CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Sexual Health   
Sexual Health
Journal Banner
  Publishing on sexual health from the widest perspective
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Structure
Contacts
Content
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
Call for Papers
For Authors
General Information
Scope
Submit Article
Author Instructions
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Library Recommendation
For Advertisers

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with us
blank image
facebook twitter logo LinkedIn

red arrow Interview with Kit Fairley
blank image
Hear Kit Fairley speak about what is sexual health.

 

Article << Previous     |     Next >>   Contents Vol 12(1)

Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

Belinda Hengel A B H, Rebecca Guy B, Linda Garton C, James Ward D, Alice Rumbold E F, Debbie Taylor-Thomson E, Bronwyn Silver E, Skye McGregor B, Amalie Dyda B, Janet Knox G, John Kaldor B, Lisa Maher B and on behalf of the STRIVE Investigators

A Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia.
B Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia.
C NT Department of Health, Sexual Health and Blood Borne Virus Unit, Darwin, NT 0810, Australia.
D Baker IDI, PO Box 1294, Alice Springs, NT, 0871, Australia.
E Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
F Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
G Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480, Australia.
H Corresponding author. Email: belinda.hengel@apunipima.org.au

Sexual Health 12(1) 4-12 http://dx.doi.org/10.1071/SH14080
Submitted: 30 April 2014  Accepted: 7 October 2014   Published: 27 November 2014


 
PDF (154 KB) $25
 Export Citation
 Print
  
Abstract

Background: Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.

Additional keywords: Indigenous, STI screening.


References

[1]  Garton L, Kaldor J, Guy R, Dyda A, Rumbold A, Hengel B, Silver B, Taylor-Thomson D, McGregor S, Fairley C, Donovan B, Maher L, Ward J. Increases in STI testing following the introduction of a sexual health quality improvement program: findings from the STRIVE trial. Darwin: Australasian Sexual Health Conference; 2013.

[2]  Geisler WM, Wang C, Morrison SG, Black CM, Bandea CI, Hook EW. The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment. Sex Transm Dis 2008; 35: 119–23.
CrossRef | PubMed |

[3]  Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS, Wang SP, Wentworth BB, MacCormack WM, Holmes KK. Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med 1975; 293: 166–71.
CrossRef | CAS | PubMed |

[4]  Low N, Egger M, Sterne J, Harbord R, Ibrahim F, Lindblom B, Herrmann B. Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women’s Cohort Study. Sex Transm Infect 2006; 82: 212–8.
CrossRef | CAS | PubMed |

[5]  Silver B, Rumbold A, Jamil MS, Kaldor JM, Guy RJ. Perinatal morbidity associated with Trichomonas vaginalis: a meta-analysis. Vienna: ISSTDR; 2013.

[6]  McClelland RS, Sangaré L, Hassan WM, Lavreys L, Mandaliya K, Kiarie J, Ndinya-Achola J, Jaoko W, Baeten JM. Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis 2007; 195: 698–702.
CrossRef | PubMed |

[7]  Røttingen J-A, Cameron DW, Garnett GP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Sex Transm Dis 2001; 28: 579–97.
CrossRef | PubMed |

[8]  The Kirby Institute. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2013. Sydney: The Kirby Institute, The University of New South Wales; 2013.

[9]  Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med 2003; 36: 502–9.
CrossRef | PubMed |

[10]  Congress Alukura and Nganampa Health Council. Minymaku Kutju Tjukurpa Women’s Business Manual. Alice Springs: 2008.

[11]  Queensland Health and Royal Flying Doctor Services (Queensland Section). Primary clinical care manual. Cairns: 2009.

[12]  Communicable DCD. Guidelines for managing sexually transmitted infections WA. Perth: Department of Health; 2012.

