People experiencing homelessness often face significant barriers and lack the supports, resources or information they require to effectively engage and be retained in sexual and reproductive healthcare. This is exacerbated by:

• their marginalisation within society

• the stigma around sexually transmitted infections (STIs) and blood borne viruses (BBVs)

• comorbidities, in particular mental health and alcohol and other drug disorders

• competing priorities and complexities involved with meeting basic needs

This contributes to missed opportunities in conventional health education, screening and delivery approaches thereby exacerbating disproportionate rates of STIs, BBVs, and a lack of adequate reproductive health care.

 Homeless Healthcare, funded by the Department of Health and in response to the declaration of the syphilis outbreak in 2020, has developed and continues to deliver a Sexual Health Outreach program within the Perth metropolitan. Although widespread, particular concern within the syphilis outbreak exists for priority populations including those experiencing homelessness, women of child-bearing age, people who use methamphetamines and/or inject drugs and Aboriginal people- all of whom Homeless Healthcare support.

The program itself provides a nurse-led service that works closely and collaboratively with other organisations (both health and community) to address these disparities with a focus on providing accessible care where it is most needed. Care provided includes STI/BBV screening and management, contraception, perinatal support, vaccination, and facilitation of engagement in GP and specialist care.

This is achieved by:

• Street based outreach and active case finding

• Nurse-led clinics

• Sector education and capacity building

• Resource development

• Involvement and contribution to relevant metro working groups, including those focused on high risk syphilis cases as well as HIV

• Weekly dedicated Women’s Clinic at the Hub

Since the outbreak was declared in 2020

• syphilis testing of clients has increased by 71%

• over two thirds of clients seen by Sexual Health Outreach are women of child bearing age and two thirds identify as Aboriginal

• per 6 monthly reporting period around 40 clients are seen for syphilis related care including new infections, contact tracing, follow up care and treatment revision

With ongoing funding, the Sexual Health Outreach program looks to continue identifying and mitigating gaps in care and service delivery to some of the WA’s most vulnerable people.