A tale of two cities

Picture this: Two sexually active 15-year-old girls are concerned that they have chlamydia. One lives in the city, the other in the country; and they both set off to get advice.

The city-dweller has numerous options; she can jump on a tram, train or bus to either the Melbourne Sexual Health Centre or the Action Centre. Here – without an appointment and free of charge – she will have access to a ‘young person-friendly’ specialist. She will be tested, and if found positive will be given appropriate medication and provided with support on how to inform her partner. She will also be given access to free condoms, lube and educational material about safer sexual practices.

While a person’s postcode shouldn’t affect access to treatment, testing, education and support for any medical condition; the journey of a 15-year-old girl living in rural Victoria and in need of similar services is a very different tale according to Director of the Centre for Excellence in Rural Sexual Health (CERSH) Associate Professor Jane Tomnay.

“For starters, transport for a 15-year-old in a country town is pretty much limited to the school bus,” she says.

“She would then have to make an appointment to see her local GP who is more likely to know her family, be trained overseas and less likely to bulk bill. She may then be charged laboratory administration and would have to pay prescription fees, is unlikely to be given professional assistance on how to inform her partner that they could have the infection and is more likely to have little or no access to free condoms and lube.”

Associate Professor Tomnay has spent the past 12 months living in Shepparton and has seen first-hand the numerous barriers in rural areas to optimal sexual health. These barriers include restricted confidentiality (as everyone knows everyone in a small town), decreased access to sexual health promotion strategies, homophobia and an ever-present stigma attached to sexual health problems.

Associate Professor Tomnay says restrictions to confidentiality when it comes to your sex life are hard to comprehend for city-dwellers who have access to endless chemist and supermarket counters.

“A long-time pharmacist in a small country town told me that he took condoms off the shelves because they were the most commonly stolen item from the shop,” she says.

“He quickly clarified that he didn’t think the locals were all thieves but that he suspected people in town, including the young people, were probably too embarrassed to buy them.

“He subsequently put the condoms behind the counter and ended up having to throw them away because they went past the expiry date.  He explained that he was very involved in the local football club, was on the primary school council and had three teenagers of his own – so most of the young people in town either played football or knew one of his kids. He ended his comments with ‘everyone in town knows me and I know them’. I think this highlights significantly the need for confidential condom access particularly for young people.”

One solution, according to Associate Professor Tomnay, is the installation of condom vending machines in public toilets, sporting grounds and public parks. CERSH has even offered to pay local government associations for the cost of installation and the first 1000 condoms.

“All the councils have to do is maintain and restock the machines and collect data in relation to how often machines are restocked, the number of condoms sold and the acceptability of machines to residents,” she says.

“We are still in talks with councils on this and while there was some initial resistance, we have also had success in partnering with some councils. For example, we have one rural football and netball club which has recently taken ownership of their vending machine after realising their earning potential, and now the money earned from condom sales is going back into health promotion for the club’s kids.”

Another program – carried out by MSHC and funded by the Department of Health Victoria – and endorsed by CERSH which provides a different approach to making testing and treatment more broadly available to key population groups is TESTme: a telephone consultation service with a doctor or nurse for sexually transmitted infection or contraceptive advice for young people living 150km from Melbourne.

Beyond embarrassment and accessibility to condoms, Associate Professor Tomnay says rural Victorians also have inadequate access to sexual health promotions and strategies aimed at increasing knowledge and awareness of sexually transmitted infections and safe sex practices.

 “When I first moved to Shepparton, one of the things that shocked me most was a low level of interest, knowledge and concern about sexual health expressed by some members of the community, and this included some members of the health profession,” she says.

 “CERSH are trying to turn this around by educating the community and health professionals. CERSH has visited 60 GPs over the past six months to raise awareness of issues around sexual health clinical service provision in North East Victoria.”
www.cersh.com.au