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Best Practices for Sexual Health Promotion and Clinical Care in College Health Settings

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Best Practices for Sexual Health Promotion and Clinical Care in College Health Settings JANUARY 2020 ACHA Guidelines Best Practices for Sexual Health Promotion and Clinical Care in College Health Settings ccording to The World Health Organization’s Using this document: Readers are encouraged to utilize (WHO) working definition, “sexual health” is: each of the resources and citations provided for more information on a particular issue, choosing which ones A … a state of physical, emotional, mental and may work best for their health center and in what manner. social well-being in relation to sexuality; it is not The goal of these recommendations is for them to be merely the absence of disease, dysfunction or infirmity. utilized by a wide variety of institutions, and the Sexual Sexual health requires a positive and respectful Health Promotion and Clinical Care Coalition is always approach to sexuality and sexual relationships, as well available to ACHA members for consultation. as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and Structure of the recommendations: Certain best violence. For sexual health to be attained and practices and recommendations will be more clearly maintained, the sexual rights of all persons must be relevant for either clinicians or health promotion respected, protected and fulfilled. professionals due to the nature of their roles, though it is of utmost importance to understand that improving sexual The American College Health Association (ACHA) has health is also a shared responsibility that requires close recently released a number of position statements and collaboration among clinical and non-clinical staff. As guidelines regarding sexual health issues, on topics such as such, this document is organized into three sections: expedited partner therapy (EPT),1 pre-exposure prophylaxis shared responsibility, health promotion and clinical care. (PrEP) for HIV prevention,2 trans-inclusivity,3 sensitive exams4 and trauma-informed sexual violence prevention.5-6 A note about language: We will use “queer” as an Links to current guidelines, resources, and evidence are umbrella term to describe students whose sexual provided throughout this document, which are intended to orientation is not heterosexual/straight, and “trans” as an serve as a resource for a broad range of sexual health topics umbrella term to describe students who are not cisgender. in college health. However, it is not exhaustive. The intent of this paper is to consolidate this information Shared Responsibility with guidelines and best practices presented by other national organizations to assist colleges and universities in Incorporate Pleasure and Intimacy into the provision of sexual health services both in health Sexual Health Efforts promotion and clinical care—specifically through the Sexual health should not only be discussed in relation to lenses of public health and medicine. sexually transmitted infections (STIs)/human Acknowledging WHO’s working definition of sexual immunodeficiency virus (HIV) and unintended pregnancy, health, which emphasizes the need for a holistic approach, but also how it can promote pleasure and intimacy. The we recognize the importance of mental health primary reason many people engage in sexual activity is to practitioners’ roles in supporting sexual health. This is experience pleasure. To ignore this fact not only prevents especially relevant for college health settings as campuses us from meeting students where they are and strive to meet their students’ increasing mental health acknowledging the realities of many of their sexual needs—which can and does include topics such as sexual experiences, but also reproduces (and reinforces) stigma dysfunction, healthy communication, dealing with a and shame around their bodies and sexuality. As such, it is difficult diagnosis or managing intimate relationships. recommended that questions about sexual functioning and With that said, the current version of this document does satisfaction are included during routine sexual histories. not include comprehensive guidance for clinical mental It is also worth acknowledging that a student’s personal health professionals such as counselors and therapists. views—including faith-based—will affect their decision This is both a limitation of this paper and recommendation to engage or not engage in sexual activity, and that those for a future paper. decisions should be validated and respected. Best Practices for Sexual Health Promotion and Clinical Care in College Health Settings / page 2 Here are a few practical examples of how to incorporate Considerations for Trans and Non-binary Students pleasure and intimacy: College health practitioners should seek