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Media reports

Data Use In Sexual Health

14 Sep, 15 | by shaworth

Last week, a London HIV clinic hit the headlines: in emailing service users en-masse with a newsletter, the service inadvertently emailed all clients, with names and email addresses visible to all recipients.

Like the majority of information security breaches, this was not the result of a clever hack. Many media outlets have reported this breach as being the result of “human error” as the email addresses were entered entering into the CC (Carbon Copy) rather the BCC (Blind Carbon Copy) field. By viewing the incident from this angle alone, copying and pasting into the wrong field is human error, but fails to understand that doing so is bad practice, and one which occurs due to lack of knowledge and understanding about information security.

Email can be a powerful tool for communication, and computerised databases allow us to handle information easily and effectively, but both can be crippled as a result of human users failing to understand the significance of information security, and designing systems and processes which rely on human involvement where there should be none.

Blind Carbon Copy, the function relied on by the clinic can be implemented in several ways, but the most common one is that where the BCC recipient sees only their own email address in this field. In certain situations, it is possible for users to see other BCC recipients. The security of the function depends on the implementation. A good security feature would be to use mail software that flags the use of the carbon copy field as potentially inappropriate for disseminating emails to many people, but this might not prevent leakage altogether.

It also wouldn’t address the fact that modern data management should avoid copying and pasting email addresses into emails meant for multiple recipients altogether. Plenty of off-the-peg systems exist that will automate the sending of emails to multiple clients as individuals. The concept of in-built mail merge is not a new one, but the function needs to exist within well-designed, working software. How many of us know who to ask to purchase secure software, or how long the approval process takes? If a user is faced with the option of copying-and-pasting, or waiting several weeks for an approved process to be arranged, corners will start to be cut.

All staff working within the NHS need to have, at least, a rudimentary understanding of the principles of information security, and the NHS needs to be able to provide training for them to do so, in addition to make the processes for keeping information security easily available. With increasing fragmentation of the NHS in England, and the cheapest provider chosen for service provision, this could become an increasingly common problem as users and support services diverge further.

Sue Capstick – Queens Nurse.

26 Mar, 15 | by shellraine, e-Media Editor

One of the first sexual health nurses in the country to be given the prestigious title of Queen’s Nurse (QN) by community nursing charity The Queen’s Nursing Institute (QNI) hails from Lancaster.

Sue C

As reported in the Lancaster Guardian, Sue Capstick is service manager for Lancashire Care NHS Foundation Trust’s Contraception and Sexual Health (CaSH) Service. Sue said:

“It was an honour to find out I had been awarded the title of a Queen’s Nurse. “The CaSH service is committed to providing excellent care to the people in Lancashire.“The team work together to continually develop new and innovative ways to ensure people receive the highest quality of care. I am proud to be part of such a dedicated and compassionate team and look forward to continuing to improve the sexual health for people in the future.”

A Queen’s Nurse is someone who is committed to high standards of practice and patient-centred care and Sue’s career demonstrates her dedication to the field of sexual health nursing.

She began her nursing career in 1980 and has worked as a sexual health nurse for over 30 years. In that time she has worked in Africa developing sexual health and HIV programmes as well as being a member of a sexual health nursing advisory panel at the Department of Health, developing the competencies required to work in this specialty.

For the past few years Sue has been leading a piece of work in Blackburn which is focused on providing information to women about the various contraception methods available to make informed choices and as a result avoid unwanted pregnancies. The title is not an award for past service, but indicates a commitment to high standards of patient care, learning and leadership.

Nurses who hold the title benefit from developmental workshops, bursaries, networking opportunities, and a shared professional identity.

Sue is the third member of staff at the Trust to be awarded the title . A ceremony will be held later this year in London for the Queen’s Nurses to be presented with their awards.

Many, many congratulations for a well-deserved award.

