ALL ABOUT BLACK HEALTH on SEX

ALL ABOUT BLACK HEALTH

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GENERAL HEALTH

Teaching Sexual Health and Responsibility – Every Practitioner’s Responsibility

By Maureen N. Letts, 4^th year medical student, Univ. of Cincinnati College of Medicine (USA)

After spending the month of February [2003] working at the Cincinnati Health Department’s Sexually Transmitted Diseases (STD) Clinic, my eyes were opened to some of the challenges and barriers that arise when educating patients about sexual health. It is typically a host of poor choices lead many patients to the STD Clinic. Embarrassment, fear of being judged, and ignorance of the facts make many hesitant to disclose the truth of their behavior once they arrive. The fact is, the rate of HIV/AIDS continues to rise in the African-American community, and yet many patients’ attitudes and practices are unchanged.

Many of these clinic patients, who range in age from early teens to middle- and older-aged adults, take comfort in the fact that most sexually transmitted infections (STIs) can be treated with an injection or short course of antibiotic pills. They neglect to see the potential long-term consequences of STIs and the serious threat of HIV. To my surprise, however, the majority of patients are willing to listen, talk realistically about their practices, and ask questions when they have a non-judgmental and receptive health care provider with whom they can interact.

For these very reasons, it is the responsibility of every practitioner to break down these barriers by providing a safe haven for discussion, initiating dialogue, and providing the hard-core facts related to patient sexual health and responsibility with every patient encounter.

In order to approach sensitive issues related to sexual health with patients, one must first facilitate an environment where open discussion can take place.

Many physicians display patient information pamphlets in their waiting areas or posters in examination rooms that address health topics. By including information on topics such as safe sex, HIV, birth control, and abstinence, patients become aware that these issues are of concern to their doctor, and thus, should be their concern too. Furthermore, health care providers should regularly ask questions related to sexual health as a part of a comprehensive interview.

Although some patients may be hesitant to respond initially, addressing these issues shows the physician’s interest in the patient’s overall well-being. Patients should be made aware that questions regarding sexual health are not specifically directed towards them, but instead that the physician discusses such issues with all patients. When the health care provider creates a safe haven for discussion of sexual health early in the doctor-patient relationship, it opens the door for honest dialogue in the future.

It is vital that health care providers initiate this dialogue with all of their patients, regardless of age, cultural difference, or sexual preference. Although teenagers and young adults are statistically shown to participate in more risky sexual behavior, adults and elderly patients are not immune to the consequences of unsafe sexual activities.

Discussions with teenage patients should encompass body image and self –esteem, as well as making mature and responsible decisions about engaging in sexual activity, birth control, and protection from STIs. Adults should be counseled on responsible sexuality, birth control, and sexual dysfunction. Additionally, they should be encouraged to have open and honest discussions with their adolescent and teenage children at home. Finally, all patients should be screened for sexual abuse and intimate partner violence.

Although most people will respond to these types of open discussions, the occasional patient will be apathetic or obstinate to your advice. When this type of situation arises, it is time to give them the cold, hard facts and ask the tough questions. “Did you know that HIV/AIDS is the leading cause of death in African-Americans from ages 25-44?” “Are you ready to be a father?” “Do you realize that you are putting your unborn child at risk?” When patients understand the impact of a single poor choice in the present on their future health and wellness, they often become more attentive and willing to heed a physician’s advice. This is when effective patient education can take place.

By creating a setting conducive to the discussion of sexual health and responsibility with patients, and providing pertinent factual information, health care providers form an important partnership with their patients. When the physician takes responsibility for allowing issues of sexual health to be addressed and engages the patient in the discussion, it empowers them to take more responsibility for their care as well.

There are no easy answers, and many challenges remain, but influencing a change, one patient at a time, is a success indeed!