Promoting Sexual Health in Europe through Sexology Training

The provided content appears to be a collection of research articles and studies on various aspects of sexual health, HIV/AIDS, and reproductive health. The papers cover topics such as diagnosis and management of chronic HIV in pregnant women, community cultural norms and stigma related to disclosure among women living with HIV, and the impact of HIV testing and counseling on HIV prevention practices. Additionally, there are studies on adolescent perspectives on text messaging services for sexual health promotion, integration of family planning services into HIV care, and acute hepatitis C in a pregnant woman infected with HIV. The content seems to be focused on understanding the complexities of sexual health and reproductive health, particularly in the context of HIV/AIDS.

Promoting Sexual Health
“Health promotion of HIV during pregnancy”

TABLE OF CONTENTS
Introduction......................................................................................................................................4
Background of the topic...................................................................................................................4
Main body........................................................................................................................................5
Theoretical view...........................................................................................................................5
Culture and religion.....................................................................................................................5
Health promotion.........................................................................................................................6
Ethical considerations..................................................................................................................8
Policies.........................................................................................................................................9
Provision....................................................................................................................................10
CONCLUSION..............................................................................................................................11
REFERENCE.................................................................................................................................12
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Illustration Index
Illustration 1: Health Belief Model..................................................................................................7
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INTRODUCTION
Sexual health is a broader arena which is inclusive of various issues and challenges.
These are inclusive of safeguarding of human rights associated with sexual well-being, diseases
such as Human Immunodeficiency Virus (HIV), AIDS, STI's etc. mental health, sexual
dysfunction etc (Friedman and et.al., 2014). Promoting sexual health is one way to create
awareness among people through education, decisions, safety, precautions etc (Baker and
Gillmore, 2008). In the given essay, the issue of HIV during pregnancy will be explored in UK.
This will be studied with respect to various health promotion concepts and theories related to
sexual behaviour and impact of HIV as an issue during pregnancy. Along with this, essay will
also explore the models of health promotion. It will explore the significance of cultural and
religion impact. Furthermore, in order to support the safer pregnancy, policies and provision
programs by the UK government for HIV prevention will be discussed with respect to the UK
population.
BACKGROUND OF THE TOPIC
Sexual health promotion is defined as step towards supporting sexual well-being of
individuals through awareness, education, prevention, etc. (Günthard, H. F. and et.al., 2016)
Promotion focuses on broader level thereby a shift is made from individual to society as a whole
to aware about safer practices during pregnancy through cultural, social and religion aspects as
well (Perry and et.al., 2012). Health promotion of HIV during pregnancy is essential as at the
time of Mother to Child Transmission (MTCT), HIV positive woman is at risk to infect her
children as well during pregnancies, labour, breastfeeding or delivery. 90% is the probability of
children who become infected with HIV through MTCT. There is need to taken in considerations
to this issue as it has been found that prevalence of HIV in pregnant woman of England was 2.2
out of 1000 (SIBANDA, 2008). It was highest in London with 3.5 per 1000. In this regards, the
prevalence of women who are infected from HIV, had also increased from 17000 in 2006 to
26000 in 2013 (Hoffman, R. M. and et.al., 2015). It has been examined that by taking suitable
interventions actions, the transmission rates can be reduced to 1%. Therefore, there is need for
considering the significance of HIV as an issue during pregnancy which should be addressed
through various health promotion ways.
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MAIN BODY
Theoretical view
There are various theories that are associated with the sexual behaviour and psychology
carried by an individual. Regarding present essay where theories of Sexual Behaviour Change
(SBC) for HIV has been taken.
According to theory of gender and power which is a social structural theory, change in
social aspects occur to create perception of the social, cultural and economic forces of woman
(Ojikutu and et.al., 2016). It includes distribution of authority, gender specific standards etc.
