A Rural Voice: SexRurality 2019

My trip to Victoria two years ago to attend my first SexRurality conference in Lancefield was invaluable. It took me out of my bubble here in the West and reassured me that there were clinicians, practitioners and researchers experiencing similar frustrations; eager to find solutions to common issues and struggling under the constraints of the rural sexual health sector. I was so excited to head back to Victoria; back to SexRurality and in some ways, back to my people this year in Creswick.

Creswick. Beautiful Creswick.

Where the hell is Creswick, you ask? You and everyone I spoke to about SexRurality before I left. The look of utter confusion on everyone’s faces reassured me that I was heading to the right place. What better setting for rural health focussed conferences than towns that no-one knows about? Or has driven through once on their way to somewhere bigger and better. Creswick was perfect.

Day one: Get political, get connected

Creswick is found on Dja Dja Warrung land, and Rick Kerr was charged with Welcoming us to these lands. Rick is an Elder and a direct descendant of Leonard Kerr, a Dja Dja Warrung man born at Mount Hope in 1854. He spoke to us about the dreaming stories of the area: of Bunjil Dreaming and the actions of the Raven, the Cockatoo and the Rainbow Serpent. Rick spoke of the passing of knowledge and learning through the ages; how the Dja Dja Warrung “danced their stories in to the fire”. We were welcomed to this country – and ready to begin.

Marie Bubnic provided the conference opening on behalf of the Department of Health and Human Services (VIC) and highlighted the number of demand pressures that are felt within sexual health and reproductive health services provision.

There was an acknowledgement of something that rural workers and researchers understand intimately: that rural service provision is often personnel and personality-based. The doctor in a rural town impacts on what services are available. Marie also spoke about how there was a lack of service integration, and that while cost and travel are significant barriers, the Department had found that rural people are more than willing to travel for services that are inclusive and de-stigmatised.

There was also recognition that current funding and structures are focussed primarily on specialist service provision, and that a transition to more place-based primary care was a challenge that will require collaboration with the sexual health workforce. A subtle plug that Health Promotion must be considered within this attempt to reorientate health services is inserted here.

Kylie Stephens, the Senior Health Promotion Manager at CERSH, gave us an update on what was happening in their world, what they were proud of and the areas CERSH needed to pay attention. Kylie discussed the potential to increase the geographical reach of CERSH while also ensuring that we, as the rural sexual health workforce, continue in our efforts to broaden the responsibility of prevention efforts.

In settings where resources and power are contested, there is a need to ensure that rural voices are provided and heard – and that localised solutions and community participation are important in the rural setting. Kylie also highlighted the need to address workplace attitudes and cultures: practitioners and workers learn that sexual health lacks priority and focus from their peers. So much of this overview resonated with me that it pretty much reinforced why travelling across the country was such a good idea this time, and last time.

When someone says something at a conference and you feel vindicated.

Next person to take the lectern was Fiona Patten MLC. Now this isn’t your usual local member address. As the Member for Northern Metropolitan Region in the Victorian Parliament’s Legislative Council, Fiona has been called “Australia’s most effective legislator.” Her legislative achievements put many of our far longer serving elected representatives to shame and her ability to hold us as a crowd was very impressive as she talked about “How do we get politicians to say the ‘S’ word?”

Fiona talked about her engagement with politics before becoming elected and how she went about engaging politicians in ways that aren’t possible now. Fiona spoke of a time when politicians were brave, such as attending a sausage sizzle at a brothel for Open Brothel Day when it coincided with Safe Oral Sex Day. I fear those days are gone. It was also highlighted that sex workers have a strong role in sexual health promotion as educators and should be respected as a resource.

Very, very grateful to return from Crewick with this wonderful souvenir

Fiona highlighted what we know: access, stigma and confidentiality are key determinants underlying rural sexual and reproductive health. Now, just because we know it – it doesn’t mean it isn’t nice to hear someone else acknowledge it. It also flowed in to one of the key takeaway points for me from SexRurality 2019: that we need to talk to our politicians about sex – before they start talking about it. And we, the 150+ people in the room were a clear directive and call to action: go talk to our politicians. Talk to them about the issues in our local areas. Tell them our stories. Go with actions and solutions. We are excellent sexual health communicators doing the best that we can – so we need our politicians on OUR side, advocating and lobbying for OUR needs. They can’t do that if we don’t communicate with them.

