Let’s Talk About Sex
As the year 2020 ends, Coronavirus continues to always grab our attention, but there’s never been a better time for Teakisi followers to consider their own sexual health. A combination of the pandemic and Marmot’s 10 year follow up report have helped to bring unfair health inequalities into focus, and one of the most concerning is the state of Black, Asian, and Minority Ethnic (BAME) sexual health. What I’m hoping to achieve here is a piece about health promotion where it’s normal that sexual health matters are planned as an ongoing part of your life, rather than being considered as an afterthought.
Without forward planning, one night stands are a common occurrence where enjoyment in the heat of the moment comes first, and consideration about sexual health comes after. Whilst nothing to be ashamed of, the implications can extend far beyond sorting out some emergency contraception. Sexually transmitted infections (STIs) can easily be passed on if a condom is not used. They’re easy to miss, as some people have no symptoms at all. Pelvic inflammatory disease can occur in some women and this can affect fertility. There are some instances of infections being resistant to antibiotics and this makes them difficult to treat. Being pro-active about your sexual health has many advantages. You may well discover an infection that you never knew that you’d had. Consider your own moral compass as remaining “in the dark” may mean that you are unknowingly passing on an STI to your next partner. How will you know unless you get tested?
At this point HIV should get a specific mention. HIV isn’t a label to be ashamed of, yet the stigma about the diagnosis is definitely there. People may feel that they are being judged, for example about how they may have contracted HIV. People can live for years without getting symptoms so encouragement to get tested is hugely important. It’s awful that stigma may discourage people from getting tested and learning their HIV status, as early treatment leads to better health outcomes and can help prevent you from transmitting the infection to others. My experience is that an HIV test is as much part of a sexual health check up as chlamydia or gonorrhoea. There is a “window” for HIV testing which means that it could be anything up to 3 months until a test is truly accurate (talk to your clinician about what the specific time window is for the test that you are getting). I’d recommend reading more at: https://www.tht.org.uk/ as the information is great and an easy read that promotes “National HIV Testing Week” in the first week of February which we should all support.
Access is crucial as this isn’t the usual route of attending your GP. Get to know your local services as you will need to get into contact with a community sexual health clinic. Perceived stigma about getting in touch with a sexual health service is immense, and it’s easy to see why people might feel they will be judged. I’ve accessed both the New Croft Centre (Newcastle City Centre) and the One to One Centre (Shiremoor) locally. Newcastle also has SHINE (Email at: email@example.com) which is a service specifically aimed at women from Newcastle aged 16 and over.
I’ve always felt anxious making the initial telephone call to a service, but my experience is that staff are adept at dealing with my nerves and ready to explain how the services work. In the past, booking face to face appointments or attending walk in sessions have been options for some services. With the advent of COVID, please “talk before you walk” as you should for any healthcare service right now. Be ready to have an initial telephone discussion with a clinician before there’s any talk of an appointment, and some services may struggle to offer any face to face appointments at all right now. There are some options for postal testing. But whilst services may be limited there is some provision for sexual health care so don’t give up, and I’ve never found the staff anything but helpful and reassuring.
So when should you go? If you have symptoms, or a recent partner has symptoms, then it’s recommended. My experience has been getting checked out when I have a new regular partner, and it’s nice to know that you both have the “all clear”. If you’re worried about a specific encounter (e.g. having sex without a condom) then you can’t have tests straight away. Tests for chlamydia and gonorrhoea aren’t accurate until 14 days after the encounter, so unless you have symptoms then you have a bit of a wait. All things considered getting checked at a clinic isn’t exactly akin to going for coffee or a walk in the park…… but it should be. It doesn’t matter whether you’ve been checked just once or whether you feel that you deserve some kind of loyalty card, it should be a normal part of looking after your health and it’s the right thing to do.
The issue isn’t just maintaining your own sexual health, but also making sure that you don’t pass on an STI to future sexual partners. Waiting for test results can feel like an eternity but receiving a text message to say that your recent tests are all clear is always welcome. If an infection is found then it’s always better sooner rather than later and it’s most likely that you will get a telephone call from a clinician and not a text message. Recent partners should be informed so that they can be treated where appropriate too (this is a process called contact tracing and staff will help you with this).
So where do health inequalities fit in? I first learned about them in 1995 and Michael Marmot’s 2010 and 2020 reports have highlighted little progress. But it’s more than that: if somebody’s sexual health is maintained in a poor way because of a certain attribute (e.g. BAME, age 15-24 heterosexual, man who have sex with men, or people residing in the most deprived areas in England), then it’s not just an inequality, I would consider this discrimination. We all know that inequalities are unfair and avoidable, so why are they still there?
If access isn’t easy for all then that’s a huge barrier. Literature and services need to cater for all languages. I’ve used Language Line for telephone consultations, and the BigWord for face to face consultations so it’s possible. Reducing stigma is key, along with making services culturally appropriate. I don’t claim to have the answers, but I would like to open a dialogue. If you don’t access sexual health services right now, what sort of barriers do you feel that you face? What could be done to make services more user-friendly and acceptable for you?
For black women in particular, social justice dictates that no patriarchal element should affect your health choices. That means autonomy with regard to sexual health and contraception. You should be empowered to do this and it will not only benefit your physical health, but your own emotional and mental wellbeing. Sexual health shouldn’t remain taboo. Make use of suitable online resources (e.g. https://www.sexwise.org.uk/ ) and consider contacting your local clinic. It’s time to look after your own sexual health, and that of anyone else that you become intimate with along the way. We need to face this sexual health inequality head on.
Health Equity in England: The Marmot Review 10 Years On | The Health Foundation
Sexually transmitted infections (STIs) – NHS (www.nhs.uk)
Health Matters: Preventing STIs – Public health matters (blog.gov.uk)
Salha / 8 January 2021
Let’s talk about sex indeed … thanks for writing this Doc. Speaking from my culture’s point of view.. no one talks about sex to anyone or you for that matter. Well, except when it’s to do with learning things that are to please your future husband. It’s a shame that we are brought up to not ask questions, or see sexual health including contraception as a important. Would love to see this way of thinking change …
Dr. Daniel Jefferson / 22 January 2021
Hi, highlighting such cultural nuances I think will help bring this topic out into the open where it deserves to be. Not talking will only contribute to the considerable stigma that exists if sexual health remains taboo. Any patriarchal element that persists in stopping women having full autonomy over their sexual health and contraception choices needs to stop. I would also love to see the change to which you allude.