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Right. Hello everyone. Welcome to this Dash evening webinar on Sexual Health in Prisons. My name is Tony Masters and I'm Coch chairing this evening along with Lemi Pli and we are both G un registrars. Um I'll mention a couple of housekeeping things first before I go on to introduce our speakers this evening. So after this event, everyone will be sent a link to a feedback questionnaire. It's really important both for our speakers as well as to support our future webinars and that we get good quality feedback on these sessions and also your attendance certificate will be sent to you after completion of your feedback as well. And so I'll go on now to introduce our two speakers. So we've got Doctor Suzanna Currie, who is a consultant in GU medicine and HIV at Sheffield teaching hospitals. Suzanna is the chair of the British Association of Sexual Health and HIV that Bash Prison special interest group and has a special interest in tackling health inequalities. I'm presenting alongside her. We are also delighted to have Mr Panetti who is speaking as a patient representative of the Bash Prison. SG Pan is an advocate for social change and prison reform. And he is a leading expert on education and advocacy for HIV and sexual health across UK prisons. In addition to being a tht positive voices speaker, workshop, facilitator and GM I Partnerships manager for Positive East in the community. He's also conducted workshops across the prison estate. He is a board member and trustee of the only charity that uses a peer led program to train prisoners who can read, to teach those that can't. So we are honored to have him speaking to us this evening. If you have any questions throughout the evening, then please pop them in the chat and we will go through them at the end. But without any further ado, I will hand over now to Suzanna and Pa. Thank you. Thank you, Tony and thank you for the introduction. Um I'm always humbled when I'm speaking with Pan. Um I need to embellish my bio a little bit. Um So yeah, I'm a sexual health consultant um in Sheffield. Um I've been there since the beginning of the year and before that, I was up in Cumbria for about four years as a consultant as well. I did my training in Manchester and I'm more than happy to be contacted about kind of training questions or any career opportunities and things. Um but concentrating on um prisons um as we are tonight, um I have got a special interest in equality of care. Um and I think as a just to be clear, we have um the example I use, which is most easy and there are lots of visual diagrams of this is um is allowing people to see over the garden fence so we could give everyone the same size box and the majority probably could see over the garden fence. But what the quality of care is is giving them different size boxes to match the characteristics that they have, that they need to look over the garden fence. And I think in a high resource country, in particular, I am appalled at the quality of care and the inequality of care that we provide and it gets worse as we narrow down where we're providing that care. Um So I first recognized my interest or realized that I was interested in it. I think the moment you come into du medicine, you're probably interested in um coming to medicine, you want a quality of care. But a particular interest was highlighted when I was doing my diploma in tropical medicine in Liverpool. Um quite a long time ago, I don't know what year it was. Um But we did sessions talking about the sex workers in African countries and how difficult it was to reach them, to provide them with care and particularly with sexual health care and education. Um And they, the term used at the time was hidden populations. Now, I know this has gone out of vogue and it's really, we don't have hidden populations, we have populations that we struggle to reach, but they're not hidden, they're not aware of what's available. Um, or they don't access it for various stigma. Um And another key part of our role now in sexual health is the agenda for 2030 whereby we're not going to have or we don't want to have any further transmissions of HIV and to be able to tackle that and achieve that, we've got to work even harder than we've ever worked before. There aren't quick wins anymore. We've got people who are vulnerable that aren't aware, um, that we, we need to somehow reach. Um, but I think hidden populations, we should stop using that term because it kind of puts the onus on the population and it's not their fault, it's our fault and we need to support them and provide additional care. Um, so I joined the prison special interest group in about 2017 just as I was coming to the end of my training and there was an advert in the bash newsletter and I really recommend reading that there's so many opportunities on there that I've managed to glean from the newsletter. Um, I'd had experience of providing prison sexual health care in prisons in strange ways in Manchester, which was a phenomenal experience. Um And I was just about to take up a consultant post in Cumbria where I'd be the lead of sexual health care within prisons up there. I mean, there's one prison on the west coast of Cumbria that, um, is fairly bleak and encourages anyone never to aim to be in prison. Um, so when I joined, unfortunately, and it's with no disrespect to the members within it because it's done in addition to your work hours. So, if you are in a sig, it's not in your job plan, you're not paid for it. And it was an inactive group. everyone had their time pulled in different ways. And I don't really know how it happened, but I ended up taking on the role of chair because it was inactive and then reestablishing it at the end of 2019, beginning of 2020. So, um as we all know, that's the timing of COVID. Um but despite that managed to reestablish it and it was when online really took, took things forward very effectively. And so it was part of reestablishing, the group had to kind of really work from the bottom up. So getting the aims and objectives of the group together, thinking about which members we wanted, what were we going to achieve and what was our purpose? Um So we wanted to define the standards of care for sexual health provision in prisons in the UK. So there weren't standards of care and I