“Talk sex to your politicians.”

Go to them. Tell them your stories from the field.Go with action and solutions.

Next up, was Associate Professor Christopher Fisher from the Australian research Centre in Sex, Health and Society giving us some rural focussed findings from the 6th National Survey of Secondary Students and Adolescent Sexual Health (research protocol here).

It was brilliant to get the rural focus on these findings and it generated a lot of discussion on why some things were seen in the data. Rural young people were more confident in using sexual health services – and somewhat more trusting. This is something I’ve seen within my own research, where young people did not feel the same level of anxiety over confidentiality concerns accessing rural GPs as the rural GPs themselves felt.

Young people wanted relationships and sexuality education that was real and useful. They did not want tokenism. Findings highlighted the massive burden that young women bear in terms of provision of informal relationship and sexuality education. It’s great that peers are seen as one of the best places to turn to for advice – but how are we supporting these peers?

We then broke for what seemed like the first of several hundred meal breaks and our first real chance to network. I’d been beating off a sore throat for a few days before travelling and was seriously worried I’d lose my voice before I presented on the second day – but there were far too many people to catch up with and talk to. Oh, and some networking of course.

Inigo Montoya’s guide to conference networking

We came back from break to a panel discussion facilitated by Yumi Stynes, the host of one of the best podcasts going around (go listen to it now!). I think Yumi is pretty cool and I can safely report that I (and a few dozen other delegates) totally kept it together after lunch and didn’t descend into pools of pathetic fan-boy/fan-girl/fan-nb behaviour.

Anyway, cart before the horse – before I embarrassed myself, Yumi facilitated one of the most diverse panels I’ve ever seen at a conference. I don’t want to list the ways in which this was achieved in some diversity checklist/shopping list – but let’s just say there were a lot of boxes ticked and a lot of amazing perspectives.

The thing that hit me very early on in the discussion was how a number of the panellists had been failed by their health professionals when seeking help. From a young trans-person being told they were insane, to a pregnant women with genital mutilation being met with overt fear and stigma, to terrible management of a new HIV diagnosis.

The panel was incredibly brave in what they shared with us and were candid in their responses. Yumi asked the panel what they would like to see included in relationships and sexuality education in schools: they were queer inclusivity, pleasure, abortion, understandings about cultural sensitivities, respect, the need to love yourself first. Nothing shocking – but enough to send a politician scared of gender whisperers into a tizz no doubt. These are not the political times of brothel sausage sizzles.

In closing remarks, Yumi encouraged us to get out there and consider podcasting to communicate what we are up to. Expect a heap of sexual health podcasts coming your way – hell, one even popped out of here! We then broke again for food, the chance to network, and the chance to embarrass ourselves at the feet of Yumi. We launched at those three opportunities with gusto.

Split sessions

After food, we started the first of the split sessions. Conferences always present dilemmas on who to see; who to miss. It brings me back to my early days going to festivals when I would scorn the organisers for putting Machine Gun Fellatio and Shihad against each other. Do I choose provocative on-stage antics or power rock?

Now, I’m not going to say which one was which, I’ll leave that to your interpretation – but I started in the Open Topics stream with Shannon Hill and Siobhan Bourke, before racing across the festival conference to the Place-Based Stream to catch Amy Isham, Cath Tischler and Bernadette Lewis.

Shannon Hill started with a strong question asking ‘What good intention we could put out in our work and make come back to us?’ before presenting on the great work that Women’s Health Grampians had done in developing a Theory of Change – a pathway towards a vision. The Theory of Change was about plotting the way to achieve the vision clearer, thus creating supportive environments and setting foundations for future progress. I liked it. Siobhan Bourke gave a great overview of the Sensitive Physical Examination Program used to teach medical students how to negotiate sensitive examinations. Consent and feedback are key components that students learn – as well as important feedback on body language and how they interact with patients. There was also the great point that we presume medical and nursing students have had great relationships and sexuality education in the past – when often they haven’t.

