Sexual Health News Issue

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1 Sexual Health News Issue Item type Authors Publisher Other Health Service Executive (HSE) Health Service Executive (HSE) Dowloaded 26-Apr :12:23 Lik to item Fid this ad similar works at -

2 ISSUE 02 SEXUAL HEALTH NEWS WELCOME TO ISSUE 2, SPRING / SUMMER 2016 Miister for Health Leo Varadkar lauches Irelad s Natioal Sexual Health Strategy (photo left to right: Dr. Kate O Flaherty, Miister Leo Varadkar, Dr. Fioa Lyos ad Mr. Ray Darcy). F E A T U R E S I N S I D E T H I S I S S U E Lauch of the Natioal Sexual Health Strategy A Overview o HIV by Dr. Fioa Lyos HIV i Irelad 2016 alog with a persoal story by Mr. Rory O Neill Psychotropic Medicatio ad Sexual Health by Professor Ages Higgis Sexual Health ad Autism by Dr. Valerie Murphy Cosultat Psychiatrist Supportig ad Promotig Sexual Health by Dr. Mary Roga Registered Medical Specialist i Geeral Practice Sexual Health i Actio 1 S P R I N G / S U M M E R

3 GENERAL NEWSLETTER INFORMATION CONTENTS Lauch of the Natioal Sexual Health Strategy Page 4 WHATS NEW? Page 5-7 What s New for the Foudatio Programme i Sexual Health Promotio 2016 Smart Coset: Evaluatig a Itervetio to Promote Active Coset o the Part of Youg Adults Promotig Coset i Sexual Ecouters Youg Wexford People Talkig about Sex A Research Study REPORTS, RESEARCH ARTICLES AND RESOURCES Page 8 Global Health: Sciece ad Practice Sexual Health ad HIV Policy Etre Nous HIV IRELAND 2016S Page 9-11 A Overview of HIV New HIV Diagosis HSE Drugs/HIV Helplie Livig with HIV, 21 years o TRAINING & EVENTS Page Natioal Foudatio Programme i Sexual Health Promotio dates for 2016 Recet Graduates of the Natioal Foudatio Programme i Sexual Health Promotio Mayooth Uiversity Masterclasses Supportig Uplaed Pregacy 2016 Real U ad Life Ucovered by Broagh Colo Foróige FEATURES Page Sexual Health Promotio ad Me with Autistic Spectrum Disorder Sexual Health from a Life Course Perspective Psychotropic Medicatio ad Sexual Side-Effects SEXUAL HEALTH PROMOTION IN ACTION Page Doegal Wome s Cetre: Sexual Health Services Support for the Natioal Foudatio Programme i Sexual Health Promotio i Kerry Sexual Health Services i the Midlads INTERVIEW WITH Page 21 Mulligar Sexual Assault Treatmet Uit (Satu) BRAINTEASERS Page Desig & Prit Murphy Prit & Graphic Desig Ltd Woodlads Idustrial Estate Park Road Killarey Co. Kerry Every effort has bee made by the Health Service Executive (HSE) to esure the iformatio i this publicatio is accurate. The iformatio cotaied i this ewsletter should i o way be a substitute from seekig expert advice from the appropriate health professioal or agecy. The iformatio that is writte by the differet cotributors i the Sexual Health News is the view of the authors ad ot that of the HSE. Some photos may be posed by models for illustratio purposes oly. 2 S P R I N G / S U M M E R

4 ISSUE 02 Thak You from the Editor by Mr. Marti Groga, Sexual Health News Editor, Health Promotio & Improvemet HSE South West Thak you to everyoe who took the time to ad telephoe your positive feedback o Issue 1, it was really appreciated by all of us ivolved with Sexual Health News (SHN). We would like to express our thaks to everyoe who took time out of their busy schedules to cotribute to this sprig editio. We hope you fid the What s New sectio useful i keepig up-to-date with some iovative projects i Irelad. The Resource sectio poits us i the directio of what is happeig iteratioally i sexual health i terms of best practice ad research evidece. This editio cotais a strog feature sectio with articles writte by cliicias who are experts i their respective fields. Issue 2 also looks to highlight what is happeig i sexual health throughout Irelad from Kerry, Doegal ad the Midlads As always, please do cosider cotributig to Issue 3 due out this autum, it s a great way to share our work ad to keep iformed i what s happeig withi sexual health promotio i Irelad. Marti Call for Submissios Issue 3 Autum 2016 closig date for receipt of submissios If you have ay feedback o the ewsletter or would like to cotribute to the ext editio please cotact Marti Groga at marti.groga@hse.ie Editorial Team Marti Groga Health Promotio & Improvemet HSE South West Orla McGowa HSE Sexual Health & Crisis Pregacy Programme 3 S P R I N G / S U M M E R

5 LAUNCH OF THE NATIONAL SEXUAL HEALTH STRATEGY Miister for Health Leo Varadkar published Irelad s first Natioal Sexual Health Strategy ad Actio Pla i October 2015 to raise awareess of sexual health ad stem the risig icidece of sexually trasmitted ifectios. This is the first time that a atioally coordiated approach has bee developed to improve the sexual health ad wellbeig of the populatio. The Strategy will ru from ad a Actio Pla for 2015 ad 2016 has bee drafted so that work starts immediately. The Natioal Sexual Health Strategy was lauched i October Miister Varadkar said at the lauch: We wat to remove the stigma aroud sexual health ad promote a more mature ad ope attitude to sexual health. Our goals are to expad existig services ad make it easier for people to get tested, raise awareess of sexual health issues, ad improve educatio by traiig teachers, youth workers ad healthcare professioals Miister for Educatio ad Skills, Ja O Sulliva said: Sexual health educatio of childre i Irelad is primarily the resposibility of parets. It is supported through Relatioships ad Sexuality Educatio (RSE) programmes i primary ad post-primary schools, ad by youth orgaisatios ad NGOs. The State has a resposibility to esure that childre ad adolescets receive RSE that is comprehesive i order to help them attai the kowledge, uderstadig, attitudes ad skills required for healthy sexual expressio Dr Fioa Lyos, Natioal Cliical Lead for Sexual Health Services i the HSE said: I am lookig forward to providig leadership ad goverace to esure high quality sexual health services for everyoe i Irelad. This strategy gives us the opportuity to work together ad build further o the great work already i progress towards realisig the visio that everyoe i Irelad experieces positive sexual health ad wellbeig. The Strategy has three goals: to esure that everyoe has access to appropriate sexual health educatio ad iformatio to esure that high quality sexual health services are available ad affordable ad esure that good quality data is available to guide the service. Some of the key actios iclude: Complete a mappig exercise of existig cliical sexual health services (cotraceptive, STIs ad laboratory services) to iform a assessmet of service eed icludig capacity of laboratory services required to support STI diagostic services Prioritise, develop ad implemet guidace to support cliical decisio makig for STI testig, screeig ad treatmet ad o the appropriate use of atiretroviral therapy i HIV prevetio. This guidace should be developed i lie with the Natioal Cliical Effectiveess Committee (NCEC) Natioal Stadards for Cliical Practice Guidace Develop ad dissemiate guidelies ad advice to parets of childre aged uder 10 years o sexuality, sexual developmet ad growig up Establish a HSE Foudatio Programme i Sexual Health Promotio as a atioal sexual health traiig programme Cotiue to deliver Johy s got you covered atioal sexual health campaig to ecourage youg adults to use codoms every time they have sex; evaluate the campaig aually to esure its effectiveess, ad re-develop whe required Publish MISI (MSM Iteret Survey Irelad) 2015 survey report ad implemet dissemiatio pla. To view all of the strategy actios or to dowload the strategy i full please view the followig lik 4 S P R I N G / S U M M E R

