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Sexual and reproductive healthcare provided onsite in an inner-city community drug and alcohol service
  1. An Vanthuyne1,
  2. Rosie Mundt-Leach2,
  3. Alastair Boyd3,
  4. Stephanie Broughton4,
  5. Rudiger Pittrof5
  1. 1ST6 in Sexual and Reproductive Health, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
  2. 2Head of Nursing, Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
  3. 3Associate Specialist in Addiction Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
  4. 4Blood Borne Viruses CNS, Health Inclusion Team, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
  5. 5Consultant in Sexual Health and HIV, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr An Vanthuyne, Burrell Street Sexual Health Clinic, Guy's and St.Thomas' Hospitals NHS Foundation Trust, 4-6 Burrell Street, London SE1 0UN, UK; an.vanthuyne{at}doctors.org.uk

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Background

People with substance dependence problems are at increased risk of poor sexual and reproductive health. They are known to be at high risk of sexually transmitted infections (STIs) and women have an increased risk of sexual violence, unplanned pregnancy, poorer pregnancy outcomes as well as having their children taken into care.1–7 They are therefore a target group for specialist sexual and reproductive healthcare (SRH). However, take up of services is not meeting the existing need in this patient group. Delivering this care has always been challenging as clients who use addiction treatment centres do not readily engage with mainstream SRH services. This is not only related to ease of access of conventional SRH services but also to barriers such as internalised stigma or perceived infertility by drug-dependent women.8

Why was change needed?

Attempts to provide effective services for people with severe drug and alcohol addiction are often based on more effective signposting and advertising of existing services and the provision of priority care pathways. Our experience showed that this approach did not work even with a clinic within close geographical proximity. We believe that the main reasons for this were lack of trust in unfamiliar services and internalised stigma by drug users. Other barriers that have been identified are the demands of a drug-using lifestyle, altered perception of risk around sexual health, and practical problems. Drug users are within their comfort zone in the drug treatment centre and often have a very good relationship with health workers. In addition, The Hidden Harm Report has recommended the establishment of sexual health services within drug treatment centres.9

How did we go about implementing change?

A needs assessment, completed by 104 potentially fertile women of reproductive age at the drug and alcohol treatment centre, revealed a high level of unmet contraceptive need as well as an interest in onsite service provision. …

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