Mind The Gap: addressing HIV and STIs among young people in rural and regional areas

HIV Australia | Vol. 11 No. 3 | October 2013

By Ann-Marie Roberts

In 2009, the Department of Education and Early Childhood Development released a report on the health and wellbeing of young people in Victoria which revealed over half of all sexually transmissible infection (STI) notifications (chlamydia, gonorrhoea, syphilis and HIV) were among young people aged between 15 and 24 years.

Chlamydia notifications had increased considerably between 2007 and 2008 in four of the five rural and regional Victorian areas, including Gippsland, Hume, Loddon Mallee and the Grampians. Syphilis and gonorrhoea notifications had also increased in the Loddon Mallee and Gippsland areas over the same period.¹

A more recent 2011 report shows the trend continues, with STIs higher for young people in rural Victoria than metropolitan Victoria – this difference has become more pronounced over time.

The highest and fastest growing rates of STIs among young people are for chlamydia.² While chlamydia is the STI most commonly associated with adolescence, other STIs are also more common in younger rather than older individuals.

Gonorrhoea is most common amongst men, especially those having sex with other men, but this disease still causes the greatest burden of disease in those under the age of 25 years.³

Mind The Gap – a three-phase project

In response to the rising prevalence of STIs among young people in rural and regional areas, the Victorian Department of Health funded Family Planning Victoria (FPV) from 2010–2012 to implement Mind The Gap, a community engagement project.

FPV delivered the project in collaboration with primary partners – the Victorian Aboriginal Community Controlled Health Organisation and the Centre for Adolescent Health.

Supporting partners were FAR Social Enterprises (NSW), The Twenty 10 Association (NSW) and the Burnet Institute.

The project targeted young people under the age of 29, with a particular focus on two priority groups: gay, lesbian, bisexual and transgender (GLBTIQ) young people; and Aboriginal and Torres Strait Islander young people.

Project aims included the primary prevention of HIV, STIs and blood borne viruses (BBVs) in young people.

Fundamental to the project was working with key organisations and agencies to develop and implement social and health strategies to reduce STI and HIV transmission and raise awareness about sexual health, discrimination and diversity in GLBTIQ communities and beyond.

The disparity in the burden of disease carried by GLBTIQ young people compared to heterosexual youth appears to be largely due to the impact of stigma and discrimination, combined with many young people’s reluctance to access health care and screening due to perceived poor practitioner knowledge and sensitivity.

Despite some increases in legal protections for GLBTIQ citizens over recent years, social or cultural acceptance of GLBTIQ communities is still not a given, particularly in rural and regional areas.

GLBTIQ people are more likely to face isolation, social exclusion and disconnection from family and community networks – factors which all contribute to increased risk of sexual and mental health issues, homelessness, suicide, self-harm and drug and alcohol misuse among this population.

Poorer health outcomes are also higher in Aboriginal and Torres Strait Islander young people than among other Australians, including in the area of sexual health. Indigenous Australians have substantially higher rates of STIs, BBVs and teen pregnancy than non-Indigenous Australians, particularly for chlamydia, gonorrhoea, infectious syphilis, hepatitis B and hepatitis C.⁴

Phases of the project

Initially designed as a three-tiered project with interventions to occur concurrently each year across regional and rural Victoria, Mind The Gap initiatives included the Sexual Health & Diversity Enterprise (SHADE), Q&A Emerging Youth GLBTIQ Leaders program and the Mind The Gap social networking site.

SHADE workshops

The SHADE campaign helped raise awareness about the importance of prevention and testing for STIs and BBVs in young GLBTIQ, Aboriginal and non-Aboriginal people, while supporting greater access to sexual health care through a small community grants program.

The campaign included workforce development workshops for health care workers. These workshops aimed to improve the cultural competency of practitioners working with clients from sexual minorities, with a view to improving access to local services for GLBTIQ youth, and reducing the disproportionate burden of disease – including the risk of HIV transmission.

Organisational culture, the lack of adequate resources and time were identified as the main barriers affecting the ability of participants and their workplaces to respond more effectively to the needs of sexual minorities.

These workshops were effective in increasing health care workers’ understanding of the effects of stigma and discrimination experienced by sexual minorities and the importance of communicating more effectively with sexual minorities.

Leadership program

The Q&A Emerging Youth GLBTIQ Leadership program nurtured the leadership capacity of young people – providing them with knowledge about their community together with leadership skills to deal with issues and challenges associated with their progression into leadership roles.

This adaptive program was delivered through a combination of experiential learning, community visits, readings, personal reflections, practical engagement and mentoring over a three to four month period.

The program evaluation provided strong evidence that participation had yielded durable effects and lasting impacts on the young people’s ability to take on new challenges and leadership roles, enabling them contribute to the wider community as emerging young LGBTIQ leaders.

