Young People Want Better Sexual Health Care

Sexual health care providers in B.C. need to switch things up to improve care for young people aged 15 to 29, according to a new report.

The report was produced by Options for Sexual Health and the University of British Columbia, with funding from the Canadian Institutes of Health Research. Researchers spoke with 91 young people and 47 sexual health-care providers and focused on rural, remote and underserved communities.

Over the last decade B.C. has made some big strides towards improving services for sexual and reproductive health, including introducing mail-order cancer screening, making medication for abortion more widely available, making all contraceptives free and able to be prescribed by a pharmacist, and introducing GetCheckedOnline, which allows people to access screening for sexually transmitted infections without providing their ID.

Still, rates of sexually transmitted infections, sexual violence, unplanned pregnancies and early-age parenting remain disproportionately high in rural, remote and mixed urban-rural settings and equity-deserving communities, the report said.

Young people today do not know more about sexual health than their peers did 10 or 20 years ago, Rachel Bergen, who led the report as sexual health evaluation project lead at UBC, told The Tyee.

And while sex education in schools is provincially mandated, it remains spotty or even non-existent, often centred on heterosexual relationships and focused on fear and stigma, the report said.

Young people also reported not knowing what services were available or how to access clinics, especially in small towns where privacy and transportation are a challenge.

Access to the wealth of information on the internet also isn’t as helpful as it may seem: young people are unsure about what online sources to trust.

“Youth spoke a lot about being overwhelmed by information and how hard it can be to find reliable information,” Bergen said.

“We heard a lot about misinformation and scary stories and anecdotes that you might see on social media that warp youth’s perspectives on sexual health.”

That’s a problem because sexual and reproductive health are a fundamental part of well-being — especially for young people, for their development and life trajectories, she added.

Sexual health care can include information; education; contraception; STI prevention, screening and treatment; cancer screening; abortion care; and pregnancy care.

To figure out how to better serve this young demographic, researchers spoke with young people and sexual health providers in Fernie, Vernon, Whistler, Maple Ridge, the Comox Valley, Salt Spring Island, the Clayoquot Sound region and newcomer communities in the Lower Mainland.

Bring the services to where young people already spend time

The main takeaway from the report is that young people want safe, inclusive and youth-centred sexual health care, with providers who understand their lived experiences, take time to build relationships, and create spaces that feel culturally safe, inclusive and designed around the needs of young people.

It could be possible to provide that by slightly shifting how already existing services are delivered, Bergen said.

For example, bringing sexual health services to youth spaces such as schools or youth centres makes them more accessible.

This is already happening in the Comox Valley on Vancouver Island, where public health nurses visit high schools and Foundry youth clinics once a week for a couple of hours, she said.

So long as a patient doesn’t need an exam and is not symptomatic, sexual health-care providers can meet them anywhere, said Nicole Pasquino, a registered nurse, Options for Sexual Health’s clinical director and a contributor to the project.

Pop-up clinics can support patient confidentiality, which can be difficult in small towns if, for example, the only pharmacist in town is your friend’s mom, Pasquino said.

It’s also important to know that what a patient tells a doctor or sexual health-care provider is always confidential, she said.

In B.C. there is no age of requirement where patients can suddenly consent to care. Instead, it is up to the health-care provider to establish that their patient has the emotional and decision-making capacity to consent to care.

“A 13-year-old doesn’t need their parent’s permission to access sexual health care if we can determine that they can provide informed consent,” Pasquino said.

Patients are not required to speak with their parents about care but are encouraged to, she added.

It’s also important for the patient to feel comfortable with their provider, and for the provider to be comfortable providing sexual health care. Not all doctors will feel comfortable talking about sex, which is why accessible sexual health services are important, especially in small communities.

Not all teachers are comfortable talking about sex either. Sex ed is fragmented in B.C. because teachers don’t receive training in their pre-service education, Pasquino said.

A key finding of the report was that young people “overwhelmingly” emphasized they’d prefer to be taught sex ed by an external specialized sexual health educator, who can provide age-appropriate lessons in an inclusive and destigmatizing way, she said.

Options for Sexual Health has sexual health educators who have contracts with some school districts and also runs a sexual health educator certificate program. The sex ed Options teaches is highly tailored to the age appropriateness and developmental needs of students in B.C., Pasquino added.

But whether or not schools have external, specialized sexual health educators is dependent on what districts choose to fund.

The report also highlighted that young people want community outreach, inclusive and welcoming spaces and one-stop-shop supports, such as primary care, mental health care and sexual health care being offered at the same place.

The study’s findings will be used in two pilot projects at two locations this fall where sexual health care is provided in multi-use spaces as opposed to clinical spaces.

The two locations will be announced in September.