Local health departments, like many other organizations, are reluctant to implement change, especially when it entails providing reproductive health services to males.  However, barriers, regardless of their difficulties, need to be overcome for the benefit of the community.

The following interview with Dr. Rangel, Public Health Clinician, underscores the potential for success when local health departments become partners in the delivery of reproductive health services to males. This interview highlights a local health department that provides reproductive health services for males. An in-depth analysis and review of  the Pike’s County  Male Teen Pregnancy Prevention Program is available in a report entitled “PREGNANCY PREVENTION IN PIKE COUNTY: A FOCUS ON TEENAGE MALES”, by Rafael Rangel, M.D., June 20, 2005. The report is available upon request at the above captioned address.

Is there any connection between the male clinic and the local family planning program in Pike County?

Yes. I am the Medical Director of the Family Planning Program for both males and females. I also serve as a Public Health Clinician in the male clinic with reporting responsibility to the local Health Administrator of the Pike County Health Department.

Why did you create a special clinic for males? Why not integrate males into the existing family planning program?

Let me start by stating that the goal of the Pike’s County Health Department is to provide non-coercive services, on a voluntary basis to anyone, male or female, requesting high quality family planning services. The male clinic, at least in our community, is a recognition that gender does play a role in how clinical services are delivered and received by different segments of our community.

There were several reasons for operating a male clinic. In our community, family planning is viewed by the general public as a service for women. Therefore, men will not typically visit the health department for family planning services unless some distinction is made in the way services are marketed and delivered. Secondly, sensitivities, services and environment involved in operating a male clinic are quite different than for females. Even the terminology used may have different meanings. Example: In our community, males prefer the term male clinic as opposed to family planning clinic.  However, we serve everyone who comes into any of our clinics regardless of gender or sexual orientation.

Males are too often concerned that health services are cost prohibitive and therefore do not seek reproductive health care.  Many low and middle income males do not have health insurance and believe that they cannot afford health services.  Efforts to inform males that fees for services are predicated on a sliding scale will greatly increase the number of males receiving health services in the future.

Prior to the opening of our health clinic, males in Pike County had no access to reproductive health care.  We learned early that high school dropouts, community college students and older males were in need of medical and counseling services on family planning and other reproductive health services.

How many males are served in your male clinic?

We provide services to approximately 300 new male patients each year. However, 50% of the patients will make multiple visits each year.

What services do you provide in your male clinic?

Our clinic conducts a physical/medical examination on each patient and provides other routine medical services including lab testing and treatment for STDs, including HIV.  We also provide one-on-one counseling, education and training on topics such as: self testicular examination, sexuality, condom use, STD/HIV, pregnancy prevention, contraceptives and other services.  This information is used to develop a complete health history and record for each patient.

Does your program provide referral services?

Yes, we often refer patients to local dermatologists and urologists.  If the patient requires services which cannot be preformed by our network of health care providers, they are referred to the local hospital for further treatment.

Who pays for your clinical services?

Many of our patients face economic challenges, so we charge fees predicated on the Title X sliding fee scale which correlates fees with the income of the patient.  However, if a client seeks treatment and needs a referral for additional services, the clinic will  pay for the first visit to ensure that the patient will continue to seek treatment and not fall between the cracks of the health care system. The provider of referred services, such as community health centers, will most often continue to see the patient, regardless of ability to pay, once he is accepted in their program.

What services are most frequently requested by males in your program?

Contrary to popular belief, personal counseling is our most requested service.  Personal counseling sets the stage for almost all other activities involving male reproductive health. In addition to reproductive health counseling and responding to other health concerns, we also address insurance, employment, and other social issues.  Other services requested include services related to STDs, requests for tests prior to sexual relationships, issues relating to homosexuality and sexual dysfunctions, including  erectile and premature ejaculation issues.

What are the ages of your patients?

The Male Reproductive Health Clinic began with a mission to focus on teens and young adults between the ages of sixteen to twenty-five. In response to demand by older males in the community, we are currently providing reproductive health services to all males requesting reproductive health services.

How do you attract males to your clinic?

Our main goal is to let males in the community know that we (Pike County Health Dept) welcome male patients and the types of services we provide. This is done through several outreach methods which include; Radio/TV advertising, print advertising, newspaper articles, visits to local colleges, YMCAs, and similar types of organizations.However, the most effective methods of attracting new patients to the clinic is word of mouth from former/current patients and female partners as well as outreach efforts in places males frequent and congregate.

What is your reaction to the statement that “males will not utilize local health departments for health services”?

I believe that statement is absolutely false.  Males, like any other groups, will access services from a Health Department if they are aware that the health department is a central source of health services and that the health services will be delivered in a sensitive and caring manner.

In your opinion what is involved in starting and operating a successful male clinic in a health department?

In addition to an adequate budget, there are several essential elements needed to get started and to operate an effective male clinic: cooperative support from the community and health department; health services that respond to the needs of the males in the community; shared negotiated expenses between the health department and the program; and sensitive and competent staff. It is also important that the clinic is viewed by males and other members of the community in a positive and accepting manner.

Do males make use of the regular family planning program? Do females use the male clinic?

Males are not accustomed to utilizing family planning services.They need to be educated regarding the importance of family planning and reproductive health care as it relates to their overall health.In our community, family planning clinics are mostly single sex.  Even though females do not utilize the male clinic, 40% of the males who come into the male clinic are accompanied by females providing support for their spouses and partners.

What are the hours of operation of the clinics?

We have two clinic sites. The Pikeville Health Department Clinic site is open from 4:00 – 6:00 pm (or until the last patient is seen) Tuesdays and Thursdays of each week; and the Pikeville College Campus Clinic location is open every Wednesday from 10:00am – 12:00 noon. The waiting rooms in each location provide an excellent opportunity to disseminate information and education through brochures, videos and other printed materials as well as the distribution of condoms.

How long has your male clinic been in existence?

A. Our male clinic has been operating since 2000. However, our male school program started in 1999. In addition to our regular family planning program, both the male school and clinic activities are components of the same Office of Family Planning (OFP) funded grant.

How is your Male Health clinic funded?

The Pike County Health Department provides $25,000 in funding per year in conjunction with their in-kind services such as space and various types of equipment. The balance of the program costs are supported by a Title X Family Planning Grant.

What is the size and composition of your staff?

The Clinic staff consists of me and two part-time nurses. The nurse(s) secure the medical intake information, patient history and are responsible for administrative activities associated with lab requirements. I perform the patient physical examinations and other medical services, referrals and provide appropriate follow-up counseling.

What advice would you offer other programs that want to start a male reproductive health program within their local health department?

Confirm the need for a male clinic, secure male and community support and do not make promises that you cannot fulfill.