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Submitted By oziomaeriugo
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Table of contents
1) Introduction………………………………………………………………… Pg. 1
2) Demographic and Statistical Information……………………… Pg. 2
3) The National Picture………………………………………………………Pg. 5
4) The Local Picture…………………………………………………………… Pg. 6
5) Relevant Local and National Organisations…………………….. Pg. 6
6) Health & social care related theories…………………………………Pg. 7
7) Conclusion…………………………………………………………………………Pg. 7
Appendix
Relevant information…………………………………………………………… Pg. 7
References …………………………………………………………………………Pg. 9

TMA: O5
A Report on Current & Possible Future Services for
Ashley, A Homosexual Man With STD Diease.

One: Introduction
This report will base on the case study of Ashley, because among the six available case studies, Ashley’s is the most relevant and enhancing to the writer, both personally and professionally. Having a good knowledge of substance mis-use, homosexuality and sexual transmitted disease, this report will explore the relevant theories and services available and how people can acquire these services. This report will give some illustration, using East Sussex, where I worked as an involvement worker in substance mis-use settings and the chosen audience for this report are members of local mental health and LGBT charities.

Ashley is a 40 year old, who has recently been diagnosed with sexual transmitted disease, and alcohol drinking problem. He is extremely isolated and his wife knows that there is something wrong but does not exactly know, what is wrong; she is also extremely concerned about his alcohol consumption. He was raised to be a devout Christian and to remains loyal to his religion. His problems started when he found out that, he is sexually attracted to men than woman (homosexuality),
Ashley is at a point in his life where, if he does not make changes soon, his state of well-being will deteriorate even further. His wife and other vulnerable people that he is having unprotected sex with will be at risk of contracting sexual transmitted disease (STD).The main concerns are:

* His relationship with his wife * His sexuality and his rejection of it * His unsafe sex practices * His mental health and alcohol consumption

The members of sexual health counsellors of the Claude Nichol and Lawson
Units of the Royal Sussex County Hospital (RSCH), the Joint Commissioning Group
(JCG) which unites the P.C.T. (Primary Care Trust), the Public and Commercial Service Union (PCS) the Sussex Partnership Trust and the local Council will work together to help Ashley with the appropriate skills and knowledge. The JCG deals with the commissioning new services will have some more relevant information on which the workers helping Ashley will base their decisions.

Two: Demographic and statistical information
According to Public and Commercial Service Union (PCS), is estimated that 1 in 10 of the population are lesbian and gay (PCS LGBT Equality Toolkit) although due to externalised and internalised homophobia many of these people may be in Ashley’s position of being a secret homosexual. The Sigma Research annual Gay Men Sexual Health Survey indicates that 51.7% of men diagnosed with HIV had unprotected anal intercourse (UAI). In the last year, almost 35% of men questioned had had UAI with a partner whose HIV status they did not know, and 14% had UAI with someone they knew to be HIV positive (UK Gay Men’s Sex Survey, 2010). Figure one shows that of the 84,983 HIV diagnoses between 1996 and 2005, the most common route of infection was among men who have sex with men (Homosexual men).

Ethnicity | Sexbetweenmen | Heterosexualcontact | Injectingdrug use | Mothertoinfant | Recipient ofblood/tissueproducts | Other/undetermined | Total | White | 26,978 | 7,711 | 2,075 | 91 | 120 | 1,197 | 38,172 | Black-African | 624 | 32,580 | 98 | 1,254 | 172 | 479 | 35,207 | Black- Caribbean | 816 | 1,924 | 39 | 18 | 14 | 96 | 2,907 | Black-other | 349 | 769 | 40 | 2 | 2 | 73 | 1,235 | Asian | 565 | 968 | 33 | 30 | 45 | 103 | 1,744 | Other/mixed | 1,769 | 1,375 | 154 | 159 | 29 | 140 | 3,626 | Not reported | 555 | 360 | 83 | 12 | 9 | 1,073 | 2,092 | Total | 31,656 | 45,687 | 2522 | 1,566 | 391 | 3,161 | 84,983 |

In the context of Ashley, there are levels of mental distress among LGBT people, which lead to depression disorder and psychiatric syndromes. These statistics record showed both one year and lifetime prevalence of the affective disorder and psychiatric syndrome, homosexual men scored high in all, except Bi – polar disorder

Alcohol Dependency | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Drug Dependency | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Agora -phobia | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | PanicAttacks | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | GeneralisedAnxietyDisorder | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | MajorDepression | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | AnyPsychiatricSyndrome | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 0% | | | | 5% | | | | | 10% | | | | | 15% | | | | | 20% | | | | | 25% | | | | | 30% |

One-year prevalence of psychiatric syndromes in men that is sexually active.