went to, there's the Health and Justice Conference which is predominantly attended by GPS who provide care in prisons. And I remember speaking to them in November 2019 and say, I just want people in prison to be tested for syphilis. I can't believe this doesn't happen as routine. And they said, well, if you give us a guideline, we'll do what you say. And it was from there that I was SPD on to get some kind of national paperwork together so that people could refer to it and we'd have more influence nationally. Um, so we wanted to define the standards of care, which should be really straightforward because the standard of care should be that of what the community gets. Um, but it's obviously a massive part, a bit of work and the other important part of the special interest groups. And I think as important as that the patient care is supporting our colleagues so often these special interest groups, um, we work in quite, in unique ways. There aren't that many of us who work in prisons. Um, and how do we support each other because there are so many frustrations on the politics of providing health care in prisons. Um I was asked recently by a rep for Hepatitis B vaccination. Um, well, surely we can just, um, pay for it through the normal ways that we pay for medication in prisons. I said, what normal ways that we pay for medication in prisons? That it, it will it be the sexual health team that provides that medication or will it be the prison GPS or has it been privatized? Further, I've just paused on my screen but, ok, I'm back. Um And there are some, there are massive logistics and DNA rates are higher. Is it that the, the, the sexual health clinic? Um How does, and it's certainly not a standard of care um provide confidentiality to, to, to patients. Um And how do we standardize care in an environment where it is so different across, across the UK? Um So that was our, that aims. Um And we've got, we've now got over 20 members. They represent the whole MDT. Um So we've got, um we've got doctors and nurses and health advisors, we've got um trainees, we've got um patient representatives. So pan is a member of our um sick. Um And together, we've had a small group who've been the writing group for our standards, which are due to be published. They were finished in May ready for publication in August. And we're still working, but they will be out and they're brilliant and I'm so proud of the special interest group for getting these together. And it was an opportunity for registrars to be on a standard to writing group. So, um we had, we did educational fellowships. So they normally last about a year and they came and joined the SIG and we provided supervision and support and they were the main um main authors of our standards, which is a phenomenal thing to achieve. So we've got an educational aspect to our sick and we also almost represent the four nations. We just don't have representation from Northern Ireland at the moment. Um But again, because of governments and politics and it just the structures of sexual health across the nations. That's another challenge and really interesting to see. Um So I thought um because Pan is an inspiring and articulate speaker and I really enjoy listening to him. So I invited him to join me today and I hope you all enjoy listening to him. I thought as a, as a segue in and I was torn if we'd been on a team's platform, whether I would ask you to raise your hands or whether actually I didn't have, I didn't feel ok with doing that. But I want, there are a few scenarios I'm going to go through. They're very simple and I just want you to have a moment to think if we were on teams or we were in a lecture theater or we were in a public space. If I were to say, ask you a question and ask you to raise your hand, if the answer was yes. How would you feel? So, if I were to say, raise your hand, if you've been to the GP, raise your hand, if you've got diabetes, raise your hand, if you've been to the sexual health clinic, raise your hand. If you've got HIV, raise your hand, if you've ever been in prison, there are some of those questions. I don't think I can, I don't feel comfortable asking and I don't feel comfortable answering and it highlights how difficult and how, well, how privileged we are to keep our anonymity if that's appropriate for us. But I think I suspect Pan might lead on to show how little respect there is for that within the prison setting, how basic human rights are taken away, how respect and things aren't. Oh, you're so much articulate than me. But, and why is that? You know, I think there's stigma attached to these answers. I think there's stigma still still attached to. If you answer, if you've got diabetes, there's a little bit of stigma if you've needed to see a health care professional, but the stigma seems to be much greater. If you've got a sexual health care need. If you've been in prison, there's lots of Presumptions, lots of judgment that could be in the room there. And I want to break that down and I want to break it down, you know, across the board. Um We have the right to look after our own health needs and we shouldn't be ashamed of how we do that. Um But I think it just thinking about those questions, highlights how difficult it is to provide equity care in a prison setting when we're thinking about sexual health. Um and just from very minor experiences that I've had while providing that care, if the patient wants to come to the sexual health clinic, they have to provide a pee sample. So while they're waiting to come to see me in clinic, they have a pea pot with them. If they're going to see their GP in prison, they don't need that. So they're identified very easily and there's no confidentiality there for them. Um And I say hidden populations is rubbish. People are scared of the ski stigma. People cannot um don't know how to access sexual health care and we just need to think about it and, and be a little bit embarrassed that we are in a high resource setting and we're not doing it as well as we could do. Um But again, if anyone wants to message me has any questions, I'm more than happy to talk about my training, about my career path about my other interests about the prison sick. You're all welcome to join. If you want to, the more the merrier, we have excellent discussions three times a year. Um And um yeah, I