RePRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT 8 REPRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT: SYDNEY SEXUAL HEALTH CENTRE

REPRODCUTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT 8 REPRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT REPRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT: SYDNEY SEXUAL HEALTH CENTRE Author note: Introduction The Department of Health (2019) denotes the contribution of social disadvantage in hindering availability of products, services and information sources pertaining to RSH, which is why, the reproductive and sexual health of certain marginalized and vulnerable groups, like

Running head: REPRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT
REPRODUCTIVE AND SEXUAL HEALTH PROGRAM ASSESSMENT: SYDNEY
SEXUAL HEALTH CENTRE
Name of the Student:
Name of the University:
Author note:

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Introduction
The Department of Health (2019) denotes the contribution of social disadvantage in
hindering availability of products, services and information sources pertaining to RSH, which is
why, the reproductive and sexual health of certain marginalized and vulnerable groups, like
Australian Aboriginal and Torres Strait Islander (ATS), disabled and Lesbian, Gay, Bisexual,
Transgender, Intersex, Queer (LGBTIQ) populations, are at risk within Australia. The Australian
Medical Association (AMA 2019) reports increased incidences of Sexually Transmissible
Infections (STIs), teenage pregnancies, pregnancy complications, infant mortality and low birth
weight across ATS groups as compared to non-ATS populations. The AMA (2019) and
Department of Health (2019) also denotes higher risk of rape and sexual abuse across physically
and psychologically disabled Australian groups and a prevalent stereotyping that such
populations are devoid of sexual needs and thus, do not require comprehensive Reproductive and
Sexual Health (RSH) information. LGBTIQ groups, on the other hand, encounter RSH service
complexities in terms of sexual discrimination, decreased accessibility to subsidized screening
and medication services and usage of discriminatory gender-normative language across health
workers present in RSH Services (Pienaar et al. 2018). The following report thus focuses upon a
relevant Australian RSH service, the Sydney Sexual Health Centre (SSHC 2019) and the scope
with which its facilities align to national policy recommendations and the needs of these priority
populations.

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Discussion
Sydney Sexual Health Centre
Brief Description
The SSHC’s comprehensive RSH services are categorized into various types, such as
General, Xpress, Late night, Youth, Thai and Chinese, Counseling, Needle and Syringe Program
and a[TEST],. The SSHC’s General Clinic provides RSH services associated with testing,
treating and managing HIV and SITs coupled with an online based risk assessment for
individuals wishing to check their sexual health status at home. The SSHC’s ‘Xpress’ clinic
provides quicker STI testing services without any physical examinations and specially cater to
individuals free of STI symptoms but frequently require testing. The ‘Satellite Youth Clinic’
delivers RSH services and testing for Australian youth in the locality who are under the age of
25. For individuals unable to visit the organization during usual working hours as well as for
Chinese and Thai workers, the SSHC’s ‘Late Night’ and ‘Thai and Chinese’ clinics are of special
importance and comprise of a multilingual staff and interpreters. The SSHC also caters testing
and screening of Australian men who are gay and bisexual or engage in sexual relationships with
men, with it’s a[TEST] clinic. Lastly, the SSHC’s RSH services also focus provision of sexual
health advice to Australian couples and individuals alike as well as free-of-cost sterilizing
equipment via its ‘Counseling’ and ‘Needle Syringe Program’ clinics and services (SSHC 2019).
Alignment with Policy
The NSW Sexually Transmissible Infections Strategy 2016-2020, implemented by the
Ministry of Health (2016) of the NSW Government, aims to decrease rates of STIs and HIVs
across priority groups like sex workers, ATS, young individuals aged 15 to 29 years and men

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who are gay and homosexually active, via strengthening priority RSH service areas of infection
prevention, testing, treatment and management. Indeed, it can be observed that indeed, SSHC’s
RSH services are centered around STI and HIV prevention, testing, management and treatment
across all the above priority populations (SSHC 2019). Additionally, the SSHC’s provision of
RSH services specifically to ATS groups and homosexual men via prevalence of separate clinics,
demonstrates specific compliance to other state policy frameworks like the NSW HIV Strategy
2016-2020, NSW Aboriginal Blood Borne Viruses and Sexually Transmissible Infections
Framework 2016-2021 and the Sexually Transmitted Infection Testing Guidelines for Men who
have Sex with Men (NSW Government 2019).
The availability of such specialized RSH services by the SSHC also demonstrates
national policy alignment with the Eighth National HIV Strategy 2018-2022, implemented by the
Department of Health (2018), which also demonstrates prioritization of vulnerable groups like
ATS populations and homosexual men. However, this national policy also focuses upon the RSH
needs of transgender populations - a key priority group which finds no mention in the present
RSH services provided by RSH. Additionally, the National Women’s Health Strategy 2020-2030
has been designed by the Department of Health (2018) for the purpose of ensuring
comprehensive and non-discriminatory accessibility to RSH services pertaining to information
access, treatment and diagnosis for socially marginalized groups like lesbian and bisexual
women as well as women with a disability. There is no mention of such groups in SSHC’s RSH
services thus indicative of an absence of compliance to national policy guidelines and
recommendations (SSHC 2019).

