Sexual Health Advising: Legal and Professional Aspects in Ireland

This report analyzes a scenario involving a sexual health advisor working with an MSM couple in Dublin, Ireland, where one partner has been diagnosed with syphilis. The assignment explores the advisor's role in providing counsel, information, and education, while adhering to Irish legislation and ethic...Read More

Running head: SEXUAL HEALTH ADVISING
Sexual Health Advising
Name of student:
Name of university
Author note

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Contents
Introduction:....................................................................................................................................2
Main body........................................................................................................................................3
Background:.................................................................................................................................3
Irish legislations:..........................................................................................................................4
Scenario.......................................................................................................................................7
Analysis and Evaluation..............................................................................................................7
Recommendations......................................................................................................................11
Conclusion.....................................................................................................................................12
References......................................................................................................................................13

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Introduction:
I am a sexual health advisor and I aim to adapt my professional practices for the further
development of my role. My area of practice is at the MSM Men’s Health Services in Dublin
Ireland. Throughout the years of my practices, I have developed the understanding of the
importance of the topic of homosexual health while conducting the role of a sexual health
advisor of a MSM (Men who have sex with men) community in Ireland. Among the various
numbers of sexual infections that tends to affect the health of the MSM couples, the disparity in
the syphilis diagnosis rate has been steadily increasing (Sun et al. 2015). The assignment focuses
on the scenario of a MSM couple in the Ireland, one of whom is affected by sexually transmitted
disease, syphilis and has come to visit the health clinic where I work as a sexual health advisor.
My area of professional practices includes various functional roles such as advices, counseling,
information and educating people about healthy sexual life. My role of helping out the patients in
the context of managing and advising positive measures or remedies for the infection caused due
to sexually transmitted bacteria’s and diseases gives confidence to my clients or the patients
while battling such infectious diseases (Bacchus et al. 2018). My purpose of the assignment is
the achievement of the competencies for efficient and effective performance in the field of sexual
health advisor. Throughout this assignment I am focusing on the legal practices of Ireland and
the assessment planning and the delivery of care for providing the best services for client
satisfaction related to their sexual health issues. In context of the above scenario, I followed
BASHH guidelines for the recommendation of the antibiotics for the treatment of syphilis and
partner notification to the MSM couples who visited the health clinic (British association for
sexual Health and HIV 2018). I have structured the assignment with relevant background
information on the Irish Health Care System under the relevant Irish legislations and Irish laws

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related to same sex marriages, sexual offences act and the equality legislations (Hayes and Nagle
2016). The critical analysis with evaluation on the scenario of the MSM couple in the clinic
following up with relevant recommendations and conclusion are some of the positive measures I
have included in the assignment (SSHA 2018).
Background:
Society of Sexual Health Advisors (SSHA) have developed a framework framework that
identifies the relevant competencies for the trainings and the education of the sexual health
services for the fulfillment of the role of sexual health advisor which I serve (SSHA, 2018). This
framework enables facilitation and development of the advisory skills in supporting the
diagnosed patients with a sexually transmitted infection and provides assistants in health care
systems (SSHA, 2018). I believe the sexual health advising is a recognized strategy because
several health advisory and health promotional plans in the context sexual health has been
organized across Ireland which includes genitourinary medical services, MSM community health
services, and reproductive and sexual health related diagnosis and in the context of the national
Chlamydia screening programs (Glynn et al. 2018). The competency furthermore highlights
number of required competencies in the context of the sexual health advice (Greenfeld and Seli
2016). Some of the necessary details of the competent areas of discussion include the following.
The practice of the professional and the legal requirements in the context of the health care
services are few of the most important areas in this approach as it might change the mindset of
people and people can take care of their health and safety through this regulation. I believe this
must be considered and keep in mind while providing health care and advisory services to the
clients visiting the clinic irrespective of the nature of the disease and their sexuality.