think I'll hand over to PAC. Thank you very much, Doctor Currie. Um, ladies and gentlemen. It's a pleasure to be here this evening. Thank you so much for the invitation. I'm gonna start my story. Um The first day that I arrived in prison, I got off the bus, I went to the reception and um after having an altercation with the officer behind the counter, I I was then shown to a nurse and the nurse sat me down and asked the questions that we would expect a nurse to ask. You know, so that we know, did I have any, any medication that needs that I did? I have any conditions. And of course I shared with her that I was living with HIV. And there was nothing wrong with saying that except for the fact that I had to say that in front of everyone else in front of this line of prisoners that had just got off the bus. Um, where there was no privacy and who I didn't know. So, of course, um, it wasn't very long before the rest of the prison knew my status. Um It wasn't something that I wanted to share, but they knew it. This was further than amplified every single day when I would go up to the medical hatch, which is where I had to go to get my medication. Um, and I was asked every single day, what is your medication for? And so every single day in front of a queue of prisoners, I had to tell them that I was living with HIV. This was something that they knew. Of course, they knew it was there on their system, but it was asked of me every single day. This of course was three weeks after I'd arrived simply because I wasn't allowed the medication that I took in with me, even though it was sealed, even though there was a letter from my consultant to state. This is what it was for because they hadn't issued it. I wasn't allowed it. So I had to go three weeks without medication. And up until that point, I'd never missed a dose. My consultant had always been very clear, you know, so I've been very staunch about it, do not miss any doses. And so the anxiety that came with having to go three weeks without it was, was bad enough, especially at a time where I had only just entered prison. Um, now I don't care what people think about me. I'm pretty secure in myself and I know what my, my own self-worth is. But when you sit down to eat your food and everyone else gets up around you and walks away and moves away, it gets to you, of course, it gets to you. And so I started to get quite depressed very, very quickly. Now, thankfully, I didn't actually have to stay at that particular prison very long before I was moved to another one. this one was two doors down from where I was, um, a brown man with a beard is sent to a prison called IIS, which I just thought was hilarious, but that's where I was sent. And it was here that a Samaritans listener whose job is simply to shut up and listen, decided to tell the entire prison that I was living with HIV. Um, it wasn't a problem to begin with simply because I used to get on with my day. I used to teach English and maths functional skills up to a G CS C level. And I loved my job as an educational mentor. I was doing really well. I was making a difference to these young people's lives. I was afforded a great education and I just wanted to be able to share that with people that hadn't had that opportunity and it was great to see them grow. The problem came when at, just for something to do at the weekends, I started working in the kitchens and because I was touching food, suddenly it became a problem and it took the, uh, the governor of, of the residence to come up to me on a Sunday afternoon and he pulled me aside and said, there is intel that there is a real threat to your life. What do you want us to do? And I had a choice. I could either be moved to another prison or I could stay where I was. And the truth is I liked what I was doing. I was making that difference to these young lads lives. And so I wanted to stay and I wasn't gonna be afraid of what people thought. And so I decided that that's what I was going to do. I was gonna stay. But what I suggested was that they put the, all those that had an issue into a room and let me talk to them. Well, we don't think that's a good idea. He said that wasn't a choice that I was giving him. That was literally the option that he was gonna be given was if he wanted me to stay there and I wanted to stay there, put them in a room. So that's what we did when they locked everyone else up, they put them all in a room and they sat down, I stood there center stage and I asked them what seems to be the problem? Well, we just wanna know whether you've got. It is the answer that I got. And I asked, would it make a difference if I did? Well, yes, because you're touching food. So I asked them, you know, how exactly do you think HIV is transmitted? And the answers that I got were through sharing forks, toiletries, cups, everything that we would have expected back in the late eighties, early nineties. And it showed me in that moment just how little education there was around sexual health and HIV, especially with this prison population. I completely understand if they had been in there for 30 years or 40 years without any contact with the outside world. But these were individuals that had access to information that had come in and out of prison and would have known exactly how it was transmitted. But the moment they walk in this mob mentality takes over where suddenly if one person believes that this is the way it is then that's the way it is. And that's what I had to endure. And so in that moment I explained to them, I educated them, told them exactly how it was transmitted, told them about the fluids that you know, that it can only be transmitted in and explained to them about treatment, how effective it was about prep about you equals you. And what I saw was them all change and each of them individually got up, came over, either shook my hand and gave me a hug, told me that if I had any issues or any problems with somebody to tell them that they were sorted out, you know, the irony is they were the ones that were, that were the problem, but it changed and I saw how it changed their mind. And so I went to the governor and I said, you need to capitalize on this. There was something quite profound that happened and you shouldn't waste that opportunity. She agreed. And we decided that we would actually create a program, a