Australia has been experiencing increased rates of sexually transmissible infections (STIs) over the past ten years as a direct result of unsafe sex practises (ABS- Australian Social Trends, Jun 2012). These infections are some of the most common illnesses worldwide affecting the health and wellbeing of people infected, particularily women in regards to their fertility (Gerbase, Rowley, heymann et, al 1998). Northern Territory Health (2008) along with the other Australian states have identified that the age group at being most at risk of contracting sexually transmitted infections is people aged between 15 and 29.
This paper will establish whether a positive change and attitude in sexual health has been achieved and if the strategies endorsed in the program were effective in achieving these goals. It will also review whether improvements could be made. It will address the relevance of targeting young adults and adolescents and whether or not the program was justified by looking at current knowledge, awareness, beliefs and attitudes towards safe sex and health benefits.
The Ottawa Charter defines health promotion as ‘the process of enabling people to increase control over, and improve their health’ (Talbot & Verrinder 2010 pp. 265). The Charter for has ‘five action areas’ that offer guidance when implementing and developing strategies. This paper will also investigate and discuss the level of guidance the program adopted from these guidelines in its strategies to improve sexual health.
The Australian Government (2005) had identified the need for education and prevention programs as being essential intervention tools in the fight to reduce the spread of STIs amongst the 15 to 29 year old age group. The New South Wales Government lead a very successful “Safe Sex, No Regrets” campaign that was adopted by both the Western Australia and Northern Territory Governments to combat this growing health issue across the country. The strategies are focussed at educating the groups identified as being more at risk of infection rather than the entire population.
Due to Australia experiencing epidemic levels of sexually transmissible infections with an estimated one in twenty people becoming infected, the Northern Territory Government attempted to adopt the very successful “safe sex, no regrets” campaign from the NSW program focusing on increased use of condoms and lube by younger, sexually active people and to encouraged them to get a sexual health check if they are sexually active and finally, keep them informed on how easy it is to get tested and be treated. It was essential that the campaign target the 15 to 29 year age group for sexual health.
Due to rising rates of Chlamydia and other sexually transmittible infections (NSW Department of Health 2006) it is important for public health to prioritise prevention strategies. Prior to the campaigns, Stancombe Research & Planning (2009) discovered that the key motivator to condom use for those that used one was for pregnancy avoidance and not as a preventative measure to reduce the risk of contracting a sexually transmittible infection. The key aim of the safe sex, no regrets campaign was to bring about a reduction in the prevalence of STIs by encouraging behavioural changes to reduce sexual risk.
This was to be achieved through the promotion of preventative behaviours (use of condoms) information on testing and bringing STIs and the related health issues that these infections cause, to everybody’s attention. Most people with sexually transmitted infection are asymptomatic. (Chen et al 2011) argues that STIs are a major health concern and that intervention such as health education to promote safe sex by increased use and access of condoms would contribute to the elimination of STIs.
He further argues that early detection and treatment are a crucial strategy in the control of STIs because of the effect it has on breaking the chain of infection. The Australian Government recognises the importance of this by establishing interventions such as the safe sex campaign. The National Notifiable Diseases Surveillance System (2010) received reports that the predominant sexually transmissible infections during 2010 were Chlamydia and syphilis. It has been established that the 15 to 29 year age group have the highest rates of infection and this is continually increasing (Wilkins & Mak 2005).
Research carried out by Stancombe Research & Planning (2008) have confirmed that people falling into this age group not only show higher rates of infection of STIs but also have limited knowledge of correct safe sex practice. These findings brought to the forefront that the awareness of STIs was extremely low, particularly amongst the younger population bringing to attention that education about the harm associated with STIs was and is crucial, along with informed structural strategies that help reduce the risks, if changing beliefs and attitudes in regards to improved sexual health are to be achieved.
Undiagnosed and untreated sexually transmissible infections (STIs) have negative health outcomes for both individuals involved and the community (Strobel & Ward 2012). Higher costs to medical services are a direct result from complications such as infertility, pelvic inflammatory disease and cervical cancer caused by STIs. Risks need to be brought to the wider communities attention and messages that STIs contribute to the ‘mortality statistics through deaths associated with AIDS, liver cancer, anogenital cancers, miscarriage and still births’ (NSW STI Strategy Environmental Scan: 2006 – 2009. p9) must be emphasised.
According to the Australian Government (2010), research indicates that eight out of ten cases diagnosed with a STI are in people aged between 15 and 29 years. The Australian Government believes that low awareness about the dangers of STIs and the misconceptions of what safe sex is; there is more to “safe sex” than avoiding pregnancy and a general lack of knowledge in regards to infections are asymptomatic contributing elements to these increases. The Government is aware that regular tests for infection are crucial in the control and the community needs to be enlightened through campaigns such as the safe sex promotion.
Reports of STIs amongst this age group is a worldwide issue and other research shows in addition to the above markers, that the increase is also contributed to significant barriers this group have to accessing condoms and previous access to sexual health services. The success of a health campaign can be assessed based on how effectively it uses the principles suggested by the Ottawa Charter for Health Promotion and to take all the variables into account such as behaviours and attitudes.
Individuals’ beliefs dictate these behaviours and if attitude and behaviour towards sexual health is to be changed, personal and community beliefs need to change. The Government had recognised that behavioural changes within the 15 to 29 year old population were required. Funding was provided in order to promote sexual health awareness campaigns in the attempt to promote change. The Government has envisioned that the behavioural changes would be achieved by reducing sexual risk taking through promoting preventative behaviours and preventive measures by encouraging regular testing and providing the education and promotion of condom use.