Across town, Amy Isham and Cathy Tischler gave an overview of how their ethnographic research is embedded alongside (under?) an active participatory action research project to provide deeper understanding of the issues relating to social service delivery and access faced by teenage parents in Horsham. Another great example of regional researchers in a regional area finding local solutions to problems – that will no doubt have value to the wider population. They highlighted the need to address the gaps and ensure that the real world practitioners know as reality is expressed within the research literature. One point Cathy made that ties back to Fiona Patten’s call to action was that politics influences health at all levels and there is a need to empower our regions as a whole. Bernadette Fraser rounded out the session giving an overview of the Storylines project – a collaborative project that gathered women’s lived experiences that highlighted intersections between social determinants, health inequities and barriers to access.

The beautiful paperback vulvas made by BlackGin

After lunch, Edwina Jachimowicz, a fellow out-of-towner presented on a program that SHINE SA had implemented to build workforce capacity within the rural and regional workforce. The project came about from the knowledge that the sexual health workforce is expected to do as much, if not more as before, with the same or less resources. This brought about the need for a partnership approach. This involved negotiating some turf wars and managing expectations but led to considerable knowledge gains. Next up was Jenny O’Connor from CERSH, talking about working with LGAs in trying to install condom vending machines. Now this is something I know about from my area – I’ve been laughed at for suggesting condom vending machines in our area – and as a Councillor as well as a Health Promotion worker, Jenny has a foot in both camps. Navigating very local politics still needs advocacy, nuance and hard work.

Dr Tim Staunton Smith presented a really nice project on the physically-visible and Web search-able signs that rural GP practices are LGBTQI friendly. It was not the most complicated study – but it did what it was designed to do and I’d love to replicate it here in rural WA. Interestingly, in the days after the conference while in Hamilton, I noted several shops and cafes had Rainbow Flag stickers on their doors. It was subtle. It was simple. I don’t know anything about it – if it’s a local scheme – let me know.

Hamilton and the subtle Rainbow Flags

And well – from there, I tapped out for the final 30 minutes and found somewhere quiet to gather myself. Conferences can be really full-on – and with an evening drama performance and dinner ahead – I needed a quiet moment. It wasn’t quite a Bex and a lay-down, but it was close. I followed the Twitter hashtag as I rested, and was again reminded of how useful Twitter can be. Yeah, it can be a waste of time – but #sexrurality was trending locally. I had a heap of interactions from both people at the conference and around the place, and I knew when I got home to write this there would be something to work with. About five years ago, I wrote a little thing for Croakey blog after the PHAA Conference in Perth about joining Twitter. Have a read and a think if you are still to be convinced.

I’ll be honest – I had gone to the chill-out tent for this one. I was cooked, but still followed along via Twitter.

Before we were unleashed on the conference buffet, we were treated to an early showing of ILBIJERRI Theatre Company’s VIRAL. Director Kamarra Bell-Wykes reminded us that the cast were still in the early days of settling into rehearsal and not quite ‘show ready’ – and for us to be kind. This was more of an open rehearsal than a full show.

What followed was gritty, stark and determined story-telling that delved into the realities of health care access, discrimination and colonisation, and the ongoing impacts on the social determinants of health. The sharp and witty dialogue was often split across the three performers (Jessie Butler, Shannon Hood & Nikita Tabuteau) to create power in shared messaging.

It was a raw performance – but a fantastic one. It was great theatre and wonderful to see art and health coming together. Since the last Sexrurality, I’ve gone on a bit of an accidental arts/dance adventure and I think we need to work harder to find synergies between the arts and health – both in terms of messaging, but also advocacy and sharing of ideas and resources.

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Day two: Research, presentations and farewells

I awoke as fresh as a daisy and ready to take on what was going to be another big day of rural sexual health. Today was game day for me – and I could not have asked for a better preparation. It was time to get caffeinated, get excited, warm up our Twitter fingers and get back into it.

Well, SEX(ually transmitted infections anyway)

Associate Professor Eric Chow kicked off the day with what was new in Gonorrhoea control. This was a pretty epic presentation that I’m not sure I can wrap up that easily. From the question of “Can you use saliva as lube for anal sex?” (You can, but should you? The prevalence of gonorrhoea in MSM who did use saliva was greater than 2 times the prevalence in those who didn’t), to exploring if mouthwash can be a novel treatment for oropharangeal gonorrhoea (or dandruff*) – there was a lot of content covered. What is clear, is that with gonorrhoea on the rise – we need to pay more attention to some of the unrecognised risk factors in transmission.