series of workshops where we could educate the population um on the topic of HIV in particular and have this as a rolling exercise and periodically so that people coming in would understand that I was then moved to another prison before we could actually implement that. Um And I was moved to an open prison because of course, I had, I had completed everything that I needed to complete in order to get to a stage where I could start to go back into the community, go home, start seeing my family ready for release. Um, three days into this new prison, I contracted pneumonia taken to the hospital. Now, usually an open prison, you would be allowed to make your own way there and back because you're trusted enough. But because I'd only just got there, I hadn't gone through that security process yet and therefore had to be accompanied by an officer. I didn't know that that officer didn't have to come into that consultation with me, but he chose to, even though he knew that I should have been allowed that privacy. And so when the consultant that I was seeing asked what, you know, what, what conditions I had, I told them. And then it was this time, an officer who told everybody in the prison that I was living with HIV. So three different prisons, three different routes of disclosure without my permission or knowledge. At the time, it was here at this third prison that it was used as a weapon against me. I had made a call to a best friend. We had had a discussion, they had taken that completely out of context and had accused me of having sex with, with other prisoners and putting them at risk because I was living with HIV. Um, now I explained to them that a it was none of their business but I did b um, I was undetectable and therefore no risk to anyone but they wouldn't believe that unless I could prove it, which meant releasing my medical notes to them, for them to see I was, er, and what they had said was if I didn't, it would severely impact my ability to go home on home leaves. So it was used as blackmail against me. Of course, I had worked really hard to get to this point and I didn't want anything to stop me from going home. So I was happy and willing to sign that piece of paper. And I had to go over to the healthcare department and get them to sign it to. Thankfully, I had a nurse who was and is incredible. She had my back, she understood everything about the, about the virus. She understood everything about HIV and she made sure that she was the biggest and best advocate that could possibly be. And she charged back over to the big house, which is what we used to call, where the offender management unit was. And I have never before or since ever seen a woman come out with so many expletives in one sentence as she did. But what she said to them was that if they ever asked to do that again, she would have them removed. And I was lucky that I had her, that wasn't always the case in any of the other prisons. Um, and what it did was immediately shut down my right to privacy, my right to disclose when I wanted to. Um, these instances made me realize that this was something that had to change and the way that people were bullied, the way that people were, um, were discriminated against, the way they were ostracized was something that I wasn't prepared to continue to endure or allow. And the straw that broke the camel's back was a young lad who I'm going to call Steven, who took his life seven days before he was meant for release because he couldn't take the bullying anymore around the fact that he was living with HIV and he wasn't physically bullied, but it was the mental bullying and the emotional bullying that he had to endure and no one, no one should ever feel like that seven days before they're meant for release. He should have been excited about going home having served his sentence. And I want you to just think about how, how difficult, how tough does it have to be for you to not be able to wait? Seven days. That's all. It was seven days. And when I saw his body being bought out of his cell, go out of his room, you know, on a gurney. Um It's something that I never wanted to see again. Um And it shows how, how dangerous discrimination and stigma can be when it comes to the topic of HIV. Now, I left prison with a resolve that I wanted to do something about it. I was a photographer before I went to prison and I was a great one. When I traveled the world, I had amazing appliance and it was a wonderful life, but suddenly none of that felt important anymore. And so I decided to, that I wanted to back into prison to do these work that we had originally planned. And that's what I started to do and over the last six years on that, and it is, and it is slowly and steadily grun to the point where I was asked to become part of the prison s but you know that I gained the position as the GM partnership manager, provide those prevention and testing services to the whole of London. Um where I am a trustee now of two different charities, both of them that have links to prisons and I've done everything that I could possibly do to make sure that that story changes, that the narrative changes and that, that for people like Steven and people like myself that are in prison that are living with it, that things are different, that they don't have to endure the same things, but it still exists and it exists partly because of people within health care. There is, and it's something that has been noted and is documented that there is a vast amount of stigma around the topic of HIV within the healthcare system in the UK. And a lot of this is because I think of the diversity that we have of people from all parts of the world and what what happens is that they allow cultural and personal opinions to infiltrate health care and the service that they adding. And this is again, where it becomes dangerous because ultimately, anything that is said to a patient should be based on scientific fact or medical fact, not a personal or a cultural opinion. I'm gonna give you an example of something that I encountered recently that um shows just how dangerous again that this, this stigma can be. Um, a gentleman had been, um, he was living with HIV, he had been for appointments for a variety of different things. And one of the examples that he gave me was that he had gone to an appointment and the nurse that