Wyndham Report - Women`s Health West

Improving condom access and
availability in Melbourne’s West
Wyndham City Council
Action for Equity: A Sexual and Reproductive
Health Plan for Melbourne’s West 2013-2017
Action for Equity is a four year sexual and reproductive health promotion plan for
Melbourne’s west that incorporates primary prevention initiatives that work to redress the
social determinants of sexual and reproductive health in order to achieve health equity. The
plan integrates long-term strategies across a range of settings and sectors to generate and
maintain the social and cultural change needed to achieve optimal sexual and reproductive
health through a regional partnership approach, the sharing of resources and knowledge,
and a common planning framework.
Improved condom access and availability by increasing the number of vending machines in
public places is a key Action for Equity strategy. Condom access is a key public health
consideration as using condoms and lubricant consistently and correctly can prevent the
transmission of sexually transmissible infections (STIs) including chlamydia, gonorrhea,
syphilis, HIV, blood borne viruses, and can protect against unwanted pregnancies.
Limited publically assessable and affordable condoms still presents a fundamental barrier to
condom use for many young people and other population groups such as men who have sex
with men, and street sex workers. Public toilets and parks throughout Melbourne’s west are
commonly used as beats and for the solicitation of sexual services, and hence is an
important site for STI and blood borne virus prevention initiatives.
This project is designed to create an enabling environment through supportive council
policies that increase public access and availability to condoms. This project aims to redress
social inequities by making condoms more available for marginalised populations who might
not have access to these resources due to limited finances, lack of transportation, social
stigma and embarrassment, and other factors than impact on access. This project also aims
to increase knowledge about the importance of safe sexual practice, screening and
treatment through a social marketing strategy implemented via social media.
Project proposal
Improving condom access and availability in Melbourne’s West
Why action is needed
The following indicators illustrate why a condom access and affordability strategy is needed
in Wyndham City Council:
During 2011 there were 19,238 notifications for chlamydia in Victoria, with 521
notifications from the Wyndham municipality (Dh, 2011)
There were 1,863 notifications for gonorrhea in 2011. Of these 58 notifications in the
Wyndham local government area (DH, 2011)
There were 857 notifications of syphilis for Victoria in 2011. Of these notifications,
223 were from the western region, which accounted for 26 per cent of syphilis
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Project proposal
notifications for Victoria that year. In the Wyndham local government area there were
26 notifications (DH, 2011)
There was an 81.5 per cent increase in chlamydia from 2009 and 2011, compared
with a 34.6 per cent increase in the western region (DH, 2011)
Between 2009 and 2011, there was an increase of gonorrhea by 70.6 per cent in the
Wyndham local government area, higher than the western region at 41.9 per cent
(DH, 2011)
There was a 52.9 per cent increase of syphilis in Wyndham compared to a 5.7 per
cent increase in the western region between 2009 and 2011 (DH, 2011)
Wyndham municipalities reported higher teenage fertility rates than the Victorian
state average. In 2008, 12.9 out of every 1,000 teenage women had a life birth
compared to the western regions rate of 8.9 per 1,000 teenage women and the state
of Victoria’s rate of 10.6 per 1,000 teenage women (DEECD, 2011)
In 2009 in Wyndham, only 41.1 per cent of sexually active adolescents practiced safe
sex with a condom. This figure is lower than the western regions percentage of 53.7,
and the Victorian average of 58 per cent (DEECD, 2011).
It also needs to be taken into account that if individuals who present at a clinic (e.g. the
Melbourne Sexual Health Clinic) did not provide a postcode, they are likely to be assigned
the Melbourne post code. Therefore the number of STI notifications or teenage fertility rates
in Wyndham might not necessarily reflect the number of STI numbers or teenage
pregnancies for the resident population in Wyndham.
Economic modeling on the effectiveness of condom distribution interventions
Research shows that the male condom is the single most efficient available technology to
reduce the sexual transmission of HIV and other STIs. There is yet to be economic modelling
produced in Australia or Victoria that relates to the social and economic burden associated
with STIs. However, economic modelling conducted in the United States (US) shows that
there are 20 million new infections in the US each year, costing the American healthcare
system nearly $16 billion per year in direct medical costs alone (CDCP, 2013).
