NACCHO Aboriginal Male Health News : Shame’ deters males from sexual health help

Ingkintja Male Health Congress Alice Springs

“The sexual health of men in remote Indigenous communities would likely improve if they had access to “male safe areas” in health clinics .If Indigenous men are reluctant to present to clinics because the service does not feel appropriate to them, we would argue that the health service is inequitable.

Our findings may also have implications for other important areas of men’s health, such as chronic disease of mental health management if a sex disparity in screening, testing and treatments is found in these areas

School of Health Associate Professor Suzanne Belton Charles Darwin University ” Gendered sexual health services are needed in remote communities “

“Sexual health programs need to be conducted in appropriate settings for males, and it is notable that while women may be screened opportunistically at several convenient events (Ante natal Clinic, Pap smear and breast check, while bringing kids in to the Primary Health Care Centre) there are fewer opportunities for adult males.
For adolescent males there are even less opportunities, so targeted interventions will be necessary at times. Aboriginal men occupy a range of sexualities and all should have appropriate unbiased access to primary health care including, gay males, men who have sex with men (MSM) and sister-girls (transgender)

NACCHO Blueprint for Aboriginal Male Health: Sexual and Reproductive Health (see full Blueprint below )

Photo Above : Ingkintja Male Health Congress Alice Springs

The sexual health of men in remote Indigenous communities would likely improve if they had access to “male safe areas” in health clinics or male-specific outreach services, a Charles Darwin University academic says in the May edition of an international health journal.

School of Health Associate Professor Suzanne Belton said men’s sense of shame from being seen by women while visiting a clinic was one of several factors that contributed to high rates of sexually transmitted infections in remote communities.

“Some men do not seek testing for sexually transmitted infections because they cannot see a male clinician, which is particularly important in this type of clinical encounter,” Dr Belton said.

“If Indigenous men are reluctant to present to clinics because the service does not feel appropriate to them, we would argue that the health service is inequitable.

“Until culturally and gender appropriate approaches to sexual health services are implemented, sexually transmitted infection (STI) rates in Indigenous Australians are likely to remain high.”

Dr Belton and co-authors Dr Jiunn-Yih Su and Dr Nathan Ryder posed the question “Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities” in an article published this month in Culture, Health and Sexuality.

“To our knowledge, this is the first study in Australia to investigate the reasons for disparity in STI testing rates between men and women in remote Indigenous communities,” Dr Belton said.

The study in a remote Northern Territory community confirmed a low level of health literacy among some Indigenous men.

“Culturally appropriate sexuality education and health promotion to men and boys would improve understanding of their own sexual health needs. “Men and boys require sexuality knowledge to be able to look after themselves and their sexual partners.”

Dr Belton said Indigenous men and women deserved the highest standard of health care that a country was able to provide and if men’s sexual and reproductive health remained poor this impacted on women’s and infants’ health.

NACCHO Blueprint for Aboriginal Male Health:

(this document contains an area that deals with Sexual, Reproductive Health)

NACCHO’s position paper on Aboriginal male health (2010) describes the key policy areas and programs NACCHO has documented should be developed in male health.

These include physical health, strong minds, brother care, healing and men’s business, as well as Aboriginal male health workforce development. It summarises that Aboriginal male health should be a core primary health care service provided by Aboriginal Community Controlled Health Organisations (ACCHOs). NACCHO as a cultural organisation has always supported the proper gender based approaches to health service provision, which fits within the current approaches of primary health care service quality and research and evaluation.

Aboriginal Males have a unique and important role in their communities.

All too often Aboriginal male health is approached negatively, with programs only aimed at males as perpetrators. Examples include alcohol, tobacco and other drug Services, domestic violence, prison release, and child sexual abuse programs. These programs are vital, but are essentially aimed at the effects of males behaving badly to others, not for promoting the value of males themselves as an essential and positive part of family and community life.
To address the real social and emotional needs of males in our communities, NACCHO proposes a positive approach to male health and wellbeing. We need to celebrate Aboriginal masculinities, and uphold our traditional values of respect for our laws, respect for elders, culture and traditions, responsibility as leaders and men, teachers of young males, holders of lore, providers, warriors and protectors of our families, women, old people, and children.

The NACCHO approach is to support Aboriginal males to live longer healthier lives as males for themselves. The flow-on effects will hopefully address the key effects of poor male behaviour by expecting and encouraging Aboriginal males to be what they are meant to be.
In many communities, males have established and are maintaining men’s groups, and attempting to be actively involved in developing their own solutions, to the well documented men’s health and wellbeing problems, though almost all are unfunded and lack administrative and financial support.