6 WHAT S NEW? What s New for the Foudatio Programme i Sexual Health Promotio (FPSHP) 2016? by Ms. Catherie Byre, Natioal FPSHP Co-ordiator. The Foudatio Programme i Sexual Health Promotio has grow ad developed sice its iceptio i 2009 has bee successfully evaluated by Triity College School of Nursig ad Midwifery i The FPSHP is ow a key actio of the Natioal Sexual Health Strategy ad by the ed of 2016 there will be ie courses ruig throughout the coutry. The success of these ie courses could ot have happeed without the support of Health Promotio ad Improvemet staff i each of the four regios, as well as parterships with Public Health Nursig, Doegal Wome s Cetre ad Limerick s Geder, Orietatio, Sexual Health, HIV (GOSHH). For further iformatio o these courses please see page 12. A sexual health resource library of practical aids ad texts has bee dissemiated to each of the ie areas to support ad uderpi ay future work that participats of the courses i these regios may seek to udertake. The support libraries have bee ruig very successfully i the HSE South West ad South East sice 2009, with may past participats availig of resources to support them i their sexual health promotio work back i their ow employmet settigs. I would like to thak all the existig but especially the ew facilitators who have give so much of their time, eergy ad expertise to esure that these courses are successfully rolled out i their specific regios. It is valuable to have a agreed Natioal Traiig Programme for Sexual Health. May of the courses i ew locatios are over subscribed, so we kow that we are respodig to a real eed for this type of traiig. Over 100 people will atted the FPSHP i ie locatios i Thaks to all ivolved. Catherie Smart Coset: Evaluatig a Itervetio to Promote Active Coset o the Part of Youg Adults I 2015, Irish Research Coucil aouced a call for the Research for Policy ad Society that aimed to provide top-level research to Govermet Departmets ad agecies to support them with evidece for public policy developmet ad decisio-makig. The HSE Sexual Health & Crisis Pregacy Programme (SH&CPP) as a strategic fudig parter, provided a grat for research relevat to its strategic objectives. The SH&CPP grat was awarded to a team lead by Dr. Padraig MacNeela from the School of Psychology at the Natioal Uiversity of Irelad, Galway, to coduct a study o Smart Coset: Evaluatig a Itervetio to Promote Active Coset o the Part of Youg Adults. It will be the first study to examie the effectiveess of a theory-drive ad evidece-based itervetio aimed at promotig active coset to sexual activity. The proposed itervetio relies o a sex-positive ad geder-specific approach to coset to redress a tedecy toward o-verbal or passive coset, ad overreliace o alcohol to overcome lack of cofidece i egotiatig sexual prefereces. The study commeced i December 2015 ad will be completed i Promotig Coset i Sexual Ecouters Promotig Coset i Sexual Ecouters is a groudbreakig pilot project which took place i the School of Health ad Social Scieces (HSS) at the Istitute of Techology (IT) Tralee. The project was iitiated i respose to the Uio of Studets i Irelad (USI) atioal study of studet s experieces of sexual harassmet, stalkig, violece ad sexual assault, Say Somethig which foud that atioally 20% of wome ad 7% of me i the studet populatio experieced some form of uwated sexual experiece. The workshops cotet was uderpied by the fidigs from the NUIG 2014 study o Youg People, Alcohol ad Sex: What s Coset Got to do With it? P.T.O. page 6 5 S P R I N G / S U M M E R

7 WHAT S NEW?...cotiued from page 5 The pilot project aimed to reduce the icidece of sexual assault amog the studet populatio through a sex positive approach by establishig a dialogue aroud sexual coset, buildig skills aroud egotiatig sexual coset, challegig bystader behaviour ad creatig awareess of support mechaisms. The project ivolved a cascaded traiig itervetio, review of college sexual abuse disclosure policies, the developmet of a service iformatio sheet ad a Studets Uio iformatio campaig likig i with the Natioal USI ad Dubli Rape Crisis Cetre Ask Coset campaig. Promotig Coset i Sexual Ecouters traiig was developed ad delivered by HSE Health Promotio ad Improvemet officers ad the Kerry Rape ad Sexual Abuse Cetre. The structure of the traiig ivolved: 1 day Staff Lik Metor Traiig 1 day Studet Voluteer Traiig 1 hour workshops to all 1st years i the HSS School delivered by studet voluteers supported by their staff lik metor. A key message of the project is that Coset is give, iformed, mutual, sober ad ivolves willig participatio by all parties i sexual activity. The USI study highlighted that whe a sexual assault occurred, may studets did ot kow where to go to seek support. It also highlighted that most who disclosed it, did so to a fried. I a effort to support both the victim ad the fried the IT Tralee project has developed a comprehesive list of support services both withi ad exteral to the college ad commuicated these to studets. I total, 16 lecturers, 3 studet uio officers, 18 peer metors ad 205 first year studets received Coset traiig. Iitial evaluatios were very positive with 92% of those who had atteded feelig they had good kowledge of Coset. Whe asked about cofidece, 84% said they were either cofidet or very cofidet about askig for sexual coset ad 85% were either cofidet or very cofidet about givig sexual coset. I relatio to challegig iappropriate behaviour, 75% said they were cofidet or very cofidet to do this, 18% were ot sure ad 7% said they were ot cofidet. It s about time this taboo was tackled. I was delighted to be surrouded by like-mided people i our traiig. It was shockig to lear the facts & figures (aroud sexual assaults). It was equally satisfyig to impart this kowledge to the studets whe deliverig the material. I m very proud to have bee part of startig a dialogue aroud sexual coset. (Studet Voluteer) The pilot project Promotig Coset i Sexual Ecouters is a partership betwee IT Tralee, HSE South West Health Promotio & Improvemet Departmet ad Kerry Rape ad Sexual Abuse Cetre. 6 S P R I N G / S U M M E R

8 WHATS NEW? Youg Wexford People Talkig about Sex - A Research Study ito the Sexual Attitudes ad Behaviours of Youg People (aged years) livig i Co. Wexford The Wexford Rape ad Sexual Abuse Support Service (WR&SASS) ad other local agecies recetly commissioed research to examie the chagig sexual behaviours ad attitudes amog youg people so as to best iform their work. The study was carried out i sprig 2015 usig a o-lie survey (N=575) ad focus groups (total = 81 people) draw from school ad iformal youth settigs The resultig research foud that youg people primarily obtaied their iformatio o sex from the iteret ad frieds. Accessig iformatio from parets was geerally cosidered awkward. The majority (55%- 65%) of youg people cosidered themselves well-iformed o sex ad sexuality, with figures risig through the teeage years. They were most likely to discuss sex with their frieds ad peers. School was the pricipal place where views o sex ad sexuality were shaped, however the respodets were geerally extremely critical of the quality ad quatity of school-based sex educatio. Amog their key criticisms were that it was too little, too late, delivered i iappropriate settigs ad with isufficiet attetio give to relatioship issues. The importace of sex i the lives of youg people was see to icrease over the teeage years ad was cosidered by the youg people as a importat part of growig up. The majority of youg people (58%) idetified the ages as the most appropriate age for first sexual experiece, with 60% takig the view that this should happe i the cotext of a serious relatioship. The study s respodets reported a low but discerible level of pressure to egage i sexual activity: 6% at age 12, risig to 20% at age 14 ad fallig back to 10% at age 18. A clear patter of geder iequality i sexual relatioships also emerged; havig multiple sexual parters was deemed oly acceptable i boys who were also perceived to be the iitiators of sexual activity. Teeage sexual experieces were cosidered to have close coectios to alcohol i particular, somethig regarded by a majority (72%) as quite egative. The study highlights a umber of issues, icludig the eed to: cofrot the cotiuig deficits i school-based sex educatio provide parets, especially fathers, with guidace to eable them to give effective support fo their childre, especially boys provide specialised sexual health services for youg people address the impact of social class ad educatioal gradiet i relatio to risky sexual behaviour challege geder iequality i sexual relatioships. It is recommeded that school-based sex educatio should: start earlier (age 10 owards) be icremetal i its approach (icreasig i itesity as youg people develop) be refocused aroud relatioships ad emotioal cotet be delivered through more appropriate methods (e.g. small groups) have sufficiet support for teachers iclude parets. Withi the commuity settig, the report highlighted the eed for a idepedet, cofidetial ad o-judgmetal service which could be readily accessed by youg people i the couty. This should provide iformatio, advice, support, cliical (STI) services ad specialised help ad be either purpose-made or be a extesio of existig services. Possibly delete this paragraph if space required The project steerig group icluded represetatives from: Fers Diocesa Youth Service, Gorey Youth Needs, Tusla, Health Service Executive (HSE) South East Social Iclusio, the Wexford Support Network o Domestic, Sexual ad Geder-based Violece ad the Wexford Wome s Refuge. For further iformatio o the research or o the Wexford Rape ad Sexual Abuse Support Service please cotact Clare Williams o or clare@wexfordrapecrisis.com 7 S P R I N G / S U M M E R