Economic modelling conducted in the US also found that the average annual cost per
adolescent at risk of unintended pregnancy who does not practice safe sex is $1,267 $1,079 for unintended pregnancy and $188 for STIs (Trussell et al, 1997). One year of
savings associated with the use of the male condom was $946 in the private sector and $525
in the public sector (Trussell et al, 1997). Although such estimates aren’t directly transferable
to Victoria, this research shows that increasing condom use leads to risk reduction within a
range considered to be cost-effective when translated into health outcomes (Charania et al,
2011).
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Evidence informing this project
Research suggests that young people, particularly young men, prefer to access low-cost
condoms from semi-private places such as local parks, school toilets and shopping malls
(Sixsmith et al, 2006).
An international met-analysis of 21 condom distribution programs found that increasing
availability and accessibility to condoms in conjunction with community-based individual and
group interventions that promote respectful relationships and knowledge, attitudes, skills and
behaviours related to condom use effectively:
increase condom acquisition
increase condom use
delay sexual initiation among young people
reduce the incidence of STIs (Charania et al, 2011).
In line with the evidence-base, this project will incorporate a social media strategy to promote
safe sexual practices and inform communities within Melbourne’s west of the increased
access of public condom vending machines. This project is also aligned with other Action for
Equity community education strategies that work directly with young people and other
population groups. This multipronged approach ensures that this project sits alongside other
work that promotes opportunities for communities to gain the knowledge, skills and
resources needed to ensure sustainable sexual and reproductive health outcomes.
Cost, potential revenue raised and vandalism
Unless additional funding can be sought, councils will be required to fund an initial outlay for
the purchase of condom vending machines that cost between $1500 and $2,000 per unit.
A condom vending machine distribution project conducted by the Centre for Excellence in
Rural Sexual Health with three rural councils in the Hume region found that the outlay cost of
machines was recouped by councils within 18 months. This project also found that over a
year, six publically accessible condom vending machines raised $2626.10 in revenue
(Tomnay and Hatch, 2013).
Project proposal
During the Hume region’s 18 month pilot project there were only two significant episodes of
damage that required a machine to be sent away for repair. Graffiti on the outside of the
machine and jamming coins into the slot were the most common types of vandalism and
were repaired on site by the councils. The machines did not suffer any unrepairable damage
and were used more frequently as the study progressed. This project did not receive any
negative feedback from residents or negative reporting by the local media (Tomnay and
Hatch, 2013). All media attention associated with the project was positive and outlined
council’s commitment to ensuring positive health and wellbeing outcomes for communities
within their municipality.
It is also important to note that Melbourne’s western region is three times larger than the
Hume region. Therefore, it is likely that metropolitan councils will generate substantially more
revenue associated with such a project. Once the initial outlay of the machines is recouped,
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revenue is profit and as such, the project model is economically sustainable and can cover
any future repair costs (Tomnay and Hatch, 2013).
It is envisaged that once the costs of the machines are recoupled that revenue raised by the
machines will be reinvested in sexual and reproductive health programs within the
municipality.
Condom vending machines within Wyndham City Council
Condom vending machine project
16
14
Number of council public toilets
Project proposal
There are a total of 15 council operated public toilets in Wyndham. For this project to be
successful, a minimum of 20 per cent of council’s public toilets will have condom vending
machines installed. Currently there are no condom vending machines in Wyndham City
Council operated public toilets. A minimum of three condom vending machines is
recommended to be installed by Wyndham City Council.
