, 2019). The sexual
script of indivuals can depend on social script such as how culture tells individuals to behave which has a
knock-on effect onto interpersonal script where individuals may be hesitant to discuss contraception
and protection with sexual partners (Gagnon, j et al 1974). The government needs to promote sexuality,
offer excellent quality sexual health services without stigma and discrimination through education
(Andreson, RM). Aspects of sexual health such as sexual self-efficacy, sexual pleasure and sexual selfesteem have a positive knock-on effect onto an individual's overall health and well-being (Philpott A,
2009). However, the discussion of sexual pleasure in education and official government policies has not
been apparent and is delivered in a ‘top-down strategy approach with the government overshadowing
the sexual health educational professionals (Cavander, 2015). The promotion of the pleasurable aspects
of condom uses for example less anxiety during sex regarding unintended pregnancy can effectively help
reduce the spread of Stis and decrease unintended pregnancy (Philpott 2006).
Learning outcome 2
Critically examine and evaluate public health policy and its impact on sexual health outcomes of
individuals at risk groups and communities.
,
Public health is the understanding the prevention of disease, prolonging life, and improving the quality
of life for individuals through education and informing society of the threats to the populations health
Acheson, 1988; WHO) Public health id broad and consists of three different domains: health promotion,
the prevention of ill health and the protection of health (Royal college of nursing, 20210). Changing the
behavour of the population to prevent ill health and protect health is central to public health policies
such as the public health outcomes framework 2017 which has domains of health issues and the
strategic action plan 2016 has four main outcomes (PHE, 2020) both policies define a vision for the
future, informs the public and builds consensus focuses on HIV, Under 18 conceptions and STIs (WHO,
2020). However not in the strategic action plan is violent crime, regarding sexual health violent crime
can be a sexual attack that can result in an unintended pregnancy the main influence in health policy is
the health inequality of groups of people such as MSM and bisexual men (PHE, 2018). MSM and bisexual
men are the groups most affected by HIV in the United Kingdom, although in 2016 new HIV diagnosis
among msm fell, evidence suggests this is due to the availability of PrEP , earlier provision of treatment
and increased testing. (Nwokola, N, Whitlock, G McOwan, A 2017). However, there is a new concern for
the public health is the role of ‘chemsex’ (chemsex is the use of drugs) plays in HIV transmission. In 2018
a study suggested that 30% of sexually active HIV positive msm engage in chemsex, which is aocciated
with unprotected sex and stis and hep c. (PUfall e et al 2018 sexualised drug use chem sex and high-risk
sexual behaviours in HIV positive msm). The fingerprint data that focuses on Public health outcomes
framework tells us the HIV late diagnosis from 2017-19 is still on the increase. To meet the targets in the
future there needs to be more funding in health promotion and prevention and in sexual health
education.The importance and need for a sexual health policy or framework reduce stigma and taboo
around sexual healt enables focus on areas of sexual health and encourage knowledge and information
sharing (PHE). However, it also has it disadvantages such as it puts sexual health care professionals
under added stress such as targets to meet e.g., a certain amount of people to test for chlamydia, this
takes the focus away from a person-centered approach to practice which has better outcomes for the
client ().
Learning outcome 3
Critique and explore behaviour change model, theories and approaches and their application in reducing
sexual health and risk-taking behaviour
No one performs a behaviour without thinking about it first, although the intention to act or perform a
certain behaviour is determined by the individual's attitude, beliefs, background, socioeconomic
environment, education, and culture and is subjective to every individual (Ajzen and Fishbein 2005).