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I believe it is utmost important for the role of the sexual health advisor which I serve to
possess or have the relevant understanding and knowledge of the related legal issues and the
dilemma. These are prone to rise in case of sexual health advising in the clinics dealing with
sexually transmitted diseases and infections in Ireland such as agitation in the group practicing
such methods. As per my insight, I acknowledge and accept each and every bonding and
relationship among the human irrespective of their sexuality and the relation of it with the health
and the service towards powerful combination of the effective treatment services for the
improvement of the outcomes of the health of the clients visiting the clinics (Rowley et al. 2015).
The professional competencies of mine have helped in improving the performance and the
knowledge in providing effective care to the clients affected with sexual diseases, because I had
provided them the knowledge of sexual transmitting diseases, their mode of action and spread
strategy so that the clients can fight their battle.
It is thus necessary for me towards the improvement and the development of the
understanding of the care level and the professional and legal factors associated with the
community I am serving (Beyrer et al. 2016). With relevant skills of communication, skills and
knowledge in the context of effective organization and time management, non-judgmental
approach towards the client or the patient are some of the basic requirements and the set of skills
I should possess for effectively addressing the role of sexual health advisors (Evans 2017).
Irish legislations:
Human Rights, the very word describes the morals and the norms of certain human
standards which are under protection of the legal and the natural rights in the international justice
and the legislations (Hayes and Nagle 2016). One of the common factors to the inalienable and
fundamental principles of norms is the right to equality. ‘All human beings are born free and

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equal in dignity and rights’- one of the most resonant international agreement as statement stated
in the Universal Declaration of Human Rights promises and states all the social, cultural,
economic and civic rights to all the citizens in the world free from any fear, limits and lifelong
barriers (Blau 2017). The drafting of the milestone document furthermore illustrated the
inalienable right towards freedom from discrimination which is recognized as basic and
fundamental human rights and included in the principles of egalitarianism.
In the context of the assignment over the context of the MSM couple of the Ireland, I
would like to notify some of the interesting facts in the legal perspectives of the country. The
attitudes towards the MSM couple in the country of Ireland are one of the most liberal in the
globe (Hayes and Nagle 2016). With overwhelming liberal perspectives, Ireland is the first
country in the globe to legalize the concept of same sex marriage in the national level by voting
structure at May 2015. This historic move by the government of the country has expanded the
social change as I have noticed that most of sexual orientations in the Ireland are now outlawed
and the country furthermore forbids the incitements towards any sort of discrimination,
marginalization and hatred on the basis of sexuality or sexual orientations (Reygan and Moane
2014).
From 16 November, 2015 same sex marriage has been legalized in Ireland. According to
the referendum on the 22 May of 2015 amendment, the Constitution of Ireland mentions that
marriage will be recognized irrespective of the sex of the partners involved. The thirty fourth
amendment of the constitution of Ireland on 2015, 29th August explained the marriage act which
was passed by the oireachtas at 22 October 2015 (Thomson 2016). Article 41 of the constitution
of Ireland illustrated “The State pledges itself to guard with special care the institution of
marriage, on which the family is founded and to protect it against attack” (Jowett and Peel 2017).

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I believe the article states and evaluates the extent of harmony among the different groups of
people with a view to decline if the changes in them would bring balance among the groups of
people in the country as it involves all the groups and communities while creating the legislation
related to the homosexual and bisexual marriage and sexual relationships so that the STIs can be
controlled. Another of the important legal instrument is the civil partnership and Certain Rights
and Obligations of Cohabitants Act of 2010 which provided the same sex couples similar rights
and responsibilities but not the rights of civil marriage because these were the primary source of
sexual transmitting infection among the younger as well as older generation of MSM
community.
Discrimination and inequality on the basis of sexual orientation towards the access of the
fundamental rights and services related to health and social care services are some of the
negative factors or the stereotypes that prevails in the globe till decade (Abedinifard 2016). The
assignment focuses on the MSM couple and the health services towards their infection of the
syphilis. It is to be remembered that the discrimination on the basis of sexuality has been
outlawed in Ireland by the Equal Status Act of 2000 and the Employment Equality act of 1998
(Weber and Lin 2015). MSM couples should not be discriminated in any of the grounds related
to health care and social services that targets their health and the opportunity of wellness (Blau
2017). Each and every person in the world is entitled to life free of any discrimination, free to
choose their partner according to their preferred sexual choices, freedom of expression of their
thoughts, freedom of beliefs of their liberal thought process, the right to life and the right to
privacy. Possessing relevant knowledge related to the local and the statutory policies such as the
rights of the MSM couples in the community, the rights to their equal and effective remedies
towards health services and fair treatment towards the sexually transmitted infectious diseases