Professor Jane Hocking was next with a focus on Chlamydia Control. Jane asked us about our current practice and if it was evidence based – our focus tends to be on promoting increased testing – however, this doesn’t necessarily reduce the incidence of Chlamydia and ultimately we want to prevent Pelvic Inflammatory Disease. But PID isn’t monitored. Perhaps we need more of a case management approach to reduce reproductive morbidity and minimise reinfection.

Also, with rectal Chlamydia being detected at increased rates in women – is it something to worry about? Literature shows there is 32 fold incidence in women testing positive rectal infection with urogenital infection. Contamination? Problem? Auto-inoculation? Its unclear. What is clear though, is that Chlamydia vaccine development needs to be a priority if we want to effectively control Chlamydia at population level

Dr Kathryn Cook started off telling us about St Denis, who I have to say, sounded a little bit like a late night conference delegate. St Denis was beheaded. Refused to die. Walked off carrying his head. Then died. And is the patron saint of syphilis. We all reach different heights. As wild as this was – Kathryn wanted to remind us that Syphilis is NOT history. We need to be kind contact tracing, we need to be diligent, we need to understand that even “nice ladies” that got to private clinics for IVF might have STIs. Congenital syphilis is not to be messed with.

After the break and just one more cake, I swear, Anne Roseman hit the stage with an intro song (I wanted my own stage entry song) to talk about Aboriginal Community Controlled Health Organisations and the work they are doing in sexual health. We also heard from Belinda Payne, Tara Purcell and Peter Wapoles-Crowe on their perspectives, involvement and insights. They highlighted that there are thousands of things to be done and sexual health is just one of them. There is under-reporting of STIs – most likely due to stigma and shame – and that universal screening is the key to reducing that shame. ACCHOs are also better placed to do holistic health care – but the FTE provided for sexual health is ridiculously low. Also, being aware of the intersections of gender, sexuality and culture cannot be ignored.

We then got more art in our face with the hilarious Alyce Fisher. It started with dancing condoms and ended with the charming word smith, Cameron. Again. Art. Health. Together. So happy. And safe:

Totally normal for a sexual health conference

Split sessions

Before lunch, we split again. Some went and engaged with the MoCCA Project as they ran a session about strengthening Chlamydia management in general practice; while the attention-seekers of the conference headed across to participate in an interactive creative development theatre session with ILBIJERRI. No guessing where I went. We worked hard in the theatre group, and all tried our hardest to be respectful of other people’s creative ideas when ours were clearly better, and came together to produce some really pleasing and thought-providing images through our dramatic staging. I hope ILBIJERRI got half as much out of it as we did.

There was time for one last buffet onslaught before the final split sessions – rural research and abortion care in the rural setting. I was at the research stage for that full set – so apologies for the lack of abortion care round up – but I was able to catch Pamela Doherty, from Children By Choice (another out of stater) talking about the barriers and facilitators that were faced in delivery of Medical Termination of Pregnancy (MTOP) in rural and remote Queensland.

Pamela Doherty

Marieke Dam presented the comprehensive approach taken from Women’s Health Grampians within their Increasing Reproductive Choices project. This was a great example of how you must address multiple socio-ecological and service levels to be effective – your approach must encapsulate top-to-bottom. It starts with the public facing front: it’s important that health centre reception staff have training in how to handle inquiries about accessing MTOP. Something I found fascinating a couple of days after the conference, while on a tour of the Budj Bim National Park, was learning that the Gunditjmara people had used green kangaroo apples to terminate unwanted pregnancies. This was normally when there were incoming harsh seasons and there would be pressure on group in terms of nutrition and health. It seems MTOP has been happening in rural Victoria, on country for a very long time.

Green Kangaroo Apple – used to terminate pregnancy

Dr Cameryn Garrett delivered on the impact evaluation of nurse and midwife contraceptive training. A lack of a Medicare rebate and supportive policies and procedures are barriers to nurses being able to insert contraceptive implants, and must be addressed – regardless of the training. Lily Claringbold presented on research into the factors influencing young women’s contraceptive choices, with fear relating to side-effects and pain, and invasiveness as major potential barriers for the low LARC uptake. Overall, there were many reasons women choose to use a particular contraceptive method, beyond contraceptive effectiveness, and they often make these decisions before speaking to their GP.