I’m Positive: The Game

12 Jan, 15 | by shaworth

I’m Positive: The Game is a text-based adventure game that won the CDC sponsored US Games for Health jam in 2014. Developed by a team of four, with a further medical advisor team, you play as Tim, a young man who receives a life-changing phone call from his ex-girlfriend informing him of her newly diagnosed HIV positive status. The game is available for Windows, Mac OS and Linus. Mobile versions for Android and iPhone are due later in the year. It cannot be played online at present and must be downloaded.

The game aims to mimic the real-life dilemmas and choices faced by Americans who find themselves facing the possibility of an HIV positive diagnosis: can they afford to get tested? What if they do not have insurance? It also allows the opportunity to discuss the misconceptions about HIV address concerns about treatment.

The game’s outcome depends on the choices you make during the game: you can be obnoxious to the ex-girlfriend, and choose to ignore her advice to get tested, which results in you eventually collapsing, contracting pneumonia and dying a year later, or get a test which results in you being given the HIV positive diagnosis. It transpires during the clinic appointment and subsequent interactions with your family that today is your birthday and you have the choice of telling your family during the celebrations about your HIV diagnosis, or not.

Whilst the dialogue of the game can be somewhat awkward, particularly in the clinical part of the game, where it doesn’t reflect how most of us would structure a consultation where we break bad news, and crams a lot of information into a very short consultation, the interactions you have with your ex-girlfriend and family feel similar to that which could happen in reality. This likely reflects the games primary aim as a health education tool, rather than a form of artistic expression, which is unfortunate, as it’s not making full use of the medium.

In style, the game reflects early DOS games, likely playing to the nostalgia of the thirty-something generation, but whether this resonates with younger users remains to be seen as the CDC are not evaluating the success of the game until later this year. It’s possible that those not viewing the game with the tint of nostalgia will find the high contrast, occasionally lurid backgrounds and jarringly cheery electronic background music off-putting, which would be unfortunate. It’s possible to produce low-resolution graphic games which manage to express the artistic and educational aspects of the game successfully, such as Unmanned, a game produced to show the dehumanising monotony of drone warfare, without needing to co-opt retro clichés.

Ultimately, the game is an interesting way of communicating the emotional challenges faced by a positive diagnosis, and explores some of the difficult decisions which need to be made as a result. Whether it proves to be of value will ultimately depend on user feedback, but whilst this may not be perfect, it’s certainly opening up a new angle in health education.

Google, Sex and Censorship

5 Jan, 15 | by shaworth

Men Only Tayside is a sexual health partnership which has developed beween NHS Tayside Sexual Health and Tayside’s Blood-Bourne Virus Managed Care Network which aims to provide unbiased information and sexual health services for men who have sex with men (MSM) and men who have sex with women and men (MSWM) in the Tayside area of Scotland. Recently, they have been the focus of media attention after developing an app, in conjunction with local firm Faff Digital, to support the information on their website.

The Men Only Tayside (MOT) app was accepted by Apple to the Apple Store with the caveat of a mature (17+) rating, but was rejected outright by Google Play, the main provider of apps to the Android market. Reported in the Dundee Courier, Google’s response to the developer John-Paul Thain, was that the app violated their stance on gratuitous sexual content, in essence equating it with pornography. The rejection was appealed, and again turned down.

Looking over their website, the information is succinct and well-presented. They provide information on their campaigns, volunteering opportunities, how to obtain free condoms and sexual health testing in addition to providing a wealth of unbiased information on common sexual behaviours and how to stay as safe as possible if you choose to experience them. It also includes information on HIV diagnosis, local support and legal information.

If it was aiming to provide arousing erotica, then I’m sorry to say that it fails miserably. The MOT app’s content presumably mirrors that of their website, where the nudity on display is a single male nipple (as an android user, your humble blogger is unable to review the app itself…).