These calls for a need to take an action against the forces that are oppressive. In this notion,
gender and power factors are significant (Dinh and et.al., 2015). For example, it is with respect
to use of condom as a contraceptive tool. Here, the sexual concept of power occupies core
significance in sexual behaviour among pregnant woman. In regards to the issue of gender
during health promotion of HIV during pregnancy, several issues exist. An important role is
played by gender in determining the vulnerability of women to HIV infection. Issues also arise in
relation to the ability of women to access care, support and treatment for HIV infection (Clift and
Page, 2015). The concern highlights the issue of lack of gender equity. Moreover, there is also
gender inequity associated with power imbalances within relationships which lead to increased
incidence of adoption of unsafe sexual behaviour by women. The issue of gender inequality acts
as a major factor behind violence inflicted by an intimate partner. Moreover, another issue is the
lack of gender sensitive interventions into sexual and reproductive services (Riekert, Ockene and
Pbert, 2013).
Males as a gender have been majorly considered responsible for the reason behind HIV
transmission. It is believed that generally males are main reason for which implications in
females are faced. But, this is not always true (Bailey and et.al., 2015). Various studies have
shown that in UK HIV in women is also the reason for the issues regarding their health. But in
comparison to men, they are more reluctant to discuss the HIV issues pertaining to its symptoms.
For instance, a man can observe a primary chancre of syphilis on his glans. But woman cannot
see one on her cervix. Another issue is with respect to accessing of health care services where
due to barriers to various health care services and lack of comprehensive HIV and Sexual and
Reproductive Health (SRH) services are not used properly by women.
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In the same vein, another theory which is related to the sexual behaviour of pregnant
woman is Theory of Reasoned Action (TRA) (Mnyani, 2009). It focuses on the use of reduction
of HIV among pregnant women by predicting the use of contraceptive devices. Along with this,
it is about awareness regarding the decision which is needed to be planned during pregnancy. In
respect of conceived woman, it is applicable in changing their behavioural for taking actions that
support healthy and safer delivery or child birth (Wight and Fullerton, 2013). For example,
perceived risk of infection can be minimised by adopting the positive behaviour of getting HIV
test done. It suggests, empower, encourage, suggest and influence the pregnant woman to
undertake informed decision on prevention of unborn babies from contracting HIV from them
(Iheanacho and et.al., 2015).
Culture and religion
Cultural factors
Culture is defined as an aspect where an individual is bounded by some aspects which act
as barrier to their health promotion. With respect to current study on health promotion of HIV
during pregnancy, cultural factors have been assessed (Żaba and Osiński, 2012). These are
inclusive of age, gender, personal and power relationships within family, peer group, and
husband. In many parts of UK, there exists male dominance where women are limited by sexual
autonomy. The lack of communication between couples also leads to affect sexual and
unplanned child birth. In similar fashion, it is advised to woman to get HIV test at third month of
her pregnancy but with the factors such as objection, attitude of force, peer influence or pressure,
she does not underwent the test. Another factor which states that pregnant woman avoid
participating in any HIV test or MTCT is due to the fear of discrimination, violence, and stigma
(Osuji, A. and et.al., 2015). The fear of disclosing their HIV status with their husband or family
is another reason.
Religion factors
There are still some areas in the UK where population believes in traditional pattern of
delivery with some rituals (Day, 2011). These may have adverse effect on the child of HIV
mother and to their health. Religious doctrine is one factor which has been viewed as significant
by the UK population. For instance; there is African population in the UK who were very
peculiar regarding the HIV tests and treatments. Women are not allowed to get treated as it is not
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considered favourable with respect to their pertaining religion (Bailey and et.al., 2015). This is
turn is impacting the other local population residing in UK thereby increasing the rate of
transmission at very fast rate. Also, these aspects and factors influence woman intention and
desire for or against the HIV or other similar tests (Schwartz and et.al., 2015).
Social factors
First factor in regards to challenges that are related to social aspect is pressure to have
unprotected sex. Also, there is some couple who being diagnosed with HIV feels that condoms
minimize sexual pleasure or intimacy (Iheanacho and et.al., 2015). This in turns become more
challenging to take care of the risk at the time of child birth. Lack of knowledge is another factor
that revolves around the individual about the use of programs, policies and provisions given by
the UK government for their beneficent (Wight and Fullerton, 2013). They are thus, unable to
access them and therefore become part and victim of negative or adverse impact of HIV
(Kontula, 2011). The risk is associated to both mother as well as child.