Marieke Dam

Is was then my turn to speak on how I accidentally became a PhD candidate how I got over-involved as a volunteer in trying to solve some sexual health problems within my own community. I was lucky enough to deliver effectively two presentations: one on the Delphi methodology that I utilised to validate the framework for sexual health provision in the rural area, and the second on the four key factors that the framework suggests. I realised as I hit the lectern that there was no presenter’s screen for me to look at – and as someone that tends to use the slides as prompts, rather than write a presentation – it made things a little trickier. Oops. Few tense moments.

Fundamentally, the presented framework suggest four key pillars for rural sexual health promotion from the research: we need to be providing credible and consistent relationships and sexuality education to our young people; ensuring that health services are well-connected and accessible; making sure condoms are easy to get and if possible – free; and building collaborative networks amongst traditional and non-traditional youth sexual health stakeholders. In many ways, it’s what people on the ground already know and do day-to-day. This project was about providing evidence, structure and guidance – not just pointing out what should be done. Hopefully it’s useful.

Anna Roberts presented some more exceptional rural research done by rural people explaining their project’s focus on mapping access to emergency contraception and MTOP – not just in terms of pure service access- but also availability or restriction of medication. Madeline Lim then presented about the artist formerly known as the Condom Fairy: a project that saw university students delivered free condoms on campus. The Condom Fairy was ranked the most convenient way for students to access condoms, and has been since renamed the Safer Sex Program. Finally, Jess Wynn brought us home with her research project asking “Do patients prefer a male or female urologist?” The thing that really resonated with me was that patient preferences are dynamic and open to change – a positive interaction has the potential to alter previous considerations. In my previous life as a nurse that happens to be a male, I would suggest that this research replicates my lived experience.

Wrapping up

There were some fantastic presentations this year at SexRurality, but one of the best things about this conference is the collegiality. People want to chat, they want to find out what you do and they want to share what they are doing. It’s an environment of support, encouragement and collaboration. Last time I attended, it was a real boost to my PhD in terms of validating what I was doing and reassuring me that people actually did care. This time around was a similar sense of validation and support – and I always speak highly of SexRurality to my WA-based colleagues. We just need a few more to come next time.

Star studded line up – can’t wait for the next one

In the days after SexRurality, while driving around rural Victoria checking out the Ballarat’s St Patrick’s Cathedral (timely), Grampians (amazing) and Budj Bim (incredible) – I reflected on the wrap-ups. So many fantastic points – but what was my take away? It took me until the flight home to settle, but I really agreed with Shannon Hill’s presentation and Jenny O’Connor’s interpretation of it during the wrap-up. I then kept reflecting on Fiona Patten’s call to action to engage our politicians. Finally, from the research stream, I agreed with Meredith Temple-Smith’s summation of the session – the need for strategic change.

My take away from SexRurality in 2019 is that we need a clear vision for rural sexual and reproductive health. A vision that includes strategically broadening the responsibility of prevention efforts beyond traditional stakeholders and fostering collaboration while championing reform to policy and appropriate resource provision. There are thousands of things to do, too few people and FTE funded positions to do them – but keeping on our current pathway there will be little change. Frameworks, mapping, systems approaches and solutions are the tools we need to strategically advocate for change from our policy makers. We can’t discount or neglect the amazing work that is happening in the field, but if we don’t collect the evidence, and more importantly, hand that evidence to our politicians on a silver platter – they aren’t going to find it before they start talking, and more importantly, deciding about sex.

So, that leaves me at the end. To finish my PhD. To make an appointment with my local members about my framework. To be a little bit more annoying. Oh, and to enrol to attend ASHM. What are you going to do?

Listen to the Southside Grind podcast about Sexrurality here

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Down and dirty in Lancefield – SexRurality 2017

This August I was lucky enough to pack my bags and head across the land to rural Victoria. Lancefield to be exact. I was heading to SexRurality 2017, a small but vibrant conference put on by the University of Melbourne’s Centre for Excellence in Rural Sexual Health. As a rural-based PhD candidate, researching how to improve the coordination of sexual health interventions in small rural towns – I’d struggle to find a more relevant conference.