was taking his observations had said, well, I've had my COVID job because I had to. Otherwise they won't let me work. But I don't believe it, it's all a load of bollocks was what she said. And he heard this on a number of occasions about a variety of different things and what it did was it made him question everything else. So suddenly he was questioning, well, if that's a load of bollocks, then does that mean that the other medication that I'm taking is as well? And so what he did was stop taking his HIV medication because he genuinely was confused. And 18 months later, um, he died as a result of T cell lymphoma as his primary cause of death and HIV as his secondary cause of death. Now, this gentleman was my brother who died three weeks ago and I'm angry at the fact that this happened. I'm angry at the fact that there are people within healthcare who will use their personal opinions or their cultural opinions to dictate what information they give to a patient that we, we are in a developed country. We should not have a I DS related deaths in 2023. And the fact that we have the fact that we did and the fact that he was my brother and the fact that I work in sexual health frustrates me even more because I didn't know that he'd stopped taking his medication. I didn't know that this is how he felt, but he's not the only one we know that there are a large number of people that are lost to care and it is only going to be a matter of time before these individuals develop symptoms and where it will be too late. And we will see that rise in A I DS related deaths again. And that's something that we have to be aware of and that we have to try and change. And this is where you come in because as students, as juniors, you get to be the next generation, you get to actually dictate what it is that is said and told to the rest of us people that actually believe what you say. When we go, when we go to a hospital, when we go to a clinic, we trust you, we trust everything that you say because you are the expert and there is a responsibility that comes with that and that responsibility has to also include accountability because if that's the kind of information that's going to then be disseminated, then there has to be accountability held in. And my brother should not have died. You know, you should never have to bury someone that is younger than you. And that's something that I'm gonna have to do in a couple of weeks time when we have his funeral because individuals felt that their opinion was far more important than actually telling him the truth, you know, sort of, and, you know, sort of, if I gave this example earlier, if, if this was, this is manipulation as far as I'm concerned, it is manipulation. If you were to manipulate somebody that was mentally, you know, sort of incapable of actually taking care of themselves or making decisions, there would be ramifications, you would be hauled up in court straight away. But his death and the person or the people that have manipulated him will get away with it because of course, you know, it wasn't as important or it's not as, it's not as, as, um er, er, what's the word? It's not as, as vo or invo, as Suzanne said earlier on. You know, it, it simple as that, but ultimately people in healthcare killed him and that's something that I have to now walk around with and try not to be angry about, you know, and I think my anger will dissipate but I will only dissipate if you do your part. You know. So as the next generation of medics, as of clinicians of people within health care, please understand that. What you say makes a big difference to how someone thinks and feels. And ultimately, your job is to protect them is to make sure that they are safe and well. And that includes not just their physical self, but their mental self as well and their emotional self. And it's a lot to put on a person. I, I know I understand that completely, but that is the role that you have chosen and with that you have to actually then take that responsibility. And I hope that you do and I hope that, that I don't have to have this conversation again about somebody else that we've lost because again, I said in 2023 we shouldn't have to lose people, not like this, not this way, you know. So from diagnosis to death was six weeks, that's all I got with him. That's all he got. You know, in terms of the time to say goodbye to people which wasn't enough. And when I asked him the day before he died, if just before I left the house, I said, is there anything that you need? And he said simply more time and I couldn't give it to him? Yeah. That's the one thing that, you know, I've always been a problem solver. You go into prison all of that. None of that. None of that is important. I can handle all of that. But this was something that I couldn't change. The inevitability was something that I couldn't control. And that was something that was taken away from me because of individuals within health care who chose to actually tell him what their opinion was as opposed to what the clinical opinion should be. So all I ask is be aware of that. Remember this story, remember, remember Nathan that was his name and remember that he had as I told him before he died, purpose, he mattered and he will be remembered and he'll be remembered because I will talk about him and I'll make sure that he's remembered. And I hope going forward that you remember that too. And I hope that it does influence the way that you actually speak to your patients and actually continue with your medical careers. And I hope that you go on to do great things and be a part of Suzanne of the prison sig make a difference. But you can make that difference regardless of whether you're a part of the prison sig or not simply by making sure that what you actually tell people is based on fact, as opposed to opinion. Thank you very much for listening. That's all I have to say. Thank you so much, Doctor Currie and Pan for that really thought provoking um, presentation, please. If anyone does have any questions, feel free to pop them in the chat, none have come through yet. But I suspect people were listening so intently and they haven't had a chance. So we'll give people a few minutes to ask any questions that they've got. Um, I'll start off pan by asking you from your recent work in prisons. Do you feel there has