‘Proximity and visibility’: Scholarship winning essay investigates young people’s use of local sexual health services

OVER THE MOON: Medical student Amelia Smart has won this year's Bega Cheese Rural Clinical Placement Scholarship. Picture: Alasdair McDonald

OVER THE MOON: Medical student Amelia Smart has won this year's Bega Cheese Rural Clinical Placement Scholarship. Picture: Alasdair McDonald

A recent conversation at the regional hospital inspired the theme of this year’s Bega Cheese Rural Clinical Placement Scholarship winning essay.

Third year Australian National University medical student Amelia Smart said while on a placement with Dr Katherine Turner from the Bega Community Health Centre’s Sexual Health Service, she learned that while “once upon a time they had lots of young people come through the centre” those numbers have now dropped off.

The 26-year-old has won the $3000 scholarship for her essay on sexual health access in regional Australia.

“I was very surprised to win, I was over the moon, and I think it helped that I wrote about something I am interested in,” she said. “It is a massive help financially.”

Her essay details health workers at the hospital’s community health clinic describing a downturn in visits by young people with sexual health concerns since the hospital’s move from in town to the outskirts of Bega. 

“Two factors are at play here: proximity and visibility,” Ms Smart said in her essay.

She said a lack of accessible transport and anonymity could also be reasons for the downturn. 

“With a sexual health clinic in the city you can find one where you don’t know anyone, and you can also be bulk billed. I think I took it for granted, having the access I did while growing up in Melbourne,” she said.

As part of the university’s rural stream, her time in Bega this year is her first experience at life outside the city, after moving to Canberra to study.

“I had never lived in a rural area, but I liked the idea of being surrounded by nature and not battling with traffic everyday,” she said.

“So this was a good chance to see how it goes.

“Everyone has been welcoming, and I feel Bega has a lot going for it compared to other country towns.”

Ms Smart said she sees her time in Bega as an opportunity to experience as much as she can.

“This year is formative in what kind of medicine I will do,” she said.

Ms Smart’s winning essay in full.

Young people in rural communities should have equal access to services that promote sexual health. Unfortunately, several factors related to living rurally restrict access for many young people, particularly gender diverse individuals.  Rural communities as a whole can work to reduce these barriers and ensure that the rates of sexually transmissible infections (STIs) and blood-borne viruses (BBVs) do not disproportionately affect the youth living in rural Australia.

The Department of Health’s Third National Sexually Transmissible Infections Strategy 2014-2017 lists young people as a “priority population”. Young people are more inclined to engage in risky behaviours and therefore may place themselves at greater risk of STIs and BBVs. Despite generally good health in young Australians, the Royal Australasian College of Physicians has stated that rates of STIs in young people are of concern. In particular, rural youths may experience greater difficulty in accessing sexual health services due to geographic isolation, service scarcity and fears surrounding lack of anonymity in small towns.

In the southern NSW town of Bega, the sexual health clinic once saw a steady influx of teenagers from the local high school conveniently located nearby. Health workers at the new South East Regional Hospital community health clinic have reported that the number of youth presentations for sexual health concerns has declined since the relocation of the clinic to the outskirts of town. Two factors are at play here: proximity and visibility. Proximity is vital in promoting access for young people, who often have limited means of transport and restricted time periods during which they can schedule appointments without informing parents, should that be desired. Visibility ensures that young people are aware of the services available to them and are informed of the importance of sexual health.

For young people in rural communities who identify as lesbian, gay, bisexual, trans, queer or intersex (LGBTQI), the difficulties that impede access to sexual healthcare are even greater. In addition to the aforementioned problems, the major additional factor to consider for this population is fear of stigmatisation. Research from La Trobe University found that bullying and feelings of isolation for LGBTQ youths might be more pronounced in rural areas. Although stigma is in no way unique to rural communities, its effect may be more damaging due to a lack of support services and LGBTQI community networks. A recent study published in the Australian and New Zealand Journal of Public Health found that gay, lesbian and bisexual individuals in rural Australia were more likely to conceal their sexuality from friends and were more concerned about disclosing their sexuality compared to their metropolitan counterparts. This is a major difficulty in sexual healthcare, as disclosure of such details is required for provision of appropriate care.