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I arrived in Victoria tired, excited and unsure what to make of this conference. I’d followed the 2015 instalment via Twitter and had liked what I had seen. This conference is primarily pitched at workers, researchers and educators in rural Victoria – I was unsure how relevant I would be to them, and what would be made of my presentation. Getting away to Lancefield was the culmination of an absolutely desperate couple of weeks – busy family life, hectic work and a few curve-balls thrown in along the way. Funding my trip was a stressful challenge – as a PhD student that has the privilege of undertaking my research sans scholarship (APA or otherwise), I found myself in the position that my School would fund my trip – provided I was presenting. Except abstract acceptance took a little while. They would also fund certain things upfront, others I would need to claim reimbursement. After a fragile few weeks that bordered on financial ruin, my abstracts were accepted, money flowed where it needed and I was buckling my seatbelt and stowing my hand luggage.DGGWWBJV0AADfXU

Lancefield seemed nice. Nestled near the Macedon Ranges, it is a tiny country town, with a quiet main street. I wandered around the afternoon before the conference trying to get a feel for the place. It was so close to Melbourne (75kms), but felt so far at the same time. It was, thankfully close enough that coffee in the local cafe was good and cheap! SexRurality was being held at a winery conference venue. It was going to be a tough few days.

Our conference kicked off as any should – with a heartfelt, informative and challenging Welcome to Country. Given how we came to be in possession of this land, I have no problem when a Welcome to Country touches on the removal of land and property and makes you uncomfortable. How can we understand where we are going, if we cannot acknowledge the past? Perry Wandin delivered this Welcome to Country. We were meeting on Wurundjeri land – and from what I had seen of it so far, it was beautiful. Perry gave us a bit of history of the area, told us about the Healesville mission, about Coranderrk, its granting to the Wurundjeri people and its removal when local farmers decided the land was too profitable to be in the hands of Aboriginals. Perry’s delivery was relaxed, passionate and informed. He gave me a glimpse of what had come before us in the area, and a hope of what could come.

We had a solid opening session. Professor Bill Adam welcomed us to the conference and touched on the need to train rural health workers in the rural setting. In order to get people in to the country, you need to train them – but you can’t just drop them there as juniors or students and hope for the best. There must be training for the trainers. Centralisation of training not just an issue for rural Victoria – it is incredibly challenging to do post-graduate or doctoral study in rural WA.

MP, Mary-Anne Thomas delivered a welcome address and launched the CERSH online modules on Rural Sexual Health Care. Thomas is the Labor Member for Macedon – and I have to admit, gave an impressive address. I’ve seen many an MP “phone-in” conference addresses. There was, of course, a nod towards the work her Government was doing, but what I appreciated was the sincere engagement with the topic and the context – Thomas spoke like someone who understood rural sexual health, not just read a briefing note. Thomas encouraged everyone present to “keep making waves and ripples”. This I appreciated.

 

Louise Galloway spoke on strategy developments to address stigma and discrimination as part of State wide policy in Blood borne virus and sexually transmitted infection control. Galloway asked us – what target is acceptable for stigma and discrimination? Her team were trying to set an appropriate target and agreed, you must set a target of zero. Associate Professor Jane Tomnay, gave us an overview of the work that CERSH was undertaking – and highlighted that there was not a single piece of work that CERSH did on its own. Tomnay noted that a lack of specialisation is a key characteristic of workers in rural areas who address sexual health. This is a key component of my own research – it’s no ones job. While this is an issue, there will be no improvement in specialisation any time soon, so we have to find ways to harness this generalist approach and find intersections in roles and improve collaboration. Professor Chris Fairly rounded out the morning session giving a clear and interesting presentation on the importance of government policy in addressing sexual health; how policy is more important that individual choice in this area.

After the break, we heard from Deakin University researchers and peer educators on the Sexual Lives and Respectful Relationships project – a program focussed on intellectual disability and sexuality. We were asked if supporting people with intellectual disability part if your core business – and it was highlighted within the presentation that accessibility takes more than a ramp, but a whole system approach. The SL&RR project peer educators gave us an insight in to what the project was really about and the type of content that was delivered. The program isn’t about teaching slang for body part and sex, about setting the rules on who you can hug and how, or about condom use. Its focuses on conversations, facilitation and community connections.