Behaviour change is a process and involves the internal locus of control, change cannot be imposed
externally and must come the inside (Proshaka et al, 1992) In regard to risk taking behavuour such as
condom less sex while HIV positive the medical/ preventative model targets at risk groups such as MSM
and bisexual men (). Thos is preventative model that uses scientific methods to prevent transmission of
HIV and early detection and has been successful reducing the mortality rate though many men with HIV
disclose feelings of discrimination and stigma from health professionals, this however could be
internalised negative beliefs that individuals feel from society rather than an individual health professional
(Beany t, 2018). It is a ‘top down’ approach with highly sucessfulexapmles in sexual health such a syphilis
was nearly eradicated in however due to Art and individuals feeling less at risk of HIV and the change in
behavour auch has condom less chemsex the rates of syphilis have risen (vinh-kin n et al2018). However,
there are many disadvantages to this model such as clients who are symptomatic may only go to sexual
health services to get tested which rules out a percentage of people with asymptomatic and do not get
tested (PHE, 2018) also the medical model focuses on the illness and does take into other dimensions such
as poverty, drug dependency and access to services Natasal-3(). A more integrated approach that does
consider AN individual's influences on health is the behavuour change model which encourages
individuals to adopt healthy behaviours such as condom use (eigh et al, 2008). Using the trans theoretical
model the individual will go through stages of change, precontemplation, were the indicual may be
unaware that chemsex is a problem and risk to their health. Contemplation becoming aware of issues
around risk taking behaviour such a stis and intending to change their behaviour. Determination having a
desire to change, accessing services and condom use the individual weighs up the pros and cons of
changing their behaviour and they begin to gain in confidence believing they can change. Action accessing
sexual health clinics and wearing condoms. Then relapse beahbbiour change takes time and is complex
due to their social and environmental factors such as substance misuse so drug and alcohol services may
also have to be accessed however the model of change can be reentered at any stage with support(Varney
J et al, 2015) It is important that individuals have the knowledge of where and how to access sexual health
services, using digital access also Tones and tiford (2001) beeves than empowering individuals with
education enables individuals to become more conscious of sexual health issues(). Using screening testing
establishing relationships between sexual health professional and clients reinforcing positive behavour
change with sex education and advice however this method can cause individuals to become more reliant
on sexual services and a rounder holistic method encompassing a collaborative method of change will
facilitate healthy behaviour change (PHE, 2015). Being able to have a safe and pleasurable sex life is central
to an individual well-being and it is important that individuals take responsibility for their own sexual
health.
Learning outcome 4
Critically discuss the social and ethical and political influences that may impact upon sexual health
education promotion strategies and interventions
The changing of individuals behaviours is central to public health, behaviours are seen in environmental,
social, and economic contexts. Berridge, 2016). Health pilcy refers to plans, actions and decisions that are
taken to achieve specific health care goals. A health policy can achieve a vision for the future, establish
targets and outline prorities. In the context of sexual health an estimated 101,600 pople in the united
Kingsoma re living wwith HIV in 2017 (Public health England, 2018). New diagnosis of HIV diagnosis in the
uk occurred amoung gay, bisexua men and men who have sex with men (MSM). (Public health englans,
2018). Although HIv diagnosiss has been on the decline, in 2017 43% of hic diaanosis were made in the
late stage of infection (PHE, 2018). Early diagnosis is vvital in preventing mortality from HIV in 2017 428
people died from HIv with an estimated 248 of that could have been prevented due to early diagnosis
(PHE, 22018). The decline in Hiv evidence sugests is due to the availailty of Prep, increased testting and
provision of treatment (Nwokola etal 2017). However public health england has concerns relating to MSM
and chemsex and the role it plays in the transmossion of HIV. A study in 2018 suggested that 30% of
sexually active HIV positive MSM in the ukhave engaged in chem sex also associated with this is the tise
of stis and hep c. (Pufall et al 2018). In 2017 1.1 million people who attend sexual health services 10%
were gay and bisexual men and over haldf of new diagnosis were in this group (PHE, 2018). However there
have een many missed opportunities for HIV testing in 2018, 350,00 people who attended sexual health
services were not offered an HIv test despite eing eligile for example gay and isexual men. The national
institute for clinical excellence (NICE) advocate testing outside of clinical settings, engaging communities
and developing strategies to increase HIV testing (NICE, 2011). this has been successful with hic testing
now available in A and E departments, antenatal clinics and some communities such as gay clubs (NICE,
2011). Due to covid 19 self-testing kits have also increased they can be bought online or in a chemist.
