Challenge: How to uncover invisible men’
Take a look at the list of patients who have entered your examination room in the last five days. Are any of them young men?
If not, perhaps you may want to examine your center’s approach to attracting this underserved population. Critical gaps exist in reproductive health services for young men, particularly when it comes to sexually transmitted diseases (STD), contends Harlan Rotblatt, adolescent services director for the Los Angeles (CA) County Department of Health Services — Public Health STD Program.
"The focus of traditional reproductive health services on women has contributed to the lack of care for males, creating in turn a persistent reservoir of undetected male cases," state Rotblatt and associates in a poster presentation at the 2000 national meeting of the Washington, DC-based American Public Health Association.1 "These undetected cases increase the likelihood of both female reinfection and sequelae in males."
This problem is reflected in imbalances in STD reporting in Los Angeles County, Rotblatt notes. Males accounted for only 18% of nearly 16,000 reported chlamydia cases in 1998 in Los Angeles County among ages 10-24.
Teen-agers remain at high risk for STD infection. According to the Atlanta-based Centers for Disease Control and Prevention (CDC), teens account for a significant proportion of the 15 million STD infections in the United States.2 Forty percent of chlamydia cases are reported among young people ages 15-19.2
The opportunity to educate teens about pregnancy and STD prevention is often missed in routine physical exams, note CDC researchers. Among surveyed high school students who received a routine checkup during the previous year, only about 40% of females and 25% males had discussed the subjects with their health care provider.3
To address the challenge, the Los Angeles County STD Program hosted a summit on young men and reproductive health. It was attended by about 70 representatives from more than 40 agencies, including family planning providers, community clinics, managed care organizations, government agencies, schools, and other youth-serving agencies.
Program participants identified the following needs in enhancing male services:
• increased funding, not only for male health services, but also for the agency staff necessary to deliver them;
• more attention and support on the issue from state and local health department officials;
• assistance for community agencies in accessing existing funding sources for male clients;
• provision of early reproductive health education to boys and girls;
• the development of guidelines for conducting urine-based STD screening for male clients in various settings;
• collaborations between agencies to create community testing events.4
Since the summit, a working group of representatives from public and private agencies has met regularly to plan strategies to meet male reproductive health needs. The group is looking at these strategies:
• education of managed care organizations, traditional family planning clinics, and other health providers;
• trainings to foster STD urine screening by community agencies;
• resources to facilitate access to services and funding streams;
• promotion of positive perceptions of young men and policy advocacy.
While change is slow, more young men are accessing care, reports Julie Kirk, director of adolescent services at Westside Women’s Health Center in Santa Monica. The nonprofit community clinic sponsors a teen clinic for young men and women each Monday and Thursday. The number of male patients has grown since the clinic’s inception, she notes.
Apart from nurse practitioners and supervisors, the clinic is run by teens for teens, using the clinic’s trained peer educators. Young men can get urine screening for chlamydia and gonorrhea; blood screening for hepatitis B, HIV, and syphilis; testicular cancer checks; as well as general medical care.
A sign on the front door specifically states that the clinic is for young men and women, and a male peer educator is one of the first people viewed when patients walk in the door, says Kirk. The clinic is walk-in by design, which further reduces the stress for young men who might be hesitant to access the clinic. Word of the program is spread by the center’s regular presentations at area high schools, notes Kirk.
To further reflect its growing umbrella of services, the center is changing its name to Westside Family Health Center this summer, says Kirk.
With the advent of urine-based nucleic acid amplification tests for STDs, young men also may be reached through community outreach efforts, notes Rotblatt.
"Urine-based nucleic acid amplification tests offer new opportunities for large-scale, nonclinic-based STD screening for males; yet these opportunities remain largely unexplored," he notes.
References
1. Rotblatt H, Boudov MR, Ramirez R, et al. Invisible men: Addressing the critical need to improve reproductive health care for male youth. Presented at the 128th annual meeting of the American Public Health Association. Boston; Nov. 13, 2000.
2. Centers for Disease Control and Prevention. Most Teens Not Provided STD or Pregnancy Prevention Counseling During Checkups. Atlanta; Dec. 6, 2000.
3. Burstein GR, Lowry R, Santelli J. Sexually transmitted disease (STD) and pregnancy prevention services received by sexually experienced U.S. high school students. Presented at the National STD Prevention Conference. Milwaukee; Dec. 6, 2000.
4. Summit meeting explores gaps in services for young men. STD Examiner 1999; 4(4): accessed at Web site: http://phps.dhs.co.la.ca.us/std/news/exam/HTML%20Exam/November1999.htm#summit.
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