The app’s developer believes that part of the problem is Google’s automated app assessment system, which seems to equate any kind of sexual content as being pornographic. As Google is essentially the gatekeeper for Android users to legally download apps, their prudish filtering essentially denies those users access to high-quality, impartial sexual health advice. Whilst it may have legal obligations to prevent the supply of pornographic material to minors, does it also not have a duty of care to those who are legally entitled to engage in sexual behaviours. In the UK, there is no divison between the legal age of consent for men who have sex with men versus those who have sex with women. This age is 16, and Apple’s maturity setting already puts this app out of reach of young men who can engage legally engage in sex with other young men.

The app’s problem relates to the idea of net neutrality, and whether Google has a public duty to allow this information to enter the public domain. Google is not a public body, it’s a corporation in the same way that Facebook, Apple and Twitter are, which means that it essentially retains the right to decide whether it supports certain information provision or not, regardless of whether or not users have a legal right to access this information. Should this be the case? Does Google occupy the same position as a restaurant where a woman wishes to breastfeed? In UK law, this may be the physical property of a company, but has been deemed a public place, and as such, a company is unable to prevent the woman from feeding the infant, regardless of nipple visibility.

Google’s policy, automated and dictatorial, is not a good one. Apple’s confusion between health advice and erotica isn’t either. The problem of private companies acting as gatekeepers of cultural morality is not a new one. Walmart, a supermarket chain in the United States (and who control ASDA in the UK) have a longstanding policy of refusing to stock music which has been labelled with the “parental advisory” sticker indicating explicit content. With their large stake in the market, this puts pressure on artists to avoid lyrics that are controversial, ultimately acting as indirect artistic censorship. Ultimately, our confusion between private company and public body is not good either, and perhaps it’s time for us to start questioning our own stance on the matter.

The Three Ghosts of Child Protection

9 Oct, 14 | by shaworth

It’s been a depressing time for child protection in the UK recently. Admittedly, child protection work rarely hits the headlines for the right reasons, as confidentiality restricts the pronouncement of victory, and the media rarely gets excited about restoring safety and normality. The prevention of bad outcomes doesn’t make for headlines that sell newspapers in the same way that terrible events do.

This year, historical accusations of abuse have been a recurring feature in the news, sometimes too late for justice to be served, but sometimes with successful convictions against perpetrators who probably thought they had gotten away with it. Many of us felt that the public figures involved in these crimes were people that we could trust, and feel a sense of revulsion that we innocently did so. At the same time, it is some comfort to see that fame is no protection from justice.

Unfortunately, the same cannot be said for the widespread sexual abuse of vulnerable children in Rotherham, which has garnered widespread media attention, sometimes for the wrong reasons, with several media outlets quick to place the blame on the race of the perpetrators, and ignoring the police inefficiency at following up complaints. Perhaps what’s most worrying are the disturbing reports of attempts to silence those who spoke up to report the abuse, and the repeated instances of incompetence such as losing or destroying evidence.

Earlier this month, the Liberal Democrat leader Nick Clegg announced new legislation that will make a failure to report child abuse a crime. The motion was originally tabled by the Prime Minster in July, and takes the form of an amendment to the Series Crimes Act, which is currently sponsored by the Bishop of Durham and Baroness Walmesly. Concerns have been raised that this may result in malicious or nuisance reports, but where similar legislation has been enacted abroad, the proportion of reports deemed to be nuisance, has not been shown to have increased.

For those of us who work with vulnerable children and adolescents, the knowledge that our attempts to keep children safe, and bring justice to those who seek to harm them are being undermined elsewhere is disheartening in the extreme. We as medical professionals can only so much to collect evidence and share with external agencies, in the hope that due processes will be followed.

We can but hope that an increased media focus on child protection issues will encourage the government to fund social work and charitable organisations which work to safeguard children, but for all the talk of Big Society, the lack of cohesion between voluntary sector organisations and local authorities has been thrown into sharp relief by the publication of the Centre for Social Justice’s Report “Enough Is Enough” earlier this year, which worked with the charity Kids Company to detail instances of failure to act by local authorities where the charity had voiced concerns.

