Assessing the provision of contraception in a novel sexual
health service for the Homeless
T.M. Groom, A. McLellan, M. Kennedy, A.H. Brown
Sandyford Initiative, Glasgow, UK
Background A sexual health
service dedicated to the homeless commenced in August 2004, aiming to provide a
flexible, accessible service to the homeless clients at a range of sites across
the city.
Objective To examine the contraception type issued during the first
year of this service; the number of clients receiving contraception
opportunistically and the proportion of clients attending for follow up.
Method
Case notes and electronic records of all female clients, who received a
prescription for contraception between August 2004 and July 2005, were examined.
Data regarding reason for attendance, type of contraception issued, and follow
up was recorded. Information regarding a history of addiction, sexual and
domestic violence, and prostitution was also recorded.
Results Forty-four women
(average age 25 yrs) received contraception. 16(39%) women had a history of
Intravenous Drug Use (IVDU), 16(38%) women had a history of alcoholism,7(17%)
had been or were involved in prostitution, 26(62%) had experienced sexual
violence and 19(46%) domestic violence. Twenty-one women attended specifically for
contraception and 23 were prescribed it opportunistically. Long acting
reversible contraception (LARC) was issued to 34/44 (77%). 81% of women affected
by IVDU and 100% of women involved in prostitution accepted LARC. Implanon users
had been affected by IVDU in 5(29%) of cases, alcoholism in 4(23.5%), sexual
violence in 8(47%), domestic violence in 9(53%),and prostitution in 3 (18%) of
cases Clients who were issued with Implanon (17) were most likely to attend for
follow up (65%) compared to 56% for women receiving other long acting methods,
and 50% of those receiving other methods.
Conclusion Homeless women are
affected by complex issues which may make regular clinic attendance difficult.
The majority of our clients accept long acting reversible contraceptive methods.