Sexual Health Nursing: 'At least you can make people better'

Sexually transmitted infections may be on the increase, but so, too, is awareness. It's all thanks to those on the front line of this vitally important sector of the NHS, sexual-health nurses. Tim Walker reports
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The Independent Online

I look back on the annual "sexual-health awareness week" at university with a certain whimsical affection. Some enterprising soul had even come up with an appropriate "G" word to make the acronym "SHAG week".

Every student was given a sexual-health goodie bag: condoms, lubricant, and leaflets about how to avoid sexually transmitted infections (STIs), which most of us would throw carelessly away. For days, the campus would echo with the slap of bursting water bombs fashioned from the free prophylactics. One year, a student-union officer caused an outcry in a meeting when she pondered aloud the merits of including in the packs what she rather graphically dubbed a "fisting glove". How we laughed.

But, children, sexual health is no laughing matter. Those of a sensitive disposition may wish to stop reading and, indeed, avoid a career in sexual-health nursing. But everyone should, at least, know the dangers posed by sexually transmitted infection (STI). In 2004 alone, genitourinary-medicine clinics in the UK diagnosed 22,320 cases of gonorrhoea; 18,923 cases of herpes; and a whopping 103,932 cases of chlamydia. And 2,252 people were found to have syphilis. Yes, syphilis, the one that sent royal families across Europe mad in the 1700s. It's back on the rise.

In 2003, there were over 6,000 new diagnoses of HIV - bringing the total number of people living with HIV in the UK to 53,000. In the same period, around 500 people died from Aids-related illnesses.

As the first point of contact for people wanting treatment for, or advice about, sexual health, nurses are on the frontline of a growing health-service sector. While STIs are on the rise, so, too, is awareness of sexual health. Now, many conscientious people make regular visits to a sexual- health clinic for a check-up. "People visit the sexual- health clinic now the way they would a dentist," says Joanna Dam, nurse manager at the Marlborough clinic, part of the Royal Free Hospital in north London. "Ideally, people come in for a check-up before deciding to practise unprotected sex with a long-term partner."

Many of the taboos surrounding STI have now been dispelled, and its new profile as a prominent public-health issue make sexual health a popular area of the NHS in which to work, argues Kathy French, sexual-health adviser at the Royal College of Nursing. "People actually want to work in the field now, whereas 15 years ago, it was the Cinderella service of the NHS," she says. "It's partly a cultural thing - people are less embarrassed by STIs and sexual health in general, which means that clinics can be called sexual-health clinics rather than whispered euphemisms such as 'the special clinic'. That's also good for the nurses who work in them."

The day-to-day work of a sexual-health nurse is taken up predominantly by the diagnosis and treatment of STIs. It's not for the squeamish, but Joanna Dam is sure that people's expectations are far worse than the simple reality. "There was an edition of Panorama recently where they made testing for STIs sound very scary, but it's not," she says. "It's not pleasant, but it's not painful. For a woman, it's very similar to a smear test; for a man, it involves taking a swab from the urethra; and then both have a urine test and a blood test. If they have had oral or anal sex, then we take swabs from those areas, too."

One of the most rewarding things about working in sexual health is the opportunity to really cure people. "It's less stressful than, say, being on an oncology ward where people might die every day," Dam continues. "In sexual health, you can make people better. If they have a bacterial infection, you can treat it."

Of course, this is not always the case with viral infection. Every sexual- health clinic offers an HIV test to all of their patients. If this proves positive, explains Liz Plastow of the Nursing and Midwifery Council, then "sexual-health nurses may perform tasks such as contact-tracing other people who may be infected, and epidemiology. That's the cause and effect of disease - if a particular STI spreads in a certain area, sexual-health nurses need to work out why, and how to combat its spread".

Nowadays, without the stigma it used to carry, sexual health is more closely integrated with other associated areas of the health service, such as family planning, gynaecology or HIV treatment. As a result, nurses have greater flexibility to move between inter-related disciplines. Working in sexual health doesn't even always mean having a nursing degree. While many sexual-health nurses have a masters-level qualification, clinic teams include sexual-health advisers who may instead be qualified social workers.

Sexual-health clinics also have flexible employment practices. "Some sexual- health nurses will only work, say, two days a week," says Kathy French. "There are a lot of part-time posts available. So it is good, for instance, for a female nurse who wants to start a family."

For those who want to follow the career path to its logical conclusion, however, there is the shining example of the 20 or so sexual-health nurse-consultants currently practising in the UK, whose status is much like that of a doctor.

The most important quality in a prospective nurse for the Marlborough clinic, says Joanna Dam, "is a mature attitude, someone who is open and not judgemental about others' lifestyles". The huge variety of patients passing through a sexual- health clinic places a heavy demand on its nurses' "people skills".

"It can be very challenging," says French. "You must be aware of the possible circumstances of young people, and have the skills to make an assessment. Most people are in consensual relationships, but many young women are in relationships with much older men, and others may be involved in prostitution. If we think that is the case, we can refer people to social services, but it is delicate because you don't want to jeopardise their trust."

Young people make up the majority of a sexual- health nurse's caseload, and raising their awareness of the risks involved when they become sexually active is a priority. Dam is trained by her local sexual-health education team as part of an outreach programme. "We teach sexual health in schools," she says, "talking about the risks and advising on local services available. Schools often like a nurse to talk to pupils about sexual health, rather than a regular teacher doing it."

Mixed reception for award-winning nurse's fast-food approach to contraception

Some people are just more committed than others. The 2005 "sexual-health nurse of the year" (as judged by the National Association of Nurses for Contraception and Sexual Health) was Angela Star, 37, a specialist nurse employed by Gateshead Primary Care Trust (PCT). However, in September, Star made the news for another reason. Speaking at a Royal College of Nursing conference in Belfast, she admitted having given a schoolgirl a contraceptive injection in the toilet of a local branch of McDonald's, as part of a campaign to tackle the high rate of teenage pregnancy in Gateshead (which the trust hopes to halve by 2010).

Star runs an outreach service, which involves advertising her telephone number in local youth centres. This means that she can arrange to meet and engage with young people in their own environment, rather than try in vain to persuade them to make regular visits to their GP or family-planning clinic. As part of her work, she admitted, she had been known to wait outside school gates with a glass of water to administer emergency contraception. She has dealt with sexually active girls as young as 13.

Anti-abortion charities and family campaigners were up in arms, and McDonald's bosses themselves expressed shock, perhaps understandably, that their premises were used for such a controversial purpose.

However, both the chief executive of Gateshead's PCT and the Department of Health stood by one of their star (no pun intended) employees.

The lowdown

Any questions?

What is sexual-health nursing? Sexual-health nurses diagnose and treat sexually transmitted infections (STIs). That includes HIV testing, though in most hospitals, patients diagnosed with HIV are treated by a separate HIV outpatients department. The nurses can also provide contraception and advise people on family planning.

Is it just for women?

No. There are a lot of male nurses working in sexual health. That is another of the old taboos that has now been overcome. Most patients are comfortable with both male and female nurses.

How much does a sexual-health nurse get paid?

They are on the same pay scale as other NHS nurses. See www.nhscareers.nhs.uk

Do I have to be a nurse to work in sexual health?

No. Sexual-health clinics are run by a team of specialists, not all of whom are nurses. Many are social workers.

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