Guidelines for condom distribution to people at higher risk of unplanned pregnancy or sexually transmitted infections

Transcription

1 Guidelines for condom distribution to people at higher risk of unplanned pregnancy or sexually transmitted infections For all professional groups and to be used across all agencies To be used with people who are at higher risk of unplanned pregnancy or sexually transmitted infections, where it is identified that condoms would be a suitable method of contraception and/or advisable for the prevention of STIs People at higher risk are currently defined as being: people aged under 25 men who have sex with men sex workers intravenous injecting drug users people from Sub-Saharan African Countries or other countries where there is a higher prevalence of HIV. This definition may change in future. Standard requirements All staff who distribute condoms will have been CRB checked and will have received training in sexual health promotion, these guidelines and processes and Safeguarding/Child Protection to Level 1 Basic Awareness. They will also have been approved by their agency to distribute condoms. It is expected that staff will use their professional judgement, working to their agency s professional standards and to their agency s policies and protocols. Staff distributing condoms must liaise with their agency s nominated Safeguarding/Child Protection Lead to ensure they are working to the latest version of the Derby & Derbyshire Safeguarding Children Boards Protocol for staff working with sexually active children and young people under the age of 18. Staff will work within their own agency s Lone Working Policy when necessary. It is expected that staff undertaking condom distribution will refer clients on or encourage clients to attend other specialist services where appropriate. Supplies for people aged 16 and over First request Client assessment, consultation and condom demonstration 1. Put the client at ease and provide reassurance to reduce any anxiety about the consultation. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 1 of 7

2 2. Explain confidentiality boundaries and legal aspects, including explaining how you are legally expected to assess Fraser competence (where appropriate see below). Use the following prompts and further questioning as necessary to assist in assessing Fraser competence before giving advice/treatment: Parent involved Yet client understands risks Assessed Competent Yes/No/Not Yet Yes/No Yes/No Explain agency s data protection requirements and in what circumstances data may be used and shared. 3. Establish why client is requesting condoms. Ensure your questions do not present an assumption of heterosexuality: Are they currently sexually active? - Are they thinking about becoming active? - Do they just want more information about sexual health? Are they in a relationship with anyone? - How long have they been in a relationship? - Have they talked about having sex? - Have they discussed contraceptive choices? (where male/female relationship) - Are they able to negotiate condom/dam use with their partner? Why do they want to have sex? - Because they think everyone else is? - Peer pressure? - Pressure from their partner? - To have a baby? Have they considered delaying/not having sex? Are they able to negotiate condom/dam use with their partner? Have they already discussed this? Have they discussed with their parents/carers or another appropriate adult issues around becoming sexually active. Complete agency client record/case notes, including recording decision on Fraser competence. Be aware of any Safeguarding issues and act according to Safeguarding protocol as necessary. 4. If sexually active, take brief sexual history risk assessment to include: G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 2 of 7

3 Gender of partners Whether unprotected sex has taken place or not What type of sex e.g. genital-genital, oral-genital, anal. Whether other risk-taking behaviours have taken place or not (e.g. alcohol/drug misuse) Assess need for EHC or pregnancy test, or refer on or encourage attendance at another appropriate service Assess need for referral for STI screening or encourage attendance at another appropriate service 5. Where appropriate, offer emergency contraception, chlamydia screening or refer on to, or encourage attendance at, other service (e.g. Contraception and Sexual Health service, alcohol/drug support service). 6. Give condom demonstration. This is compulsory on first request. If the client says they ve already had one elsewhere, let them talk you through the demonstration: Male condom BSI kite mark/ce mark. Expiry date. Storage avoid keeping in pockets, wallets and near radiators. Safe opening. Use of lubrication. Putting on a condom. What to do if condom goes on inside out Refer to loss of erection and to condom slipping off Refer to what happens if a condom splits Safe withdrawal of penis. Disposal. Varieties available and recommendation of particular type Available sizes Dams - where the client s sexual history shows these are appropriate BSI kite mark/ce mark. Expiry date. Storage avoid keeping in pockets and wallets.. Safe opening. Use of lubrication. Uses of dam oral-genital sex, as finger cot Disposal. 7. Condom/dam demonstration by client to include above. This is imperative to check that the client properly understands how to use the products. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 3 of 7

