To the Editor: It is well recognised that Aboriginal and Torres Strait Islander men are one of the most disadvantaged population groups in Australia in terms of physical wellbeing.1 Annual Medicare Benefits Schedule health assessment items are essential tools to help Aboriginal and Torres Strait Islander men (and women and children) receive primary health care matched to their needs, as well as opportunities for preventive health care and education.
A growing body of evidence suggests that erectile dysfunction (ED) coexists with, or is a clinical marker for, other common life-threatening conditions, such as coronary heart disease and type 2 diabetes, due to shared underlying neurovascular mechanisms.2 Indeed, the relative risk and severity of coronary artery disease appears to be higher for young men reporting ED.3 Despite this, discussion with Aboriginal and Torres Strait Islander men about sexual health is often lacking. In such population groups at risk of chronic disease, the opportunity to assess erectile function may present a window of opportunity to identify and better manage life-threatening disease.2
To engage these men in sexual health discussions, a greater focus on culturally appropriate health services is needed. Cultural competency training is essential to overcome the barriers affecting how Aboriginal and Torres Strait Islander men access health services (Box 1). However, the sex-specific nature of some barriers and the impact of traditional and cultural roles on health service access pathways for men often require further attention, particularly for more culturally sensitive issues such as sexual health.
There are many other strategies and practical approaches that health services and primary health care professionals can implement to better engage Aboriginal and Torres Strait Islander men in positive and broader help-seeking behaviour and health service access (Box 2).6 Being able to implement such strategies may be an indirect reflection on the ability of health services to support cultural respect and provide culturally safe health care more broadly.
1 Factors influencing health service access and help-seeking behaviour for Aboriginal and Torres Strait Islander men4,5
Societal
- Illness-related stigma
- Sex-specific differences in health
Cultural
- Traditional gender-related law, masculinity and gender roles
- Language barriers
- Beliefs around causation
Logistical
- Lack of transport
- Conflict of appointment times with other family and community priorities (eg, ceremonies)
Health system
- Limited access to specialist services and/or treatment
- Complicated referral process
- Too few (male) health professionals, leading to patients seeing many different doctors
- Medical terminology and jargon
Financial
- Difficulties in meeting health service costs
Individual
- Knowledge or perception of the nature of the illness
- Previous illness experience
- Low prioritisation of preventive health care
- Lack of understanding and embarrassment
- Low self-esteem and confidence
2 Examples of culturally appropriate strategies for engaging with Aboriginal and Torres Strait Islander men about sexual health issues
- Provide a safe, private and comfortable environment that supports open and free dialogue
- Men may not open up in the first consultation — take time to build trust and respect
- Encourage men to have annual health assessments and incorporate sexual health questioning into these
- Make the clinic conducive to talking about sensitive issues; for example, a model of the male pelvis in the consulting room might help initiate discussion
- If only female health care providers are available, approach gender-specific issues in a sensitive way and use male Aboriginal health workers for advice or, if not urgent, refer to a male general practitioner
- 1. Australian Institute of Health and Welfare. The health of Australia's males: a focus on five population groups. Canberra: AIHW, 2012. (AIHW Cat No. PHE 160).
- 2. Schwartz BG, Kloner RA. Clinical cardiology: physician update: erectile dysfunction and cardiovascular disease. Circulation 2011; 123: 98-101.
- 3. Riedner CE, Rhoden EL, Fuchs SC, et al. Erectile dysfunction and coronary artery disease: an association of higher risk in younger men. J Sex Med 2011; 8: 1445-1453.
- 4. Wenitong M. Indigenous male health: a report for Indigenous males, their families and communities, and those committed to improving Indigenous male health. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing, 2002.
- 5. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2005. Canberra: AIHW, 2005. (AIHW Cat. No. IHW 14.)
- 6. Andrology Australia. Engaging Aboriginal and Torres Strait Islander males. The Healthy Male 2013; (46): 3-4. https://www.andrologyaustralia.org/engaging-indigenous-males (accessed May 2014).
We acknowledge and thank the members of the Andrology Australia Aboriginal and Torres Strait Islander Male Health Reference Group for their ongoing advice and contribution to our work in this area. The Andrology Australia program is supported by the Australian Government Department of Health. The department played no role in the writing of this letter.
No relevant disclosures.