Sometimes traditional methods of service provision can make working with young men more difficult. Registration, triage, the emphasis on diagnosis and treatment and one-to-one work can cause problems with groups of young men wanting a quick and easy access to condoms and check-ups. Here are some suggestions for practical strategies to overcome these challenges.

One of the major obstacles to providing services to young men is the registration process, particularly for those wanting condoms, information and advice. Clinical services register clients by taking full names, full addresses, telephone numbers, GP’s address, date of birth, ethnicity details and age. This takes some time particularly if processed individually and many young men object to having to give so many details for condoms. Confidentiality is important to young men and many worry about their details being shared (to the extent that in reality clients rarely give correct information anyway).

This also causes problems for clinics because young men are likely to be feeling very anxious at the beginning of their visit. If they feel intimidated because of the registration procedure then they are more likely to exhibit ‘macho’ behaviours which other people find unacceptable in a waiting area (see below). Challenging behaviour which upsets the smooth running of a clinic is inexcusable and needs to be dealt with effectively, but why not try to prevent this from happening in the first place?

Specialist provision and condom distribution schemes are able to take fewer details from clients more quickly yet still are able to monitor and evaluate effectively. We need to be clear why we need to take information from clients. For example it is important to find out which electoral ward or postcode area our clients are coming from in order to see if our clients are coming from the area that we targeted – we can get this information from the first part of a postcode.

When accessing clinical services young men understand that they need to give more information; however there are ways that the stress and anxiety of registration can be reduced. Taking details from clients in the consultation room for example when they are less anxious, allowing the clients to fill their own forms in, only taking the details that are necessary at that time and taking more on subsequent visits for example. Also be prepared and confident when being asked questions such as: will anything be sent to my home address? How will I get my results? Why do I have to put my GP’s name down?

Many clinical services find working with groups of young men difficult and unmanageable. With all that we hear about young men in hoods hanging out in ‘gangs’ on the street this isn’t surprising.

However the fact is that these young men are attending our services because they want help, guidance and condoms. If they want to be seen in a group (and we have a room for them) then we should see them in a group, unless, of course, they are in need of a STI screening.

1. They are in a group because they are feeling vulnerable. Remember seeking help is unmanly. Doing it in a group is more acceptable.
2. Often young men attend in friendship groups where one of them has expressed to their friends that they have a problem. They use the group dynamic to support each other and to prompt the person with a problem to speak up (see below).
3. Often existing clients bring in their friends to the service because they like the service and want them to have a similarly pleasant experience. If we don’t see the friends together then the referrer misses out on the praise and status with the worker of being the one to bring them in.
4. Young men are much more fun in a group. Their laughter, energy and enthusiasm to learn is very infectious and great fun.
5. Seeing young men in groups means that they are seen more quickly and also means that there are fewer young men in the waiting area getting bored.

Many clinicians worry that young men are less likely to ‘open-up’ with their friends present. In my experience this is not the case, often friends can facilitate another to ask the question: “you know! that thing you were telling me about before.”

To work with young men in groups, I find that the following helps

1. Try to make sure that you have the largest consultation room in the building.
2. Have some chairs set out in the room in a semi-circle behind a table. Boys get erections when they are talking about sex – a table can hide them.
3. Make clear what is their space and what is yours. If you sit too close to them it can be intimidating for them.
4. Have all the condoms set up and spread some leaflets out on the table so that they know that they can ask questions and learn. Make sure that the condoms are fully stocked and that they look pleasing to the eye.
5. Have rituals each time you see a group so that they know what to expect. For example, where clients sit and where you sit, introducing yourself and the service etc.

For more see Communication Skills Section.

One of the key messages of sexual health promotion for young people is ‘if you’re thinking about having sex go to a clinic to ask about condoms and contraception’. Yet how many young people actually do this? Perhaps there is a perception on our part, and on the part of young people, that our services are somewhere to go if you are in trouble or have already had sex, rather than somewhere to go for some advice, information and condoms.

Being more pro-active about offering preventative sexual health services would be obvious benefit in our work with young men but also with our work with young women. Such preventative services may be offered elsewhere such as in condom distribution schemes but if we want young people to get the best possible advice surely we also want them to come and see family planning clinics, young people’s clinics and GUM clinics too.

In order to attract more young people to our clinics for preventative services we need to make them more attractive in our publicity (see below) and also in the nature of the service that we deliver (see above). We also need to make them quicker and easier to access by specifically raising their priority. We can do this by having an allocated worker who just sees all young people who want condoms and advice only or we can ensure that if a young person only wants condoms then the first available worker sees them.

Many services already have an allocated worker who will either see all young people or young men who want such a preventative service. This may be an outreach worker (for example working for Brook, or THT). Such workers may be clinicians but are usually from a youth work background who are trained to working in an educational and young person centred way which is suited to this kind of work.

However there aren’t many men with these skills that are happy about talking about sex with young people and their contracts are not usually full-time or well paid and are rarely core-funded and permanent. The good news however is that

1. workers can learn the right skills and values to do this work through training and professional supervision
2. these workers do not have to be men

Invariably such posts are advertised as being for ‘males only’ because being male is viewed as being a qualification. Working With Men found in their research with young men that the most important thing is that workers are confident and know their stuff – if they are male then this is a bonus. Furthermore many men applying for such roles may have the skills but may only have a limited, traditional understanding of masculinity. Additionally this approach to recruitment misses out on the skills of many women who are able to work effectively with young men.

Brook London adopt both approaches in their main clinic settings. Often there is an educational outreach worker who sees young people who do not need to see a counsellor or clinician. When the outreach worker is not present the clinic team ensure that if there is a young person present wanting such a service then they are seen by the first available member of staff. If a young person has already been registered and the clinic is busy then reception staff are able to see such clients.This sends out a very positive sexual health promotion message.

Although condoms can be given out easily it is important to not to adopt the here’s your bag off you go approach (see above) but to build in opportunities to create space for the client.

Part 4

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