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and syphilis (Jowett and Peel 2017). In other words, it is thus necessary for all the sexual health
advisors like me to understand the effect of the Irish legislations, the guidelines and the laws
under the constitution of Ireland to the rights of the MSM person in the community (Weber and
Lin 2015). The equal respect, non-discrimination from heterosexual men and the enforcement of
the proper effective guidelines towards the partner notification and unconditional positive
regards for the requirements of the health care of the MSM men in the Ireland community are
thus important for me to address while critically assessing and evaluating the below stated
scenario of the MSM couple and their health issue related to syphilis. As a sexual health advisor
it is my duty to amend all the professional and the legal requirements together with the
assessment planning of the delivery of care in the field of MSM rights and the development and
improvement of their health status within the public health agenda.
Scenario
A significant amount of health concern is posed by the increasing rate of sexually
transmitted diseases round the globe (World Health Organisation 2018). It has been seen that the
infection majorly affects a large proportion of MSM men and the men who have sex with other
men (MSM). Occurrences of Syphilis are growing in such groups of individuals where there is
an increased risk of acquiring HIV, as per mentioned in the governmental data of Ireland (Health
Protection Surveillance Centre 2018). The scenario here reflects the occurrence of Syphilis in
one of the partners of a MSM married couple who have approached a clinic in order to seek help.
The clinic then referred the couple to see a sexual health advisor, in order to get solutions around
issues dealing with their sexual health (Health Protection Surveillance Centre 2018).

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Analysis and Evaluation
I have been working as a sexual health advisor in the particular clinic where the MSM
couple had come to seek help. As an advisor, my role requires me to deal with situations of
sexually transmitted diseases such as Syphilis in a meticulous manner. The first step is to discuss
the problems that has occurred and the problems which can occur in future because of it. Next
step is to inform the patient regarding the ways one can get protection from the infection. As a
health advisor it is also required to inform the client about the correct treatment procedures and
encouraging the patient to talk about it to their sexual partners so that they too are aware of the
condition and the nature of the treatment (Curtis 2018). My role as a sexual health advisor also
involves advising the clients regarding their general sexual health, discuss the issues of sexuality
and other such issues.
There are standard operating procedures (SOP) which are accessed via BASHH
guidelines for managing the STDs like Syphilis. It required for us to follow these standard
operating procedures so that we get clear guidelines to carry out the role of adviser. For
providing efficient treatment to my client, I followed the British Association for Sexual Health
and HIV (BASHH) guidelines which successfully provides recommendations in terms of the
diagnostic tests, proper regime of treatment and promotes health principles which leads to proper
prevention of transmission and chances of infection in the future (Kingston et al. 2016).
When the couple had arrived at the clinic, they were primarily unaware that the disorder
that had caused was Syphilis. The patient could only state that he had been suffering from certain
general symptoms like lesions and inflammations. I had to take a detailed history to the patient in
order to identify the disease since sometimes the disease might be asymptomatic. It was required
to take the full sexual history of the couple as a sexual health advisor. I asked other questions

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which were related to the symptoms of the disease, exploring previous syphilis diagnoses,
previous syphilis testing, and occurrences of any early disease which might include genital
examinations, skin examinations or neurological examinations.
Once all the questions were answered by the patient, certain diagnostic tests were
required to be carried out in order to gain surety as toe the occurrence of the disease. The first
test included detection of Treponemapallidum, which is the causative agent of Syphilis. A dark
field microscopy is generally performed followed by Polymerase chain reaction (PCR). I also
advised the patient to undergo certain serological tests like the Treponemal antibody tests. After
the confirmation of the positive results treatment regimens were suggested which included
Benzathine penicillin 2.4 MUIM single dose, Doxycycline 100 mg POBD * 14 days and
Azithromycin 2 g PO stat (Patton et al. 2014).
While the treatment procedures were prescribed I made sure to make the patient aware of
the reactions to the treatment. There can be certain possible reactions to the treatment and in such
cases it is required for resuscitation to be available in the treatment area. I reminded him that he
should be in the clinical premises for about 15 minutes after first injection so that observation
can be done for immediate adverse reactions. Often there is a Jarisch-Herxheimer reaction,
which is generally caused as an acute febrile illness which includes symptoms like headache,
myalgia, chills and rigors which occurs within 24 hours. In such cases antipyretics is
administered to the patients. It is my duty as the health adviser to make the patient of the worst
case scenarios which might include anaphylactic shock. This is caused due to heightened amount
of hyper allergic reactions in the body of the patient, which mainly occurs due to presence of a
history of penicillin allergy (Reed et al. 2014).

