Determinants of Health in Relation to Sexually Transmitted Infections in Young People under 35

Introduction
        Young people and adolescent sexual health is a significant issue in today’s Australian society due to the increased sexually transmitted infections (STI) notification rates and limited education on safe sex/sexual practices. Sexually transmitted infections are infections or diseases that are passed on during unprotected sex/sexual practices with an infected partner. Sexually transmitted infections cases are among young people aged 15-30 years old and approximately 25% of young people engage in unprotected sexual practices with one or multiple sexual partners (AIHW, 2016). This is a major issue in the fact that these young people are putting themselves at higher risk of contracting a sexually transmitted infection. However, there are ways that young people or any aged person can reduce their risk of contracting or passing on an STI and that’s by using protection and engaging in safer sex. Safer sex means using protection such as a condom and not allowing the other person’s body fluids to encounter your body and vice versa (Dean, H & Fenton, K. 2010). This essay however will focus on outlining the relationship between the determinants of health and influencing factors of STI’s in young people in Australia. The three categories of the health determinants that will be addressed are; socio-ecological determinants, behavioural determinants and psycho-social determinants. The individual influencing factors of STI’s amongst young people that are associated with each determinant will be spoken about in more depth throughout the essay but will primarily focus on culture, education, drug & alcohol use and mental health. This paper will also address the initiatives aimed at improving young people and adolescent sexual health and seek to find the key influences of contracting an STI’s and decrease inequality of these sexual health outcomes in Australia.

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Socio-ecological Determinants
         According to the World Health Organisation (WHO, 2018) the socio-ecological health determinant has the greatest influencing factors on most health-related issues. WHO addresses many key factors on the influences of health-related issues in Australian society, but this essay will elaborate primarily on: culture, education, employment, income and access to services influencing STI’s in young people under 35 (Australian Institute of Health and Welfare, 2016). In today’s generation young people have more access to education and information about STI’s but they aren’t aware of the perceived risks that are associated with unprotected sexual practices. Young people from low income areas or who are unemployed may also engage in unprotected sexual practices due to not being able to afford adequate protection; such as condoms. This can lead to many complications and increased chance of contracting an STI. Studies express that high-risk behaviors such as unprotected sex and practices are major causes of disease transmission, however, the effectiveness of preventive and control interventions are reducing the percentage of young people awareness of implications from unsafe sex (Smith, A., Dyson, S., Mitchell, A., & Pitts, M. 2003). Many of the diagnosed cases of STI’s arise from the circumstances in which young people live, work, socialise and the access they have to health services. If young people aren’t having regular check-ups or testing due to not having close enough access or don’t have time around busy work and lifestyle hours to be seen may be unaware they have a STI and can be putting themselves at high risk. STI are mostly contracted through unprotected sex or unsafe sexual practices and while symptoms may not be obvious or evident to the infected person, long-term consequences may arise if not treated (Senior, K., Helmer, J., Chenhall, R., & Burbank, V., 2014). Education is one of the major factors in young people developing an STI an in recent times sexual health education has been a significant issue in the national Australian curriculum and has been made a priority area for educators to sex-ed to secondary students. The emphasis for educators to have more emphasis on sex-education in their lesson was on the importance of developing STI awareness and knowledge for their students (Department of Health, 2017). Raising awareness and knowledge of STI’s and their consequences to young people and adolescents continues to be vital in sexual health education. This should include developing skills to reduce sexual risk behaviour and approaching ways in which young people can effectively access the health system/services that is convenient to them and their lifestyle circumstances (Devenish, B., Hooley, M., & Mellor, D., 2017). Aboriginal and Torres Strait Islander people suffer majorly from problems with sexually transmitted infections and their complications. Due to their limited education, access to health services and financial stability to afford adequate protection. Cultural respect and safety are a priority in prevention, testing and management of sexually transmitted infections and there needs to be holistic care provided by health services to address this population’s complex care needs. There are, however, challenges associated with providing adequate preventive programs and initiatives in rural and remote communities (Johnston, K, Harvey, C, Matich, P, Page, P, Jukka, C, Hollins, J & Larkins, S. 2015)