9 REPORTS, RESEARCH ARTICLES AND RESOURCES This sectio of the ewsletter provides a update of ew materials that the reader may fid helpful i their respective roles. If there are ay ew resources, factsheets, ifographics or booklets you are aware of, the please let the Sexual Health News team kow; we ca iclude details of these i the ext editio. Research Paper titled What Does Not Work i Adolescet Sexual ad Reproductive Health: A Review of Evidece o Itervetios Commoly Accepted as Best Practices by Chadra-Mouli V, Lae C, Wog S. Glob Health Sci Pract. 2015;3(3): This research paper offers health ad youth focused professioals a iterestig read o what the evidece is sayig about the effectiveess of oe-off public meetigs, youth cetres ad peer educatio programmes ad how they are geerally ieffective i facilitatig youg people s access to sexual ad reproductive health services, chagig their behaviours or ifluecig social orms. This paper states that for programmes that have prove effectiveess such as comprehesive sexuality educatio ad youth friedly-services they eed substatial effort through coordiated ad complimetary approaches This research paper ad the o-lie ewsletter is aother good resource to demostrate that sexual health itervetios are fouded i best practice with a strog evidece base. To read more o this research paper please view: Sexual Health & HIV Policy EUROBulleti Aother iterestig o-lie resource is Sexual Health & HIV Policy EUROBulleti. MEDFASH is a idepedet charity dedicated to quality i HIV ad sexual healthcare. This o-lie ewsletter is yet aother strog resource to support ad update sexual health professioals o what is happeig o the global HIV ad sexual health stage. For more iformatio please see: Etre Nous, The Europea Magazie for Sexual ad Reproductive Health This o-lie magazie is published by a divisio of the WHO Regioal Office for Europe, Copehage. The articles are writte by a variety of iteratioal experts focusig o differet aspects of health through a lifecourse les. This magazie will give health professioals with a sexual health brief, up-to-date evidece based material to support their respective areas of work. If you are iterested i readig this magazie the please view the followig lik 8 S P R I N G / S U M M E R

10 HIV IRELAND 2016 A Overview of HIV by Dr. Fioa Lyos Natioal Cliical Lead for Sexual Health I have had the privilege of workig i the area of HIV medicie o ad off sice the early 1990s. I that time I have witessed the progress that has bee made i makig HIV a maageable coditio for may of the people livig with HIV. It is a happy situatio that we kow, from research i the UK, that people livig with HIV who are o treatmet with a good respose ca expect to live for as log as the geeral populatio. It is great to be able to say that to a perso whe you are tellig them of their ew HIV diagosis. It meas that it is possible for people livig with HIV to expect the same thigs from life as the rest of the populatio parethood, watchig their childre growig up, workig ad growig old. The first drug that was used to treat HIV was Zidovudie (AZT) back i the mid 1980s. This was followed by more drugs ad for people livig with HIV, takig these drugs usually led to a temporary improvemet i their immue fuctio but ultimately the virus became resistat to the medicatio ad stopped workig. Oe of the biggest breakthroughs i the treatmet of HIV came i the mid 1990s with the developmet of a class of HIV drugs called protease ihibitors. These drugs were used i combiatio with other HIV drugs ad it was quickly apparet that the use of HIV drugs i combiatio was the key to sustaied improvemet i immue fuctio for people livig with HIV. This combiatio is called HAART, highly active atiretroviral therapy. Whilst the advet of HAART represeted a massive breakthrough i the maagemet of HIV, may of the drugs had horrible side effects, some of which could be life threateig. May of the HAART regimes at that time required people to take drugs two to three times per day ofte with restrictios aroud eatig ad drikig. Sice the advet of HAART, eormous advaces have bee made i the refiemet ad developmet of HIV drugs such that for may people livig with HIV their HIV treatmet is oe tablet (with three drugs i the tablet) oce a day. Furthermore curret HIV drug combiatios have far fewer side effects ad restrictios tha previous regimes. I 2016, i Irelad we are movig towards a positio where the majority of people livig with HIV will be offered HIV treatmet. Previously timig of iitiatio of HIV treatmet was determied by immuological well beig, measured by the CD4 cout or T-cell cout. There is a growig body of evidece to support early iitiatio of HIV treatmet for people livig with HIV. This relates to the beefits coferred to the idividual with early iitiatio of HIV treatmet but also to their sexual or ijectig parters where the risk of acquirig HIV from a perso livig with HIV who is o effective HIV treatmet is extremely low. This is the case for pregacy too, where HIV ifected wome takig effective HIV treatmet i pregacy are very ulikely to trasmit HIV to their baby. The reductio i the risk of trasmissio of HIV while takig effective HIV medicatio represets a eormous stride towards makig life for people livig with HIV ormal. At a populatio level, the more people livig with HIV o effective HIV treatmet, the fewer the icidet HIV ifectios. This cocept of givig people livig with HIV treatmet i order to prevet ew ifectios is referred to as Treatmet as Prevetio, TasP. HIV treatmet has also bee used by people ot ifected with HIV to reduce their risk of HIV acquisitio. This ca be doe before a potetial exposure to HIV (Pre-exposure prophylaxis, PrEP) or followig a potetial exposure to HIV (Post-exposure prophylaxis, PEP). Oe of the priority actios for the HSE Sexual Health ad Crisis Pregacy Programme for 2015/6 is to develop ad implemet atioal guidace i relatio to the use of HIV treatmet for prevetio. Despite all the progress that has bee made i a relatively short space of time, may challeges remai for those livig with HIV ad for those carig for people livig with HIV. At the momet there is o cure for HIV ad therefore the eed for HIV treatmet is lifelog. Lots of research is beig doe to develop a cure for HIV but, I believe that a cure is still at least a decade away. People livig with HIV still experiece stigma withi society ad oe of the key messages for the World AIDS Day campaig i December 2015 was to tackle HIV stigma. The stigma experieced (or perceived) by people at risk of or livig with HIV ca preset barriers to testig for HIV; accessig care for HIV; accessig treatmet for HIV ad disclosig HIV to others who would beefit from kowig a perso s HIV status. We kow from the Health Protectio Surveillace Cetre (HPSC) aual reports o HIV surveillace i Irelad, that a sigificat proportio of people have a advaced stage of HIV ifectio whe they are first diagosed. Stigma likely plays a part i cotributig to this. Access to HIV testig is a critical factor to cosider whe we wat to reduce the umbers of people ewly ifected with HIV ad reduce the proportio of people presetig with advaced ifectio. Work is curretly uderway as part of the atioal sexual health strategy implemetatio to develop ad implemet atioal guidace i relatio to HIV testig which will address ad idetify mechaisms to overcome barriers to HIV testig. I summary, there has bee a whirlwid of advaces i relatio to HIV treatmet sice HIV came o the scee back i the early 1980s. The challeges we face today relate, i large part, ot to the actual treatmet of HIV but moreover to esurig that people are aware of their HIV status ad that those livig with HIV are egaged i care ad o effective treatmet. Workig o these challeges will serve to deliver o the UNAIDS 90:90: target to ed the HIV epidemic. 9 S P R I N G / S U M M E R