12
10
Total No. of council public
8
Total No. of condom vendin
already installed
6
Minumum No. of public toi
install in LGA
4
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Public toilets in Wyndham City Council
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a. Chirnside Park BBQ
Area
Werribee South, Vic
Open daylight hours
Male and female
Baby change facilities
Werribee, Vic
Unisex facilities
Baby change facilities
Syringe disposal unit
Parking
Open daylight hours
b. Comben Drive
c. Kelly Park
Werribee, Vic
Open daylight hours
Male and female
Baby change facilities
Syringe disposal unit
Parking
d. Soldiers Reserve
Werribee, Vic
Open 24 hours
e. Wyndham Vale
Reserve
Werribee, Victoria
Open daylight hours
Unisex facilities
Baby change facilities
Syringe disposal unit
Parking
Hoppers Crossing, Vic
Parking
Open hours 7am- 7pm
Male and female
Syringe disposal unit
i.Mossfiel Reserve
Hoppers Crossing, Vic
Open 24 hours
Male and female
Parking
Syringe disposal unit
Werribee South, Vic
Male and female
Open 24 hours
Parking
Shower
Syringe disposal unit
m. Beach Road- Price
Reserve
Werribee South, Vic
Male and female
Open 24 hours
Syringe disposal unit
j. Warringa Reserve
Hoppers Crossing, Vic
Open daylight hours
Male and female
Parking
Syringe disposal unit
n. Little River Reserve
Little river, Vic
Male and female
Open 24 hours
Syringe disposal unit
g. Galvin Park Reserve
Werribee, Vic
Open 24 hours
Male and female
Parking
Syringe disposal unit
k. Possy Newland
Reserve
Little River, Vic
Open 24 hour
Unisex, male and female
facilities available
Parking
o. Presidents Park
Werribee, Vic
Open hours 7am-7pm
Male and female
Baby change facilities
Syringe disposal unit
Parking
h. Old Geelong Road
l. Beach Road
f. Point Cook
Point Cook, Vic
Unisex facilities
Wheelchair access
Baby change facilities
Syringe disposal unit
Open daylight hours
Project proposal
Male and female
Syringe disposal unit
Parking
*Map attached as an appendix
Where the key target populations reside
Young people, men who have sex with men and street sex workers are the primary target
populations for the condom vending machine project.
There are three known public toilets within the Wyndham local government area that are
used by men who have sex with men. On the website Cruising gays (2014), Soldiers
Reserve Public toilet in Werribee had 2250 views, Kelly Park public toilets in Werribee had
1500 views and Point Cook Public Toilets also in Werribee has 4250 views, which states that
these public toilets are used as a beat. It is recommended that condom vending machines
are placed in these public toilets. Situating condom vending machines in these public toilets
is an opportunity to directly target men who have sex with men which from a public health
perspective is an important target population due to their high risk of STIs, including
HIV/AIDS.
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It is difficult to estimate the number of sex workers in the illegal industry in Victoria and the
West, including illegal brothels and street sex based sexual services, although it has been
identified that the illegal industry is larger than the legal industry (ISCHS, 2013). Research
has demonstrated that sex workers providing sexual services on the street in Victoria are the
most disadvantaged, marginalised and vulnerable workers in the industry. Clients of street
sex workers often demand ‘high risk’ activities including sex without a condom, services with
multiple clients and sex in isolated locations (ISCHS, 2013). These activities place street sex
workers in a situation with high sexual health risk.
We know that there is a high frequency of street sex workers in an area in close proximity to
other public areas where heroin can be bought, linking street-based sex work with drug
dependency. Illicit drug use and drug dependency leaves these individuals vulnerable to high
risk sexual behaviours (Rowe, 2011). There is also high risk of street sex workers contracting
and spreading blood borne viruses if they are injecting drug users, especially when a
condom use and safe sex has not been practiced (HW, 2013). Further consultations are
needed with local service providers to determine if and where street-based sex workers
reside in Wyndham.
To ensure that the condom vending machines are accessible to the public and especially to
the key target populations, it is important that individuals have 24 hour access to the
nominated public toilets. This might require council to leave public toilets unlocked to ensure
individuals have access to the condom vending machine and therefore allow the highest
opportunity for a successful program.
Project proposal
An initial conversation with the Youth Resource Center in Wyndham City Council suggests
that there are three key areas where youth reside and the public toilets that are in proximity
include Kelly Park toilets, Mossfeild Reserve public toilets and Presidents Park public toilets.