*
Heterosexual male

* Homosexual male

Single MMD | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Recurring MMD | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Dysthymia | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Bi-Polar | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | AtypicalBi-Polar | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Any Affective Disorder | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 0% | | | | 5% | | | | | 10% | | | | | 15% | | | | | 20% |

MMD – Major Depressive Disorder
Heterosexual male
Homosexual male
Dysthymia – Mood Disorder – Mild Depression
Lifetime prevalence of affective disorders among sexually active men
(Cochran et al, 2003).

Three: The National Picture
According to the mental health charity MIND one in four of persons can expect to experience mental distress at some point in their lives, but with a person in Ashley’s position, this is likely to be much higher. From the side of Ashley’s unresolved issues around his sexuality both Stonewall (a group that fight for equality & justice for LGBT people) (http://www.stonewall.org.uk) and Avert (national & international HIV & AIDS information) (http://www.avert.org) offer free and confidential information with links to other relevant sources. The services being available online are good for someone, such as Ashley, who wishes to remain a secret homosexual.
Another issue Ashley could find help for online is the conflict between his spirituality and his sexuality. The internet could be the best places to go for information on sexuality and religion, such as the UK group known as Quest Gay Catholic in Brighton and the international groups like Dignity US.

Furthermore, Ashley’s attitude of excessive use of alcohol and unprotected anal intercourse (UAI) could be rated as self-harming, however he is not alone. The following figure shows, a high number in considered and carried out harm among gay and lesbian people.

| Heterosexual | Gay/lesbian | Bisexual | Males | | | | Harm considered | 33 | 50 | 55 | Harm carried out | 41 | 54 | 50 | Females | | | | Harm considered | 33 | 57 | 56 | Harm carried out | 50 | 56 | 59 |

(Mental Health and Well-being of Gay, Lesbians and Bisexual people in England and Wales,
King, M. and McKeown, E., 2003).

Four: The Local Picture
If Ashley were to live in Brighton and its surrounds, he would be in the city where the 2001 UK census showed to have the highest number of people living in same sex relationships, that is 1.29% of the population (estimated at 3,500), with the rest of the UK averaging at just 1% (Office for National
Statistics, BBC news). As a partial result of the higher proportion of gays and lesbians in Brighton and Hove, we do have an established collection of LGBT friendly and exclusive services. The main ones are Spectrum and MIND OUT. As mentioned above Brighton is home to a chapter of Quest, though his case study did not state him as a catholic, but a Christian. Ashley may find release from this group, as his primary issues are spirituality/sexuality challenge.

Five: Relevant Local and National Organisations
There are numerous organisations that are applicable to the case study of Ashley, too many to list, so included below are those that are most pertinent to the report.

Five (A): Service user involvement, peer support, and charities
Alcoholics Anonymous

Alcoholics Anonymous is a peer led and organised support group for people with concerns over either alcohol use, their own or someone else’s. There are meeting seven days a week, 365 days a year, meaning support, information and advice is always available to those who need it.

MIND
Mind is a national mental health charity with most areas having a local branch. This charity could have particular significance to Ashley because through MIND he could access an IMHA (Independent Mental Health Advocate) one of the many services they provide that may have particular interest to him is Mind OUT. Mind OUT is a service for LGBT people who are experiencing mental distress that offers independent advocates, peer support and individual support.

Spectrum
A Brighton based service for LGBT people offering a wide range of services and activities.

Straight Partners Anonymous
A UK based online support group for straight people whose partner is gay, lesbian or bisexual, this group will be relevant for Ashley’s wife.

Five (B): Statutory organisations, research and information providers, and professional associations.