Health and Wellbeing
Aboriginal males have arguably the worst health outcomes of any population group in Australia.
Key health issues continue to be
•       Injury and suicide
•       Cardiovascular disease
•       Respiratory disease
•       Diabetes.
There are however, a number of male specific health issues not identified here which are poorly documented, this includes mental health and wellbeing issues.

Social determinants relating to identity culture, language and land, as well as violence, alcohol, employment and education remain significant issues.
In considering the health and wellbeing of Aboriginal males, it is important also to take into account the construction of ‘masculinity’, the relationships between Aboriginal males and females, and concepts of health which may differ from Anglo-European ways of thinking.

Integration of Aboriginal male health in targeted strategies
Male health should be identified and prioritised (as appropriate) in all health strategies developed for Aboriginal Community Controlled Health Organisations (ACCHOs) including that all relevant programs being progressed in these services will be expected to ensure Aboriginal male health is considered in the planning phase or as the program progresses.
Specialised Aboriginal male health programs and targeted interventions should be developed to address male health intervention points across the life cycle continuum.

This may include
•       Community specific adolescent programs
•       Adult male health and include men as boyfriends, schoolchildren, partners, fathers, grandfathers, and children
•       Men’s business programs should be developed as appropriate
Male (Men’s Business) camps may be the most appropriate context for group education and information sessions on specific male health issues such as sexual health and sexually transmitted infections, These camps may also be the most appropriate forum for males to develop their own responses to address domestic violence, alcohol and substance abuse as well as child sexual abuse and neglect.

Improving Access to health care


Accessibility of health services to males has been identified as an issue in numerous male health conferences and summits This includes access to Primary Health Care in all contexts, but especially the clinical services.
Wherever possible males should have access to
•       male Aboriginal Health Workers,
•       Registered Nurses,
•       GPs and male specialists as required.
Accessibility within the Primary Health Care Centre may mean restructuring clinics to accommodate male specific areas, or off-site areas, and may include specific access (back door entrance) to improve attendance and cultural gender issues. For men that work, services should investigate the potential for holding regular after hour’s clinics to accommodate their needs. This need not be onerous, and could be additional 5-6 pm clinics to be held fortnightly.

Sexual and Reproductive Health
Sexual health programs need to be conducted in appropriate settings for males, and it is notable that while women may be screened opportunistically at several convenient events (Ante natal Clinic, Pap smear and breast check, while bringing kids in to the Primary Health Care Centre) there are fewer opportunities for adult males.
For adolescent males there are even less opportunities, so targeted interventions will be necessary at times. Aboriginal men occupy a range of sexualities and all should have appropriate unbiased access to primary health care including, gay males, men who have sex with men (MSM) and sister-girls (transgender)

While there are obvious funding constraints on these innovations there is much that can be achieved within current primary health care practice as well.

Workforce
A key element in providing appropriate services for males is the development of a sufficient quantity and quality of male health workforce. This includes both Aboriginal and non-Aboriginal males in the health workforce. Every service should have accessible male clinical staff for males.  Where there are deficiencies in male health workforce, recruitment should note gaps and target male recruitment.  Male Aboriginal Health Workers should be able to have access to specialist male health training and male health career opportunities, including subspecialist status as per child health and women’s health. Any service specific male health strategy and appropriate workforce should be supported by a full time male health coordinator.

A healthier generation
Male health outcomes are affected from conception to old age and insults to the body at any time, such as chemical, physical, emotional all have an effect.
Interventions to minimise risk therefore start at preconception with the health and wellbeing of the new mother having an impact on the developing foetus. This may include nutritional status, smoking cigarettes, alcohol intake and emotional stress amongst others. Males have a role to play even at this early stage, and can assist their sons and nephews by ensuring the mother is supported and help her to minimise risks.
At each life stage there are intervention points, though some are more difficult than others. Adolescence is a significant time for young males, but also a time when they least engage with health services. Services need to target this group and each service should develop strategies with Men’s Groups to engage this population.

Conclusion
The Boomerang Method
NACCHO encourages all Aboriginal males (of all ages) to ensure that they have an Aboriginal Community Controlled Health Service where they can go regularly for their health check, for monitoring and review of ongoing health problems,  for a consultation when new problems arise, and to co-ordinate their ongoing health care. NACCHO also encourages and supports all Aboriginal males who do not have ready access to a culturally safe primary health care service which is able to address all the health needs of Aboriginal males, to take appropriate action with other Aboriginal people and their organisations to overcome these access problems.

Contact details NACCHO OCHRE DAY

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