11 HIV IRELAND 2016 New HIV Diagoses i Irelad by Ms. Kate O Doell ad Dr. Derval Igoe, Health Protectio Surveillace Cetre (HPSC) HIV is a ifectious disease of immese public health importace. Prompt diagosis ad appropriate treatmet maitais the health of a HIV ifected perso ad ca also provide a opportuity to prevet trasmissio of HIV to others. There were 497 ew diagoses of HIV i 2015, compared to 377 i Some of this icrease ca be explaied by a outbreak of HIV amog people who iject drugs (PWID) i Dubli which started i 2014 ad cotiued i This led to a chage i otificatio procedures for cases diagosed i Dubli ad resulted i more cases beig otified. However, the icrease i umbers is of cocer. Four out of every five ew diagoses of HIV i 2014 were sexually acquired; 49% were amog me who have sex with me (MSM) ad 33% i heterosexuals with 7% amog PWID.3 I the te years sice 2005, the umber of ew diagoses amog MSM has icreased threefold. Over half of the ew diagoses i 2014 were i migrats, icludig 23% i migrat MSM ad 19% i heterosexuals from edemic coutries. Half of cases (49%) diagosed i 2014 were late preseters based o their CD4 cout at diagosis ad the proportio diagosed late was highest amog heterosexuals (62%) ad lowest amog MSM (38%). I light of the cotiued icrease i ew HIV diagoses particularly amog MSM, effective itervetios such as promotig codom use ad peer led outreach itervetios eed to be cotiued ad stregtheed. I additio, more emphasis o the beefits of regular testig, ad ready access to HIV testig for all vulerable groups are eeded to reduce the umber presetig late. Referece: 1. HSE. Health Protectio Surveillace Cetre. HIV i Irelad, Dubli: Health Protectio Surveillace Cetre; Available at 2. Gly R, Giese C, Eis O, Gibbos Z, O'Doell K, Hurley C, et al. Icrease i diagoses of recetly acquired HIV i people who iject drugs. Epi- Isight 2015 Jul;16 (7). 3. HSE. Health Protectio Surveillace Cetre. Weekly HIV&STI Report: Week Dubli: Health Protectio Surveillace Cetre; Available at /SexuallyTrasmittedIfectios/Publicatios/STIReports/STIWeeklyReports/ HSE Drugs/HIV Helplie by Ailee Dooley Maager The HSE HIV & Sexual Health Helplie, was established as the Drugs/HIV Helplie by the Easter Health Board Drugs/AIDS service i As the years have passed the Drugs ad Alcohol Helplie ad the HIV ad Sexual Health Helplie have emerged from the joit title, while still both accessed through the freephoe Helplie umber ad support service helplie@hse.ie. The Helplie provides support, iformatio, guidace ad referral to ayoe with a questio or cocer related to HIV, hepatitis ad sexual health ad /or drugs ad alcohol. This is ot a medical service, so staff use active listeig skills to support callers ad ers to help idetify their eeds, share their cocers ad cosider their ext steps. Typically, HIV ad Sexual Health queries come from people who have become cocered ad worried about HIV ad STIs. This worry ca start to impact o their daily lives. Cocers about stigma combied with bad feeligs about a sexual ecouter make for a difficult period for some, while they try to maitai a façade of ormality with those closest to them. Professioals are welcome to call or the Helplie for iformatio o services ad to talk through optios. The Helplie maitais a database of over 450 services atiowide. I Dec 2015, o behalf of HIV Services Irelad, the helplie created a atioal directory of sexual health services. I 2016, the Helplie hopes to cotiue to offer a good quality helplie ad support service across Irelad ad iteratioally. It also hopes to cotiue to work with etworks towards quality improvemet ad skills exchage; to progress our Prisos Pilot project aimed at providig our Helplie to Irish prisoers ad to publicise the Helplie more, so that those who eed to use it, will hear of it. 1 0 S P R I N G / S U M M E R

12 HIV IRELAND 2016 Livig with HIV, 21 years o by Mr. Rory O Neill I was diagosed i 1995 whe the ladscape of HIV was very differet tha it is today. My kid GP delivered the ews that I was goig to die a pretty miserable death i maybe te years if I was lucky, maybe three if I was t. That s ot what he said of course, but it s what we both kew he meat. For the ext couple of years, my life revolved aroud regular, depressig, but mostly just borig cliic visits. Log hours spet o plastic chairs waitig to see a doctor, waitig to have your bloods take, waitig to see the social worker, waitig to collect your meds. All the while lookig at the other patiets ad woderig which oe might be the ext oe to just ot be there aymore. Thakfully it all feels like a log time ago ow. I retrospect, 1995 was a great time to be diagosed, because it was just o the cusp of the first major advaces i treatmet. For a few years our pill boxes became our costat rattlig compaios, while we dealt with uwated side effects ad tried to get o with everyday life uder the tyray of that pill-poppig schedule. But over time the pills got better, smaller ad fewer. I do t remember what happeed to my pill box. I do t miss it. I do t have a schedule aymore either. I do t eed oe. It s ot hard to remember to take oe pill i the morig. Ad that s literally all I have to do aymore. I take oe pill i the morig ad the I forget about it. Like most people livig with HIV i Irelad, I do t have to thik about it much aymore. I still go to the cliic, but ow, icredibly, I oly go twice a year just to make sure everythig s as it should be, ad it is. I m healthy, I m fit, my viral load is udetectable. My HIV status is like the small tattoo I got o my back whe I was eightee ad druk. I ever thik about it till someoe metios it. For me the oly time it s a issue for me is whe I ru up agaist other people s igorace or fear of it, which is still amazigly commo, eve i the gay commuity. I m sigle ad beig HIV positive has defiitely played a large part i that. It s a difficult thig to tell someoe o a date that you are HIV positive; they do t always react well. You have a lot of first dates (though my frieds might argue that my aoyig persoality plays a role too!). I d be lyig if I said I did t have a sikig feelig every time a form asks if I suffer from ay coditios, but i geeral, I just get o with my life ad HIV plays a very small role i it today. However, I am aware that ot everyoe is i the same boat. I am a well-kow perso ad I have always bee ope about my HIV status, ad wheever I talk about it publicly, say o the radio, I kow that a few days later I will get desperately sad s ad letters from ofte very isolated people livig with HIV. People who are recetly diagosed ad absolutely terrified, people who have stopped goig to work ad barely leave the house because they are so icapable of dealig with it. People who are afraid to go to the cliic, people who have bee livig with HIV for years ad have ever told a sigle fried or family member. Sometimes whe I speak publicly about my experiece of livig with HIV, I kow that some people do t wat me to be hoest about it, some eve write me agry letters. They thik I m miimisig it, they thik that tellig people I take oe pill a day ad forget about it will ecourage people to take risks with their health; but I m ot goig to lie about it. Oh for sure, HIV is a pai i the ass. It s a life chagig coditio, ad you have to take your pills ad look after yourself. But it s bee a log time sice it was a death setece. But actig like it still is, is what makes people afraid of it. Ad the fear of it is what stops people gettig tested. The fear of it is why utested people take risks, thikig they re fie. The fear of it is why so few people are ope about beig HIV positive. The fear of it is why so may youg people thik they do t kow aybody with HIV ad thik it s ot part of their world. Whe the truth is that everybody kows someoe with HIV. The fear of it, is why I get desperately sad s from desperately sad people. 1 1 S P R I N G / S U M M E R

13 TRAINING Foudatio Programmes i Sexual Health Promotio (FPSHP) dates for 2016 Kerry (Sprig 2016): Applicatios for the 2016 course are ow closed but applicatios for 2017 may be submitted to: Ms Máire O' Leary, Health Promotio Officer Health Promotio & Improvemet Departmet Health ad Wellbeig Divisio HSE South, Block 1, St. Columbaus Hospital, St. Margaret s Road, Killarey, Co. Kerry Tel: mairem.oleary@hse.ie Facilitators for the Killarey course are: Máire O Leary (HP&I) ad Mary O Coor (Public Health Nurse HSE) Doegal (Sprig 2016): Applicatios for the 2016 course are ow closed but applicatios for 2017 may be submitted to: Ms Lisa O'Haga, Health Promotio Officer Health & Wellbeig Divisio - HSE West, Couty Cliic (First Floor), St. Coal's, Letterkey, Co. Doegal Tel: lisa.ohaga@hse.ie Facilitators for the Doegal course are: Lisa O Haga (HP&I) ad Eilish McArt (Doegal Wome s Cetre) Athloe (Sprig 2016): Applicatios for the 2016 course are ow closed but applicatios for 2017 may be submitted to: Ms. Margaret Whittaker, Health Promotio & Improvemet Health & Wellbeig Divisio HSE, Block 4 Cetral Busiess Park, Clomich, Tullamore, Co. Offaly R35FH59 Tel: margaret.whittaker@hse.ie Facilitators for the Athloe course are: Margaret Whittaker (HP&I) ad Marti Groga (HP&I) Dubli Mid Leister (Sprig 2016): Applicatios for the 2016 course are ow closed. Equiries for the 2017 course may be submitted to: ifo@crisispregacy.ie Facilitators for the Dubli Mid Leister course are: Moira Germaie (HP&I) ad Susa Sully (HP&I) Waterford (Sprig 2016): Applicatios for the 2016 course are ow closed but applicatios for 2017 may be submitted to: Ms Moira Germaie, Seior Health Promotio Officer- Sexual Health Health Promotio & Improvemet, Health & Wellbeig Divisio, St. Dympa's Hospital, Athy Road, Carlow Tel: moira.germaie2@hse.ie Facilitators for the Waterford course are: Moira Germaie (HP& I) ad Susa Scully (HP& I) Kilkey (Autum 2016) 6th & 7th of Sept 18th &19th Oct 29th & 30th Nov 27th & 28th Sept 8th & 9th Nov (Closig date 27th May 2016 but late applicats may be take for stadby places) Locatio: Kilkey Facilitators: Moira Germaie (HP&I) ad Tracey Tobi (HP&I) For details of future South East courses please cotact: Ms Moira Germaie, Seior Health Promotio Officer- Sexual Health Health Promotio & Improvemet, Health & Wellbeig Divisio, St. Dympa's Hospital, Athy Road, Carlow Tel: moira.germaie2@hse.ie cotiued ext page S P R I N G / S U M M E R

