Paternalistic attitudes outdated in sexual health

When it comes to sexual health, making access easier matters, writes Dr Mitchell Tanner

Stigma Health thanks the authors of this piece for reviewing our new service and we do encourage pharmacists to recommend our service. We do, however, have concern with and disagree with the statements made by Jackie Eyles and the implication that we do not test for all things possible.

The article states that Stigma Health does not screen for HPV or herpes. This is because there is no screening test for these infections, and screening is not recommended in any guidelines. Such infections can only be diagnosed on clinical review, and are therefore not suitable

Eyles makes statements that are paternalistic, lack any evidence base, and appear to be distinctly based on protecting her established clinic in the face of an alternative provider.

The statement about patients being drawn to Stigma Health but benefiting more from a clinic visit is both paternalistic and lacking any evidence base. It is an opinion, not backed by any clinical evidence. It has no place in an academic discussion.

What is the perceived negative in patients being drawn toward any STI screening program, be it Stigma Health or any other? Where is the evidence that indicates the described patients will benefit from a face to face visit? Where is the evidence that people who visit STI clinics need to discuss other issues? Where is the evidence that patients who visit STI clinics and discuss other non STI issues are actually seeing an appropriate person, rather than being referred to a GP who is an expert in primary care? There is no evidence to back the opinions of Eyles.

Further, who are we as health professionals to tell patients what is best for them? This is a paternalistic attitude that is no longer how Medicine is practiced. As health professionals, it is our job to provide services and options for patients, not to tell them what we think is “best” for them.

What does have evidence are the following statements:

  • Multiple barriers exist to young people being tested for STIs, including cost, embarrassment, shame, poor access, time constraints, fear of health professional opinion, and multiple others. (Understanding Barriers to STI Testing in Young People).
  • STI incidence remains high and is increasing. (2016 Kirby Report).
  • Only 15% of people aged 15-29 had Chlamydia testing nationwide in 2015, based on Medicare data (2016 Kirby Report).
  • National Health Policy and strategy is focused on increasing STI screening rates, and exploring new methods of testing (Third National Sexually Transmissible Infection Strategy).

Clearly, the above evidence based statements and facts indicate not enough young people are having STI screening, for a variety of reasons. Therefore, an alternative to the established methods is required, and the development of such services is inline with Australian government policy.

Stigma Health provides such an alternative and a new methodology for STI screening. We achieve this whilst following national guidelines, and providing correspondence in a highly secure method. The internet has the ability to revolutionise health care, and Stigma Health takes great pride in being at the forefront of this.

Dr Mitchell Tanner BMed(Newcastle), FRACGP is the founder of Stigma Health.

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