Healthier Life 4 You works with Families and communities.

They run workshops for parents around health issues and are currently working on Parenting and Communication.

They also invite speakers to talk about health related issues such as

• Smoke free homes
• Nutrition
• Healthier living in general

They are also currently running fun African dance sessions.

Parenting and Communication

Talking to parents about sex education is not an easy topic. People often face a lot of the following:

• Fear
• Embarrassment
• Don’t know how to approach the topic

Sometimes these sessions are the first time in which they can speak about these issues.

Why is it important?

• We believe it raises the age at which children have their first sex experience.
• Lowers teenage pregnancy rate
• Helps cut sexually transmitted diseases
• Encourages maturity  - in sexual development
• Stay safe
• Helps children to talk to parents about these issues

Think about where we got our first sexual knowledge. For most it is in the playground and the information is incorrect.

When do you start talking about this to your children?

As soon as they start asking!

So is the age of 4 too young?

The important thing is always to be truthful - at a very young age it is adequate to say that babies come from Mummy’s tummy.

The other reason it is important to be truthful and be able to talk to children is that some girls can start their period as young as 8 years old so if you leave it till 11/12 years old it might be too late.

Touching genitals – It is normal for children to touch their genitals – you need to be very careful how you tell them not to touch. The tone of voice a parent uses can put fear into the child and also shame.

There are plenty of good books out there that can be used to help. e.g. Mummy made an egg. Pamela has a book list that can be emailed out upon request – Please email the BME Health Forum or see the website Useful links section.

So when and how do you start?

At age 5 children are very curious about the body and how it works – also other people’s bodies. They like to play doctors and nurses.

Adverts on TV - A good moment to start talking about it is with adverts on TV about sanitary towels.

Older Children – ask them what they know and what they don’t know and try and fill in the gaps.

Make yourself approachable and be open.

It is important to explain about responsibility of sex in a relationship – if we give this message early on it will have better impact.

Teenagers need to know that they should never be pressurised into having sex.

Use of condoms and other forms of contraception to protect against infection and also pregnancy should be highlighted.

Sex education is compulsory in secondary schools but only optional in Primary school. However in Holland they start it at 5 years old and it is interesting that they have a much lower rate of under age pregnancy and a much more mature attitude towards sex.

Teenage pregnancy has actually dropped in the UK but there is still a long way to go.

Answer: No, I don’t think so – I think for boys there is also a lot of pressure to be experienced.

Answer: It is perfectly fine to say: No, because I am a girl and I have a vagina. It is important to normalise these issues and be as truthful as possible.

Answer: Aside from the workshops that we run, parents can come and talk to me one to one.

Answer: Yes

Answer: Some parents are fearful and for some it is difficult to accept the issues involved. But bit by bit I think it does get through.

Answer: We just have to go with what the facts are, You have to decide for yourself in the end.

Monique also now covers Kensington & Chelsea and Hammersmith & Fulham.

What I am going to cover:

The Public Health department in NHS Westminster did a Sexual health needs assessment. The document is 150 pages long and I will briefly take you through what the key findings are concerning BME groups.

Westminster is the most ethnically diverse borough in the country.

Chlamydia is number is the number one most prevalent of sexually related diseases followed by warts and Black African/ Caribbeans are disproportionately over represented.

Westminster also has a high prevalence of HIV.

SOPHID – the number of people who have been diagnosed and are accessing healthcare/ treatment.

BME groups are over represented here again.

Looking at the statistics it actually seems that there is a decrease in diagnosis amongst African communities but the figures can be somewhat askew. It could be not because less are infected but more likely that less are being diagnosed. In comparison, Men who have Sex with Men (MSM) are more likely to be diagnosed because they are more responsive.

We have to think about how we can get our message across.

Teenage pregnancies and Abortions – In Westminster teenage pregnancies are rising and it also has the highest rate of privately funded abortions.

