He Pūkenga Kōrero: Rangatahi NEET, Takataapui and STI

STI POLICY AND FUNDING STI SERVICE PROVIDERS STI AND RANGATAHI NEET

Rangatahi are over-represented  in the statistics for chlamydia and gonorrhoea (Ekeroma, Pandit, Bartley, Ikenasio-Thorpe, & Thompson, 2012; ESR, 2013; Morgan, 2013; Rose et al., 2012; Terry et al., 2012).   Rangatahi most vulnerable to STI are young Māori, 16-24 years of age, and not in employment, education or training (NEET), and young Māori who are takataapui. A socio-economic profile of Māori  in the Waikato region suggests that some rangatahi are unable to access important health information or STI services, thus making it difficult to keep themselves and their sexual partners STI-free. Rangatahi NEET and takataapui constitute a priority population for access to free and low-cost STI testing and treatment services in the Waikato  (Robson et al., 2015).

References

Ekeroma, A., Pandit, L., Bartley, C., Ikenasio-Thorpe, B., Thompson, J. (2012). Screening for sexually transmitted infections in pregnancy at Middlemore Hospital, 2009. New Zealand Medical Journal, 125(1359), 23-30.

Morgan, J. (2013). Epidemiology, screening and treatment of chlamydia trachomatis infection in New Zealand (Doctoral thesis, University of Auckland, New Zealand).

Rose, S., Bromhead, C., Lawton, B., Zhang, J., Stanley, J., & Baker, M. (2012). Access to chlamydia testing needed for high risk groups: Patterns of testing and detection in an urban area of New Zealand. Australian and New Zealand Journal of Public Health, 36(4), 343-350.

Robson, B., Purdie, G., Simmonds, S., Waa, A., Brownlee, G., Rameka, R. (2015). Waikato District Health Board Māori health profile 2015. Wellington: Te Rōpū Hauora a Eru Pomare.

Terry, G., Braun, V., & Farvid, P. (2012). Structural impediments to sexual health in New Zealand: Key informant perspectives. Sexuality Research and Social Policy, 9, 317-326. doi: 10.1007/s13178-012-0089-y. Retrieved September 2016 from https://www.researchgate.net/publication/230705402_Structural_Impediments_to_Sexual_Health_in_New_Zealand_Key_Informant_Perspectives

1. Rangatahi Care About Their Sexual Health

Research shows that Māori care about their health and wellbeing (Cram, 2014) and the thirty-seven rangatahi NEET interviewed for He Pūkenga Kōrero are no different. Rangatahi NEET  and takataapui told us they value good sexual and reproductive health and want easy access to credible information and services in order to stay STI-free.

[The more we know] the better we can take care of ourselves.  

Yeah, I like getting checked out, making sure that I’m good.

[Talking to a doctor or nurse about STIs] Then all good. They skilled up in knowledge, teach me . . . Yeah, otherwise how else are you going to find out?

One friend, she had [a STI] . . . She just told us, ‘This is how it is and I’m being treated for it’. It’s again going back to that whole looking after yourself – being [sexually] active, but looking after yourself at the same time. 

References

Cram, F. (2014). Improving Māori access to health care: Research report. Auckland: Katoa Ltd.

2. Credible Information About STI

Like many young people in New Zealand , knowledge of STI and associated risks appeared to be low amongst rangatahi NEET and takataapui interviewed for He Pūkenga Kōrero.  Knowledge levels are likely associated with poor access to credible sources of information (Waiti & Green, 2014). Evidence-based sexuality education, an excellent source of credible information, is not available in all schools (KPMG, 2013).  A study by Clark et al. (2008) found that most school-aged rangatahi reported consistent condom use (i.e. for preventing STI and unplanned pregnancies), but little is known about rangatahi reporting inconsistent use (Clark et al., 2008, Ministry of Health, 2005). Rangatahi NEET and takataapui told us that accessing credible STI information was not easy. Barriers typically include embarrassment, not feeling comfortable talking to someone, not knowing where to go or who to ask for help, and not having access to sexuality education or a school nurse while at school.

[STI]’ll be the last subject anyone woulda talked about. 