Health promotion
Various theories have been studied with respect to health promotion. In respect to the
current essay, theories are studied in regards to promotion of individual health for HIV during
pregnancy (Günthard and et.al., 2016). One model which is closely associated with the same is
the Health Belief Model. According to this model, understanding the attitude and behaviour of
human being is of great significance. In connection with the pregnant woman who is diagnosed
with HIV, awareness and getting all test done at the right time before the child birth or after
getting conceiving is essentially required. Furthermore, if they will be aware about the impacts
and adverse consequences that are caused to mother or child, they will take action to generate
self actions for advancement and betterment (SIBANDA, 2008). This will leads to generate in
them thinking about action plans inclusive of use of strategies, planned decision making and use
of suitable devices or treatment. Precaution is required to be taken right from the sexual
intercourse till the birth of a child. If HIV diagnosed woman will have planned strategy in
regards to child birth, health promotion and its objective will surely get fully filled. This will also
take in notion the most vital use of condoms as a contraceptive device. Health promotion can be
made effective among the mothers having HIV, if they feel comfortable and confidence to come
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and get effective consultancy and treatment for it. This will be a secure action for the health
promotion of a mother, her partner and the child.
Illustration 1: Health Belief Model
(Source: DAVIS and YAWETZ, 2012)
The above illustration depicts the different dimensions of the Health Belief Model. These
have been discussed as follows:
 Perceived Susceptibility and severity – According to this notion, there is need to work in
regards to promote a campaign which understand and analyze the seriousness of the
situation. HIV, its impact on pregnant mother and her child need to be aware in an
alarming manner (Hoffman and et.al., 2015).
 Modifying factors - As per this next aspect called modifying factors, HIV mothers are
known about adverse consequences of HIV during pregnancy (DAVIS and YAWETZ,
2012). The negative consequences of same may carry forward the HIV as an issue to the
child of the mother into risk as well. Along with this finance, socio-economic status etc.,
are also associated.
 Cues to action – This includes action plans that can provide information to mother
regarding the precautions and prevention to be taken for secure life ahead. Lack of
awareness is the most crucial way (Clift and Page, 2015). Therefore, there is needed to
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make them acknowledge with the education. Another similar way is the media which is
the most advanced and effective way to provide them information. Use of newspaper,
mass media, internet, social networking sites is considered as most integral tools for
communicating information.
 Perceived Benefits – The upcoming benefit of secured life of both mother and child is the
perceived advantage that can be made aware to the HIV pregnant woman (Riekert,
Ockene and Pbert, 2013). Regarding the same, they were encouraged to participate in
health promotion campaign and were made openly talk and discuss about the use of
treatment and its benefit in the long run.
 Self-Efficacy – Health promotion of HIV during pregnancy is very dominant aspect (Clift
and Page, 2015). Self-Efficacy is considered as one of the most prominent and only
effective or confident ways.
Ethical considerations
Promotion of health of HIV woman during pregnancy is grounded on some ethical ways
as well. Various health care bodies, professionals are involved in providing care and treatment
that can give a secure life to HIV affected individuals (Teixeira, França and Vasconcelos, 2013).
There are two important issues which are studied and required to be addressed in health
promotion of HIV pregnant woman of the UK. These are stated as follows:
 Safeguarding: There is need to consider the use of ethical practices which support health
promotion. Detecting HIV in its early stage is essential and provides a hope that
transmission may be minimized with the use of effective measures (Bailey and et.al.,
2015)
 . Health care professionals are required to participate in analyzing the testing strategies
and exploring the implication for possible benefits. It is therefore, should be the duty of
health care providers to provide opt-out testing for HIV and PMTCT (preventing mother-
to-child transmission) interventions.
 Confidentiality: Another ethical practice which is required to make the people or HIV
pregnant woman known is the confidentiality (Wong, 2012). There are diagnosed people
who do not access the services, treatments and interventions programs available because
of lack of confidence. With the fear of disclosing their HIV status in front of other
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people, they do not share it to anyone or to nearest access to their couple sometime.
Unless and until they will not share their opinion, they will not be able to have suitable
treatment. Therefore, confidentiality is highly required from the side of people diagnosed
with HIV.