Provision of Sexual Health Services

Access - is actually quite low and Women are more likely to access services (mainly women who are getting the pill).

Pharmacy – a small number offer Chlamydia tests and free morning after pills for under 20’s.

GUM (Genito-Urinary Medicine) services (specialist Sexual Health clinics)

Who is going? – more 25 – 34 year olds are using GUM services and there is about a half and half split between BME and white communities.

Community Contraceptive services – numbers of young people accessing these services is very very low.

Chlamydia screening programme – this was a programme targeting 15 – 24 year olds last year and there was a high uptake in black African/ Caribbean communities. This is because they did a lot of outreach in estates and sports centres.

HIV testing - is very important but there is a lot stigma, taboo and embarrassment around it. I need to have a dialogue with BME organisations so I can encourage people to use the services that are available.

Late Diagnosis is so much more prevalent in heterosexual men than men who have sex with men.

We are trying to work with Faith leaders as we know they have a strong influence. Also to French speaking African communities but we need to really understand the cultures of the people we want to reach out to in order to best approach and speak to people in the borough.

I want to get Sexual Health services out there and being used – in Vans, youth centres etc.

Answer: There is a link with the level of deprivation there.

Answer: Yes it is true that the pot is being squeezed but we must work these groups. We have a Sexual Health Partnership and Engagement groups. I would encourage these groups to approach me and talk to me as much as possible.

What is FGM? – Female genital cutting or also called Female circumcision. We use Female Genital Mutilation as it expresses the severity of the problem.

In the worst case the inner and outer lips and whole clitoris are removed and almost everything sewn up.

It is a method of control.

It is currently practiced in 24 African countries and now also in Europe due to immigration.

Some practice it for cultural reasons but some say they do it for Religious reasons – this is not true. Some think it is hygienic and some consider it a rite of passage into womanhood “now you can become a wife”.

FGM is performed mostly by women. These women have powers in their community. One has to ask why they would be encouraged to give this power up – it could be the only power they have.

So why do mothers do this to their daughters?

Their mothers will have done it and their grandmothers. Some women newly arrived here have no idea that others don’t do it at all.

Many girls look forward to it as something to be proud of. They are presented with jewellery on the occasion even.

There is also a lot of pressure on men to only marry women who are circumcised.

FORWARD

The Foundation for Women's Health, Research and Development - FORWARD - is an African Diaspora women's campaign and support charity (registered in the UK).

Our work is focussed on the practice of FGM and forced marriage. In the UK we focus on FGM.

Many people in the UK don’t know about FGM. We want to raise awareness amongst health professionals e.g when women have their smear tests and they come across cases they need to know how to respond and refer people.

We need women who have gone through FGM to come forward. We create safe spaces e.g coffee mornings where women can come together and share their experiences, talk about health complications or related issues. Hopefully through sharing they can reflect and hopefully this is a way to protect their daughters.

We equip women with information such as the fact that FGM is illegal in the UK.

We encourage women to be assertive in their communities.

We also work closely with religious leaders to dispel the myth that FGM is a religious requirement.

We also work closely with young people – they can very assertive and good at campaigning against the practice.

We go to events in communities and we have a Community Advisory Group and do partnership with BME community groups to talk to women. (Somali, Sudanese and others).

Work in Africa

We also have programmes in Africa. However resistance is very high in Africa but people in the diaspora do have an influence.

Answer: It varies but it can be from 5 – 12years. The girls often have the procedure done during the summer holidays to not interfere with school. There are signs that can identify those who have had it done e.g. not engaging in physical activities; taking too long in toilets.

Answer: We are seeing a breakthrough. Type 3 is the most prevalent but we are seeing a shift in Type 1 (the most extensive/ extreme form of FGM).

Response:  We would appreciate your contact details regarding such initiatives and services.

Answer: We encourage the women to speak to the men. It’s hard for us to create men only spaces to talk however we are recruiting men to our advisory group so it could become more possible.