Behavioural Determinants
          Behavioural determinants are the factors in which the individual choices to engaged in which can influence both positive and negative health outcomes. One significant determinant factor that can highly influence the likelihood of young people engaging in unsafe sex and/or contracting an STI is the consumption of alcohol and use of drugs. The National Campaign to Prevent Teen Pregnancy (NCPTP, 2000) studied that one-half of young people (53.3%) state the main cause for not using contraception (condom) when sexually active is due to alcohol consumption or drug use. In these situations, after drinking at a party, being out clubbing or any circumstance where the person/couple are intoxicated from drug and alcohol use, can allow for unplanned and unsafe sex/sexual practices (Lim, M., Hellard, M., Aitken, C., & Hocking, J. 2009). However, even though there is effective interventions and treatment in place for STI prevention and testing, there has been slight increases in cases of chlamydia, gonorrhea and syphilis in recent years. Messages on safe sex and interactions seem to no longer be meeting its aim and purpose. There needs to be more understanding of how to effectively communicate to young people and assist in supporting behaviour change to reduce risks. Young men are significantly more difficult to educate and inform of the risks and implications of STI’s. Connecting them and making them more aware of accessible health services and the right questions to ask health practitioners will provide them with better understanding of STI’s and the damage they can cause both to themselves and the other person, if spread (Kang M, Skinner R, Usherwood T, 2010).

Psycho-social Determinants
          Psycho-social determinants is the social and emotional factors associated with the individual that influence the chances of engaging in unprotected sexual practices. These factors include stress, social support, depression, self-esteem and coping mechanism (Australian Institute of Health and Welfare, 2016).  Mental health issues can contribute to sexual risk behaviours, as mentioned previously, and expected STI risk can be associated with income, since lower income is associated with limited access to STI preventative information there can be an increased want of sex/sexual practices as a psychosocial coping mechanism (Devenish, B., Hooley, M., & Mellor, D. (2017). Psycho-social determinants are generally brought on within person by the socio-ecological determinants, therefor to improve the psycho-social determinant factors in young people there needs to be initiatives in place to reduce the outcomes of socio-ecological determinant influences. Studies have developed statistics on young people who look for sexual interaction with another person or multiple partners as a way to release stress, improve self-esteem or as a coping mechanism. In these situations, young people don’t have the skills or experience to think effectively and control the situation more appropriately and may engage in unprotected sexual practices. The Australian Bureau of Statistics. (2018) states that 31 percent of young adolescent girls that were surveyed said they were unprotected when they last engaged in sexual intercourse. It also states that 33 percent of both male and female sexually active young people inconsistently didn’t use contraception (condoms) for protection and in most cases not at all. In today’s generation, there tends to be more emphasis on the girl to be on the contraceptive birth-control pill and therefore there can be limited thought for both partners to use a condom as another protective form of contraception (Mitchell A, Patrick K, Heywood W, Blackman P, Pitts M. 2014).

Conclusion
         The prevalence of sexually transmitted infections amongst young people between 15-30 will continually be a significant health issue in Australian society but the factors which influence young people to engage in unprotected sexual practices can be improved and changed to reduce the percentage of young people that contract an STI. This review highlighted the sexual health inequities experienced by young people which were compounded by the three health determinant categories. Improving access to health services and providing effective education to young people was one of the major outcomes that can be used to effectively increase awareness. Strategies to target young people consenting in risky sexual behaviours due to alcohol and drug use are required, to improve both young peoples physical and mental health. Young people should be informed of the complications through many types of sources and be able to use their knowledge and initiative to enhance their individual resilience and self-efficacy for being safe and keeping themselves safe when interacting with people they choose to be sexually involved with.

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