4 Following a satisfactory condom/dam demonstration by the client, you will decide whether or not to issue condoms/dams, subject to the client assessment process. Note: Female condoms are not supplied under these guidelines as the correct use of these requires specialist support. Where a client is assessed as needing a female condom, they should be referred on to the Contraception and Sexual Health service. First issue supplies Up to 5 condoms/dams and 5 sachets of lube can be given on the first issue. It is up to professional judgement to determine whether fewer or more should be given on first issue, to encourage re-attendance. Clients should be given a choice of condoms/dams at first issue to help them determine a preference (unless a preference is already expressed). Let the client choose their own condoms/dams and lube from the range available. Record the types of condom and amount taken on client record where appropriate. Complete the monitoring form where appropriate. Second and subsequent requests Use the client revisit to re-establish that it s OK to discuss sex here. Reassess Fraser competence (2. above) Revisit the process questions (3. above). Be aware of any Safeguarding issues and act according to Safeguarding protocol as necessary. Where appropriate, offer emergency contraception, chlamydia screening or refer on to, or encourage attendance at, other service (e.g. Contraception and Sexual Health service, alcohol/drug support service). Up to 20 condoms/dams in total a month may be given to each client. Let the client choose their own from the range available. Do not assume that the client will want the maximum number available. Refer to the client record, where available, to establish how many have been given out before. Professional judgement needs to be used to determine whether fewer or more should be issued. Lubrication Offer lube on the second and repeat visits some clients will want it and others will not. Do not assume either way as a preference can change with a change of partner. Have a general discussion around why the client wants lube, why they think they need it, about being ready for sex, as well as broader discussion of sexual pleasure. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 4 of 7

5 Consider referring on to Contraception and Sexual Health service or GP for further support where necessary. Complete the client record, where appropriate, on each occasion, including recording Fraser competency. Supplies for people aged 13, 14 and 15 years old To be used only in conjunction with the Derby & Derbyshire Safeguarding Children Boards Protocol for staff working with sexually active children and young people under the age of 18. First request Follow the above process for first request. Give only up to 5 condoms and sachets of lube per visit based on professional judgement and client s circumstances. Use professional judgement whether to give fewer to encourage return visits. Use professional judgement to determine whether a client under the age of 16 needs to be referred on to more specialist contraception and sexual health services, e.g. for LARC. Be aware of any Safeguarding issues and act according to Safeguarding protocol as necessary. Second and subsequent visits Follow the above process for second visit. Ask how many condoms the client would like. Where a client aged under 16 is revisiting frequently and requesting larger numbers this should trigger referral or encouragement to attend specialist services. Ask further questions using the process (3. above) on each occasion. The Contraception and Sexual Health service advises that around 20 condoms per month is an average amount. Be aware of any Safeguarding issues and act according to Safeguarding protocol as necessary. Complete the client record, where appropriate, on each occasion, including recording Fraser competency. Supplies for people aged under 13 years old To be used only in conjunction with the Derby & Derbyshire Safeguarding Children Boards Protocol for staff working with sexually active children and young people under the age of 18. First and subsequent visits Follow the above process for first request on each occasion. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 5 of 7

6 Up to 3 condoms may be given on any occasion, including a revisit. The decision rests with the individual member of staff whether to give condoms or not. Where a client under 13 is sexually active or reasonable doubt is present that sexual activity has or will be taking place, you must liaise with the nominated Safeguarding/Child Protection Lead and work to the Safeguarding protocol. Continue to provide up to three condoms on each occasion until an outcome on the Safeguarding process is agreed with the Safeguarding/Child Protection Lead (and other agencies where necessary). Complete the client record, where appropriate, on each occasion, including recording Fraser competency. Fraser Guidelines Appendix 1 A health professional can give contraceptive advice or treatment to young people under 16 (or a person of any age who is considered to be vulnerable) provided that the health professional is satisfied that the person is competent. A young (or vulnerable) person is competent to consent to contraceptive advice or treatment if: The young person understands the health professional s advice The health professional cannot persuade the young person to inform his or her parents or allow the health professional to inform the parents that he or she is seeking contraceptive advice The young person is very likely to begin to or continue having intercourse with or without contraceptive treatment. Unless he or she receives contraceptive advice or treatment the young person s physical or mental health or both are likely to suffer and The young person s best interest requires the health professional to give contraceptive advice, treatment or both without parental consent. Sexual Offences Act 2003 The Sexual Offences Act 2003 does not affect the ability of those working with young people to provide confidential advice or treatment on contraception, sexual and reproductive health to young people under 16. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 6 of 7

7 The Act states that a person is not guilty of aiding, abetting or counselling a sexual offence against a child whilst they are acting for the purposes of: Protecting a child from pregnancy or sexually transmitted infection Protecting the physical safety of a child Promoting the child s emotional well-being by the giving of advice In all cases the person must not be causing or encouraging the commission of an offence or a child s participation in it. Nor must the person be acting the for the purpose of obtaining sexual gratification. This exception in statute covers not only health professionals but anyone who acts to protect a child, for example teachers, Connexions Personal Advisors, Youth Workers, Social Care Practitioners and Parents. G33 Guidelines for condom distribution to people at higher risk - issue 3.doc Page 7 of 7