“HIV is a reality in Fermanagh and Tyrone.” That is the stark message delivered by a Sexual Health Nurse charged with managing sexual health services in Altnagelvin and developing them in Fermanagh and Tyrone.
Andrea McCauley has 20 years of experience in the field.
Pointing to figures from the Public Health Agency (PHA), she says Sexually Transmitted Infections (STIs) are on the rise in Northern Ireland and Fermanagh is no exception.
Having spent part of her career working as a HIV ward sister in London, she has seen the clear difference in people’s attitudes towards their sexual health in a city environment and in the rural environment of Fermanagh.
The county currently has no recognised GUM clinic. But that is about to change.
With a sexual health clinic for young people now established at South West College (SWC) since the beginning of January this year, Andrea says she has high hopes that a clinic will also be up and running at South West Acute Hospital (SWAH) before Christmas.
“In London there are a lot of new HIV diagnoses,” she says frankly, “Living in a smaller rural area like Fermanagh, people think big infections like HIV aren’t happening here — but they are.
“Yes, it may be to a lesser degree, but we have a smaller population here too.
“The reality is that it is happening. We had a new HIV diagnosis in Omagh last week.
“There are two new HIV diagnoses every week in Northern Ireland. It is is something that we are seeing here. And the biggest challenge we face in our work is the stigma that is attached to sexual health.”
According to Andrea, there is a two to three week waiting list at the GUM clinic in Omagh.
“We have a walk-in surgery once a week in Altnagelvin and it is always busy,” she insists, “Because of the work that I do, I know there is a need for these kind of services.”
Since the new school term began last month, the young people’s clinic at SWC has really taken off.
“This is a pilot scheme,” she explains, “We have until March next year for it to prove its worth. But since January when it began, we have seen around 150 people.
“Whether it can continue after March very much depends on the success of the project now.”
The PHA funded initiative has two clinics running on a Monday, with a morning and afternoon session.
The morning session provides advice, information and testing for and treatment of sexually transmitted infections.
The afternoon session is a Contraception and Sexual Health Clinic (CASH), providing advice and information on the many types of contraception available, pregnancy testing and general sexual health advice.
Both clinics provide free condoms for those that wish to avail of The Clinic.
But Andrea stresses that child protection is always of the highest priority.
“Parents might think that we are nearly encouraging their children to have sex. The reality is that we are not encouraging them at all. Instead we would encourage them to wait until they are mature enough.
“I have teenage kids of my own and I am scared stiff of them going out into the big bad world. We are equipping them with the knowledge to make safer, more responsible choices.
“We look at each person based on their maturity.
“And it is always very important to ensure that a young person isn’t being coerced in any way. So we ask very probing questions.
“A big part of the work at The Clinic is earning young people’s trust. But there are occasions where we have to breach confidentiality when we have real concerns for someone’s wellbeing. It can be a delicate balance between trust and responsibility.”
Andrea is determined to break down the stigma surrounding sexual health.
“I want the message to be: ‘It is noting to be ashamed about, having a check-up is a responsible thing to do’.
“People in Fermanagh and Tyrone are very sensitive about this topic. Even compared with people in Derry.
“People are very conscious and scared of being seen attending a clinic by someone they know.
“And because they don’t talk about it, far too may aren’t aware that they could be at risk.
“Unfortunately around 60 to 70 per cent of STIs don’t have any symptoms.
“And life is never fair. You don’t have to be sleeping around for you to pick up an STI.
“It can happen the very first time you have sex — even if you use a condom.
“Some STIs can be picked up through skin on skin contact.
“My work is all about making young people aware of that. Because if untreated, some of these infections can affect your fertility in the future.
Andrea says the media approach towards sexual health often doesn’t help her cause either.
“When the Omagh clinic opened, one of the papers put on its front page something like ‘Sex Clinic to open’ as if we were selling sex!
“Those kind of things don’t help to normalise sexual health at all.”
The sexual health nurse hopes that establishing a GUM clinic at SWAH will help to improve public access to a hugely important service.
“At the moment we are trying to get space to run the clinic at the hospital,” she explains, “But we hope to be up and running before Christmas.
“It will be open to everyone, not just young people and that is so crucial because sexual health affects people from all walks of life.
“Yes, young people are a high risk group for STIs. But men having sex with men are another high risk group.
“Unfortunately, that is very much not spoken about here in Northern Ireland, too.
“But there is a very high incidence rate with that particular group and it tends to be the more serious infections like syphillis and HIV.
“Through PHA funding we are hoping to run a clinic in SWAH once a month specifically for this group. Then the other three weeks would be a general GUM clinic.”
Andrea insists there is a definite need for the service. “I’m seeing men in their 40s who have never had a STI screening before. That is really worrying to me.
“It doesn’t make it any easier that at the moment, you are faced with a 70-mile round trip for your nearest GUM clinic if you live in rural parts of Fermanagh.
“When there is a service on your door it will make it easier.”
Andrea says her work is hugely rewarding. “I have had people coming in to me who maybe haven’t slept the night before because of their worry.
“A patient came into me from Fermanagh last week. He was just mortified. He had been putting off coming to a clinic for such a long time but had managed to get the guts up.
“He left with a weight has been lifted off his mind.
“The reality is that we see people from every walk of life. From people in their 80s and 90s to people who are 13 and 14.
“We get married people and we get people who are gay, bisexual and transgender. We don’t judge and we treat everyone with respect.”