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Partner notification is an important criteria when dealing with sexually transmitted
diseases. While diagnosis of syphilis is it required that there is a discussion of partner
notification which needs to be done by the health care professional. I being a sexual health
advisor, it is my duty to carry out this job. Often the case is such that this cannot be carried out in
the first attempt, in such cases attempts should be taken to document the interview of the patient
so that it can provide further support and there is a gain of information so that the outcomes can
be verified.
In situations where the patient is diagnosed with primary syphilis, there is an urgent
requirement that the sexual partner must be notified within a period of 90 days to the maximum.
In case of secondary syphilis the partner notification may extend up to two years with clinical
relapse or in early latent syphilis. Often the incidents of partner notification become difficult as
the sexual contacts are met in anonymous sex venue like the saunas, internet or the cruising
grounds. Sometimes the patients might be asymptomatic to syphilis, in such cases early syphilis
should be offered either epidemiological treatment or re-screening for syphilis12 weeks after
their last exposure. If the scenario involves latent syphilis then attempts must be made to trace
the previous serology and presence of any documentation of the treatment that might affect the
staging of the disease. If such is found, then it should be conveyed in the partner notification
process. Individuals who suffer from latent Syphilis are usually unable to transmit the infection
to the sexual partners. However there might be chances of vertical transmission of the infection
that occurs after many years of the initial infection. Although this becomes unusual as time
progresses and after the stages of early syphilis. It is the duty of the health advisers to provide the
patient with provider referral as a method of contacting any sexual partners. Consideration
should be made in terms of use of electronic means of contact. These might include profiles on

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dating websites and such other means. There is a need for clear documentation method that is
agreed upon with the patient (Sun et al. 2015).
As a sexual health adviser it was also required to help the couple in a way by playing role
in health promotion. The key aspects of the practice includes Building healthy public policy,
Creating supportive environments, Strengthening community action, Developing personal skills
and Re orienteering services. It is also the duty of the sexual health clinics to take part in such
health promotions. This can be achieved by playing an important role in encouraging services
that will help in health promotion. This can range from the provision of training like for e.g.
school nurses, GPs and reception staffs (Workowski and Bolan 2015).
It is the duty as a sexual health officer to safeguard and try to promote the s well-being of
individual patients/clients and promote sexual health of the wider community. For this while
interaction with the couple I took initiatives to make them aware of the risk factors and the
determinants of health. They should be aware that there is a range of social, economic and
structural conditions present that take part in contributing to the experiences of MSM men and
other MSMs in terms of health and illness. Certain choices available to them and their ability to
control and act on decisions help to achieve positive health outcomes. Such norms include
homophobia, heterosexism and other related stigma and discrimination. These are responsible for
vulnerability to syphilis among MSM men and other MSM. It might lead to poor mental health
and illness among them. There should be some sort of social support networks available. These
might include support from family, friends as well as communities, which has a huge impact on
the individual’s sense of belonging and ability to cope with the stress and negative impact of
stigma and discrimination. Often for MSM men, the internet and the social media play a vital

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role in social support and has able to change the ways they could access the information of health
and are able to meet their sexual partners.
Recommendations
 The patients should encourage partner notification discussed during the diagnosis
by conduction of re-interview if it is required.
 There should be a provision for epidemiologic treatment to be offered for
asymptomatic contacts during the window period of the disease.
 In case of Syphilis, follow-ups are very important with a minimal recommended
period of syphilis serology at three, six and 12 months.
 All patients with syphilis should have screening for other STIs including HIV
along with a clear explanation of their diagnosis of syphilis and its implications,
re-enforced with written information.
 Macrolide antibiotics are to be used if only available option and when follow-up
can be assured (South et al. 2013).
Conclusion
From the above discussion it can be concluded that the chances of occurrences of
sexually transmitted diseases is more in case of MSM men in comparison to others. I personally
believe that Syphilis is one such disease that can be transmitted to men while having sex other
man. Sexual health advisers like me thus have a very important role to play while providing
services to the MSM community (Solomon and Mayer 2015). It is necessary for the heath
advisers of sexual diseases like my role to ensure competency in the areas that are Professional
and legal along with assessment planning and delivery of care to the clients or the patients in the
clinics with critical sexual related diseases (Abedinifard 2016). For recognizing the professional

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competencies of the sexual health advisers I believe that it is necessary to accept the principles
and standards of our profession so that help can be provided in improving the quality of our
performance and also increase our knowledge in their relevant area of MSM sexuality that I am
practicing in. Sexual health advisers like me thus must be able to ensure the maintenance and
development of the clinical skills and practices related to their duties to propagate effective, fair
and equal treatment to the MSM couples, maintaining all the terms of professionalism and Irish
legislations (Read, Fairley and Chow 2015).

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Appendix I
A MSM married couple has approached a clinic in order to seek help. One of the partners of the
MSM married couple is affected by the sexually transmitted disease, Syphilis. The clinic then
referred the couple to see a sexual health advisor, in order to get solutions around issues dealing
with their sexual health.

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