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Outline of Services
The following are the outline of services provided by the SSHC for each of the priority
population groups:
Australian Aboriginal and Torres Strait Islander
The SSHC provides a wide range of convenient RSH facilities and services for ATS
groups residing within NSW, in terms of provision of STI vaccination, testing and screening,
counseling, condoms, treatment and management of STI and HIV in confidential settings, and at
free of cost. To further ensure compliance to cultural competence and cultural sensitivity, the
SSHC’s RSH services for ATS groups also comprises of providing referrals of local Aboriginal
Health Services and Aboriginal Sexual Health Workers to relevant clients (SSHC 2019; Botfield,
Newman and Zwi 2017).
Disabled Individuals
There is no mention within the SSHC’s online website on the prioritization of RSH needs
of Australians with mental, psychological or cognitive disabilities (SSHC 2019). This can be
considered a gross negligence in part of the organization considering that the disabled
individuals, despite their specialized needs, also have a right to gain access to holistic, non-
discriminatory, non-judgmental and comprehensive RSH services, products and educational
resources (Pinto 2018). Further, disabled populations are often discriminated on misperceptions
that their sexual needs are unwarranted and unnecessary resulting in a high risk of acquiring
sexual violence, abuse and rape (Dowse et al. 2016).

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LGBTIQ
It is evident that SSHC’s services also prioritize and address the RSH needs of men who
are homosexual or maintain sexual relationships with other men, by providing private and free of
charge vaccination, management and treatment of HIV, STI and hepatitis infections. To further
ensure that the unique needs of such groups are met, the organization also possesses a clinic
specially designed at providing RSH services and counseling for homosexual men (SSHC 2019).
However, it must be noted that the LGBTIQ community comprises beyond merely
homosexual and gay men but also other sexually diverse communities such as lesbian, bisexual,
transgender, intersex and queer groups. With this respect, there is no mention of the above
communities in the RSH services provided by SSHC, which demonstrates a lack of inclusiveness
and consideration of the diverse sexual and reproductive needs of individuals (Grant, Nash and
Hansen 2019). The lack of such inclusiveness is of further concern considering that individuals
belonging to LGBTIQ groups are at a high risk of sexual discrimination, inadequate sexual
health literacy and poor sexual health outcomes and thus are in need of equitable RSH services
like all other groups (Oakley and Bletsas 2018).
Evaluation
RSH needs of each group
The Eighth National HIV Strategy 2018-2022 demonstrates national policy initiatives of
preventing, treating, managing and assessing STIs and HIV incidences across priority groups like
ATS populations, homosexual men and transgender populations (Department of Health 2018).
The SSHC can be observed to comprehensively addresses the RSH needs ATS groups by
providing the above services as well as referrals to specialist Aboriginal services (SSHC 2019).

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This is because provision of such culturally sensitive services demonstrates cultural competence
– a key priority need for culturally and ethnically diverse groups like ATS populations (Nyanga
et al. 2018).
However, it is evident that the SSHC addresses the RHS needs of only homosexual men,
with no mention of the needs of the transgender, lesbian, intersex and queer populations as
prioritized by additional national policies like the National Women’s Health Strategy 2020-2030
(SSHC 2019; Department of Health 2018). The absence of any RHS accessibility and
opportunities of disabled populations by the SSHC also demonstrates lack of consideration of the
RHS needs of this priority group and a direct violation of the nation’s Disability Discrimination
Act (Australian Human Rights Commission 2019).
Strengths
The adherence to cultural competency is a major strength of the RHS services provided
by the SSHC. According to the National Safety and Quality Health Service Standards User
Guide for Aboriginal and Torres Strait Islander Health, developed by the Australian Commission
on Safety and Quality in Health Care (ACSQHC 2017), healthcare organizations must that the
workforce adheres to culturally competent healthcare practices. With this respect, the SSHC’s
inclusion of Aboriginal health service referrals while meeting RHS needs of ATS groups is a key
demonstration of cultural competence (Gadsen et al. 2019).
The educational level of individuals is a key social determinant of health and wellbeing
across populations of a nation. According to the Australian Institute of Health and Welfare
(AIHW 2016), an individual with commendable levels of education are likely to reap long term
benefits of positive health outcomes in life. It can be observed that the SSHC’s RHS services
addresses this social health determinant and resultant positive sexual and reproductive health

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outcomes by providing free of cost counseling and educational services for individuals and
families having doubts on family planning, reproductive and sexual health issues (SSHC 2019;
Keuroghlian, Ard and Makadon 2017).
Gaps
A noticeable gap is the lack of any information concerning how successful has the SSHC
been in addressing the reproductive and sexual health needs of the ATS and male homosexual
populations it caters to. In addition to information on the awards it has received, statistical data
indicative of the rates of priority populations the organization has successfully adhered to, could
have assisted in validating the veracity and effectiveness of the RHS services provided by SSHC
(Geary et al. 2015).
A major gap which can be observed is the lack of any mention on whether the RHS
services provided by the SSHC caters to the disabled as well as lesbian, transgender, intersex and
queer groups, especially women – who are most in need of holistic RHS services. Such groups,
due to the widespread sexual and gender discrimination they are subjected to, are often deprived
of equitable health services which places them at an increased susceptibility of encountering
poor sexual health outcomes, STIs and HIV (Toft, Franklin and Langley 2019). Additionally, it
must be noted that there is absence of national level RHS policies implemented specifically for
these groups by the federal government, which can be a key contributor to such service delivery
gaps. Thus, to ensure holistic and equitable service delivery for vulnerable populations across
RHS organizations like the SSHC, the federal government must also consider revising its priority
areas of national policy (Gorman-Murray et al. 2017).
Lastly, another key gap which can be observed in terms of service delivery is the lack of
any advocacy facilities provided by the SSHC. Socially disadvantaged populations like the