A lot of people are probably embarrassed to go to Family Planning just for condoms.

I think the younger Māori boys need more education about sexual health . . . Just educate them.

I wasn’t taught it at school . . . I guess it just comes back to the whole , you don’t want to talk about it to your parents, our teachers, our aunties.

References

Clark, T. C. , Robinson, E., Crengle, S., Herd, R., Grant, S., & Denny, S. (2008). Te Ara Whakapiki Taitamariki. Youth’07: The health and wellbeing survey of secondary school students in New Zealand. Results for Māori young people. Auckland: The University of Auckland.

KPMG. (2013). Value for money: Review of sexual and reproductive health services. Final Report. Wellington, Ministry of Health.

Ministry of Health. (2003). Sexual and reproductive health: A resource book for New Zealand health care organisations. Wellington: Ministry of Health.

Ministry of Health. (2005). Safer sex evaluation summary. Prepared for the Ministry of Health. Wellington: Ministry of Health

Waiti, J. & Green, J, A. (2014). Planning a national STI website that appeals to young Māori.  Hamilton: Te Puāwai Tapuhttps://tewhariki.org.nz/assets/stief-project-report-and-appendices-2014-for-distribution.pdf

3. When and Where To Get Tested

There is a lack of information about STI services amongst most young people, particularly those living in rural locations (KPMG, 2013).  Local youth services and school nurses (for those recently out of school) are an important source of credible STI information and support; however many rangatahi rely on mis-information from less credible sources, such as their friends or ‘Dr Google’ (Waiti & Green, 2014). Rangatahi NEET  and takataapui told us they want to know when and where to get tested, how much will it cost, how to make an appointment, how to get there, and what happens when you get tested.

Depends though – do you have to call up, or do you just rock up?

I have no idea. Do they ring you now [with test results]? . . . Don’t they call you? . . . I prefer letter, telephone’s not the one. I’d like it in writing.`

[What information about STI testing will be most helpful?] How to make the appointment . . . Where is Family Planning.

Probably not that easy, because there’s not a lot of information out there. Young people know about certain clinics, but they still don’t know what’s involved in going to these clinics, or how to get there or transport or booking an appointment time. You can’t just rock up . . .

Being told from school and stuff that it’s bad, that it hurts . . . Being told by the bros it was a disease.

Shove the old thing up the lux . . . Do they put it in, ow? Do they put it inside the eye? . . . Needle in the sac, eh . . . Might have to be like a violent one, like a fat-as swab . . . I heard of like a needle . . .Yeah, through the head [of the penis] . . .

References

Cram, F. (2014). Improving Māori access to health care: Research report. Auckland: Katoa Ltd.

KPMG. (2013). Value for money: Review of sexual and reproductive health services. Final Report. Wellington, Ministry of Health.

Waiti, J. & Green, J, A. (2014). Planning a national STI website that appeals to young Māori.  Hamilton: Te Puāwai Tapu.

4.  Eliminate Stigma and Discrimination

High levels of stigma and discrimination exist in Aotearoa with regard to sexuality and sexual health (NZSHS, 2011).  Rangatahi experience stigma as a barrier to seeking STI information, support and services (Waiti & Green, 2014). Additional barriers to accessing STI services are experienced by rangatahi who are takataapui, in particular, fear of discrimination by health professionals as a result of their sexual orientation and gender identity. A recent study of MSM in Aotearoa found that more than half did not tell a health care provider of their sexual orientation or gender identity for fear of discrimination. The study recommended health professionals address their professional health literacy as a key step along the pathway to reducing  HIV and STI infections (Ludlam et al., 2015). Health professionals should be comfortable asking rangatahi about their sexual orientation and gender identity.

It’s out of it if you’re like talking to an old lady [nurse/doctor] about it [STI test].  It’s like getting judged as soon as you ask.

People don’t even want to go and get tested because, it’s like they’re ashamed.

Just try not to let anyone else find out . . . Yeah, that’s the main one. Gotta be . . . under the radar. 

[Getting tested] sounds pretty easy, but going in for it isn’t . . . And that’s just like all the other stigmas of going to get tested for something.

