1. Centre for Excellence in Rural Sexual Health (CERSH) 2. Goulburn Valley Health

1. ‘Stepping beyond the city’ AIDS2014 MELBOURNE July 23rd 2014 1. Centre for Excellence in Rural Sexual Health (CERSH)2. Goulburn Valley Health Jane Tomnay1Suzanne Wallis2Kylie Stephens1

2. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Welcome to Rural Health in Australia…

3. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Background Key Concepts for rural health services • Access • Overlapping Relationships • Cultural Safety • Team Practice • Models of Rural Health Services

4. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Co-ordinated rural sexual health service provision • Strong linkages and shared responsibility between sexual health promotion action and accessible primary health services offering clinical services and access to prevention measures and related treatment. • Opportunities for alternative models of service provision, reorientation of service delivery, and health promotion can be explored that integrate sexual health services into comprehensive primary health care.

5. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Some examples: • Building clinical services: Creation of a Rural Sexual Health Nurse Practitioner position • Partnerships and Collaboration: Facilitation of the Northeast Victoria Sexual Health Network • Creating Inclusive Rural Services: How2 – building GLBTI accessible rural services • HIV prevention: Improving condom access for rural young people and wider communities

6. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Rural Sexual Health Nurse Practitioner • CERSH approached Goulburn Valley Heath (GVH) in 2010 to partner with us to create the RSHNP. • We convinced them of the need for improved access and provision of HIV & Sexual Health clinical services. • We developed a sustainable business model together. • We shared the cost of the position and service for the first 5 years. • A client centred, out reach focused rural service was the key to reaching those most at risk, who historically had the least access to specialist, confidential, affordable STI/HIV services.

7. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Education and capacity building clients & health professionals. NP works collaboratively with Physicians, and MSHC to accommodate the management of clients not clearly defined by the NPs scope of practice. Long term, follow up and management of clients exposed to persistent infections. Clients – anyone: self-referral, GP, Physician, Allied health, HCWs Drop in / out Re-referral prn Collaborative Patient-Centred Care of the Sexual Health Patient at Goulburn Valley Health NP led clinic for the management of asymptomatic clients. NP led clinic for the management of symptomatic clients. Community based NP led satellite clinics. Referral to Specialist Physicians, CASA, Allied Health, Professionals & GPs Rural Sexual Health NP Model. Capacity build service provision across the Hume Region.

8. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Partnerships and Collaboration: Facilitation of the NE Victoria Sexual Health Network • The direction and content of the network meetings are decided by the network members and negotiated at each meeting . • 3 - 4 meetings are held each year. • An average of 43 workers attended meetings during 2013. • Meetings allow collaboration, sharing of ideas, gaining collegial support and formal presentations. Topics covered in 2013: • Exploring practical approaches to planning, monitoring & evaluating Sexual Health & HIV Services & Programs.  • “Eroticising Inequality Pornography, Young People and Sexuality.” • Exploring sustainable models for delivery of pregnancy termination services in our rural region.

9. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians How2 – building GLBTI friendly rural services Active engagement with the dynamics of difference, diversity and culture • Not sufficient for existing organizational practices and processes to create a passive, or reactive response to issues of difference and diversity. • In rural communities the visible signs of diversity and difference are not always obvious and therefore services are not compelled to respond. • Small diverse population groups will have little power from which to leverage, influence, bargain or negotiate change. • Build the ‘diversity capital’ of organisations and communities - actions that can be undertaken to promote diversity, and recognition of difference with respect to the values and needs of diverse groups.

10. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians The How2 program run by Gay and Lesbian Health Victoria (GLHV) and supported by CERSH involved a series of workshops over a 12 month period to coach rural participants through the practical steps involved in enhancing GLBTI-inclusive practice in their organisation. The workshops aimed to support participants to plan, implement and evaluate changes in their service including: • Auditing the service against the Rainbow Tick Standards • Consulting consumers • Educating colleagues • Developing and implementing an action • Managing obstacles • Evaluating changes.

11. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Improving condom access for rural communities 24 hour access to condoms for rural young people is problematic and issues of privacy,2,3 lack of service provider choice, transport and cost4 are barriers. In 2010, we partnered with 3 local councils and installed 4 Condom Vending Machines (CVM) in each Municipality in highly accessible locations. The condoms were priced at $1 or $2 (AUD). Councils organised a local professional (sometimes a Nurse) to check the machines regularly, empty the $, re-stock and report the data to CERSH. In the first 9 months 80% (924 out of 1153) of condoms purchased were obtained from male toilets. Vandalism, tampering or damage occurred at all sites but did not present unsurmountable barriers. 2. Warr D. Hillier l. ‘That’s the problem with living in a small town’: privacy and sexual health issues for young rural people. Aust J Rural Health 1997; 5(3): 132–9. 3. Stewart FJ, Rosenthal DA. Rural and urban female secondary school students’ attitudes towards and use of primary care services. Aust J Rural Health 1997; 5(3):126–31. doi:10.1111/j.1440-1584.1997. 4. Quine S, Bernard D, Booth M, Kang M, Usherwood T, Alperstein G, et al. Health and access issues among Australian adolescents: a rural–urban comparison. Rural Remote Health 2003; 3(3): 245–56.

12. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Improving condom access for rural communities This success is now being replicated in other rural regions of Victoria.

13. Centre for Excellence in Rural Sexual Health: Improving the Sexual Health of Rural Victorians Thank You! Acknowledgements: • CERSH is funded by the Health Department of Victoria. • Thank you to all our partners and collaborators.