14 TRAINING Dubli North East (Autum 2016/Sprig 2017) 19th & 20th September th & 18th October st & 22d November th & 13th December th & 10th Ja 2017 (Closig date 8th April 2016) Facilitators: David McSweeey (HP&I) ad Olivia McGeough (HP&I) Locatio: Ardee, Co Louth For details of future Dubli North East courses please cotact: Mr Dave McSweeey Departmet of Health Promotio ad Improvemet Health ad Wellbeig Divisio HSE Dubli North East Railway Street, Nava, Co. Meath Tel: ad Ms Olivia McGeough Departmet of Health Promotio ad Improvemet Health ad Wellbeig Divisio, St. Bridget s Hospital, Ardee, Co. Louth Tel: Olivia.mcgeough@hse.ie Limerick (Autum 2016/Sprig 2017) 11th & 12th October 8th & 9th November 6th & 7th December 10th & 11th Jauary th & 8th February 2017 (Closig date 6th May 2016) Facilitators: Mairead Kelly (HP&I) ad Graie Woulfe (GOSHH) Locatio: Limerick For details of future Limerick courses please cotact: Ms Mairead Kelly Health Promotio Officer, Limerick Health Promotio, North West Wig, St. Joseph's Hospital, Mulgrave Street, Limerick Tel: maireada.kelly@hse.ie Cork (Autum 2016/Sprig 2017) 11th & 12th October 8th & 9th November 6th & 7th December 17th & 18th Jauary (2017) 14th & 15th February (2017) (Closig Date 5th May 2016) Facilitators: Marti Groga (HP&I) ad Sharo Parkiso (HP&I) Locatio: Cork City For details of future Cork courses please cotact: Recet Graduates Recet Graduates (Clomel) from the Natioal Foudatio Programme i Sexual Health Promotio (FPSHP) Clomel FPSHP Graduates 2015 Marti Groga Health Promotio Officer Health Promotio & Improvemet Health & Wellbeig Divisio HSE South, Eye Ear Throat Hospital, Wester Road, Cork Tel: Marti.groga@hse.ie 1 3 S P R I N G / S U M M E R

15 TRAINING Mayooth Uiversity Departmet of Adult ad Commuity Educatio Masterclasses o Supportig a Uplaed Pregacy, Sprig The aim of the Masterclass is to create a opportuity for professioals to gai more i-depth kowledge ad skills i maagig the challeges that preset aroud uplaed pregacy. The first two Masterclasses will be held i March ad April 2016; the fial two Masterclasses will be held i May ad Jue These fial two Masterclasses are: Masterclass 3 - Youg Migrats ad Ethic Miority Wome i Irelad: Sexual Wellbeig ad Uplaed Pregacy Friday May 13th, 10am to 4.30pm, Mayooth Uiversity Masterclass 4 Ethics ad Supervisio Friday Jue 10th, 10am to 4.30pm, Mayooth Uiversity Further iformatio ad a brochure with a applicatio form ca be foud here Relatioships Explored ad Life Ucovered (REAL U) by Broagh Colo, Traiig Officer REAL U is a persoal developmet ad sex educatio programme aimed at equippig youg people with the skills, kowledge ad cofidece to develop healthy relatioships ad delay the oset of early sexual activity. REAL U was developed by Foróige i respose to a idetified eed to ehace service delivery to youg people i the area of sexual health. REAL U is fuded by the HSE Sexual Health & Crisis Pregacy Programme. This programme is desiged to be facilitated by a traied facilitator with groups of approximately 10 youg people aged years old. Backgroud: The programme was iformed by two theories-the Health Belief Model ad the Theory of Reasoed Actio, both of which illustrate the importace of workig o attitudes ad kowledge which i tur, ehace the likelihood of a participat havig the selfefficacy to make resposible choices i relatio to their sexual health. The programme will assist i the developmet of skills such as decisio makig ad commuicatio skills, which promote positive well-beig ad cofidece i relatioships. Traiig for facilitators to deliver this programme is free of charge. Idividuals ca sig up for the traiig, or orgaisatios ca apply to have a traiig scheduled solely for their ow staff. There is the optio of a twoday face-to-face traiig or a bleded approach which ivolves the completio of olie cotet before attedig a oe-day face-to-face traiig. Please Note: This programme is desiged for those who work directly with youg people. Participats are expected to have reasoable prior experiece i facilitatig programmes i the area of commuity ad youth work ad will be expected to demostrate how they will use the programme i their work durig the two-day traiig. For more iformatio o REAL U broagh.colo@foroige.ie or telephoe / S P R I N G / S U M M E R

16 FEATURES The features sectio is made possible by the followig authors givig of their time ad expertise i their respective fields; for ay queries or further iformatio o the features i this sectio please cotact the relevat author. Sexual Health Promotio ad Me with Autistic Spectrum Disorder by Dr Valerie Murphy BA(mod), PhD, MRCpsych, Cosultat Psychiatrist i Metal Health ad Itellectual Disability (MHID) Cork For this article I have maily cocetrated o me with Autistic Spectrum Disorder (ASD), simply because it would ot be possible to discuss the difficulties wome with ASD experiece regardig sexual health i a such a short article as this. Those with ASD, have three core traits; commuicatio difficulties, social difficulties ad repetitive behaviours. Delayed laguage developmet ad sesory hypo/hyper sesitivities are also commo. There teds to be a perceptio i the geeral populatio, commoly referred to as the europtypical (NT) populatio withi ASD circles, that those with ASD do ot wat social cotact. While this ca be the case for some of those with ASD, it is ot geerally the case. Those will ASD wat relatioships just like the NT populatio. The differece is that those with ASD ofte do ot have the social skills to develop relatioships ad due to miscoceptios about their disorder, are ofte left out of ay chace to develop or explore their ow sexual idetity. Those who work i the area of ASD would geerally argue that sexual health promotio is a area which eeds to be cetral for those with ASD. If we cosider the turmoil relatioships ad sexual issues ca cause for those of us with developed social skills, is it ay surprise that this area ca ad does cause very high levels of stress for those who struggle with social iteractio? Lack of kowledge ca also result i cosiderable difficulties for those with ASD, as ca a lack of rules aroud appropriate sexual behaviour. Leavig a vacuum i the place of sexual health iformatio for someoe with a cocrete way of thikig will result i further difficulties where iformatio may be gaied from porography or other sources which do ot ecessarily give a realistic picture of appropriate sexual behaviour that may be coducive to a positive ad healthy relatioship. Nuaces ad subtleties of social iteractio are extremely difficult for those with ASD ad may result i misiterpretatio of social cues which may themselves result i misiterpretatios of itetios. Some people with ASD may be misidetified as egagig i sexually iappropriate behaviours as a result of misiterpretatios of social cues ad as a result of a lack of kowledge of appropriate sexual behaviour. Therefore, a emphasis o appropriate places to egage i sexual practice alog with poiters o commuicatio with the parter before, durig ad after sex is essetial. Iformatio aroud coset, payig for sex ad other legal issues are also importat. Appropriate commuicatio with ayoe those with ASD may fid themselves attracted to, is a essetial part of ay sexual health promotio. A example of this would be askig for a phoe umber after egagig i appropriate social iteractio, as well as recogisig the sigs that someoe is ot iterested i developig a relatioship. If the sesory aspect of sex is cosidered, may of those with ASD have differet sesory profiles to the NT populatio e.g. beig overly sesitive to fie touch or soud. Therefore, educatio regardig exploratio of what is pleasurable for that perso with ASD is essetial. However, this eeds to be accompaied by a discussio cocerig appropriateess of ay sexualised behaviour havig to take place withi a cosetual ad legal sexual activity. The immediate issue that comes to mid is that of fetishism. For example, a fetish ivolvig high heeled shoes may have a place withi a appropriate locatio ivolvig cosetig adults but followig a woma i the street who is wearig high heels is ot appropriate ad ideed could be viewed as stalkig or harassmet. I summary, those with ASD have a eed for sexual health promotio. This eed may be greater tha i the NT populatio i order to keep them safe ad to allow them to develop healthy ad positive relatioships. Referece: Baro-Cohe, S. (2008) Autism ad Asperger Sydrome. OUP Oxford Publishers Lipsky. D., Richards. W. (2009) Maagig Meltdows; Usig the S.C.A.R.E.D Calmig Techique with Childre ad Adults with Autism. Jessica Kigsley Publishers Ltd. Sicile-Kira. C. (2009) Autism Life Skills; 10 Essetial Abilities Your Child with Autism Needs to Lear Vermillio Press 1 5 S P R I N G / S U M M E R