Our next presenter was author, Clementine Ford. Now, Clementine is known by everyone to be a man hating femi-nazi that won’t rest until women are all that is left of the human race. She makes grown men cry on the interwebs; says really mean things; and spews streams of misandry laced with vitriol. This is according to the bands of MRAs on Twitter (they even sent ME a few tweets once they knew I was sharing a presentation room with her). I’m a big fan of Ford. Her book is excellent, challenging; uncomfortable reading – and I was nervously excited by what would have to say.

flagFord talked about many things. Reproductive rights were a key theme; reproductive labour and child rearing responsibilities; how women die from abortion when it is unsafe; that access to abortion is a fundamental right. Ford urged us to change the conversation and perception of who actually accesses abortion; and to stop fighting the pro-life movement using pro-life language. Ford spoke about how abortion is not a first line choice for contraception for people – but it should not be excluded from the conversation when we plan and talk about it.

The question time for both presentations was intense. It was interesting. It was challenging. And after everything that was discussed, I felt like I’d learnt many things. One of them was how poor post-partum health care is and how much better it needs to be. There was a lot of passion in the room about the pelvic floor and its recovery. I felt schooled. kegel-chat

The afternoon sessions were split streams. I missed a significant chunk of time from one session, having a great conversation with Ford in the dining room. I wasn’t kidding about being a fan, and the opportunity to have a conversation with an author I respect was not something I could miss (and an embarrassing request to sign her book). Ford was incredibly generous with her time, given the juggling of responsibilities and engagements, and I’m really grateful of the time she gave me. We talked about men, about empathy, about dance, about a few things really – and I have to say, its surprising (not surprising) how wrong MRAs (and a fair chunk of Twitter) are about Ford (given their views on feminism, maybe not a shock). Despite all the Twitter warnings that I would be dismembered or beheaded; I was left with a great appreciation of a hard-working author, a list of books and papers to Google, and a signed copy of Fight Like a Girl. I know right, who’d have thought.

I rejoined the conference and jumped in to learning about how people were improving sexual health through social media and digital technology. Anna Roberts gave us a run down how Gippsland Women’s Health had used their #areyoucovered campaign to let young people in their region know where to get their paws on contraception from condom vending machines. They even had local governments competing against each other to see who could move the most “units”. Way to go harnessing those small town rivalries. I say we do the same. I’m looking at you Mt Barker.

areyoucovered

Linette Etheredge explained her PhD project engaging young people on intimate relationships through digital technology. One of the things that stuck with me from this presentation was, aside from the content; it is so hard to explore what young people think about sex, sexuality and relationships when we can’t get ethics to study them. This group need protection from exploitation, but given how many young people are sexually active at an age younger than what we can feasible get ethics to ask them about it – how do we support them? Megan Lim from the Burnet Institute, delivered findings from their online survey on young people’s perceptions on the impact of online pornography. It was noted that watching pornography online was common and frequent in both genders – with both genders noting problematic use.

The afternoon was a fantastic panel discussion on diversity, equity, rural life and sexual health. From the provision of care to refugee women living with HIV in the rural setting, to dealing with female genital mutilation, to improving how we address sex, pleasure and diversity, to addressing the needs of queer youth, to using a consortium model to improve sexual health outcomes for young people. There were simple solutions to complex challenges – things as pure as being respectful and watching your language; finding solutions to clinic booking systems, from being flexible with bookings to code-words to improve confidentiality; to just being flexible in general. Franklin John-Leader gave a key quote for me in the context of finding solutions in your region- in that “you can’t wait for people with magic bullets”. My entire PhD project was started on that idea – there wasn’t anyone else coming to do this.

It was a huge first day. I was pretty nervous about day two – and my chance to speak. I was tired from hearing from such fantastic presenters. We headed off for the usual canapes, drinks and dinner. This was a sexual health conference, not a nutrition conference, so the food wasn’t too healthy, there was cheese and cured meat and fantastic local wine. Don’t judge me. I was self-determinating. We also had great entertainment from the very talented Benny Walker. Playing to a room full of networking delegates is tough, but this guy was great.