been any change or improvement in the management of sexual health and HIV in terms of stigma or confidentiality? Um, yes, there has been, um, I'll give you an example. We were giving a talk at a young offenders institute and what we would do is ask them to complete a questionnaire before we, we, we have that talk just so we can gauge where their knowledge, um, sort of lies in terms of HIV and sexual health. Um, and then we will also get them to fill in a post conversation questionnaire as well. Halfway through my, my talk, um, one of the young lads actually put his hand up and, and said, can I change my answers? I'm really ashamed of what I wrote and, you know, my answer to that was no, you keep the answers as they are because it shows how much you've grown just by listening to this talk. But he is just a great, just one example of how these conversations by actually having these educational sessions makes a big difference. And when, um I saw him again a few months later, he was only about three weeks um before he was meant to be released. And I asked him what he was gonna do when he was released. And he said, I want to do something like you. Um, you know, I want to make a difference to people's lives that, you know, that compliment in itself was, was more than enough. But the fact that that here is one individual who was determined now not to come back to prison to do something better with his life to actually change, not just his but other people's is exactly why we, you know, we have these conversations, why we do these workshops and, you know, and it shows how, how much of a difference it does make and how it is changing. So, yes, it absolutely does change. And we see that every time that we do these talks. Great. That's lovely to hear. We've had a couple of questions come in now. Um Lily asks probably more to use. So what scope is there for trainees to get involved in projects or research into sexual health in prisons if they're interested in this topic, I imagine it's quite tricky to gain access to prisons. Um, yes, it is tricky to gain access to prisons but it's not impossible. Um, I, to, to get involved with projects and research and in, in, with sexual health in prisons is very easy. Email me. Um, there's, there's lots of things we need to iron out lots of, lots of research to be done there and projects to be done. And if you are interested, I'd encourage you to contact the prison sick, which details are on bash website. But also I'm sure Tony, you can share my email address to people. Um That bit is easy. Um The apart from funding, so, um I've been trying to establish a educational fellowship again, um because we've had, we had five registrars do educational fellowships with us. Um the year before last and there was lots of projects and research done there and there's obviously still more to do, but actually finding funding while we kind of narrow down what we're doing is a bit tricky. But if you've got the appetite for it, contact us and we'd be more than happy to try and facilitate that and we can get access to prisons. One of the biggest problems we had with our previous registrars was location um and matching them with um, a person that was going in already. Um Also we've struggled more recently because of COVID. Um And also, um it, we struggle because of the demands of our times, don't we? We're all pulled in different ways and it's all very well if you're a trainee. But the reality of getting that time away from clinics going to a prison and things, but it's not impossible. I have managed to do it and I'm no super woman and so we can do it. And if you're passionate about it and interested I'd be very happy to try and facilitate and link you in with people around the country wherever you based. Um Because I think it's really, really important. Um And I'd really recommend those um the health and justice conferences for networking if you're interested as well, some fascinating people um attending there. Thank you. And then we've had a few comments. So George says, thanks for such a moving personal story. Pak really resonates and strengthens resolve about having to address staff stigma. I've lost count of the number of you equals you conversations I've had with other medical staff during my so far short career um which I would agree with Elie says, thank you so much for sharing your experience. It was really moving and thought provoking and hearing patient voices is so important. And maid says, thank you so much for this talk. So interesting and insightful. And I think we all share this sentiment, so sorry for your loss. Thank and thank you for sharing it with us tonight. And Millie asks this question can be to both of you. Actually, you mentioned difficulties surrounding confidentiality when people from prisons go to hospital. How do we get around the practical aspect of this? And I have a large prison population who visit my hospital and they are always handcuffed to a prison officer and we are unsure on the guidelines surrounding this. Um, I can sort of start with by answering that. Now, I'll give another example. I, er, went to, again another, um, young Offenders institute, um, and came across a patient that was effectively given a 3.5 month sentence for punching the man that raped him. Um, he was on prep, sorry, on prep. Um, he was holding to court, he was sentenced and then brought to the prison on a Saturday, the court had spelled his name wrong. And so when he arrived at the prison because his name was incorrect compared to what he gave them, he was not allowed the medication that he brought in with him because there was nothing on the cards that said he was coming in with medication. And so the PAP was taken away from him. Um, he had to wait two days before he went to see, um, somebody at the gun clinic, which is where the GP had sent him on the Monday, having seen him, the, the gum clinic had said, well, it's been two days since you've had a do. Therefore, there's no point carrying on and he then had to wait the, you know, sort of the, the agonizing, um, sort of period to find out then whether he had contracted HIV or not, he'd already contracted gonorrhea and syphilis as a result of that, um, altercation anyhow. Um, he had asked whether I would advocate for him and accompany him to his appointment. I had had driven all the way up from