Online engagement

The third tier was a Mind The Gap social networking site created to connect emerging leadership alumni from the Q&A program across the years in an attempt to facilitate continued influence, social action and change, as well as to provide an avenue for alumni to support one another.

It was designed so that participants could share information, stories, updates and ideas. The Facebook page was set up as a closed network so that frank and fearless conversations could be had between participants in as safe as space as possible in an online context.

The page had over 150 members, with about a dozen active contributors to the page. Both the Q&A and SHADE campaign have been standout components of this program, with 40 young leaders completing Q&A – four of those being Aboriginal and Torres Strait Islander youth.

The number of SHADE community grants awarded increased in number over the life of the program with twenty-seven applications received in 2012, compared to eight applications received in 2010.

Over 2010–2012, the SHADE program distributed over $123,000 in funding for community grants to more than 43 Victorian community organisations. Regions covered included Gippsland, Hume, Victorian Western Districts (Barwon South-West and parts of the Loddon Mallee).

SHADE distributed 50,000 resources and generated over 30 individual media articles about local SHADE events.

Alongside this, the workforce development workshops increased both the number of workshops conducted across time and also diversified the breadth of health care workers involved in the training.⁵

Project outcomes

Mind The Gap had the greatest success in reaching Aboriginal and Torres Strait Islander youth through the SHADE community grants campaign, which received positive feedback from participants and project staff.

The campaign saw an increase in participation from Aboriginal organisations as it offered the chance for community organisations to undertake their own sexual health and diversity initiatives outside more traditional government funding streams, which are often out of reach for such organisations.

One important design feature of SHADE was to ensure that the application process was very much streamlined and supported by Mind The Gap staff, to overcome resourcing barriers relating to time and skills needed to pull together applications for funding.

Events ranged greatly in size, from a small BBQ celebrating diversity – with 10 participants, to a ‘Health For Life’ consortium instigated by the Mildura Aboriginal Corporation – which attracted 3,000 attendees and 293 STI screenings were conducted on the day.

This year has seen some innovative activities and events, including the ‘Think About It’ Multimedia Project.

Instigated by Uniting Care Cutting Edge, Shepparton, the project centers on a travelling exhibition of videos/photo stories of 10 people (including at least one transgender and one Aboriginal young person).

The young people’s stories capture all elements of their lives with a strong focus on sexual health and diversity.

Their aim is to safely share their stories and ‘voices’ in the hope that the broader community may learn something and walk away ‘thinking about it’. Another example was a JOY radio event, which was broadcast from Bendigo.

The special outside broadcast was committed to showcasing and promoting local services and community engagement.

The broadcast aimed to increase awareness around sexual diversity and sexual health in the Loddon Mallee Region and beyond.

The 2013 broadcast event was marketed as a sexual health information forum for same sex attracted youth and their social networks in regional Victoria.

Through the array of guests, JOY FM promoted STI and BBV prevention and testing and supported greater access to sexual health care.

The broadcast was not only available to those who attended the event, but to young people who may not be comfortable being ‘out’ or who may be isolated and could listen via radio, online, or via JOY 94.9’s smart phone applications.

Extra funding has been allocated to Mind The Gap this year, with a focus on the successful SHADE community grants and workforce development workshops, which are unique in their facilitation of community-owned initiatives tailored to local community environments and based on the communities’ needs.

The funding is supportive of the work that needs to be done to create better sexual health outcomes among young people who live in rural and regional areas, as well as highlighting diversity issues and the disparity in the burden of disease carried by GLBTIQ and Aboriginal and Torres Strait Islander young people.

Ann-Marie Roberts is a Project Worker for Mind The Gap at Family Planning Victoria.

References

1 Department of Education and Early Childhood Development, Department of Planning and Community Development. (2008). The State of Victoria’s Young People: A report on how Victorian young people aged 12–24 are faring. State Government of Victoria, Melbourne. Retrieved from: www.eduweb.vic.gov.au

2 Department of Education and Early Childhood Development. (2013). The State of Victoria’s Children Report 2011. A report on how children and young people in rural and regional Victoria are faring. Department of Education and Early Childhood Development, Victoria. Retrieved from: www.education.vic.gov.au

3 Family Planning Victoria, Royal Women’s Hospital, Centre For Adolescent Health. (2004). The Sexual and Reproductive Health of Young Victorians – a collaborative project between Family Planning Victoria, Royal Women’s Hospital, Centre For Adolescent Health. Retrieved from: www.thewomens.org.au

4 Pink, B., Australian Bureau of Statistics (ABS). (2012). Australian Social Trends, June 2012. ABS Catalogue No. 4102.0. Commonwealth of Australia, Canberra. Retrieved from: www.ausstats.abs.gov.au

5 Family Planning Victoria (FPV), Victorian Aboriginal Community Controlled Health Organisation (VACCHO). (2012). Final Summary report for ‘Mind The Gap’. FPV and VACCHO, Melbourne.