Additionally, anonymity is often a key consideration of patients in seeking sexual healthcare services, as the information shared in such consultations is frequently private and sensitive. In rural areas, the limited number of health practitioners and the small population size mean the chance of encountering one’s sexual health care provider outside of a professional setting is extremely high. It is hard to imagine the level of anxiety that situation would provoke as a vulnerable teenager who was not comfortable with others knowing details of their sexual identity or sexual health status. Reassurance regarding patient confidentiality in a safe environment along with wider community acceptance of gender diversity may help alleviate some of these concerns.

Sexual health is a part of overall mental, physical and emotional health. The national survey of LGBT Australians, Private Lives 2, found that the general health of those surveyed was lower than the national average. According to the Department of Health, the rate of STIs is higher within populations of men who have sex with men compared to their heterosexual counterparts. Furthermore, STIs increase the transmissibility of, and susceptibility to, HIV. The LGBTQI population experiences a disproportionately high rate of mental illness and, according to the National LGBTI Health Alliance, has the highest rate of suicidality of any population in Australia. Thus, minimising the obstacles for LGBTQI youth in accessing sexual health services is one way that communities can increase the overall health and wellbeing of this group.

Rural communities can and do make a positive difference to the lives of LGBTQI youths. ‘Young & Free’, the current exhibit at the Bega Valley Regional Gallery, showcases art dealing with the topic of gender identity and fluidity. At the entrance is a sign promoting the gallery as a safe space for gay and lesbian people. The exhibit features the photography of Sydney artist Liam Benson. The photographs feature Benson adorned with headdresses, blouses and glitter staring straight directly at the observer. He combines symbols of femininity and masculinity and challenges gender stereotypes, provoking questions around gender and sexual identity. A video interview in the gallery shows Benson discussing the difficulties he encountered coming out as a gay man. Community projects such as this promote positive conversation, send a message of acknowledgement and acceptance to the young LGBTQI community in Bega and encourage them to feel safe. Such action will hopefully alleviate some of the feelings of alienation and fear that affect young gender diverse people. In doing so it is hoped that the barriers these young people face in accessing sexual health care will subside, thus helping to reassure them in speaking honestly with sexual health care providers.

The provision of sexual health care to young people in rural towns has numerous difficulties. Increasing the visibility of services, via promotion in public spaces and schools, will help to remind young people of the services available to them and highlight the importance of looking after one’s sexual health. Decreasing geographic barriers to access sexual health services is important for youths, who often have limited means of transport. Specifically for LGBTQI youths, rural communities should work holistically, aiming to reduce the overall stigma and alienation that they experience. Ideally, this would result in a reduction in the fear surrounding disclosure of sexual identity and practices to health practitioners, thus enabling appropriate care. Rural communities can work towards enhancing the sexual health, and thereby the overall wellbeing, of their young populations by acknowledging and minimising the obstacles they confront.

References:

  • Department of Health (2014), Third National Sexually Transmissable Infections Strategy 2014-2017. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-bbvs- sti
  • Hillier, L., Jones, T., Monagle, M., Overton, N., Gahan, L., Blackman, J. and Mitchell, A. (2010). Writing Themselves In 3: The third national study of the sexual health and wellbeing of same-sex attracted and gender questioning young people. Melbourne: The Australian Research Centre in Sex, Health and Society, La Trobe University
  • Leonard, W., Pitts, M., Mitchell, A., Lyons, A., Smith, A., Patel, S., Couch, M., Barrett, A., (2012), Private Lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians. Melbourne: The Australian Research Centre in Sex, Health and Society, La Trobe University.
  • Morandini, J.S., Blaszczynski, A., Dar-Nimrod, I., (2015), Minority stress and community connectedness among gay, lesbian and bisexual Australians: a comparison of rural and metropolitan localities, School of Psychology, University of Sydney, New South Wales, Department of Family Medicine and Community Health, The University of Minnesota Medical School, USA: Aust N Z J Public Health. doi: 10.1111/1753-6405.12364.
  • Rosenstreich, G. (2013) LGBTI People Mental Health and Suicide. Sydney: National LGBTI Health Alliance
  • Royal Australasian College of Physicians (2015), Sexual and Reproductive Health Care for Young People: Position Statement. Sydney. Retrieved from: https://www.racp.edu.au/docs/default-source/default- document-library/racp- sexual-and- reproductive-health-care-for- young-people- position-statement.pdf?sfvrsn=0
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