17 FEATURES Sexual Health from a Life Course Perspective by Dr. Mary Roga, MB, BCh, BAO, MA FECSM MICGP drrogamary@gmail.com From the cradle to the grave, we are all sexual beigs. Eve i the early stages of developmet i utero, the foetus shows pleasure related activity, suckig the figers, ad havig visible erectios i the male (Masters ad Johso 1986; Giori, Siccardi 1996; Johso, Maxwell 2000). The huma body is a woderfully complex ad itricate orgaism; its fuctio is marvelously maifold, ad ideed may of those processes occur without us eve realisig it. We breathe without cosciously itedig to, our hearts beat, our kideys filter, ad our itesties process food through digestio without ay effort o our part. Sexual fuctioig is a itegral part of our bodily fuctio, the developmet ad expressio of sexuality is programmed ito all of us. I the iitial stages of huma developmet i the womb, we are all female. At aroud week eight, those of us with XY chromosomes begi to produce testosteroe, ad thereafter develop male sexual orgas (ESSM Maual 2015), so while we do t develop sexually util puberty, we come ito the world with a sexual aspect to our beig. Eve as we grow ad develop the two sexes develop differet characteristics ad behaviours, with girls more thoughtful ad commuicative ad boys more active ad physical i their play. At the prepubertal stage we become aware of each other as male ad female, ad otice that the opposite, or same sex is differet ad attractive. Evetually as our bodies mature we will move closer to beig, ad becomig sexual as some statistics will attest to; 48 % of those aged 17 will have had sex, ad 16 % of adolescets will have had sex by age 15 (Fier ad Philbi; Paediatrics 2013) So the sexual debut is occurrig at a youger age tha i the past. We eed o the oe had to allow youg people to feel that iterest i sex is ormal, but o the other had they should ot feel pressured to be sexually active. We particularly eed to be aware that if a youg heterosexual couple have sexual itercourse ad the girl is uder 15, she caot legally give coset ad her parter is ope to a charge of statutory rape. Iformatio givig ad sex educatio the is vital for youg people. It is importat that they kow about their sexual bodies developmet ad how their bodies behave, from the early stages of dawig sexual iterest i the brai, to the geital sexual respose cycle. Kowledge is power, ad they eed also to kow how to avoid the trauma of a uplaed pregacy ad/or the egative cosequeces of a sexually trasmitted disease. Sex is a woderful, pleasure givig ad almost spiritual experiece which ca brig a couple who are already close ad itimate, eve closer together. It works better withi the cotext of a close ad itimate relatioship; I believe that we should advise our youg adolescets of this fact. They will perhaps disbelieve, ad experimet, but the adolescet is the origial risk taker, ad this is part of ormal developmet. However, if they have a good groudig of kowledge ad iformatio aroud the importace of itimacy ad good commuicatio to their sexual script, I believe that this will help them to settle evetually ito a itimate team, ad thus set the foudatio for a mature, coteted sex life. As members of the carig professios we eed to remember that sex is ot oly for the youg, healthy ad beautiful, but also for the ot so youg, ot so healthy ad ot so beautiful (Giaotte 2014). We are sexual beigs throughout all of our lives, from adolescece to older age. As a GP with a special iterest i sexual dysfuctio, I am oly too well aware of the effect of ormal ageig, illess ad treatmet of illess o sexual fuctio. The Europea Male Ageig Study (2010) foud that 30% of me aged forty ad over suffered from Erectile Dysfuctio (ED). I order to have erectile ad orgasmic capacity we eed a good blood supply ad erve supply to our geital areas. Age ad illess, like high blood pressure, atherosclerosis ad diabetes amog may others, ca do damage to both, as ideed ca prescribed ad over the couter medicatio. It is ow accepted widely that ED is a red flag or early warig sig of coroary artery disease. Why? Because the peile arteries are smaller tha the coroary arteries, so ED as a result of damage to the peile artery predicts similar problems withi the hearts circulatio. (COBRA study). All me with vasculogeic ED require a cardiovascular workup (Mier et al AmJ Med. 2014). While it s importat to kow this, it s also importat to be aware that while sexual fuctio waes with age ad illess, it does ot stop. Whatever your age ad state of health, you ca still have a sex life, if that is what you ad your itimate parter wat. Me ca have erectio problems, wome after meopause ca have vagial pai ad dryess, but all of this ca be dealt with. The ew medical specialty of sexual medicie deals with sexual dysfuctio, ad is helpig to add to doctors kowledge ad ability to treat sexual dysfuctios at every stage of the adult huma life cycle. It is importat that the medical ad ursig professios become iterested ad educated i this disciplie, so that the medical professioal ad the patiet ca feel they have permissio to ask about sexual problems ad receive the readily available advice ad treatmet, without fear or embarrassmet whether the patiet resides i adolescece or older age. Sexuality is a lifelog blessig, from the poit of view of the youg perso begiig the sexual jourey through life, right through to the elderly approachig the ed of their sexual voyage. So it is for us, with the vigor of youth ad iexperiece movig towards reducig sexual eergy but greater experiece. As Robert Browig says, Grow old alog with me! The best is yet to be, the last of life, for which the first was made A woderful remider to all of us as health professioals to keep sexual health promotio to the fore of our work is a fu but pertiet quote by Charles Bukowski - sexual itercourse (i old age) is kickig death i the ass while sigig For iformatio o the above article icludig refereces please cotact the author directly. 1 6 S P R I N G / S U M M E R

18 FEATURES Psychotropic Medicatio ad Sexual Side-Effects by Professor Ages Higgis, School of Nursig ad Midwifery, Triity College Dubli Psychotropic medicatio cotiues to be a cetral elemet to the care ad treatmet of people experiecig metal health problems. However, atidepressat, atipsychotic ad aticholiergic drugs ca have may effects, which severely impact sexuality ad sexual fuctio. The biological view of sexuality suggests that sexual fuctio ivolves a complex iterplay of eurotrasmitters, hormoes ad peptides that act both cetrally ad peripherally. However, curret scietific kowledge regardig psychotropic medicatios ad sexual fuctio caot fully explai the europhysiology, euroedocriology ad psychological iterrelatioship. I most cases, side effects that impact o sexual fuctio are idiosycratic ad upredictable with o apparet relatioship betwee the type of drug used, dose ad the icidece of a specific sexual dysfuctio. May drugs act both o the peripheral ad cetral ervous systems ad it is sometimes ot possible to kow which actio is resposible for the sexual side effects. However, it is thought that drugs that ehace serotoi or decrease dopamie ted to dimiish sexual fuctio ad desire. I additio, drugs that block the choliergic ad alphaadreergic receptors have asexual properties Atidepressats ad Sexual Side Effects The sexual problems reported with atidepressats iclude: decreased sexual desire, decreased sexual excitemet, dimiished or delayed orgasm, as well as erectio ad delayed ejaculatio problems. Paiful ejaculatio has bee reported i associatio with a variety of atidepressats, icludig the tricyclics, SSRIs ad MAOIs. I additio, decreased octural erectios, galactorrhoea (iappropriate secretio from the breasts betwee episodes of breast feedig or after weaig, ad, although rare ad maily associated with fluoxetie, loss of sesatio i the vagia, ipples ad peis have also bee reported. I some publicatios there is metio of a relatioship betwee the withdrawal of SSRIs ad the oset of persistet sexual arousal sydrome i wome. Effect of Covetioal ad Atypical Neuroleptics o Sexual Fuctio All covetioal euroleptics (pheothiazies, butropheoes, thioxaties) ca lead to sexual dysfuctio. The reported rates of sexual dysfuctio i people treated with covetioal euroleptics raged from 45-60% i me to 30-93% i wome. Sexual difficulties reported by wome icluded: arousal problems, poor vagial lubricatio, aorgasmia, irregular meses, ameorrhoea ad meorrhagia. I me, sexual dysfuctio problems reported icluded: difficulty i achievig a erectio (icludig morig erectios), ad complete iability to achieve ad maitai a erectio sufficiet for peetratio. I additio, ejaculatory difficulties, such as reduced ejaculatory volume, retrograde ejaculatio, delayed ejaculatio or total ihibitio of ejaculatio, are reported. Isolated icidets of priapism have also bee reported. Both wome ad me have reported gyaecomastia, galactorrhoea ad breast discomfort. I additio, other adverse effects, such as fatigue, sedatio, EPS ad weight gai ca also reduce sexual desire ad impact o sexuality. The atypical atipsychotics, icludig olazapie (Zyprexa ), risperidoe (Risperdal ) ad the atypical drug clozapie (e.g. Clozaril ), whe compared to the older atipsychotics were cosidered to have a sigificatly lower icidece of sexual side effects. However, more recetly people have reported o retrograde ejaculatio ad priapism with all three drugs i me ad icidets of olazapie-iduced galactorrhoea i wome. Aticholiergic Drugs Aticholiergic drugs are frequetly used to treat acute parkisoism, dystoia ad akathisia, however they ca cause erectile dysfuctio i me ad a failure of vagial lubricatio i wome. Maagemet The maagemet of drug iduced sexual side-effects is complex, as it requires a balacig of the persos desire to be sexual active ad without side-effects with the eed for medicatio. The first stage of effective maagemet is a thorough assessmet to esure that the reported sexual dysfuctio is ideed a cosequece of the medicatio prescribed. Give the lack of evidece-based treatmets, maagemet is ofte oe of trial ad error, ad may ivolve a wait ad see as there may be a spotaeous ad partial remissio of side effects as the body adjusts to the drug. A secod strategy may be a reductio i the amout of the drug to a miimum effective dose; aother strategy is switchig atidepressats to oe with a less sexual side effect profile, or the last optio to cosider is withdrawig the offedig aget altogether. Referece: Higgis, A., Nash, M. & Lych, A.M. (2010) Atidepressats-associated sexual dysfuctio: impact, effects ad treatmet, Drug, Health care ad Patiet Safety, 2: Higgis, A (2007) The impact of Psychotropic medicatio o Sexuality: What does the evidece say? British Joural of Nursig 16 (9) Higgis, A., Barker, P. & Begley, C. (2006). Iatrogeic sexual dysfuctio ad the protective withholdig of iformatio: I whose best iterest? Joural of Psychiatric ad Metal Health Nursig, 13(4), Higgis, A., Barker, P. & Begley, C. (2005). Neuroleptic medicatio ad sexuality: the forgotte aspect of educatio ad care. Joural of Psychiatric ad Metal Health Nursig, 12(4), S P R I N G / S U M M E R