In Ofsted’s 2013 social care report, the cost of looked after children had increased by £173 million pounds, and at the same time, funding for social work had decreased by a quarter over the last four years, with an overall 4% decrease in social worker psoters. Whilst local authorities with difficulties achieving good quality safeguarding services for children have complex problems underneath, a lack of funding is a chronic drain on any social work budget.

In the last month, in an attempt to rectify child protection serves which had been found to be inadequate, Doncaster has removed child services from the local authority, instead setting up a third party, not-for-profit organisation to manage services instead. Obviously, this had raised accusations of stealth attempts at privatisation; although the company will continued to be funded by the local authority. This is not the first attempt to manage childrens’ services in this way, and results from previous similar initiatives have been mixed, largely blamed on chronic budget cuts.

Ultimately, children are safer now than previously, and it’s a testament to the hard work of those in child protection that this is the case; however, we cannot continue to make gains in this area unless we are willing to priorities support for the most vulnerable who need our help.

Marie Stopes International launches “Time to Act: Achieving a world where no woman dies from unsafe abortion”

25 Sep, 14 | by shellraine, e-Media Editor

Ahead of World Contraception Day (September 26th) Marie Stopes International (MSI) is launching Time to Act: Achieving a world where no woman dies from unsafe abortion to coincide with the UNGA’s deliberations on the 1994 Cairo agenda and the post-2015 goals.  A copy of the report is available here: http://www.makewomenmatter.org/timetoact.

Part of MSI’s Make Women Matter campaign, the report brings to light the damage being caused by the unmet need for contraception and unsafe abortions and warns how much worse the situation is yet to become as the developing world faces its biggest population growth in history.

FGM Awareness

24 Sep, 14 | by shaworth

Female Genital Mutilation has come to the forefront of media attention this summer, with the government allocating a quarter of a million pounds of funding towards the eradication of the practice earlier this year. and readers of the Journal have probably noticed an increasing focus on this issue. Last week Yvette Cooper, the shadow home secretary, as part of an interview with the House magazine, outlined proposals to detain girls at risk of being removed from the UK for the purpose of FGM being performed. These measures are similar to those outlined previously in the 2007 Forced Marriage Act.

As part of the push against the practice of FGM in the UK, the UK Border Agency is being supported by officers with specialist child protection training, who are attempting to identify those at risk on both exiting and entering the UK. This year, whilst the team has been deployed at Gatwick, 30 cases have been identified compared with none previously.

In support of the move, the UK Muslim Council issued a statement earlier this year condemning the practice as being against the principles of Islam, an important move considering that religious reasons are often cited as being part of the rationale of continuing the practice. Meanwhile in Kenya, there seems to have been some progress at reducing the incidence of the practice with several cases coming to court prosecuting those who perform FGM, with increased sentencing against fatalities.

At the moment, there are UK Government interim guidelines for professionals with regard to FGM which were issued in July of this year and due to be updated in November. Readers may also be interested in the work of the Orchid Project, a charity in the UK dedicated to assisting the eradication of the practice.

Young People And Their Experiences of Anal Sex

21 Aug, 14 | by shaworth

Readers of the Journal may have come across the recent study into teenage attitudes towards anal sex in heterosexual couples by the London School of Hygiene and Tropical Medicine, published last month via their Online First initiative already, but if you’ve not, it makes interesting reading for anyone working in young people’s sexual health.

Existing data suggests that anal sex between heterosexual couples is on the rise, and often increased access to pornographic materials in the digital age is cited as the reason behind this; although the evidence to suggest this is limited. Recent data, according to this study, suggests that 1 in 5 young people has tried anal sex.