London and, and, and arrived at the clinic where he was supposed to have his appointment to find that they had already gone in and that the prison officers had gone in with him. I explained to the nurse and said, if they have gone in with them, that needs to the consultation needs to stop. Now they are breaking human rights of laws. Simple as that every patient has the right to go in and have privacy with the consultant full stop. Um The nurse did nothing about it and I did make sure that she understood that if she didn't put a stop to it, that she would be held accountable to. Um I was not allowed to talk to him even though this had been arranged for me to actually meet him there by the prison. Um There had been some confusion and the officers were told in that moment he is not allowed to talk or approach the prisoner. So I I wasn't able to actually advocate for him. But what I could see clearly from his face was that he was extremely upset and as it turned out, he had been given a reactive result. Um and, and but had no support whatsoever. Now, as far as I'm concerned, there were failings throughout the entire super course. But the prison was made very aware from the very beginning that when he walks into that appointment, that he had the right to privacy, the consultant knew that but continued with that consultation without asking the officers to be removed. So in answer to the question of how can this actually be resolved? Simple. They have long chains and there is no reason why a prisoner cannot be put on a long chain with the door closed, whereby the officers are still outside, still handcuffed, but they can allow that privacy. Um with, you know, with the consultant and the patient, it's such a simple solution. It happens all the time. It's the fact they choose not to and they choose not to because they think they're doing something to protect other people. But what they're not doing is looking at the fact that they are not protecting those that are considered vulnerable and they are prisoners, prisoners are classed as vulnerable adults yet their rights are completely and utterly ignored every single day. So as you know, as doctors as nurses, please be aware that you have the right and you should be saying to every single person that comes in with an officer attached to an officer, could you please put this person on a long chain and step outside and if they refuse to, then you refuse to do the consultation. Because if you don't, you then are actually liable in the same way that everyone else was with this individual's case in breaking those human rights that that person has. I when you mentioned this case to me, pan um it has empowered me to challenge others in authority. I think we don't, I think we don't challenge the status quo. So the person working in the hospital where um you're seeing a lot of people who are coming across from the prison. It may be a case of challenging what's happening. I I'm I remember as an F two in Rotherham when um I had a patient that would come from Doncaster prison who needed um cryotherapy for their genital warts. Um So they were coming quite regularly and he always had two offices with him and they were always chained to him on short chains. And I think one of the officers was behind the curtain with me with, with the person from prison as I froze their genital warts. But, and, and, and it's my ignorance and I think it's so important to talk about this and to challenge what, what's happening, I guess they'll be um kick back a little bit pan whereby people may be concerned about their own safety. And how do we ensure that people are safe? Again? It comes with stigma that there's a presumption that if someone's in prison, they are a threat to people. But that's not often the case and not often the reason why people are in prison, it's a misnomer. It's a miseducation of, of educated people. Um um But yeah, the main take home for me pan that I've learned today is challenge challenge the, the, the, the presentation um to enable that confidentiality and that respectful, you know, consultation. Yeah, I think on that point if somebody were a real risk, if there were a real risk of violence um towards a medical professional, then they wouldn't have been allowed to leave the prison. They would have called people into the prison to actually see them. So if they've been allowed out, then they have deemed by security have been deemed to be suitable enough to actually be in a community environment. And if security of a prison have actually deemed them to be safe, then then as medical professionals, we must do the same. I think um it doesn't, it doesn't that it, this is an obvious thing I'm gonna state and I hope that I, I don't, I don't need to say it, but it's the doctor seeing or the nurse or the health care professional seeing the person who's in prison. Very rarely needs to know why they're in prison. They need to know about their health care needs. And I'd just be mindful of that if you do find yourself in a setting where you're um talking with someone who's in prison or has been in prison. It's not relevant, often, not relevant. I have had a case where it has been incredibly relevant. Um But it often isn't. Um And we don't need to know. Um But I just, I kind of wanted to put that thought out there for people as well when you um Yeah, I just, I thought threw it out. Thank you some really interesting points there. Um Emily has made another comment to say thank you so much for sharing, Pang, so sorry that you've had to go through this and that Nathan had this experience in my future nursing career. I aspire to be like the nurse that stood up for you. And then Lily asks, um are you aware of many gum or otherwise doctors working within abolition groups or looking at the wider context of incarceration? She said, sorry if this is too big a question, but I think no such thing. Um So the doctors that work within, so the prison that is representative of the doctors providing care within prisons and also within other places of incarceration. Um The health and justice conference and team would be the best people to link in with other health care professionals within these settings that are, and I think um they'd probably be better placed than myself, obviously, because we're really niche and we're providing sexual health in prisons. It's