[13]  Hengel B, Ward J, Wand H, Rumbold A, Kaldor J, Guy R. P5. 007 Annual Chlamydia trachomatis and Neisseria gonorrhoea testing in an endemic setting: the role of client and health centre characteristics. Sex Transm Infect 2013; 89: A336–7.
CrossRef |

[14]  Hui BB, Wilson DP, Ward JS, Guy RJ, Kaldor JM, Law MG, Hocking JS, Regan DG. The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence. Sex Health 2013; 10: 348–56.
CrossRef | PubMed |

[15]  Ward J, McGregor S, Guy RJ, Rumbold AR, Garton L, Silver BJ, Taylor-Thomson D, Hengel B, Knox J, Dyda A, Law MG, Wand H, Donovan D, Fairley CK, Skov S, Ah Chee D, Boffa J, Glance D, McDermott R, Maher L, Kaldor JM. STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing ‘usual practice’ STI care to enhanced care in remote primary health care services in Australia. BMC Infect Dis 2013; 13: 425
CrossRef | PubMed |

[16]  Australian Bureau of Statistics. Community profiles. [cited 2013 26 April 2013]; Available from: http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles?opendocument&navpos=230.

[17]  Garnett S, Coe K, Golebiowska K, Walsh H, Zander K, Guthridge S, Li SQ, Malyon R. Attracting and keeping nursing professionals in an environment of chronic labour shortage: a study of mobility among nurses and midwives in the Northern Territory of Australia. Darwin: Charles Darwin University Press; 2008.

[18]  Mitchell M, Hussey LM. The Aboriginal health worker. Med J Aust 2006; 184: 529–30.
| PubMed |

[19]  Franks C, Curr B. Keeping company: an inter-cultural conversation. Wollongong: Centre for Indigenous Development Education and Research, University of Wollongong; 1996.

[20]  Yin RK. Qualitative research from start to finish. New York: The Guilford Press; 2011.

[21]  Matthews B, Scott D. Mandatory reporting of child abuse and neglect. Melbourne: Australian Institute of Family Studies; 2013. Available from: http://www.aifs.gov.au/cfca/pubs/factsheets/a141787/index.html [verified 15 January 2014].

[22]  Artuso S, Cargo M, Brown A, Daniel M. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study. BMC Health Serv Res 2013; 13: 83
CrossRef | PubMed |

[23]  Peiris D, Brown A, Howard M, Rickards BA, Tonkin A, Ring I, Hayman N, Cass A. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. BMC Health Serv Res 2012; 12: 369
CrossRef | PubMed |

[24]  Lenthall S, Wakerman J, Opie T, Dunn S, MacLeod M, Dollard M, Rickard G, Knight S. Nursing workforce in very remote Australia, characteristics and key issues. Aust J Rural Health 2011; 19: 32–7.
CrossRef | PubMed |

[25]  AIHW. Health and community services labour force 20062009 Cat. No. HWL 43. Canberra: AIHW; 2009.

[26]  Hengel B, Jamil MS, Mein J, Maher L, Kaldor J, Guy R. Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13: 1040
CrossRef | PubMed |

[27]  Jamil MS, Hocking JS, Bauer HM, Ali H, Wand H, Smith K, Walker J, Donovan B, Kaldor JM, Guy RJ. Home-based chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13: 189
CrossRef | PubMed |

[28]  Simons B, Jessen C, Rea L, Barnes M, Barnes P, Gaydos C. Providing discrete and reliable STD testing in alaska via a web-based at-home service. Sexually Transmitted Infections 2013; 89: A70
CrossRef |

[29]  Buhrer-Skinner M, Muller R, Buettner PG, Gordon R, Debattista J. Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples. Sex Health 2013; 10: 32–8.
| PubMed |

[30]  McNulty CAM, Freeman E, Howell-Jones R, Hogan A, Randall S, Ford-Young W, Beckwith P, Oliver I. Overcoming the barriers to chlamydia screening in general practice – a qualitative study. Fam Pract 2010; 27: 291–302.
CrossRef |

[31]  McNulty CAM, Freeman E, Bowen J, Shefras J, Fenton KA. Barriers to opportunistic chlamydia testing in primary care. Br J Gen Pract 2004; 54: 508

[32]  Pavlin NL, Parker R, Fairley CK, Gunn JM, Hocking J. Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice. BMC Infect Dis 2008; 8: 62
CrossRef | PubMed |

[33]  NACCHO/RACGP. National guide to a preventative health assessment for Aboriginal and Torres Strait Islander people. South Melbourne: The RACGP; 2012.


   
Subscriber Login
Username:
Password:  

 
    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2016