 Judgmental: The health care settings and care homes are available in UK for the people
to come and explore the information regarding HIV. However, there are some staff
members who do not show positive and right attitude towards the HIV infected
individual. Touching and caring them are some unethical consideration which is affecting
them and their health (Friedman and et.al., 2014)
 . These are some ways which hinders the people to access the services.
Policies
Various policies are defined by the government and health professional bodies in UK for
safeguarding the interest of the HIV diagnosed woman. There are various policies in similar
regards which have been formulated (Yañez, 2012). Firstly, there is the antenatal HIV screening
programme. The significance of this is to ensure that the most of pregnant women should
regularly provide with HIV tests. Her major role has been played by primary care. Along with
this, the most effective and essential need for earlier diagnosis of HIV is required. Policies are
stated where members of the primary care team are likely to be conceptualized by unexplained
symptoms. There is need to assess the significance of antenatal screening programmes in relation
to the steps that women can take to engage with the prevention measures. This program is
effective in reducing the chances of mother – to – child transmission of HIV infection. Hence, it
is effective in encouraging the women to undergo the screening so as to save their child from
contracting HIV. Women would engage in antenatal screening as they are aware of its benefits
that it would help them in seeking optimal treatment for their child in the situation when there
occurs mother – to – child transmission of HIV infection (Perry and et.al., 2012).
The implications will be helpful in ascertaining the prevention of HIV on child of mother
suffering from this disease. Hence, prior test of antenatal screening will prove useful. Secondly,
the effectiveness is judged on the ground of preventing the unnecessary burden on health care
sectors as early detection will prove them efficient in curing disease on time and thereby reduce
its transmission as well (Clift and Page, 2015).
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The role has also been played by the Department of Health (DOH). It is responsible for
addressing and supporting policy on HIV. There is national strategy for sexual health and HIV.
The core of promoting the policy framework lies in planning and implementing an action plan
for safeguarding HIV diagnosed individuals. Along with this, it includes the development of
standards as a key action plan.
There is a toolkit which is provided at various Primary Care Trusts (PCTs) and local
authorities (Perry and et.al., 2012). This is inclusive of effective commissioning of sexual health
and HIV services. According to this policy which states that recommended standards should
support the executing and delivery of treatment and services to communities disproportionately
affected by sexual ill-health and HIV (Riekert, Ockene and Pbert, 2013). In the same vein, these
policies are similar standards that provide a tool to bring improvements in access to sexual health
services. This is identified as a primary and priority service by the NHS in UK. They work in
improvement, expansion and reformation with a plan in coming three years. This is a broader
plan which states Priorities and planning framework 2003-2006 (DiClemente, Santelli and
Crosby, 2009). It undertakes the core of minimising the health inequalities and developing health
promotion.
The policies states that all woman who are pregnant are recommended to undergo HIV
test. As per standard 8, this is to identify the group who are required to be identified from
interventions. This is essentially carried forward by the regular antenatal care. It is recommended
that these interventions are likely to be addressed by them before, during and after the birth of a
child. This is to leverage the outcome of good and proper health. In a streamline, an attempt to
minimise the mother to child transmission has been made. This policies and provisions
pertaining to school education are effective in various respects. By giving them knowledge and
teachings at early stage with prevent them from sexual intercourse with multiple partners,
avoiding the use of contraception by both genders, early tests of HIV etc. Moreover, schools
provision of education will be helpful in supporting the women to choose best method for
contraception (Bailey and et.al., 2015). It can be analysed that school can play an important role
in providing information about the various contraception alternative available to women. This
provision of sexual education will make the women empowered to choose appropriate
contraception for themselves (Riekert, Ockene and Pbert, 2013). Along with this, it will be
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better option for them to come out with the fear of timely consultation and confidence to deal
with the issue of HIV. This will assist women in her stage of pregnancy where she might get
early preventions with respect to measures to be taken for safeguarding the transmission of HIV
into her unborn child.
According to the policy of Association of British Insurers (ABI), negative result of the
HIV test will not have any impact on the permanent life or well being of the individual
diagnosed with HIV (Wight and Fullerton, 2013). As stated by the British Medical Association
(BMA) who advised not to answer questions associated with lifestyle of applicants in similar
regards. In the similar fashion, policies on adopting and publicising on confidentiality and anti-
discrimination increases the proportion of patients (Hardy and Cu-Uvin, 2014). The crux behind
addressing these policies lies in improving the quality of care which can be provided in the
health care setting. It is to facilitate professional communication and shared care with specialist
general practitioners and clinics.
