Insert name of presentation on Master Slide 23rd March 2010 CONDOM CARD SCHEMES IN WALES Dr Marion Lyons

First C Card scheme was developed in 1989 in Edinburgh Healthcare Trust Newcastle and North Tyneside Sexual Health Promotion Units developed them further and evaluation of the initiatives concluded that: C Card schemes are well used by young people and welcomed by workers as an initiative to increase access to sexual health information and support to young people

Increase sexual health and relationship literacy Improve access to good quality sexual health services Reduce the number of unintended pregnancies, particularly among teenage girls Reduce the rates of STIs and HIV Improve the health and social care of people living with HIV Reduce the number of new diagnoses of sexually transmitted Hepatitis B and the number of people at risk Strengthen the monitoring, surveillance and research of the population's sexual health and well-being Dr Marion Lyons

2006 Health Behaviour in School Children showed that Wales has one of the highest proportions of 15 year olds reporting having sexual intercourse (out of 34 countries) Teenage conception rates high, STI rates high in teenagers Estyns report 2007 on the provision of SRE showed wide variation in the quality and impact of teaching of SRE Dr Marion Lyons Does Wales need C Card schemes?

Between 2007 and 2008 the numbers of new cases of syphilis, uncomplicated Chlamydia, herpes and warts diagnosed in GUM clinics in Wales all continued to increase. However, the numbers of new cases of uncomplicated gonorrhoea and hepatitis C diagnosed have continued to decrease. The number of new cases of hepatitis B also decreased in Dr Marion Lyons Sexually Transmitted Infections in Wales

Dr Marion Lyons Cases of infectious SYPHILIS reported to Public Health Wales CDSC through the enhanced surveillance scheme by month by region, 2002 to 2008

Dr Marion Lyons Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales on form KC60 per 100,000 population: teenagers and all ages,

Dr Marion Lyons Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales on form KC60 from

Dr Marion Lyons Reports of uncomplicated CHLAMYDIA from GUM clinics in Wales on form KC60 per 100,000 population: teenagers and all ages,

Dr Marion Lyons Reports of cases of uncomplicated CHLAMYDIA from GUM clinics in Wales on form KC60 from

Dr Marion Lyons Reports of cases of ANOGENITAL HERPES SIMPLEX - first attack - from GUM clinics in Wales on form KC60 from

Dr Marion Lyons Reports of cases of ANOGENITAL WARTS - first attack - from GUM clinics in Wales on form KC60 from

Dr Marion Lyons Clinical reports of HIV* and AIDS in Wales, 1994–2008 by year of diagnosis

Dr Marion Lyons

Rate of teenage pregnancies by area of usual residence

15 Local Authority areas in Wales have C card schemes (2 LAs jointly share – Anglesey and Gwynedd) In addition 4 other LA areas have established Condom Distribution Schemes - Conwy, Wrexham, Bridgend and Neath Port Talbot) Powys, Monmouthshire and Carmarthenshire do not have a C Card Schemes although condoms are freely available through primary care in Powys and through sexual health clinics or youth services in Monmouthshire and Carmarthenshire

LAs How long have C Card Schemes been in existence across Wales? One service established in 2004 has difficulty securing funding for 2010/2011

C Card schemes are financed from a variety of sources 7 from Cymorth, 6 from LHBs, others from small grants Only five schemes have recurrent funding, three of these are LA delivered supported by local public health team The funding to operate the service is given to: PHW for 5 schemes, LAs for 4, and HBs for 4

C Card schemes are managed by LA in 6 areas and PHW in 9 Most are supported by multi-agency/multi- disciplinary sexual health management groups A number of partners are involved in the delivery of the schemes: Youth Services, School Nurses, Pharmacies, Sure Start, Communities First, Outreach Services, Youth offending services, GP practices, PHW etc

The target age group for all C Card schemes in Wales is for 7 schemes; for 8 and for one scheme. (protocol for providing condoms to those under 13 years of age developed by Local Safeguarding Team). Advice and guidance is provided to all those over the age of 11 in all schemes

The schemes are publicised in a number of ways: Health promotion settings in local high schools Posters Flyers in GP surgeries, youth centres, leisure centres, schools, colleges etc Press releases Radio E mail Web sites Local Sexual Health Directories Local networks NHS Direct

C Card schemes are delivered in a wide range of venues: Drop-in centres, Youth clubs and youth teams Mobile bus and delivery on the street Teen Mum projects Youth cafes Community first buildings GP surgeries Youth Offending Team premises Hostels, colleges Clinics Pharmacies In Flintshire there are 12 services delivering C Card scheme across 33 outlets

On average between staff are trained to deliver the C Card scheme in each of the established schemes (youth workers, nurses, community workers, volunteers etc) All schemes have a training programme for staff which can range from ½ day to 2 days Most training programmes include the following elements Scheme protocols Sexual health values and attitudes Fraser guidance, child protection, confidentiality Condoms, STIs and services

Client information recorded varies considerably Information given to client varies from the most basic to detailed sexual health awareness and condom demonstration Child protection guidelines are always adhered to No of condoms issued/visit varies from 4-10, generally less for those under 16 years

Activity for 6 month period Number of individuals accessing the services LA areaMalesFemales

Valued locally (11 schemes have undertaken client satisfaction surveys) Provides structure to health promotion - not just about free condoms Improves accessibility to free condoms considerably But: Funding needs to be secure All Wales Standards would be a help