Terry's case: A Youth at Risk

Pre-test Answers

The answers to the pre-test questions are:

#1

When taking a history from an adolescent or young adult you should:

1. Ask about current sexual relationships
   

2. Find out about any history of abuse - physical, emotional or sexual

3. Inquire about living conditions and sources of income
   

4. Confront the person about any inappropriate use of the social and health care systems
   

5. All of the above
   

6. A, B, C
   

Answer: F. (A, B, C)
Asking about current sexual relationships can tell you a lot about a person's life and can help you to determine whether that person is at risk for STIs. Present or past abuse of any kind can lead to lifelong social, mental and physical health issues, so these questions need to be asked. Living conditions and income play pivotal roles in anyone's life and can lead to behaviours that put people at risk for STIs and other poor health outcomes.

Adolescents, and young adults, especially those who are street involved, are often accused of abusing the social and health care systems. However, they often have a limited capacity for coping and adapting that prevents them from using these systems in the most effective way. Confronting them will likely lead to even less interaction with the social and health care systems - leaving them even more at risk, further on the fringes of society.

#2

A young person who is "most at risk" should be screened for which of the following infections?

1. Hepatitis A
   

2. Gonorrhea, Chlamydia, Syphilis
   

3. HTLV 1
   

4. HIV
   

5. B, D
   

6. All of the above
   

Answer: E (B, D)
In this situation you should be screening for gonorrhea, chlamydia, syphilis and HIV. In addition, screening for hepatitis C and TB should be considered depending on what risk factors exist.

Screening for hepatitis A is not routinely recommended.

With the exception of blood donors, screening for HTLV 1 is not usually helpful.

#3

To reduce the risks associated with injection drug use, those who use should be counselled about:

1. The importance of quitting injection drug use before returning for further health care
   

2. Methadone maintenance therapy
   

3. Safe injection practices
   

4. Hepatitis B vaccination
   

5. All of the above
   

6. B, C, D

Answer: F (B, C, D)
Harm reduction is recommended when the elimination of injection drug use is not attainable. Research has shown that methadone maintenance therapy leads to a number of positive results in those who use injection drugs. Counselling about safer injection practices can reduce the risks associated with injection drug use. Because injection drug use is a risk factor for hepatitis B, vaccination should be offered if natural immunity through exposure does not already exist.

Those who inject drugs need and deserve your help. Don't shut the door to health care on them by only offering further help on the condition that they are drug abstinent. They need to have access to health care - whether or not they are using drugs. Refer them to local resources that may be able to help them out of their injecting habits.

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