The Kelly Park public toilet is an ideal site for a condom vending machine as it is close to
Werribee train station, there is a school across the road and it is known to be used as a gay
beat. Both Mossfield Reserve and Presidents Park are close to skate parks, netball courts,
play grounds and soccer clubs. It is recommended that the condom vending machines are
installed in the public toilets listed above as they have high exposure to the youth target
population and will result with the project having the highest opportunity of success.
Social media
The 2013 National Survey of Australian Secondary Students and Sexual Health highlighted
that there is a very high prevalence of young people using social media.
The study found:
Ninety-three per cent of surveyed young people use social networking sites at least
once a week and 91 per cent use instant messaging
Text messaging and mobile phones are used by 88 per cent and 86 per cent of
young people respectively
Social networking sites are used at least once a day by 87 per cent of all surveyed
students
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Facebook was the most commonly used social networking site (91 per cent of
students). YouTube was regularly used by 82 per cent of young people and
Instagram was regularly used by 49 percent of students (NSASSSH, 2013).
Social media tools that can inform the community about the condom vending machine
project include ‘Facebook’ and council run websites. The Wyndham City Council Facebook
page has 200 likes and the Youth in Wyndham Facebook page has 470 likes. These forms
of social media could be used to create awareness about installed condom vending
machines, and the importance of safe sexual practices in the community.
Project proposal
The Wyndham City Council and Wyndham Youth Services websites are examples of social
media that can be used to inform the community about the condom vending machines, and
why it is important of individuals to use condoms. This will be particularly important for newly
arrived communities who might have not been exposed to such sexual health knowledge.
Phone applications can also educate individuals about where they can access condoms and
the importance safe sex. The iCondom app is a good example of an existing app that
provides an address, map, distance to condoms, cost, what else is included with the condom
(e.g. lubricant) and an option to rate the dispenser. Providing condom vending machine
information to iCondom will allow for the most up-to-date information on where to access the
condom vending machines and is easily accessible by individuals who use smart phones.
For men who have sex with men, sexual health promotion and promoting the condom
vending machines can be done on male dating apps like Manhunt, Grindr, Gaydar and
Scruff.
Project stages
Stage one:
Ensure by in and commitment from the seven local governments that make
up Melbourne’s western region. This is important in ensuring that this project
has reach across the West
Stage two:
Develop evaluation strategy and work with partners to determine process,
impact and outcome indicators
Stage three:
Conduct mapping exercise via the use of the national public toilet map, which
is an online tool that can support the mapping of public toilets throughout the
western region (completed by Women’s Health West in Mat 2014)
In some municipalities this work has been completed through the
development of their public toilet strategies. This process will determine how
many public toilets there are. An additional process of determining how many
public toilets in the West currently have condom vending machines is also
required. This will form part of the pre evaluation data
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Stage four:
Conduct consultations with participating councils to determine which council
departments and plans this work needs to be embedding within e.g.
operations, property and legal services and environmental health
Stage five:
Conduct community consultations with population groups most in need of
increased access and availability – young people, men who have sex with
men in public parks and toilets and street sex worker community – to inform
the location of condom vending machines
Stage six:
Map access across the west to ensure equitable distribution and coverage.
Once completed condom vending machines will be installed and monitored
Stage seven:
Develop and implement social media strategy to promote safe sexual
practices and knowledge, STI screening and treatment among communities
in the West.
Stage eight:
It is also envisaged that this project include a strategy aimed at ensuring free
access to condoms via venues such as community and women health
services, youth services and secondary schools as appropriate.
Resources required
Women’s Health West has recruited a student with a public health/health promotion
background to conduct and support this project up until May 2014.
Women’s Health West on behalf of the Action for Equity partnership is also exploring
potential funding opportunities through a grant from the Helen Macpherson Smith Trust to
support local councils to implement the project.
Unless additional funding is sought, councils will be required to provide in-kind staff support
to enable the effectively and sustainable implementation of this project.
Proposed next steps
Project proposal
Preference needs to be given to locations that are open 24 hours a day and
easily accessible
Councils to undertake internal consultation with relevant council departments and undertake
necessary action required to ensure endorsement of the condom vending machine project.