19 SEXUAL HEALTH PROMOTION IN ACTION Doegal Wome s Cetre: Sexual Health Services by Ms. Róisí Kavaagh, a member of the Doegal Wome s Cetre Maagemet Committee with resposibility for sexual health The Doegal Wome s Cetre (DWC) is a volutary orgaisatio ad registered charity fouded by a group of wome i 1989 to provide a local resource for wome i the Doegal regio. With a emphasis o a holistic approach, the Cetre sought to develop programmes that could help to support persoal, social ad educatioal aspiratios ad to fulfill their eeds i key areas such as the provisio of cotraceptio. I additio to family plaig, the cliic offers cervical smears tests, pregacy tests ad advice about geeral sexual health issues. It also provides a very valuable support service for GPs. May wome faced with difficult circumstaces or complex social factors are ot accessig or egagig with sexual health services as the oe size fits all approach are ofte ot adequate for their eeds with may potetial egative cosequeces for them. I 2004, DWC carried out research to ascertai the rage of sexual health eeds of youg wome (17-26 age rage) i the Doegal regio ad their experieces tryig to meet those eeds. A sigificat miority of that sample had oe or more idicators of social exclusio such as, but ot limited to, low icome, wome livig i rural areas, sigle parets, Traveller wome, early school leavers ad wome with disabilities. The fidigs reported that sexual health services targetig youg wome i Doegal were virtually o-existet. Youg wome reported sigificat gaps i kowledge ad uderstadig of sex, sexual health ad sexuality ad poor sex educatio while still i post-primary educatio. DWC developed ad delivered the followig services as articulated i the research based o the complex eeds ad gaps as idetified by youg wome: a itegrated ad holistic sex educatio programme delivered withi ad outside the formal educatio settigs which focuses o both the emotioal ad biological aspects of sex ad sexuality. A youg wome s free health cliic, ILASH, for youg wome aged betwee17-26 is held oce weekly providig cosultatios with urse ad doctor, cotraceptio iformatio/service, chlamydia ad goorrhoea testig ad cousellig. Both projects are fuded by HSE Sexual Health ad Crisis Pregacy Programme. DWC is aware that the process of margialisatio ad social exclusio has bee idetified as complicatig factors for wome i accessig appropriate ad relevat sexual health services so specific efforts are made to target these vulerable groups to help them avail of sexual health services through the educatio project ad through workig with other orgaisatios locally. DWC provides a dedicated Traveller oly health cliic twice yearly, this cliic allows Traveller wome a cofidetial, ojudgemetal place where they ca have their cervical smear carried out, ad sufficiet time is allocated to discuss ay cocers they may have i relatio to their sexual health. The DWC promotes the right of all wome to sexual ad reproductive health iformatio ad dedicated o-judgemetal, cofidetial ad affordable healthcare services. Iformatio o all services is available o our website or visit our Facebook page o S P R I N G / S U M M E R

20 SEXUAL HEALTH PROMOTION IN ACTION Kerry HSE Public Health Nursig (PHN) Support for the Foudatio Programme i Sexual Health Promotio (FPSHP) by Ms. Mary O Coor Public Health Nurse (PHN) ad Lactatio Cosultatio The Foudatio Programme i Sexual Health Promotio (FPSHP) i Kerry is a uique partership betwee two HSE departmets, Public Health Nursig ad Health Promotio ad Improvemet. This partership with Ms. Mary O Coor Public Health Nurse (PHN) ad Lactatio Cosultatio esures the Kerry FPSHP grows from stregth to stregth. Mary origially atteded the course as a participat i 2011 ad is curretly co-facilitatig her fifth FPSHP course with Ms. Máire O Leary, Sexual Health Promotio Officer (Kerry) ad FPSHP course coordiator. Máire says it has bee a fatastic partership workig with Mary ad she brigs years of practical experiece as a Public Health Nurse workig across the life course to the FPSHP. A large umber of PHNs have atteded the course i Kerry over the years ad have icorporated sexual health promotio ito their various roles through ateatal, postatal, schools ad eldercare briefs. As well as facilitatig o the FPSHP, Mary has a kee iterest i sexual health promotio geerally ad i particular aroud paretig. Mary has refied a exceptioal paretig workshop supportig their role as primary sex educators. I Kerry the PHN & HP&I partership is set to cotiue i a ew pilot which ivolves teacher traiig o the use of Busy Bodies as a tool to teach RSE i 5th ad 6th class with the optio of a PHN facilitated paretig workshop to support the class teacher i their delivery of RSE. The Busy Bodies traiig was developed ad delivered by HP&I with substitutio provided by the Departmet of Educatio ad Sciece through the Healthy Irelad Health Promotig Schools Programme. Sexual Health Services i the Midlads by Mary O'Neill, HSE Project Maager Sexual Health Sexual Health Services i the Midlads have bee provided by GPs for several years. I 2001 the appoitmet of a Project Maager for Sexual Health Services was sactioed; this role had a remit to expad sexual health services i the four couties of Laois, Offaly, Logford ad Westmeath. The work ivolved cotactig all GPs i the regio ad compilig a directory of cotraceptive services. The work was carried out i cojuctio with the the HSE Health Promotio Uit. The work of the Project Maager edeavoured to develop services i the Midlads ad followig several meetigs ad securig a budget the first Sexually Trasmitted Ifectio (STI) cliic opeed i Portlaoise i The locatio of the cliic chaged to Out Patiets Departmet, Midlad Regioal Hospital i 2013 as the origial premises was too small to accommodate the large umbers attedig. This was followed by a cliic at Midlad Regioal Hospital Mulligar i This work is still o-goig, I 2016 the GUIDE cliic at St. James Hospital Dubli commeced o-site cliical goverace for the cliic at Portlaoise saw the opeig of the Sexual Assault Treatmet Uit (SATU) i Mulligar. This service is oe of six uits i Irelad ad i 2014 referrals from fiftee couties preseted at the service. Other services iclude liaisig with ad supportig Domestic Violece services provided by NGO s. The Crisis Pregacy Cousellig service commeced i 2003, the post is divided amogst part-time cousellors who operate from six locatios, this makes it easily accessible for those who live i rural areas. Additioally support is provided to those who had symphysiotomy performed whe deliverig their babies. The sexual health services i the Midlads could ot have developed without the hardworkig dyamic staff who provide support i the developmet of the services. 1 9 S P R I N G / S U M M E R

