8/10/2015. NSW Aboriginal Sexual and Reproductive Health Program. Background 1. NSW Aboriginal Sexual and Reproductive Health Program.

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1 8/10/201 Background 1 Median age first sex is 1 yrs for males; 16 yrs for females (GOANNA, 2014) NSW Aboriginal Sexual and Reproductive Health Program Kong M, Ford B, Watchirs Smith L, Ritter T,Harrison K, Monaghan R Ward J, Saulo D, Duley P, Cairnduff S, Graham S, Jarret J, Wand H, Kaldor J, Guy R One-third yr olds report no condom at last sex (GOANNA, 2014) Condoms and oral contraceptive pills most common contraceptive choice (NATSIHS, 200) 2 3 Background 2 Higher notification rates of sexually transmitted infections (1-19 years) (Kirby Institute, 2014) Higher rates (6x) of adolescent pregnancy (AIHW, 2013) Teen childbearing can impact educational and employment opportunities (Fergusson, 1999 & Hofferth, 2001 ) Teenage mothers are also at higher risk of having low selfesteem and depression (Quinlivan, 2004 & Barnet, 1996) 4 NSW Aboriginal sexual and reproductive health program Health promotion program, funded by NSW Ministry of Health ( ) Aimed to increase Aboriginal young people (12-19 years): SRH literacy and confidence Access to SRH services / testing Use of condoms and contraception Extensive planning and community consultation Aboriginal community: governance, meetings and feedback Aboriginal Community Controlled health services (ACCHS) and local Aboriginal SRH workers NSW Aboriginal sexual and reproductive health program Eight (8) local Aboriginal SRH workers Formal training for SRH workers, and state-wide support State-wide campaign It s your choice! Have a voice! (AH&MRC) Camps Condom accessibility Workshops SRH service delivery and screening Sports Evaluation methods Clinic data (de-identified) Before and after design & Youth survey N=248 Peer education School based Arts based One to one Community events and campaigns 6 1

2 Number Number 8/10/201 Results from the clinic data Number of youth attending Clinic data (de-identified) Before and after design 6 ACCHS (1-24 year olds) Attendance Chlamydia testing Before Sexual and reproductive health program July Dec Female 1-19 Male 1-19 Female Male Number of youth attending Number of patients tested for chlamydia Sex Age group Before program-6 months During program- 36 months Female Male P * Before Sexual and reproductive health program July Dec 2013 *t test Female 1-19 Male 1-19 Female Male Number of people getting chlamydia tests Results from the youth survey Sex Age group Before -6 months During-36 months Female Male *t test P * Aboriginal youth survey (n=248) Cross sectional design Aboriginal youth aged 16-2 years Distrubuted by SRH workers during activities and at ACCHS using ipads/paper-based, target 0 per clinic Self report participation in activity versus no activity groups STI and contraception knowledge, STI testing/vaccination, contraception use, and sexual behaviour

3 8/10/201 Females discussing sexual health issues 9 p= p<0.001 p<0.001 p=0.001 Males discussing sexual health issues 7 p=0.013 p=0.002 p=0.021 p= With anyone With ACCHS With AHW about staff about about With AMS for prevention/cont prevention/cont prevention/cont STIs advice raception raception raception Participated 78% 78% 33% 8% 13Not participated 74% % 27% With anyone With ACCHS With AHW about staff about about With AMS for prevention/cont prevention/cont prevention/cont STIs advice raception raception raception Participated 9% 18% Not participated 14 33% % 3% 24% Females who were tested or vaccinated 9 p= p=0.103 p=0.662 p=0.81 Males who were tested p=0.60 p=0.1 4% % 4 2% 1% % Chlamydia test Last chlamydia Pap test (last 2 HPV (last 12 months) test at AMS years) vaccination Participated 36% 81% 4% 69% Not 1 participated 37% 62% 43% 63% Chlamydia test (last 12 months) Last chlamydia test at AMS Participated 24% 44% 16 Not participated 27% 46% Females knowledge of contraception 9 p=0.002 p=0.001 p= Females knowledge of STIs 10 p=0.068 p=0.023 p= Emergency contraception is available at the chemist Emergency contraceptive pill is still effective 48 after sex Parental consent not required for contraceptive prescriptions for those aged less than 18 years Participated 81% 41% 9% 17 Not participated 6% 7% % STIs can be asymptomatic Chlamydia affects both men and women Guidelines recommend annual sexual health check Participated 72% 74% 92% 18 Not participated 2% 61% 77% 3

4 8/10/201 Males knowledge of STIs 9 p=0.039 p=0.498 p= Females contraceptive usage and condoms - current 8 7 p=0.27 p= STIs can be asymptomatic Chlamydia affects both men and women Guidelines recommend annual sexual health check Participated 9% 6% 78% 19 Not participated 3% 46% 69% Using at least one form of contraception Using condoms Participated 7% 66% Not participated 73% 3% 20 Males contraceptive usage and 8 condoms - current p=0.103 p=0.668 Using at least one form of contraception Using condoms Participated 7% 67% 21 Not participated 73% 73% Females contraceptive use - current 6 p= p=0.124 injection (Depo p=0.001 implants p=0.42 Intrauterine device-iud (Mirena) pills provera) (Implanon) Participated 37% 9% 1% 22 Not participated 33% 6% 1% 6% Females knowledge of STIs 10 p=0.00 p=0.906 p=0.414 p=0.473 p=0.743 p=0.337 p= Males knowledge of STIs 9 p=0.013 p=0.223 p=0.287 p=0.436 p=0.006 p=0.006 p= Chlamyd Gonorrh Trichom HIV Herpes HPV ia oea oniasis Syphillis Participated 9 67% 7% 71% 36% 14% 6% 23 Not participated 86% 68% 82% 77% 39% 7% Chlamyd Gonorrh Trichom HIV Herpes HPV ia oea oniasis Syphillis Participated 84% 68% 77% 71% 3% 23% 4% 24 Not participated 73% 7% 68% 72% 11% 3% 46% 4

5 8/10/201 2 Limitations Survey Single time point could not measure behaviour change Did not capture <16 years, or those not attending ACCHS/ community events Small sample Clinic data Patients could be tested elsewhere, e.g. Sexual health clinic Evaluation Differences may have been influenced by external factors Large number of diverse SRH activities implemented by localbased SRH workers Program activities led to : i. Increased health care access (attendance and STI testing) ii. iii. Conclusions Improvements in seeking advice by young people Improvements in SRH literacy (chlamydia, contraception, testing guidelines) Program successes may be attributed to: i. Extensive planning and consultation with community ii. Aboriginal governance Acknowledgements NSW Aboriginal SRH workers Seven ACCHS located throughout NSW Evaluation investigators and reference group Aboriginal Health & Medical Research Council of NSW Family planning NSW NSW Ministry of Health Kirby Institute ATSIHP team Megan Tapia (Kirby Institute) 27