Structural interventions such as easy access to condoms are a crucial element in preventing sexually transmitted infections (Cohen 2009). The safe sex no regrets campaign has adopted this strategy to some extent by encouraging the employment of condoms by standardising safe sexual activity and providing access to sexual health services as an attempt to reduce the high spreading rates of Chlamydia and other sexually transmissible infections. This indicates that the safe sex campaign understood that health will be influenced by the environment.
Strategies used to send the message to the target population involved posters, pamphlets, television and a website (NSW STI Strategy Environmental Scan: 2006 – 2009). After review it was discovered that the television was not relevant to the target population so the message was not reaching the audience and that part of the campaign dropped. Prevention and reduction of the spread of STIs cannot be accomplished unless strategies address the influences (Shaw et al 2011). Shaw (2011) identifies risk of transmission, number of partners and length of infection as the key influences in the spread.
Sexual health promotion should adopt strategies in accordance with the Ottawa Charter framework. In order for effective health promotion to be achieved, the Ottawa Charter for Health Promotion advocates that the following five action areas are essential as part of the framework: developing personal skills, creating supportive environments, strengthening community action, reorienting health services and finally, building healthy public policies (Talbot & Verrinder. 2010).
The strategies that the Northern Territory safe sex no regrets campaign used to address these factors included a focus on promoting condom usage and lube, promoting behaviour change that reduces the risk of STI transmission, promoting both treatment, and ensuring that access to clinical services are available (NSW Department of Health 2006). Long-term changes in health outcomes do not eventuate on isolated single strategies. To be effective in bringing about health outcomes, all five strategies; action areas as defined by Ottawa Charter Health Promotion need to be addressed.
The safe sex campaign acknowledged that barriers to practicing safe sex needed to remove in order to promote healthy public policy. Advocacy was adopted to reduce these barriers by increasing awareness. The predicted outcome was to encourage cultural changes that would impact knowledge, beliefs and attitudes surrounding safe sex among groups of young people. The Northern Territory Department of Health and Families (2008) have acknowledged that they are unsure if changes in sexual behaviour since running the campaign have been uccessful.
The Western Australia AIDS council has used a similar campaign in the past which was successful in behavioural change through use of websites (Australian Government. 2005). It is essential for further advertising and continual messages are implemented if changes in behaviour are to be successful. The Safe Sex campaign was able to provide a supportive environment by understanding that stigma and discrimination associated with STIs do not have a place in society.
Social marketing campaigns were adopted to highlight STIs on the public agenda and normalise safe sex as a strategy to reduce stigmatisation and to encourage open and honest discussion of sexual health and an overall awareness of the significant health effects caused. There has been solid support to indicate that the campaign had been successful in normalising STI checks but discrepancies exist as to whether the campaign was actually relevant to NT viewers.
The campaign has recognised ‘that building supportive environments and developing healthy public policy is a shared responsibility between government, non-government organisations and communities’ (NSW Department of Health 2006). In order to achieve better health, community action is important in ‘setting priorities, making decisions and planning strategies (Talbot and Verrinder 2010, pp. 267). As part of recommendations to improve future campaigns, the Department will continue to collaborate with stakeholders and relevant agencies.
The Northern Territory Department of Health and Families (2008) understands the importance of improving health outcomes by agreeing for future campaigns, young people assist with shaping them. It also acknowledges that future campaigns be supported through involving communities, briefings and liaisons to discuss core messages. It is important that people are able to control their own health outcomes which can be achieved through the development of personal skills which has been identified by the Ottawa Charter as an important factor in health promotion (Talbot & Verrinder 2010).
The campaign was able to empower people by ensuring that they have access to appropriate information and normalise safe sex which enabled young people to resist coercion into sexual activity. It was unfortunate however, that the campaign was not as strong as it could have been by not reaching Australia’s Indigenous communities. The delivery of effective health services relies on the re-orientation of health services. The NT Government is committed to ‘strengthening the integration of sexual health into primary health care ervice provision, particularly in general practice.
This Strategy also emphasises the importance of partnerships between publicly funded sexual health clinics and general practice’ (NSW STI Strategy Environmental Scan: 2006 – 2009 p7). This campaign was not as successful as other similar campaigns despite its adaption from them. Elements such as misunderstandings between agencies as far as who was collecting data. Furthermore, schools failing to nominate people to initiate school supported messages via screen savers saw that part of the campaign fail.
This has been acknowledged and future campaigns will need to improve data collection so that the effectiveness of the campaign can be evaluated (The Northern Territory Department of Health and Families, 2008). The campaign would have been greatly improved if the messages had reached the indigenous communities. It has been argued that the messages could have been stronger, given the fact that the Northern Territory has the highest incidences of STIs.
The prevention of STIs is an important public health priority due to evidence that rising rates of Chlamydia and other sexually transmittible infections continue (NSW Department of Health 2006). With the right support from government, non-government organisations, and local communities successful programs can be achieved. The Northern Territory Department of Health and Families (2008), admit that the campaign has not had a substantial effect in increasing condom use amongst the target group but has had a number of influences on the way respondents thought about sex in regards to condoms (Woolcott Research 2010).
The campaign was successful in encouraging people to get tested for STIs; this is verified by significant increase of Chlamydia cases reported since the campaign. Managing STIs must continue and can be achieved by using policies focused on behavioural changing strategies, such as encouraging and normalising condom use, as well as ensuring that access to services that treat and test are available should help to achieve this.
It was unfortunate that this campaign was not as effective amongst the indigenous communities because it was too mainstream-Anglo orientated. The department has acknowledged that if the message is to reach Aboriginal and Torres Straight Islanders, future sexual health promotion must consider culturally appropriate messages specifically targeted to them and other social campaigning methods.
January 9, 2018
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