The study took place in three centres in England, surveying 130 young people in total with various levels of interviews. Questions involved their perceptions of their own experiences, their partner’s experience and their reasons for trying anal intercourse. The answers seem to confirm some of the previous hypotheses, but with pornographic material being a small factor in why young people explored the idea of anal intercourse; although the belief that anal intercourse would be more pleasurable for the male partner due to a linked believe that “tightness” was integral to male sexual pleasure during penetrative intercourse, and encouragement from peers to try anal intercourse as part of a sexual conquest, were also prevalent attitudes amongst male interviewees.

Perhaps what’s most worrying is the evidence that some men felt that they had a right to coerce partners into trying anal intercourse, despite holding the belief that female partners would find anal sex painful. To those of us interested in the wider climate of sexual equality and sexual behaviour, this isn’t a shocking finding. The idea that some men feel entitled to sexual favours from women, and how this defines their behaviour and attitudes towards them, has been a centrepoint of modern feminist debate in recent years.

The study is of value to those working in sexual health, particularly with young people. It highlights that young people are unaware of the risks to their sexual health with regard to anal intercourse, and suggests that targeted interventions to improve condom use and safe anal intercourse is needed in this group. It also suggests that the worrying disparity between male and female experiences of anal intercourse needs to be addressed, perhaps through initiatives that empower young women to control their own sexual experience, and perhaps through initiatives that educate young men on how to achieve sexual pleasure for their partner as well as themselves.

Sexual Health Organisations Put Pressure On Politicians Before Polls

18 May, 14 | by shaworth

England goes to the polls for its local elections on May 22nd, and leading sexual health bodies are challenging politicians to commit to investing in Sexual and Reproductive Health. The combination of BASHH, BHIVA, Brook, FRSH, FPA, MEDFASH, Terrence Higgins, the National AIDS trust, and the National HIV Nurses Association issued a joint statement:

“Sexual and reproductive health and HIV is an important issue for the whole electorate. In February 2013, the Department of Health published a Framework for Sexual Health Improvement in England which set out a series of ambitions that, if achieved, would ensure everyone has the information, support and services they need to lead healthy lives.”

“We call on all those standing for election to provide leadership to achieve these ambitions and to commit to support investment in sexual and reproductive health, including access to all forms of contraception, HIV prevention and testing, and support services.”

Readers will remember that sexual health services in NHS England went out to tender earlier this year. Local services may wish to address their potential representatives about these issues in hustings, or to contact them during free communication sessions locally regarding their commitment to sexual health provision.

New Guidance For Young People At Risk

3 Apr, 14 | by shaworth

A joint document designed to help healthcare professionals identify young children who may be at risk of sexual exploitation has been launched today. The project, Spotting The Signs, was funded by the Department of Health and produced by BASHH (the lead professional representative body for those managing STIs and HIV in the UK) and Brook (a charity which provides sexual health services for young people) . The document is a pro-forma, aimed at those working in sexual health services and is designed to be used within existing social and sexual health history frameworks, supporting professionals to engage young people in conversations about their risk of sexual exploitations.

Based on current research and evidence, the document assists professionals in indentifying circumstances and behaviours which be concerning, and reminds us about the dangers of assumptions based on the stereotypes we hold of certain social groups and cultures. The project was developed through consultations with young people.

The proforma was written by Dr Karen Rogstad of BASHH and Georgia Johnston of Brook. Dr Karen Rogstad is a  Consultant in HIV and Sexual Health at Sheffield Teaching Hospitals NHS Foundation Trust, and previously chair of the BASHH Adolescent Special Interest Group “This is the first national proforma to be developed which covers all sexual health providers working with young people, and that has been developed with young people’s input. It is particularly valuable because of the range of services that have evaluated it, including General Practice, and its endorsement by a wide range of organisations.  I hope it will help in identifying those young people who are being exploited as well as those who may be at risk in the future.”

Spotting the Signs is available to download from Brook and BASHH’s websites. It can be used alongside existing Brook guidance documents such as the traffic light toolkit which helps identify behaviours which may be cause for concern.

 


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