Some places are extremely rude . . . I’ve been to a few places where nurses are just very old school and think that homosexuality can be changed by dating some girl. So those nurses will then be very hard to talk to and be very rude about the whole situation.

References

NZSHS (New Zealand Sexual Health Society). (2011). Request for action on the development of a National Sexual Health Strategy and Action Plan (New Zealand Sexual Health Society report to the Ministry of Health on sexually transmitted infections in New Zealand). Wellington: NZSHS. Retrieved from http://nzshs.org/news/policy-submissions/188-development-of-a-sexual-health-strategy-and-action-plan/file

Ludlam, A., Saxton, P., Dickson, N., & Hughes, A. (2015). General Practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New Zealand. Journal of Primary Health Care; 2015 7(3): 204-212.

Waiti, J. & Green, J, A. (2014). Planning a national STI website that appeals to young Māori.  Hamilton: Te Puāwai Tapu.

5. Rangatahi NEET and Takataapui Require Free Services

The cost of health services is identified as a significant barrier to accessing health care (Cram, 2014) and rangatahi interviewed for He Pūkenga Kōrero had direct experience of this. A study by KPMG (2013) found that providing free or low cost SRH services to populations with high needs and low income (e.g. rangatahi NEET and takataapui) is an important component of effective service  delivery. In reality however,  funders operate different funding formulae. This means that in the Waikato DHB region, consultation fees for rangatahi seeking an STI test range from ‘no cost’ (Hamilton Sexual Health Services), ‘no cost’ up to 22 years for a consultation at Family Planning or a GP practice that is part of a primary care organisation, to a discounted part-charge for a rangatahi with a Community Services card attending a GP practice that is not part of a PHO, to a full after-hours consultation fee at the Anglesea Clinic, and a myriad of fee scales in-between. Prescription fees are in addition to consultation fees.

[Did the old clinic used to charge a lot of money?] Nah it was just a koha . . . [but] now we gotta go to Dinsdale . . . I think it might charge now. Yeah, some of us do APs [automatic payments].

It’s shame [to get condoms], sometimes they cost heaps.

I think it would be easy to go to any GP or practice to get [free] condoms, wouldn’t it? It’s just taking the time out to go get them, and all the young people will take time out . . . will seek to find them I guess, I’m not sure.

References

Cram, F. (2014). Improving Māori access to health care: Research report. Auckland: Katoa Ltd.

KPMG. (2013). Value for money: Review of sexual and reproductive health services. Final Report. Wellington, Ministry of Health.

6. STI Services ‘Closer To Home’

Lack of transport is a significant barrier to Māori access to health care in the Waikato region (Robson et al., 2015). In a study on the health and wellbeing of secondary school students in Aotearoa (Clark et al., 2008), 25.7% of respondents identified having no transport as a barrier to accessing health care.  The issue is exacerbated for rangatahi living in small towns and rural areas where STI services are not readily available (KPMG, 2013). This highlights the importance of ensuring there are outreach services ‘closer to home’ (Ministry of Health, 2016).  Rangatahi interviewed for He Pūkenga Kōrero mentioned transport issues, including having to rely on asking parents or whānau to transport them to  STI services, as a barrier.

[T]here is not a lot of information out there. I guess young people know about certain clinics, but they still don’t know what’s involved in going to these clinics, or how to get there or transport or booking an appointment.

Yeah, it is pretty hard [asking someone to take you to a clinic] when you put all that in.

References

Clark, T. C. , Robinson, E., Crengle, S., Herd, R., Grant, S., & Denny, S. (2008). Te Ara Whakapiki Taitamariki. Youth’07: The health and wellbeing survey of secondary school students in New Zealand. Results for Māori young people. Auckland: The University of Auckland.

KPMG. (2013). Value for money: Review of sexual and reproductive health services. Final Report. Wellington, Ministry of Health.

Ministry of Health. (2016). New Zealand health strategy: Roadmap of actions 2016. Wellington: Ministry of Health.

Robson, B., Purdie, G., Simmonds, S., Waa, A., Brownlee, G., Rameka, R. (2015). Waikato District Health Board Māori health profile 2015. Wellington: Te Rōpū Hauora a Eru Pomare.