However, this has its issue such as the socioeconomic environment of people who need a HIV test. The
cost of kits and the availability to those at higher risk of HIV is an issue however the Terrance Higgins trust
has tried to address this in 20118 offering people from high-risk groups HIV self-testing kits for free.
(terrance higgins trust). The prevention og hic programme is primarily run by HIV prevention england
(HOPE) whic hn is cooorfinated with the tht and focus on at risk groups such as msm and uk based black
afriacn people (HIV prevention). In 2015 public health England began an HIV prevention fund supporting
community lead approaches the HIV prevention some of these projects are through outreach and peer
support groups, PROMOTE which targets male sex workers ().Alsdo project receiving funding between
2018 and 2019 The grass 9s always grndr and catwalks for power educating and empowering individuals
in HIV (PHE, 2019). In 29017 a 3-year prep trial began across 200 sexual health clinics in England. Previously
the nhs said they could not commission the availabiltiy of prep however this weent to court and as due to
reach 13,00 indiviuals at hich risk of hiv. This decision ny the nhs was overturned and by jan 2019 more
than 10,00 0 individsulas had sgned upo and by 2020 26,00 had signed up (NHS england 2019 news
updates on the prep impact trial. Due to individual's low income the monthly expenditure of prep is not
sustainable as the living wage (Mages Portman). All the frame works that phe is a call to action to all health
care professionals to embed prevention in their day-to-day practice, this is done through education
materials such as leaflets, tools, and resources to make a greater impact in protecting and preventing HIV
infections. The legal aspect of sexual health policies provides the framework for sexual health policies,
these can protect human rights and protect vulnerable individual and groups, this however can create
limitations in how sexual health is presented (). As a health professional there are ethical and moral
responsibilities such as following the code of ethics, facilitating the relief of suffering, and working to
improve the health for communities and society (). Applying ethics to sexual practice can cause conflict
between sexual health and opinion, as a sexual health professional personal judgement cannot be taken
into practice (). Ethical theories can highlight important aspect in compels issues, and ethical theories
informed judgments and helps induvial work out whether certain actions are right or wrong (). Ethical
consderaqtions relating to sexual health are individuals may not be comfortaable discussing their sexual
behavious, they may feel guilt ot dshame and attitufdes to sex can be generaational and cultural (). There
are four guiding principles when a health care professional is delivering sexual health, they are autonomy,
client is given sufficient information about their healthcare and make informed choices for them self's.
Benificenec., to do good, non-maleficence, prevent harm and harm reduction and justice to be fair and
appropriate treatment is given (). There are several things that may impact autonomy such as an
individual's culture where there may be a bias in relation to information, the capacity for client to
understand the information given such as language Varriers (). The access to information for clients in
vital in the facilitsating screening programmesand the ability to discuss action and any poritive negative
outcomes for a health descion (). For health professionals this may be an issue of having the rime to deliver
this information in practice, opportunistic screening such as in sexual health clinics for chlamydia, can be
an issue as the client may not have the needed information beforehand to make an informed choice this
can be an ethical issue for the health professional as it may feel like they are influencing a client into being
screening instead of them making a personal informed choice (). There are ethical questions regarding
screening and intervention the opportunity to identify and educate with screening programmes, coercion
into screening (Gardern j 2014), (Scriven 2017). the benefits of screening are the reduction and prevention
of illness at an early stage and treatment will more effective when caught early however a poorly
conducted screening process can cause harm psychologically such as a client receiving a false positive ()>
the pressure heath care professionals feel to deliver targets and demonstrate and adequate uptake of the
screening programme (). Also, targeting at risk groups excludes other groups due to age, sex,sex,and
sexuality ().
