Culturally and linguistically diverse people
Fatemah - 28-year-old who identifies as female (she/her) who has migrated to Australia. Fatemah is married to Milad who identifies as male (he/him). She is attending her routine antenatal screening at 28 weeks. Milad is present during the consult. The pregnancy management has been straightforward to date, and her anatomy scan was normal. You offer Fatemeh a Syphilis test as part of her routine antenatal care.
Clinical indicator
- Young person (< 30 years old).
- Culturally and linguistically diverse people
- Pregnancy
Key learnings and take away
- Normalising – Normalising that syphilis screening is routine in pregnancy.
- English as a second language – Acknowledging that English is Fatemah’s second language and ensuring an interpreter was offered. Although Fatemah’s husband is present who might have sufficient English it is inappropriate to use family members to interpret.
- Role of assumptions – Not just assuming because Fatemah is there with her husband, she doesn’t need to be offered the test. Just because someone is there with their regular partner does not mean they aren't at risk.
Disclaimer
The purpose of this video is to model communication. For testing and treatment advice refer to the Australian STI Management Guidelines for Use in Primary Care and local guidelines.
Abebe - an international student from Ethiopia, 24-year-old who identifies as male (he/him/they) and has been sexually active for the last five years. Abebe’s appointment is by telehealth. About three months ago, he started exploring his sexuality and has had sex with a few male partners (if asked for more detail – 4/5 partners, both insertive and receptive anal and oral sex, infrequent condom use). Abebe is feeling confused and uncertain about his sexuality and would never have felt comfortable exploring it further while living with his parents in Ethiopia. He is worried about anyone in his family finding out, particularly his father. Abebe has no significant medical history but has been feeling a little anxious lately. Abebe has never smoked cigarettes but has been experimenting with some recreational drugs since coming to Australia. He drinks alcohol with friends on weekends (4-5 drinks per occasion) and has tried some MDMA. These occasions are also when he started to experiment having sex with men. Harm reduction education is provided regarding drug use and linked into community organisation for ongoing support.
Clinical indicator
- Young person (< 30 years old).
- Culturally and linguistically diverse people
- MSM
- People who use drugs
Key learnings and take away
- English as a second language - Despite Abebe appearing he could understand and speak English quite confidently from the start of the consult the clinician still confirmed the need for an interpreter.
- Role of assumptions – This consult is a very comprehensive and detailed consult in terms of addressing any of Abebe’s assumptions about HIV, STIs and risks associated with condomless sex. This also assisted in the clinician in ascertaining all information required to perform a comprehensive sexual history.
Scenario_9_v2.mp4 from ASHM on Vimeo.
Junior - 37-year-old who identifies as male (he/him) who three years ago immigrated from Africa to the Northern Territory. He attends the sexual health centre for a routine STI screen. Junior regularly attends the clinic given he is a sex worker. Junior has sex with both male and female (including people with a penis and vagina) partners for work and uses condoms most of the time. Recently a rash has appeared on Junior’s penis. Junior has been searching the internet regarding his symptoms and signs. You address the misinformation from online platforms.
Clinical indicator
- Culturally and linguistically diverse people
- Syphilis Outbreak region
- Sex worker
- MSM
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions to determine what tests need to be performed. Although Francisco is a regular patient and had previous sexual health check-ups this is still important.
- Normalising – The role of the internet when searching for answers related to health but also the way in which the internet may reinforce anxiety related to health concerns.
- Role of assumptions – Without the right questioning and making assumptions that Junior might not have sexual contact outside work a full understanding regarding his risk profile might not be obtained.