Sigma Research: Sigma Research is a social research group specialising in HIV and sexual health and are responsible for the annual gay men’s sexual health survey (Ford Hickson, 2007)
National AIDS Trust: A national AIDS/HIV charity that also, in their remit, covers sexually transmitted infections (STI’s). www.nat.org.uk S.M.M.G.P. (substance misuse management in general practice): SMMGP is a network to support G.P.’s and other members of the primary healthcare team who work with substance misuse in the UK. Part of RCGP (Royal College of General Practice) www.smmgp.org.uk National Institute for Clinical Excellence (N.I.C.E.): N.I.C.E. provides guidelines for healthcare workers and others on most instances of health and social care. www.nice.org.uk SIX: Health and Social Care Related Theories

Six (A): Holism
A holistic approach is the only way forward with Ashley. Unless all aspects of his problem are tackled, he is unlikely to reach a satisfying conclusion. He is unlikely to stop drinking and participating in unsafe sex for any length of time if the, underlying issues are not dealt with immediately. This would mean dealing with his social (his relationship with his wife), the psychological (depression), the spiritual (conflict between spirituality and sexuality), the physical (alcohol consumption and unsafe sexual practices), and the emotional (how he feels about himself)

Six (B): Ethics
There are many different sorts of ethical dilemmas in this case. The main one’s lie with the
G.P. Should the G.P. breach confidentiality over Ashley’s contraction of syphilis. The National Aids Trust would say only if his behaviour is directly affecting the health of another person. The dilemma becomes deeper when the G.P. has responsibility for the health of both parties. Any primary care services ‘providing sexual health services should agree that the principle of enhanced confidentiality (like a G.U.M. clinic) for sexual health services need to be applied anywhere the service is provided’ (N.A.T. response to D. of H. guidelines on confidentiality)

Six(C): Stigma
There is potential for stigma in this case. A survey carried out by MIND OUT and Spectrum found that 47% found primary care services to be unfriendly/very unfriendly (Count me in too, MIND LGBT report, 2009, p. xi) A finding backed by Professor J. Elford from City University who identifies primary healthcare workers as a significant source of HIV/LGBT related stigma and discrimination’
(N.A.T. response to D. of H. guidelines on confidentiality)

Six (D): Power
Power and lack of power resonate through Ashley’s case study. Kwok Fu-Wong identified four arenas of power, though not all are evidenced here. ‘Power over’ plays a large part in this story. The G.P. has the power, potentially, to expose Ashley’s STI. This, could, in turn lead to an exposure of his sexuality and sexual proclivities. ‘Power with’ could be there if Ashley and his G.P. co-operate with a view to onward referrals that would assist Ashley in deciding where he goes from here.

SEVEN: Conclusion
The MIND OUT project is a service that is LGBT specific and has the experience and contacts to give Ashley a service that could really make a difference. However, the client has to approach them. For the present, Ashley is unwilling or unable to do this. So, how can he be reached?
Initial contact is still most likely to be through his G.P. and although he may still have concerns about confidentiality, his G.P. and the G.U.M. clinic are the only options at this stage. Ideally, a referral to a complex needs (CN) worker would be the answer, but, with most CN workers overworked, this is unlikely to happen until he accepts referral on to another service, as few
G.P. practices have resident CN workers. word limit: 1928

Relevant Details
Alcoholics Anonymous, www.alcoholics-anonymous.org.uk
MIND, www.mindcharity.co.uk
Spectrum, www.spectrum-lgbt.org.uk
Straight Partners Anonymous, www.straightpartnersanonymous.org.uk

References
LGBT Equality Toolkit, Public and Commercial Services Union, [online] Available at www.pcs.org.uk/en/equality/lgbt_equality_toolkit/index.cfm, accessed 08/04/2014.

UK Gay Men’s Sex Survey, Vital Statistics 2010, [online] Available at www.sigmaresearch.org.uk/files/local/All_England_2010.pdf, accessed 08/04/2014.

Estimating prevalence of mental and substance using disorders in lesbians and gay men from existing national health data, Cochran, S. and Mays, V., [online] Available at www.stat.ucla.edu/cochran/PDF/Estimating%20prevelance%20, accessed 08/04/2014.

Mental health and well-being of gay men, lesbians and bisexuals in England and Wales, King, M. and Mckeown, E., the British Journal of Psychiatry, 2003, 183: 552-558. Office for National Statistics, [online] Available at www. news.bbc.co.uk/1/hi/England/3456635.stm, accessed 08/04/2014.

Count Me in Too, LGBT Lives in Brighton & Hove, Browne, K., University of Brighton, 2008, [online] Available at www.nat.org.uk/Media%20library/Files/PDF%20documents/DH-confidentiality-response.pdf, accessed 08/04/2014.

Kwok Fu-Wong, Exploring Health, social care and well-being, p. 20, Open University, Milton Keynes,
2010.

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