Day two kicked off hard and fast. Marilyn Beaumont, OAM and Buga Up Alumni, got us rolling with a stirring and powerful reminder of the importance of advocacy in women’s health. Beaumont gave us the history of improving access to abortion in Victoria and the incredible amount of sacrifice and effort that their group went to. There was a standing ovation. It was deserved. To hear from this person, and the amazing work she and her colleagues did to advance human rights in Victoria (and Australia) was humbling, inspiring and a privilege.

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Dr Paddy Moore followed to give the current context of abortion service provision and access in rural Victoria. Circa 2013, the single most common reason for women to travel to Royal Women’s Hospital was to access abortion with many women travelling from across rural Victoria to access abortion services at this central. Moore spoke of the need to continue to improve rural access to services – in town, not in the city; and how they had gone about doing this. Dr Alan Hulme Chambers followed, to explain systems, statistics and stories of medical termination of pregnancy – and highlighted the need to maintain advocacy alongside service and system development. Hulme spoke of the importance of building local networks and ties for improving on the ground intelligence; and trust. These things were critical in delivering services in rural area. All spoke of the complications of providing abortion services in rural towns with abortion provider stigma and community politic – and how despite overwhelming public support of medical termination, health services still don’t advertise due to fear of backlash.

The late morning session was sexual health research in rural communities. I was up. I tried my best to focus on my fellow presenters and tried my hardest not to break in to a large sweat. There was a presentation giving a comparison between metro and regional medical and nursing care; Stephanie Atchison stepped out of her lab to present on the (lack) of knowledge HPV in Australian Men; Emily Grant told us about her roving exploration of the Barwon South West region in search of condoms (to assess for young people’s access). Vendors hiding condoms above the cigarettes to stop them being stolen, condom vending machines in weird places and a general lack of access were the key themes.

Shannon Hill presented on the referral pathways and practices in rural Victoria – with a lack of clear pathways, confusions and inconsistent knowledge common. Next up, was me. It was a kind crowd and there were mainly positive reviews. A big thank you to Siobhan Bourke for snapping me, and thanks to everyone that didn’t leave. Declan McGavin rounded of the session with his presentation on practice nurse and practice manager perspectives on sexual health discussions with older Australians. We can’t forget “older” Australian’s are having sex. As one of my nursing lecturers once said to me – when would you like to stop, pick an age.

Lunch was eaten with the appetite of a man relieved to no longer have to present – a tired content that bordered on an inability to re-engage with the conference at all. If you’ve presented, you know what I mean – it’s not that you don’t WANT to get back in to it, it is just that the pressure is off, you can relax, and a nap would be amazing. I held off on the nap, ponied up and went back for more.

Jack Nelson, from CERSH, spoke about their SHOUT project. One of the things that really stuck in my mind about this presentation was the analysis of previous poster campaigns by young people. The language on the posters didn’t match with the young people’s own language – it was trying to be cool. That was lost on them. Anna Roberts doubled up to talk about trying to get schools to engage in collaboration to deliver relationships and sexuality education. Results hadn’t been amazing – and goes to show, even with incentives, sexual health can be a hard sell. It was also great to hear about things that weren’t working so well – we can learn from struggles as much as success. Eileen Berry, professional journalist come sexual health resource creator presented/was interviewed about developing her parent guides resource. As well as giving us a great insight into what is basically a passion project (of wonderful merit) and how it came to be, Eileen also gave us some great tips on dealing with the media, the best being:

“There is no such thing as a free lunch, if you’ve got a lot of secrets – don’t go lunch”.

We wrapped the conference with a review of all the sessions – there was so much great content. Then wearily, everyone headed off, back to reality. Back to places where sexual health is nobody’s job; where no one is that interested in young people getting condoms; where abortion is judged through a moral lens; were the world is binary and there is much contradiction. We’ll go back to worlds where people will want to argue the definition of rural. Where people will say, yes, ok, sounds important, but what about the ice problem? Where feminism is a dirty word.

I was going back to WA. Back to my little office. Back alone, muddling through a project that at times seems obvious and unwanted. At least we know, come 2019, somewhere in rural Victoria, we might all come back together again, to be around friends, to search for solutions, collaborations and ways to make sure sexual health is on the agenda. In the meantime, I’ll be here:

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