Answer: We are working on it but there is a lot to consider in terms of the procedure – how we do it.

I am a mother and Grandmother and a specialist in Women’s Health.

NHS Westminster put out a tender for Community Gynaecology work and Chelsea and Westminster Hospital won the contract.

It is a 3 year contract with a yearly review. We won it at Christmas last year and started work in February.

My remit is to promote the service in the community.

Key Parts:

• We go out into the community – we are very flexible and can use floors in children’s nurseries – we want to reach diverse communities – we have talked to women in full burkhas.
• We run clinics.
• We can provide secondary care.
• We have a dedicated female team
• We have consultants working with us and senior nurses and clients will always get to see a doctor.

We have clinics in South Westminster clinic, Health at the Stowe and Marylebone Health Centre.

We have 4 clinics a week including 1 early morning one from 7am and 2 during the week that run till after 7pm.

The clinics run as a One stop shop – patients are seen, assessed and treated at the first visit. 80 % of patients are actually diagnosed and treated at the same time.

We have also trained all our staff with FGM awareness and with the opening of the FGM gynaecological clinic in January we will refer women for reversal operations.

This is not a training service – people only get seen by professionals.

Chlamydia Screening

We also offer chlamydia screening.

We want to have a 4^th clinic in the top left hand corner of the borough in the Queens Park are – this is in negotiation

We are struggling with reaching hard to reach groups – BME groups. If you would like me to talk in your communities please contact me – I want to speak to you.

92% of the feedback for our service has been excellent or very good.

72% of patients were seen within 4 weeks of seeing a GP.

Our FGM clinic will be opening in February.

Answer? Yes they can. We have easy read information on services.

Answer: We have senior clinicians who can give scans there and then at the same moment. We also never cancel clinics.

Answer: At Health at the Stowe women are already accessing these services for sexual health. We are also going out to community groups.

Comment: Word of mouth is the best way.

Answer: Yes

Rain Trust – we primarily offer support to people living with HIV.

Services Provided:

• Access to peer and emotional support
• Training and employment to affected groups
• Work with Faith groups

HIV support for BME communities

• Services are provided in a culturally appropriate environment
• One to one sessions

People come to see us with low morale – even suicidal.

When people come to us they also have access to training and employability courses.

Incorporating HIV services into GP practices.

• GPs need to work with GUMs closely due to speciality needs and advice.
• GPs need to be very careful to uphold patient confidentiality at all times such as in reception.
• There should be Co-partnerships between GPs and GUMs

 So what are the issues around Sexual Health in BMEs?

• Stigma
• Denial for those who have STIs (even HIV)
• Late Diagnosis
• Cultural and religious factors
• Sexual orientation differences (most BMEs accessing services are heterosexual)
• Practicing safer sex – continues to be a problem
• Use of traditional herbs to treat STIs

Community Empowerment (Faith groups)

There can be an assumption that people who go to church don’t have HIV or STIs. However some faith leaders do recognise that members of their congregation may have HIV.

Health Promotion – we do outreach work with a focus on BME salons.

If you want to contact us visit our website:

www.raintrust.org.uk

Why are our HIV services needed?

• Unique – it is from and African perspective.
• Culturally geared – we offer a counselling style that is more appropriate and useful for our clients rather than what is generally offered at GPs.
• Listening – mentoring
• We offer peer related advice for more specific issues – such as particular skin conditions.

Answer: Not at all – the more generic programmes you mention actually compliment our main service.

• Zero tolerance to FGM day is on the 26^th February at the Stowe Centre on Harrow Road.
• Sviatlana Istamianok from Rain Trust Health Trainers programme announced Free Health Walks in Royal London Parks starting from July.

[You can see the programme at this link: http://www.bmehf.org.uk/news/from-the-community/249-new-free-health-walks-in-the-royal-parks-coordinated-by-the-rain-trust ]