professional • Discuss fit and feel of external condoms; if condoms development opportunities to increase their competencies fit properly and feel good, then students will be much in caring for transgender and gender-nonconforming more likely to use them individuals. Further, several professional organizations • Explain how using external condoms with IUDs, for endorse gender-affirming hormone therapy and pre- and example, can enhance the sexual experience by post-gender affirming surgical care as being within lowering anxiety about STIs/HIV and unintended primary care provider’s scope of practice.7-9 While gender- pregnancy affirming care is not exclusively related to sexual health, • Emphasize to students with new STI/HIV diagnoses sexual health clinicians often have enhanced training in that they still have the right to healthy and queer and trans health and provide these important pleasurable sexual experiences services. As such, we advocate for the provision of these services in CHCs. More Information: Implementation Resources: • Sexual Pleasure, American Sexual Health Association • Gender Dysphoria/Gender Incongruence Guidelines and Resources, Endocrine Society • Publications, International Society for the Study of Women's Sexual Health • Safer Sex for Trans Bodies, Human Rights Campaign • Herbenick, Fu, Arter, Sanders, Dodge. (2018). Foundation and Whitman-Walker Health Women’s experiences with genital touching, sexual • UCSF Center of Excellence for Transgender Health pleasure, and orgasm: Results from a US probability • Trans-Inclusive College Health Programs, ACHA sample of women ages 18 to 94. J Sex Marital Ther • World Professional Association for Transgender Feb 17; 44(2): 201-212. Health (WPATH) • Herbenick, Bowling, Fu et al. (2017). Sexual diversity in the United States: Results from a Collect Sexual Orientation and Gender Identity (SOGI) nationally representative probability sample of adult Data women and men. PloS ONE 12(7):e0181198. Queer and trans communities experience unique health Create a Welcoming Clinic Environment and disparities and are invisible until they are specifically Provide Inclusive Resources and Services counted in electronic health records (EHR) and other public health systems (i.e., needs assessments, program Services start when patients enter your college health evaluations, infectious disease reports). As such, CHCs center (CHC). Care should be taken to use gender-neutral should collect and document these demographic data in terms interpersonally and on forms. Posters, brochures and order to: other materials should have sex-positive messages with • Provide tailored campus and community resources same- and different-gender couples, as well as people of different ethnicities, gender expressions and physical • Measure healthcare utilization among queer and trans abilities. Spaces should be sensitive to trauma experiences students through using calming designs and providing students • Identify at-risk student populations when reporting with as much control over their experience as possible. infectious disease data Implementation Resources: • Adequately conduct quality improvement activities and patient satisfaction surveys • Healthcare Equality Index, Human Rights Campaign • Provide a more holistic approach to care • 10 Ways to Make Your Health Center More Welcoming for Diverse Students, ACHA Ideally, explicit fields in the EHR should capture the patient’s: • Statement on Cultural Competency, ACHA • • Creating an Inclusive Environment for LGBT Sexual orientation Patients, LGBT Health Education Center • Gender identity • Sex assigned at birth • Pronouns • Name that they would like to be called (i.e., lived name or chosen name). Best Practices for Sexual Health Promotion and Clinical Care in College Health Settings / page 3 The collection of gender identity should be a two-step behaviors do not always correlate with sexual identities, so process, where the patient is first asked their gender identity, simply taking a sexual history and asking about partners is followed by their sex assigned at birth; this is to not an accurate way to determine a patient’s sexual immediately validate a student’s gender identity before orientation or gender identity. determining their medical needs. Additionally, sexual Figure 1. Gathering Sexual Orientation and Gender Identity (SOGI) Data Adapted from the 2017 Recommendations from the University of California LGBTQIA+ Directors' Council Lived Name What name would you like to be called? Pronouns What are your pronouns? Gender Identity What best describes your gender identity? ● Woman ● Man ● Transgender ● Trans Woman ● Trans Man ● Non-Binary ● Intersex ● Intersex Woman ● Intersex Man ● Genderqueer ● Gender Non-Conforming ● Questioning ● Two Spirit ● Agender ● Other (Please specify) ● Decline Assigned Sex at Birth What sex were you assigned
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