Provision
Attaining good sexual well being and health has now become a complex procedure. It is
due to ample of variations that are noticed in services imparted and intervention for different
class of people. Previsions are established with a motive to develop certain ways that leads to
effective and positive of health. Therefore, integrative and collaborative approach has been
followed. The provision, as an initiative in schools has been commenced. Here, the effectiveness
of this approach is helpful in making them aware about the measures to be taken with respect to
health care measures and prevention actions to be familiar and taken before in assessing the
future harmful implications in individual which further contribute to impact the entire population
of the UK (Clift and Page, 2015). The students especially teenagers were made aware about the
sexual health and related matters. It tends to cover the broad arena with respect to HIV and its
impact.
In the same vein, there is key role played by the health and well being boards. They work
to ensure the provisions with respect to develop the process of JSNAs and JHWSs (Youngkin,
2013). The role of these new developed and commissioning arrangements is to work for
minimising the inequalities. The development of Public Health England and its provisions holds
a key concept of creating a real difference to the future of sexual health in consideration of HIV
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and its major impact (Riekert, Ockene and Pbert, 2013). The provisions and their impact are
monitored through the PHOF indicators. These are sexual health indicators. The provisions for
HIV are said to be well established and achievable when information and actions are set to
support good commissioning.
The most significant provision is creating awareness among people. In the modern era,
there is need for making people understandable with the use of technology. There are provided
various support self care. Now days, there are also available ‘My contraception’ online tool
developed by Brook and FPA22 (Bailey and et.al., 2015). It is formulated generally for those
people who are unaware about HIV and pregnant woman for safer child birth. It provides the
recommendation and provisions for safety at the time of sexual intercourse. Along with this, time
period and access to services with confidentiality regarding the HIV screening and test. Use of
technology and health promotion is made through education. It assists people with effective
treatment and prevention aids. The effectiveness of this tool will be helpful for those people
specially females who are less confident in consulting to the health care professionals regarding
the same. By the help of this online tool, they can easily be able to get quick information and
prevent themselves from further adverse implications.
Role of health and wellbeing boards (HWBs) in provision and policy
Health and wellbeing boards play an important role in provision by coordinating the
services at the local level. By drafting a Joint strategic needs assessment, the health and well-
being boards place a duty on the NHS clinical commissioning groups to formulate a Joint Health
and Wellbeing strategy in the area of HIV prevention and treatment (Hardy and Cu-Uvin, 2014).
Moreover, HWBs have the responsibility to reduce health inequalities and improve the health
and well – being of the people in their area. This would assist in tacking the issue of HIV
prevention during pregnancy (Riekert, Ockene and Pbert, 2013).
According to the evaluation of British HIV Association conference, there are areas which
have high prevalence of HIV in England. The role of health and wellbeing boards in provision
and policy is to work in order to bring together the representatives from public health, local
councilors, social services, clinical commissioners and Health watch (a ‘consumer champion’)
(Perry and et.al., 2012). The main motive is to engage people in Testing Action Plan so that
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prevention measures can be taken among the people with respect to foster joined approach for
the public residing in the UK. Their other role is providing a coordinating move in order to
achieve the set policies and provisions for their successful move in the long run.
Challenges associated with health and wellbeing boards
The support of Health and well being Board to the nation is effective but the major
question is how to engage people for same. There are various peer challenges that are associated
with the promotion of stated health related policies and provisions. In an order to promote the
aspect of health inequalities, they play major role of reducing them (Clift and Page, 2015).
However, they need to plan actions where ways to motivate and make people conscious towards
the same should be developed.
CONCLUSION
In a nutshell, this essay covers a broad arena of health promotion on HIV during
pregnancy. With the help of this report, the understanding of various concepts and theories that
are associated with sexual health has been underpinned with HIV. The significance in regards to
safeguarding of HIV and its impact on mother and unborn child has been examined thoroughly.
This report acted as a good attempt for me to enhance the role of cultural, social, religious and
ethical factors in promotion of health.
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