Improving the sexual health of homeless people: does providing nurse-led care within hostels improve contraceptive use and uptake of sexual health screening?
ESC Congress Library. SHAWE J. 05/28/14; 50498; A-082
Dr. JILL SHAWE
Dr. JILL SHAWE
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Abstract
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Objective


The project aimed to establish and evaluate a Nurse-led Contraception & Sexual Health Service providing care within hostels for the homeless in London.  Homelessness is a risk factor for poor health and particularly sexual ill-health.  Homeless women are more likely to become pregnant and to have sexually transmitted infections.   They often use drugs and alcohol and then need to sell sex to feed the habit.   Little is known about the sexual health of homeless men.


Design and Methods


The service was established once a week in three hostels.  Contraception and sexual health promotion, screening and treatment were offered by the Specialist nurses, health care workers and health promotion staff.


 


The project was evaluated by analysis of service and epidemiological data (Sexual & Reproductive Health Activity Dataset (SHRAD) and Sexual Health & HIV Activity Property Type Coding (SHRAPT) extracted from electronic records between 1st June 2012 and 31st May 2103 and analysed using IBM SPSS v20.   Primary outcomes were the number of people screened and treated for STIs and the number starting contraception. The project was part of a larger study which included questionnaires and interviews with residents and staff from the three hostels with the service and three hostels without a service.


 


Results


151 clients (81 women, 67 men, 3 unknown) used the service with 367 attendances. 96 (63.5%) clients had full STI screens and 31 (20.5%) had chlamydia and gonorrhoea self-taken tests.  59 infections were diagnosed and treated including 3 Syphilis, 4 Gonorrhoea and 10 Chlamydia cases.


Hepatitis testing was carried out on 63.6% (n=96) of all clients. 167 tests for Hepatitis were performed as some were tested for more than one hepatitis virus and on more than one occasion. The percentage of women tested (56.6%) was higher than that of men (43.4%).  Overall 23 % of clients tested for hepatitis A, B and or C had positive results for one or more of the viruses.


11 clients started contraception, 7 chose long acting methods including 2 IUDs, 4 implants and 1 Injection.


Conclusion


The service has demonstrated unmet need and an impact on men and women who would not normally attend mainstream services.


UK Department of Health policy suggests that homeless people require targeted, specialist services.  The service enables women & men at high risk of sexual ill-health to access appropriate care within a familiar non-threatening environment.


 

Objective


The project aimed to establish and evaluate a Nurse-led Contraception & Sexual Health Service providing care within hostels for the homeless in London.  Homelessness is a risk factor for poor health and particularly sexual ill-health.  Homeless women are more likely to become pregnant and to have sexually transmitted infections.   They often use drugs and alcohol and then need to sell sex to feed the habit.   Little is known about the sexual health of homeless men.


Design and Methods


The service was established once a week in three hostels.  Contraception and sexual health promotion, screening and treatment were offered by the Specialist nurses, health care workers and health promotion staff.


 


The project was evaluated by analysis of service and epidemiological data (Sexual & Reproductive Health Activity Dataset (SHRAD) and Sexual Health & HIV Activity Property Type Coding (SHRAPT) extracted from electronic records between 1st June 2012 and 31st May 2103 and analysed using IBM SPSS v20.   Primary outcomes were the number of people screened and treated for STIs and the number starting contraception. The project was part of a larger study which included questionnaires and interviews with residents and staff from the three hostels with the service and three hostels without a service.


 


Results


151 clients (81 women, 67 men, 3 unknown) used the service with 367 attendances. 96 (63.5%) clients had full STI screens and 31 (20.5%) had chlamydia and gonorrhoea self-taken tests.  59 infections were diagnosed and treated including 3 Syphilis, 4 Gonorrhoea and 10 Chlamydia cases.


Hepatitis testing was carried out on 63.6% (n=96) of all clients. 167 tests for Hepatitis were performed as some were tested for more than one hepatitis virus and on more than one occasion. The percentage of women tested (56.6%) was higher than that of men (43.4%).  Overall 23 % of clients tested for hepatitis A, B and or C had positive results for one or more of the viruses.


11 clients started contraception, 7 chose long acting methods including 2 IUDs, 4 implants and 1 Injection.


Conclusion


The service has demonstrated unmet need and an impact on men and women who would not normally attend mainstream services.


UK Department of Health policy suggests that homeless people require targeted, specialist services.  The service enables women & men at high risk of sexual ill-health to access appropriate care within a familiar non-threatening environment.


 

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