WHW in partnership with participating councils will develop a detailed project plan including a
memorandum of understanding (MoU) and identify and potentially source project funding.
Further consultation is needed with Wyndham Youth Services and other relevant
communities to determine where young people, gay beats and street sex workers reside in
the community, and therefore the most appropriate locations to place condom vending
machines.
Once MoUs are signed the project stages will commence. This work will be overseen by the
Action for Equity regional reference committee.
Unless additional funding is sought, it will be council’s responsibility to provide funding for the
condom vending machines and their maintenance. It is proposed that profit from the condom
vending machine will be reinvested into sexual and reproductive health projects in the
Wyndham community.
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References
Australian Research Centre in Sex, Health and Society, 2014, National Survey of Australian
Secondary Students and Sexual health 2013, Date Retrieved May 10th 2014
Centers for Disease Control and Prevention (2013) Incidence, Prevalence, and Cost of
Sexually Transmitted Infections in the United States, retrieved March 4 2013,
http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf
Charanbia, M., Crepaz, N., Guenther-Gray, C., Henry, K., Liau, A. and Lyes, C. (2011)
‘Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and
International Studies, 1998-2007’, Aids Behaviour, vol. 15, pp.1283-1297.
Project proposal
Cruising Gays, 2014, Melbourne Gay Toilets and Washrooms, Date Retrieved May 3rd 2014
<http://www.cruisinggays.com/melbourne/c/toilets/>
Department of Education and Early Childhood Development (2011) Adolescent Community
Profiles 2010, Victorian State Government, Melbourne.
Department of Health (2011) Victorian Health Priorities Framework 2012-2022: Metropolitan
Health Plan, Department of Health, Melbourne.
Department of Health (2012) Communicable Disease Epidemiology and Surveillance Unit,
Surveillance of notifiable infectious diseases, retrieved January 7 2013,
<http://ideas.health.vic.gov.au/surveillance.asp>
Rowe, J. (2011) Shantusi: Surveying HIV and need in the unregulated sex industry, Inner
South Community Health Service: Melbourne.
Sixsmith, J., Griffiths, J., Hughes, J., Wren, J., Penfold, S., and Natusch, H. (2006)
‘Accessibility of condoms to young people in Manchester, UK.’, Family Planning and
Reproductive Health Care, vol. 32, no. 4, pp. 219-225.
Tiong, A., Patel, M., Gardiner, J. Ryan, R., Linton, K., Walker, K., Scopel, J. and Biggs, B.
(2006) ‘Health issues in newly arrived African refugees attending general practice clinics in
Melbourne’, Medical Journal of Australia, vol. 185, no. 11, pp. 602-606.
Tomnay, J. and Hatch, B. (2013) ‘Council-supported condom vending machines: are they
acceptable to rural communities?’, Sexual Health Journal, retrieved January 7 2013,
www.publish.csiro.au/journals/sh
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Trussell, J., Leveque, J., Koenig, J., London, R., Borden, S., Henneberry, J., LaGuardian, K.
Stewart, F., Wilson, G., Wysocki, S and Strauss, M. (1995) ‘The Economic Value of
Contraceptives: A Comparison of 15 Methods,’ American Journal of Public Health, vol. 85,
no. 4. pp. 494-503.
Trussell, J., Keonig, J., Stewart, F. and Darroch, E. (1997) ‘Medical Care Cost Savings from
Adolescent Contraceptives Use’, Family Planning Perspectives, vol. 29, no. 6.
Project proposal
Ward, J., Bryant, J., Worth, H., Kaldor, J., Delaney-Thiele, D., Pitts, M., Kelaart, D., Moore,
E., Cairnduff, S., Williams, S., Waples-Crowe, P., Byron, K., Bamblett, A., Betts S. and
Coburn, T. (2013) ‘Findings from the GOANNA study’, HIV Australia, vol. 11, no. 3.
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Project proposal
Appendix one
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Source: Adolescent Community Profile Series, DEECD, 2011.
Project proposal
Appendix two
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Project proposal