My guest today is Melanie Gadd, who has spent 15 years in North Wales mastering the challenge of connecting with young people. Managing the Jiwsi project, Melanie and her team talk to these individuals in a language they understand and guide them towards a brighter future in which sexual health is a priority. Let’s find out how she does it.
Tell me about what you and your team do.
The Jiwsi project in North Wales is part of the Family Planning Association (FPA), but funded by the local health board. Our role involves delivering sexual health and relationships education to vulnerable young people aged eight to 25. They could be homeless, young offenders, have learning disabilities or been excluded from school. We also run training programmes for a network of healthcare professionals.
Why has it been difficult to connect with young groups historically?
Although sex education is compulsory in Wales, each school is allowed to decide how it is delivered, so some will deliver it all in one day. For many children with difficult backgrounds it can be a case of missing school when sex education happens. Those with impairments often don’t connect the dots – children with autism, for instance, are able to tell you perfectly what reproduction is, but don’t understand what sex is, and miss out on social cues about sexual relationships.
What are the major challenges your team needs to combat?
People only realise when they’ve missed out on this area of learning when problematic behaviour starts to arise. Internationally, and in the UK, work is being carried out about the effects of adverse childhood experiences, such as exposure to violence, parental separation or drug abuse. Evidence shows that if a child has more than four of these, they are much more likely to have poor health, violent relationships or go to prison. They are also six times more likely to have, or have caused, a teenage pregnancy.
It sounds like you are taking on problems that have been endemic for generations.
People who were born to teenage parents are more likely to have a teenage pregnancy themselves. Furthermore, if you have a baby under 18, it is likely to have poor health throughout its life, so the impact is much wider on society than just the individual.
It’s about breaking the cycle and providing people with the control over when they become a parent. We say parents should be talking about sex, but if the parent hasn’t had any adequate sex education, they are passing on the culture of silence.
In the past British people have sniggered their way through sex ed. How do you overcome that?
In British culture sex is either dirty or funny. Hardly anybody talks about it as a normal function like eating or going for a walk. You need to get past that barrier. I have been in this job for 15 years and am constantly working with new groups. When I started out it was all about teenage pregnancy reduction, but now it’s sexting, pornography and sexual exploitation. The picture has shifted.
Your career has covered the entire digital revolution.
When we started there were no smart phones. The reduction in teenage pregnancies over the last few years is actually down to the development in technology. In the past, when young people wanted a social engagement they had to meet up; now they can do it from their bedrooms.
It’s sorted out one social problem, but created another!
When I met young people 10 years ago, the most challenging were still very streetwise, and I used to think “you’re having a hard time, but you’ll be okay.” These days, vulnerable people can be a bit more like turtles without shells – they don’t know how to interact with the world. They’re amazing on their devices, but if they were left entirely alone, they wouldn’t have the resilience to survive.
What do you cover when it comes to STIs?
Some groups cover how they are caught. Lots of young people don’t understand the concept of fluid transmission. We talk about whether they are viral, bacterial and parasitic, how you get tested and accessing local health services. It’s also important to discuss how treatable they are.
How do young people access medicines in these communities?
Community pharmacy is a major player – around here it is most young people’s first port of call for emergency contraception. When we talk to young people about treatment for STIs we give them a general overview about the treatment they might expect. For example, a course of antibiotics if they have chlamydia. We do tend to sugar coat sometimes, because we want to encourage them to seek treatment. With gonorrhoea, we know there are potential complications, but we wouldn’t explicitly tell young people, because we don’t want to put them off getting tested.
HIV is very treatable now. Do young people know that?
Not many professionals know that. Recently, we had an HIV nurse in to provide an update to 40 healthcare professionals. HIV is a lifelong condition, but we now have medication to stop people passing it on and catching it in the first place. In Wales, PReP is also available to all sexual health services, and we see it in the same category as contraception. Why should someone who doesn’t want HIV be treated differently from someone who doesn’t want a baby?
Do young people leave your groups empowered?
We work with them for six to eight weeks, but we don’t then stand beside their beds to make sure it’s put into practice. We have, however, met people who tell us it really made them think. I did get an immediate reaction the other day when I was talking to a group about sex in terms of social media, and many of them got their phones out and started changing their privacy settings. Young people have a very poor perception of risk but, in the future, they might just remember what we talked about.
On the soundtrack of your life, what record would you choose?
Little Creatures by Talking Heads – whenever I listen to the title track, it always makes me think of the job I’m doing.
It’s your last supper, what are you having?
A really hot curry.