Australia and New Zealand have taken the leadBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6988.1194 (Published 06 May 1995) Cite this as: BMJ 1995;310:1194
- Basil Donovan,
- Graham Neilsen,
- Adrian Mindel
- Director Staff specialist Professor Sydney Sexual Health Centre and Academic Unit of Sexual Health Medicine, Sydney Hospital, Sydney, Australia
EDITOR,—Yvonne Stedman and Max Elstein's editorial touches on an issue in which Australia and New Zealand have perhaps taken the lead—the development of broad based sexual health services.1 Indeed, as well as providing services for sexually transmitted diseases and basic family planning under one roof2—a common practice for state funded sexually transmitted disease clinics for over 20 years—the clinical staff increasingly receive training in such diverse topics as sexual and relationship counselling, sexual assault, sexual dysfunction, and promotion of sexual health.3 As a minimum this promotes the identification of problems and efficient referral. Specialist counsellors on site can manage most of these broader problems, particularly if they give rise to a risk of sexually transmitted diseases or HIV infection. There has been no rivalry with our federally funded (and therefore separately located) family planning services, which have enthusiastically provided many of their clients' needs with regard to sexually transmitted diseases and other sexual health problems for the past decade. Cross referral is confined to problems requiring specialist assessment.
In recent years almost all of Australia's sexually transmitted disease clinics have changed to the title “sexual health” clinics. This change reflects a population based approach to health. It also gives patients and staff permission to address a wider range of concerns regarding sexual health. A request for “morning after” contraception may be a more reliable indicator of risk of a sexually transmitted disease or HIV infection than a vaginal discharge. Helping a young gay man through the process of “coming out” provides an opportunity to ensure that his sexual career will be safe. Whatever patients' presentation, the prime objective is that they leave the service with the knowledge and means to reduce morbidity from sexually transmitted diseases and HIV infection within their sexual milieu. All patients are screened for bacterial sexually transmitted diseases, hepatitis B status, contraceptive cover, genital neoplasia, drug use, and other personal or cultural risk factors for acquiring sexually transmitted diseases or HIV infection, and most are counselled and tested for antibodies to HIV.2 When appropriate the model has included full primary medical care for populations with particular need—for example, gay men, aboriginal people, drug injecting “street kids,”4 and sex workers.2 4 5 General practitioners ensure that they are an essential component of the network by managing most people with symptomatic sexually transmitted diseases or early HIV infection and by addressing the bulk of the population's contraceptive needs.
Australasian sexual health services see their roles as addressing gaps in services; providing specialist support; and functioning as a focus for training, research, and surveillance. Some services also provide clinical services and health promotion on an outreach basis.4 5
The training of Australasian venereologists places less emphasis on training in internal medicine than that of their British counterparts. Australasian venereologists tend to focus on ambulatory care and leave most inpatient care of patients with HIV infection to immunologists and infectious disease physicians when they are available.
Though the model is still evolving, we believe that there is merit in reducing the fragmentation of individual patients' sexual health needs. Discussion has even begun on the notion of partially blending medical training and career structures through an integrated body of sexual health physicians while maintaining subspecialist skill.