1. Sexual Health and Wellbeing for Wales
19th March 2010
Sexual Health and Wellbeing for Wales
Dr Marion Lyons

2. Sexual health and Wellbeing for Wales, 2009 – 2014 Aims:
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

3. How far have we to go? Increase sexual health and relationship literacy
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
Estyn’s report 2007 on the provision of SRE showed wide variation in the quality and impact of teaching of SRE
Economic, social and cultural influences all impact on the sexual health and wellbeing
Dr Marion Lyons

4. Increase sexual health and relationship literacy Future tasks:
WAG to develop and publish updated guidance for the delivery of sex and relationships education in schools
PHW to profile sexual health of the population and undertake targeted awareness raising campaigns
Dr Marion Lyons

5. How far have we to go? Access to good quality sexual health services
AOF 2010/2011 Target 24 Sexual Health Services
To ensure that all patients have access to core sexual health services (HIV and sexually transmitted infection testing and routine contraception advice*) provided by appropriate specialists within 2 working days.
Dr Marion Lyons

6. Access to good quality sexual health services Future work:
Diagnosing Urogenital Chlamydia trachomatis and Neisseria gonorrhoea with an amplified DNA assay on self-taken vaginal swabs and first-catch urine
Improve access to services in rural areas
Review availability and provision of LARCs across all service providers
Dr Marion Lyons

7. How far have we to go? Reduce the rates of STIs and HIV
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 2008.
Dr Marion Lyons

8. the enhanced surveillance scheme by month by region, 2002 to 2008
Cases of infectious SYPHILIS reported to Public Health Wales CDSC through
the enhanced surveillance scheme by month by region, 2002 to 2008
Of the 119 cases reported in 2008, 78% (93 cases) were in men who reported having sex with men. This compares with 71% of reported cases in 2007 and 59% of reported cases in In 2008, 18 men and eight women (22% of cases) reported acquiring syphilis through heterosexual sex (Figure 7). With the exception of a peak in 2006 (40% of cases), the proportion of cases reported acquiring syphilis through heterosexual sex has varied between 22% and 29% since 2002.
Dr Marion Lyons

9. Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales
on form KC60 per 100,000 population: teenagers and all ages,
In 2008, there were 403 episodes of uncomplicated gonorrhoea and 177 epidemiological treatments of suspected gonorrhoea reported from GUM clinics in Wales (19 new cases per 100,000 population). Two episodes of gonococcal ophthalmia neonatorum were reported by GUM clinics in Wales in 2008 (Table 8a).
The number of cases of uncomplicated gonorrhoea reported by GUM clinics in Wales in 2008 was lower than the previous years (Table 8a), and represents a decrease of 11% since 2007 (Figure 8). This continues a general decrease in reported cases since 2004.
Fifty-four of the 274 episodes (20%) of uncomplicated gonorrhoea reported in males in 2008 were in men who have sex with men. This compares to 89 (28% of infections in men) in 2007 and 81 (22%) in 2006.
The majority (36%) of the episodes of uncomplicated gonorrhoea (61 female; 44 male) reported in 2008 occured in those aged (97 and 47 cases in females and males respectively) (Table 9).
The clinic in Cardiff continued to report the highest number of cases of gonorrhoea (134 in 2008), but the number had decreased from a total of 146 in Most clinics reported a decrease in cases between 2007 and 2008.
Dr Marion Lyons

10. Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales on form KC60 from 2004-2008
Dr Marion Lyons

11. Reports of uncomplicated CHLAMYDIA from GUM clinics in Wales
on form KC60 per 100,000 population: teenagers and all ages,
As in previous years, in 2008 rates of laboratory reports of anogenital chlamydial infection were highest in those aged years old (Table 15), at 579 and 1157 per 100,000 population for males and females respectively. Overall rates of anogenital chlamydial infection continued to increase in all age groups except in females aged or years, where the rates continued a decrease seen since 2005.
Dr Marion Lyons

12. Reports of cases of uncomplicated CHLAMYDIA from GUM clinics in Wales on form KC60 from 2004-2008
Dr Marion Lyons

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

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

15. HIV – Source SOPHID data – analysed by HPA
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
MSM
161
166
192
245
274
332
390
453
527
574
IDU 7 15 19 14 18 22 27 26 29
Sex between men and women 71 85
107
154
211
257
280
336
385
417
Blood/Blood products 31 30 28
Mother to child 3 4 8 13 16 17 23
Other/unknown 2 5 11 12
Total
277
302
350
451
550
658
741
874
1001
1082
Dr Marion Lyons

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

17. HIV infections by exposure risk 1999-2008
100
200
300
400
500
600
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
HIV infections by exposure risk
MSM
IDU
Sex between men and women
Blood/Blood products
Mother to child
Other/unknown
Dr Marion Lyons

18. Approximately 100 new cases are diagnosed annually
The prevalence of HIV infection in Wales is low – approximately 0.05% of the population have been diagnosed with infection.
There is a steady increase in the number of people living with HIV reflecting both an increase in survival and new diagnoses
Approximately 100 new cases are diagnosed annually
Using data from 2008, we can find no evidence of follow-up in approximately 20% of those with a new diagnosis of HIV
Heterosexual risk behaviour accounts for approximately 60% of all new infections, of these 60% were from black and minority ethnic group (BMEG)
Infections arise in all age groups with very few infection in those under 20 years of age
Dr Marion Lyons

19. Reduce the rates of STIs and HIV Future work:
Review provision of Condom Card Schemes in Wales and develop national standards
PHW to profile sexual health of the population and undertake targeted awareness raising campaigns
Cognitive behavioural work focusing on risk reduction, sexual negotiation etc can be effective in reducing risk taking behaviour in men who have sex with men (MSM)
Deliver multi component interventions for group work
Interventions to be targeted at specific sub groups of MSM e.g. those from ethnic minority groups
Increase access to testing for HIV in hard to reach groups
Dr Marion Lyons

20. Dr Marion Lyons

21. Rate of teenage pregnancies by area of usual residence 2001 - 2008
Dr Marion Lyons

22. Reducing the rate of teenage pregnancies Future work:
Use multiagency partnerships to identify the causes of teenage pregnancies and address the underlying risk factors such as low self- esteem and educational attainment
Commission easy to access contraceptive services
Revise the sexual health service specification to include primary care services
Pilot and evaluate a community based intervention (funding secured)
Dr Marion Lyons

23. Develop high level indicators for sexual health
Strengthen the monitoring, surveillance and research of the population's sexual health and well-being
Develop high level indicators for sexual health
Review KC60 and KT31 in light of the integration of services and develop future capture systems and construct a minimum data set for collection of standardised sexual health data across genitourinary medicine, community clinics, general practice and pharmacy
Dr Marion Lyons