um that there is a greater need for a wider healthcare system. So GPS and predominantly they're GP SS under private providers within prison. Um But certainly I'll have links if lilies want thinking of specific things she might want to get involved in. Perfect. Thank you. And then um Emily asks, are there any courses you would recommend for healthcare professionals to complete to become better in this area? So I think Emily has just suggested a project. So there, there's the e-learning for health, isn't it? With lots of modules on there? And I don't think prison health is represented there. Um I think it'd be a fabulous project to, to look at that. Um My, there are diplomas and things like that. I was thinking my tropical diploma that taught me a lot about kind of niche healthcare aspects. But as far as prison health care goes, I'd be interested to talk again to the GPS who provide um prison healthcare because I imagine they've got resources. Um But yeah, a great question Emily and I really want to get a module on the learning for health now. So um watch this space for a um an opportunity on the bash newsletter. I would say great idea. Love it. Thanks. Join the prison. And I think the fact that there isn't a module is again representative of this inequality that there is in prison healthcare. So then we've had another thank you for the answers to the questions And thank you. Thanks for sharing such an intimate and personal part of your life. George asks a question may be more specific to Sheffield where they work and they trained in London hospitals where we tested for HIV as an opt out process in A&E to try and increase early detection. Are there any plans to roll this out in Sheffield or are there any projects around this? George says they work in a department with numerous high risk people as patients and whether they get tested is a bit sporadic at the moment. Another brilliant question, George, the reason that you've noticed a difference between London and Sheffield is to do with the prevalence of HIV. So you have to hit a certain prevalence of HIV to get the funding and to have to have opt-out testing in A&E and in GP practices as you register in that area. So London is lucky in that respect that they hit the 2%. Forgive me. My figures are a bit out of date now, but they hit the target. Sheffield doesn't there are plans. So what we're currently trying to achieve is that Sheffield become a fast track city again. We're struggling because our prevalence is lower and it may be that South Yorkshire becomes a fast track county. Um And Claire Snap, who's the president of Bash is my colleague in Sheffield and she's working really hard with this. And I would suggest I really want to know which department you work in, in Sheffield. So you can find me really easily on the NHS dot net email system and ping me an email, George and I'd love to work with you because um, as I've said, I'm new to new to Sheffield since the beginning of the year and always love a good project. So, um, send me an email and we can, we can think about that a bit more. Um I remember being the trainee doctor in A&E and driving people wild with my HIV requests, but I still however many years later think is really, really important. So yeah, it would be good to work together. Do you want me an email? Talking about the fast track. Now, the fast track cities program in London has um 12 new ambassadors who will effectively be pushing for the targets that we've set for 2030 who will also be pushing for things like the rollout to a departments across the entire country. I'm fortunate enough to be one of those ambassadors that have been chosen. So um one of the things that I will 100% be doing over the next three years publicly in the media is making sure that it is known that, that we need that opt out testing across every A E department in every hospital in, you know, across all four nations. So, you know, rest assured I will be pushing as much as I can to make sure those things happen as well. Thank you. And then we'll have one final question before we close, um which has been asked by a couple of different people just around whether pan the rights that you've explained about the availability of long chains um are true in all of the devolved nations. So we've got people who work in Northern Ireland and Wales on the call. And do you know whether there is different policy there? Um, I'll be honest, I'm not 100% sure. I would have assumed that long chains would be available and it should be available to all prisoners. Um, but I can't say sort of with complete ty, I'm not sure if George Currie knows, um, or could, could perhaps, you know, sort of, um, attest to that, but certainly northern Ireland, if, if I, I guess anything to do with prisons as well as, as health and justice, you know, Eamonn is an incredible person to try and contact and get a hold of. Um, he is by far one of my favorite people on the planet. Um, and, and, and when it comes to knowledge, I think in Ireland you can't get any better than him and he trained as a gu physician so important to know that, um, Tony, would it be ok if I, if I am I best to put my email address on the, on the group, is that the best way of sharing it? Yeah, I think it if you pop it in the chat. Ok. And if it doesn't say I can, um, I've got anyway. Um, yeah, because I am, I am the prison sick. That's fine. I'll make sure your email ends up in the chat and I'm gonna hand over to LEK me just to close the session now. Thank you. Thank you, uh, Doctor Susanna and a punk for the amazing session. Uh, really, really enlightening and very intern session and such a thought provoking discussion, really enjoyed each and every bit of it. Thanks to all the audience who took their valuable time to join the session on behalf of Stash and uh Tony and me, we are really really grateful to all of you. Please fill up the feedback form so that we can get back to you uh with your comments and suggestions and modify or include the topics which you want to discuss further in this session. Um I would also like to announce about our next upcoming webinar uh which will be held on 26th of October by Doctor Laura Jarvis on psychosexual medicine. And we will be advertising in our site very soon and hope to see all of you there again. Keep in touch. Have a lovely evening. Thank you. Mhm.