21 SEXUAL HEALTH PROMOTION IN ACTION Midlad s Sexual Health Services These services are free of charge, regardless of icome, easily accessible, o-judgmetal ad friedly. Sexually Trasmitted Ifectios (Sties) Defiitio: STIs are ifectios passed from a ifected parter(s) durig uprotected sex (vagial, aal ad oral). They are caused by specific bacteria ad viruses. I some cases you may be at risk eve if you do t have full sex kissig ad touchig each others geitals may pass o some STIs. Key Messages: Reduce the risk of gettig a STI by usig codoms. Talk to your parter, egotiate safer sex. Have a check-up. STI screeig service operates from the Out-Patiets Departmet, Midlad Regioal Hospital, Portlaoise ad the Ash Uit, Midlad Regioal Hospital, Mulligar. Appoitmets self referral is ecouraged. To make a appoitmet telephoe: Portlaoise Tuesday from 5.00p.m. 7.30p.m. Mulligar Thursday 8.30a.m a.m. Sexual Assault Defiitio: Sexual assault icludes peetratio (however slight) of the aus or mouth by peis or, peetratio (however slight) of the vagia by ay object held or maipulated by aother perso. Aggravated sexual assault ivolves serious violece or threat of serious violece, or is such as to cause ijury, humiliatio or degradatio of a grave ature to the perso assaulted. Crimial Law (Raper) (Amedmet) Act, Key Messages: Have credit i your phoe Have the battery of your mobile fully charged. If walkig aloe, walk o outside of path (earest kerb). If you are o a ight out text your fried whe you get home ad tell them your are home safely. Sexual Assault Treatmet Uit, Midlad Regioal Hospital at Mulligar. The service is available 24/7. It is offered to post pubescet 14 year olds who wish to avail of a foresic or a o foresic service. Foresic cliical examiatios are carried out withi 7 days (ideally withi 72 hours) of sexual assault. The Gardai will always be ivolved if a foresic examiatio is requested. No-reportig care, cliical examiatio if A Garda Siochaa are ot ivolved. To make a appoitmet telephoe: or Sexuality Workshops/Traiig Sexual Health Awareess Workshops/traiig takes place twice yearly aimed at frot lie health workers ad commuity based groups. Specialised traiig courses for Nurses are available o request. For further iformatio, cotact: Health Promotio Uit Tullamore at Domestic Violece Defiitio: Domestic Violece is the use of physical or emotioal force, or the threat of physical force, icludig sexual violece i close adult relatioships. It ca also ivolve emotioal abuse: the destructio of property, isolatio from frieds, family ad other potetial sources support; threats to others icludig childre; stalkig; ad cotrol over access to moey, persoal items, food, trasportatio ad the telephoe. Key Messages: Recogise Respod ad Refer Recogize: kow the sigs, idicatios ad sequece of abuse Respod: kow how to deal with the issue of abuse Refer: make a good, appropriate referral Curret Work: The Natioal Strategy o Domestic Sexual ad Geder Based Violece are beig implemeted. Iteragecy meetigs are held four times yearly. Cotact umbers for local services: (volutary sector): Offaly Wome i Crisis: Esker House Refuge Athloe: Tullamore Sexual Abuse ad Rape Crisis Couselig Service: Logford Wome s Lik: Athloe Rape Crisis Mulligar Commuity Couselig Services: Westmeath Support Services: Midlads Crisis Pregacy Couselig Service. Defiitio: A pregacy which is either plaed or desired by the woma cocered, ad which represets ad persoal crisis for her. Couselig service provides 3 optio couselig to help the cliet to make a iformed decisio ad their pregacy. The optios iclude keepig the baby, adoptio or abortio. Key Messages: Use cotraceptio accordig to istructios The oral cotraceptive pill is ot effective if you have diarrhoea or vomitig Use emergecy cotraceptio, effective for up to 72 hours. Cotraceptio is ot a protectio agaist STIs Data from 2008 shows that there has bee a decrease i the umber of females givig Irish addresses at UK abortio cliics seekig abortio. Couselig Locatios: Logford, Mulligar, Edederry, Tullamore, Portlaoise, Athloe. To make a appoitmet Telephoe: S P R I N G / S U M M E R

22 INTERVIEW WITH Ms. Elizabeth O Grady Brea RCN RGN BSc, Mulligar Sexual Assault Treatmet Uit (SATU) I was aware i a very geeral sese about the service offered by the SATU based i the Rotuda Hospital but I had ever give ay thought to workig i this area before. I was itrigued by the idea of doig somethig very differet. Iitial o-site traiig was provided i the ew uit ad from the begiig I was glad that I had made the decisio to broade my horizos. I started work i the ewly opeed Mulligar SATU i A large umber of urses workig as assistats to the foresic examiers commeced work but gradually our umbers reduced as people discovered what was ivolved i the ew uit for varyig reasos. Some members of staff left to udertake the Sexual Assault Foresic Examier course themselves, both ow work as foresic examiers i other uits. Whe assistig at a alleged sexual assault case I meet people I would ot usually ecouter durig my work, victims, family members, frieds, support workers from the Rape Crisis Cetre, Gardaí if they are ivolved ad occasioally crime scee photographers. SATU cliets are offered a follow up appoitmet for sexual health screeig, as a result the uit has brached out ad is ow providig a sexually trasmitted ifectio (STI) cliic oce a week. At first I thought that I would ever be comfortable talkig explicitly about sexual matters especially to potetially traumatised patiets. Over time with experiece ad additioal traiig ad professioal developmet my cofidece has grow. With the support of the local HSE Health Promotio & Improvemet Departmet I udertook the Sexually Trasmitted Ifectio Foudatio (STIF) course, approved by the British Associatio for Sexual Health ad HIV (BASHH), i St James Hospital i This course equipped me with the theory ad cliical competecies ecessary to expad my scope of practice to work withi the STI cliic specialty. As a result I am ow i a positio to: act as a support to the victims of sexual abuse ad their families take detailed sexual health histories perform male ad female geital examiatios give advice about safer sexual practices take screeig blood tests admiister cryotherapy assist i cotact tracig whe a STI has bee diagosed advise patiets about the implicatios of vacciatio, ad admiisterig vacciatios advise patiets about follow up care. Some of the most poigat iteractios i SATU are whe cliets retur a moth after their iitial visit to the uit for their follow up STI visit. It is at this time that the full effect of the abuse suffered by them ad how it has impacted o their daily existece is evidet. For me workig as a urse the case-by-case idividual ature of cosultatios, which differs from the time ad workload pressures of my ward work, is a very rewardig experiece. Statistics ad iformatio about the activity i SATU ad the STI cliic are very importat ad kept up-to-date by a very committed clerical staff. I this way, it is easy to pipoit ay emergig treds ad how our activity compares to other uits. I fid the SATU ad STI cliic a very dyamic ad satisfyig place to work. The SATU i Mulligar is oe of a atioal etwork of uits see for more iformatio icludig cotact details ad aual reports. 2 1 S P R I N G / S U M M E R

23 BRAINTEASERS Sexual Health Braiteasers by Marti Groga, HSE Health Promotio ad Improvemet HSE South West Crossword Theme Geeral Sexual Health Across 1.& 10. (3 & 8 dow) A cycle to sexual respose (5,7,7,6) 4. A overlooked fuctio i sexual activity (7) 6. What ot to do with our patiets/cliets (6) 8. A age group to promote sexual health with (5,3) 13. A iterruptio to sexual respose could be i the mid (8) 14. A key igrediet i trustig sexual cotact (4) 15. A les to view sexual health promotio through (4, 6) 17. Healthy habit for adult wome (6) 18. A startig poit for sexual health promotio (8) 20. A empowerig tool i sexual health promotio (9) Dow 2. A female maturig marker ( 8) 3. See 1 across (7) 4. A cotraceptio requirig some metal (4) 5. Legal age of coset i Irelad (9) 7. A acroym to use whe thikig about the morig after pill (2) 8. See 1 across (6) 9. Possible upward movemet i sexual activity (5) 10. Aother iterruptio to sexual respose could be? (8) 11. A paiful time for females (11) 12. A useful model to address sexual cocers (7) 14. Keepig sex fu ad movig (9) 16. Helpful with sexual attractio (4) 2 2 S P R I N G / S U M M E R