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disabled, ATS and LGBTIQ groups often encounter discriminative reproductive and sexual
health services as well as deprivation in terms of equal opportunities in healthcare, employment
and education (Winter et al. 2016). Advocacy by health care professionals are beneficial in
assisting such priority groups to achieve positive health and social well being across all spheres
of life, which is largely missing in the RHS services provided by the SSHC (Harley 2016).
Recommendation
As per the above observations, the aforementioned recommendations have been
suggested for improvement for SSHC’s RSH services:
 According to the United Nations Conventions on the Rights of Persons with Disabilities,
which was ratified by Australia in the year 2008, governments must seek to ensure that
every disabled member of the nation have the ability and opportunity to partake in
independent decision-making. Further, the Disability Discrimination Act of Australia
provides protection to the disabled from discriminatory treatment as well as ensures
promotion of equality in terms of opportunity, rights and access across all spheres of life
(Australian Human Rights Commission 2019). Thus, in alignment of the same, it is
recommended that the SSHC include disabled individuals as a part of their RSH services
to ensure positive sexual health outcomes through the provision of free of cost testing,
management and treatment of STIs and HIVs. Further, taking insights from the sexual
discrimination and stigma subjected towards these groups, it is recommended that the
SSHC also incorporates sexual health counseling and educational resources for these
vulnerable groups (Nguyen, Liamputtong and Monfries 2016).
 As per the Department of Health’s Eighth National HIV Strategy 2018-2022 as well as
the National Women’s Health Strategy 2020-2030, transgender groups as well as women

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engaged in bisexual and lesbian relationships are major priority populations in need of
the STI and HIV testing, prevention, treatment and management as well as accessibility
to discrimination free RSH services (Department of Health 2019). Thus, it is
recommended that the HHSC follow the steps of these national policy recommendations
and include RSH services for lesbian, bisexual, transgender, intersex and queer groups as
a part of its priority populations in addition to homosexual men. Further, considering the
gender based discrimination and stigmatized language encountered by these groups, it is
recommended that the SSHC incorporate separate clinics for such populations, like it is
has done for homosexual men (Byron et al. 2017).
 As per the Closing the Gap framework established by the Australian Government, every
healthcare organization catering to provision of health services to ATS groups must
include an Aboriginal Liaison Officer (ALO) as a part of its staff. The responsibility of
the ALO comprises of educating, counseling and comforting the concerned ATS client on
the available services in a culturally competent manner (Green 2018). It can be observed
that the SSHC’s RHS services towards ATS groups comprising of connecting or referring
clients to specialist Aboriginal Health Services if the need arises. To improve existing
RHS services as well as reduce hassle to the clients, it is recommended that the SSHC
recruit an ALO so that ATS clients find access to comprehensive care without having to
visit multiple healthcare organizations (Ireland et al. 2015).
 For ensuring optimum sexual and reproductive health outcomes across socially
marginalized populations, healthcare organizations are required to focus on services
beyond merely alleviation of disease and physical symptoms. Social disadvantaged
groups such as the disabled, ATS individuals and LGBTIQ populations are frequently

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victims of racial and gender stereotyping and stigma, which is why, they are deprived of
equitable access to relevant healthcare, educational and employment opportunities (Santa
Maria et al. 2017). To combat the same, healthcare professionals must not only be
empathetic and sensitive in terms of the language they use for communication, but must
also aim to advocate for such socially disadvantaged groups (Paton et al. 2016). Thus, it
is recommended that the healthcare workers of SSHC, in addition to their comprehensive
RHS services, also incorporate advocacy services to ensure sexual and reproductive
service equity across ATS, LGBTIQ and disabled groups (Dickson and Lobo 2018).
Conclusion
While SSHC’s RSH services demonstrate alignment to state and national policy
recommendations on STI and HIV testing, prevention, treatment and management, the
organization’s lack of prioritization of transgender and disability groups is a major limitation.
The absence of any specific policy for LGBTIQ and disabled groups by the federal government
could be a key contributor for such discrepancy. Further, apart from merely mentioning names of
awards and achievements, the SSHC does not provide any information on how successful it has
been in addressing RSH needs of such priority populations. Thus along with the need for SSHC
to provide comprehensive information as well as addressing RSH needs of LGBTIQ and
disabled groups comprehensively, it is expected that the federal government incorporates the
needs of these vulnerable groups in its national health policies as well.

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