SEXUAL HEALTH STRATEGY An Update Nick Payne Sexual Health Team, Department of Health, London

22 Daily Star National Survey of Sexual Attitudes and Lifestyles

33 Sexual Behaviour Changes  Age of first intercourse reduced in last 10 years  Increase in unprotected sex - associated with alcohol and binge drinking  Number of lifetime partners increased in the last 10 years  Concurrent relationships increased  Condom usage increased, but offset by number of sexual partners  44% of HIV+ men have sex with new partners in the last month of whom 40% reported no or inconsistent condom use.

Part of physical and mental health and well-being Inequality, poverty and social exclusion Infertility,ectopic pregnancy, premature delivery Chronic conditions e.g.Cancer, hepatitis Unintended pregnancies/abortion HIV Stigma and discrimination Consequences of Poor Sexual Health

55 New diagnoses of selected STIs/HIV in GUM clinics England, Wales & Northern Ireland STI Cases in 2004 % Change 2001 to 2002 % Change 2002 to 2003 % Change 2003 to 2004 Chlamydia 97,027 14%9%8% Genital Warts 73,350 2% 4% Gonorrhoea 21,567 9%-3%-13% Genital Herpes 17,640 3%-2% Syphilis 2,088 63%28%32%

November 2004 Public Health White Paper - Choosing Health

77 Summary of Sexual Health Topics in Public Health White Paper  A new national STI advertising/media campaign.  New capital and revenue funding for modernisation of the whole range of NHS sexual health services.  A national chlamydia screening programme, covering all of England by March 2007.

88  Audit of contraceptive service provision in early 2005 and investment centrally to meet gaps in local services.  National review of treatment services to provide advice and support on service modernisation for both commissioners and service providers.  By 2008 everyone referred to a GUM clinic should be able to have an appointment within 48 hours.

99 Funding announced - over 3 years  Advertising Campaign £50m  Treatment Services (Capital and Revenue) £130m  Chlamydia Screening £80m  Contraceptive Services £40m

 10 New national campaign  Targeting younger men and women  Risks of unprotected sex in terms of STIs and unintended pregnancies  Promoting benefits of condoms  Engaging support of stakeholders

Chlamydia screening Accelerated roll-out of national screening programme by March 2007, backed by £80 million investment Piloting screening in pharmacies across London and Cornwall

Contraceptive Services Audit Comprehensive audit of contraceptive service provision will include specialist providers, general practice, outreach services etc – Audit should be used at local level to support service development and identify gaps – Investment of £40 million to improve services in line with results of audit

 13 Newer DoH Initiatives  GUM Development Pilots  GUM Services Review  Cost-effectiveness of Sexual Health Services

Warrington West Dorset North Cumbria Waltham Forest Weston & Bristol Northumberland North of Tees Swindon Telford & Wrekin Salford & Manchester GUM Development Pilots

 15 GUM Development Pilots  Ten in England  Invitations for Local Bids  BASHH involved with Department of Health in prioritising  Each gets about £250,000 over 2 years  What general lessons can we learn?

 16 Main Issues arising from GUM Development Pilots  Recruitment and staffing  Accommodation

 17 GUM Services Review

 18 GUM Services Review  Being conducted for DoH by MEDFASH – Medical Foundation for AIDS and Sexual Health  Pre-visit questionnaire  Aim to visit all ~ 200 GUM Clinics in England  Local Sexual Health Economy also part of Review Process  Results should inform investment

 19 Health Economics of Interventions in Sexual Health  Limited literature  Not well presented to NHS – especially with Finance and Commissioning Leads  Some interventions are cost-saving, others are very cost-effective  Consensus meeting  Dissemination of “Solid Facts”

 20 The Economic Case for Investment  Average lifetime treatment costs of each HIV +ve patient £180,000  Each case HIV infection prevented saves £1/2-1 million in terms of individual health benefits and treatment costs  Cost of infertility due to chlamydia - 20% + of infertility treated by IVF

 21 Example of Results Cost-saving  Condom provision for high risk groups  Condom subsidy schemes  Outreach health promotion and safe sex programmes for high risk groups and hard to reach groups  High quality integrated Sex & Relationships Education Outstandingly cost-effective  Wide variety of routes for condom distribution  Short access times for GUM services Averagely cost-effective  Highly Active Antiretroviral Therapy (HAART)  Routine HIV screening for STD clinic attenders Not very cost-effective but within current NHS range Screening and suppressive therapy for genital herpes

 22 The Times National Survey of Sexual Attitudes and Lifestyles

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