Methods for health promotion include twitter, social media, radio and television, health promotion
campaigns such as red ribbon day, advertising and mass media which reaches a large population of people
(). In 2020 there is a decrease to the traditional healthcare appointment due to covid 19, NHs digital 20201
are using telephone and online appointments (). In 2014 the nhs had a 5year forward plan which looked
at the need tom change how people access health services this however is a little out of date and the
digital use has propelled faster due to covid 19 (). The nhs Longterm plan 2019 supports the development
of digital online resources, however this has its challenges as online appointment can mis safeguarding
issues such as domestic abuse and can potentially miss vital health issues (The future digital landscape
Imsion 2016). 71% of 15–24-year Olds have sought sexual education information online (UNSECO,2020).
This is having positives such as the availability to information however it is important that the information
on line is up to ate and relevant (Strasburger and braun, 2014). For
Learning outcome 5
Analyse critique and evaluate Uk sexual health screening programmes
For patients to make positive lifestyle changes it is important they have the information to take
responsibility for their own health. The desire to implement a lifestyle change it is important that the
individual has the support, motivation to change and relevant information to make informed choices ().
The process of change found that positive support is valuable in the process of change (Bowden et al,
2004). Communication between sexual health professional and client is important in enabling open
conversation and disclose any issues (Mayers et al 2005). Un fortunately healthcare professionals
experience pressure due to lack of time owing to a heavy work load which prevents the open discussion
to encourage change (decola etal 2012). those at increased risk of HIV infection are msm and there is
evidence that behaviour change can take place with sufficient 1-1 support, this behaviour change can
increase condom use and reduce partner numbers (NICEi (, 2011). Interventions can be based on the
prevalence of infection in at risk groups and this can prove cost effective in preventing transmission (hebst
etal 2005). One of the health promotion approaches uses the medical model to reduce morbidity, targets
a whole at-risk group and promotes intervention. Such screening programme is the chlamydia screening
programme this uses scientific methods for prevention and early detection (). Between 2008 and 2018
the rates of new sti diagnosis increased for chlamydia but decreased fir genital warts ().
Learning outcome 6
Demonstrate an understanding of the sexual health advisor role in their work with the community and
individuals
The role of the sexual health advisor is to deliver quality sexual and reproductive healthcare and
information. The role supports a wide range of the community males, females, trans and intersex, victims
of sexual assault and grooming (RCN, 2020). The sexual health advisor role is pivotal in the management
of partner notification, information provision and Liases between the community sexual health provision
and GUM services (). The framework for sexual health improvement places and emphasis on partner
notification and the number of ways this can be delivered however consistency is required (SSHA, 2004).
The sexual health advisor is a role to drive positive change in at risk groups through clinic, outreach
education. This role can help reduce the transmission of stis, HIV and unintended pregnancies (SSHA,
2004). There are differences between the role of a sexual health advisor and the promotion of health are
the clinical element where individuals can be tested, contact tracing and test of cure ().public health
England and the department of health requires sexual health services to deliver information so serv9ces
can be commissioned. The data submitted enables the provision of sexual health services (). The skills
required by a sexual health advisor is the ability to communicate, non judgement, organisational skills,
network, and ability to analyses and research (). The role involves advising and giving relevant information
on precautions, trace and contact, the promotion of good sexual health. The sexual health advisor also
promotes and educated the public about risk reduction, the ability to change, empowering individuals
through education and encourage responsibility for the individual on the sexual health (). The health
advisor also counsels' clients pre and post abortion, sti diagnosis HIV testing and safeguarding tools (). A
sexual health advisor may deliver sexual health education in a variety of locations such as a university,
school. Drug and alcohol services and on the street (). Partner notification is a vital part of a sexual health
advisor role this is the process of contacting a sexual partner of someone with a sti including HIV (). The
sexual advisor wilt informs and advise them about the risk of exposure and encourage them to attend the
clinic for testing and prevention treatment (WHO, 1999).
partner notification is vital to interrupt the transmission stis and HIV, promote behaviour change, allow
the adult of potential at risk groups (). There are 3 types of partner notification they are the index, patient
referral, provider, referral and contact referral ().