1. Sexual Health Strategies May 2004 Dr Kevin Fenton HIV and STI Department Communicable Disease Surveillance Centre

2. Content Background – recent trends in the epidemiology of HIV and sexually transmitted infections. Reflections on reproductive health The National Sexual Health and HIV Strategy – what is it all about? How is it being implemented? What role can each of us play in making it a success?

3. Sexual Health in the UK today “ I do not use the word lightly, but during the course of the inquiry, it has become plain that with sexual health we are looking at a public health crisis” David Hinchcliffe, Chairman of the Health Select Committee, May 2003 “As the figures released today by the Health Protection Agency show, it is vitally important that we address the nation’s poor sexual health” John Reid, Secretary of State, 24th November 2003

4. Government’s Response to Health Select Committee “The Government shares many of the Committee’s concerns… It believes these will be addressed through the continued implementation of the long term sexual health strategy”

5. Increasing media interest and public concern…. Metro 30th Nov 2001

6. The Facts…... HIV and AIDS: Estimated 49,500 people living with HIV in the UK in 2002 - a 20% increase over 2001. A third are undiagnosed. 80% of HIV heterosexual infection acquired abroad. Increasing rates among gay men. Sharp increases, both in and outside of London.

7. Exposure category of HIV-infected individuals by year of diagnosis in the United Kingdom, 1993-2002 1 Numbers will rise, for recent years, as further reports are received. Reports received by the end of June 2003. Data source: HIV/AIDS reports. 0 500 1000 1500 2000 2500 3000 3500 1993199419951996199719981999200020012002 Year Number of diagnoses Homo/bisexual men Heterosexual men and women Injecting drug use Mother to infant Blood/tissue Other/Undetermined 11

8. The Facts (2)……. Sexually Transmitted Infections Increases across the board, for example: Rapid increases in chlamydia (up 14% in 2002, to 82,200 cases) - the most common STI. Often asymptomatic, and can lead to infertility, pelvic inflammatory disease, ectopic pregnancy if untreated. Gonorrhoea up by 9% to almost 25,000 Syphilis up by 63% in 2002 to 1193 (increase of over 500% since 1996).

9. Rates of diagnosis of uncomplicated genital chlamydial infection by sex and age group, GUM clinics, United Kingdom, 1993-2002 1 1995 data not available for Northern Ireland, 2001 and 2002 data not available for Scotland. Data source: KC60 statutory returns and ISD(D)5 data. Females Males

10. Rates of diagnoses of uncomplicated gonorrhoea by sex and age group, GUM Clinics, United Kingdom, 1993-2002 Females 1 1995 data not available for Northern Ireland, 2001 and 2002 data not available for Scotland. Data source: KC60 statutory returns and ISD(D)5 data. Males

11. The Facts (3)……. Reproductive Health Abortion rate is 17 per 1,000 women - 30% have already had one or more previous abortions. Wide variations in waiting times for NHS abortion services (maximum variations in NHS funding of terminations) Reports of disinvestment in community contraceptive services. Restricted access to some long-term methods of contraception.

12. The Vision Everyone to have access to quality services and information on sexual health Services focused on people Key groups to get what the information and services they need Fewer undiagnosed infections Lower rates of unintended pregnancies Better care and support for people living with HIV and STIs No discrimination

13. The Challenges…. Inequalities: Poor sexual health disproportionately affects young adults, gay men and black and ethnic minority populations. Poor access to services in many areas. Increased sexual risk taking behaviour Stigma and discrimination - add to social exclusion and poor sexual health. Long waiting times for GUM and abortions increased risk of spread of infections and medical complications

14. The Challenges (2)…. NHS Structure and Provision of Services Sexual health promotion - low public awareness of STIs. Long standing under investment by PCTs and lack of priority. StBOP - new NHS structures affecting workforce and skills. Pressure on services and bad experiences for the patient - at odds with the ‘choice’ agenda

15. Consequences of Poor Sexual Health Unintended pregnancies increase risk of poor social, economic and health prospects for both mother and child Infertility,ectopic pregnancy, premature delivery Chronic conditions e.g.Cancer, hepatitis

16. Sexual Health as a Priority? Not a key priority BUT it is in the Priorities and Planning Framework No Govt target BUT goals and standards No key PCT target BUT it is in star rating No National Service Framework BUT recommended standards Helping to increase priority within existing PPF and LDPs ­High Ministerial Interest “Govt expects PCTs to address waiting times and investment in services”

17. Themes of the National Strategy for Sexual Health and HIV Better Prevention Better Services Better Commissioning Supporting Change

18. National Goals and Standards Goal-25% reduction in the newly acquired HIV infections and gonorrhoea infections by 2007 Standard-all GUM services should offer HIV test to clinic attendees on first screening for STIs Standard-women who meet legal requirements should have access to abortion within 3 weeks of the first appointment with referring doctor All GUM to offer HIV test to clinic first screening attenders; all gay/bisexual men first clinic attenders to be offered Hep B vaccine

19. Framework for Delivery Local Implementation- PCT leads StHA leads Commissioning Toolkit published Common sexual health data set developed Improved STI surveillance with HPA Aids Control Act reporting requirements reviewed Sexual Health and Green Paper on children at risk National Independent Advisory Group established

20. Better Prevention Review of public information New STI leaflets (Sexual Health Direct) IT resource re STIs young adults experience Health Promotion Toolkit published Sexual health direct launched Extension of CHAPS re work with gay men African Policy Framework Research re refugees sexual health priorities

21. Sex Lottery Campaign Review of evidence Focus group testing Campaign launch www.playingsafely.co.uk PR & Partnership Evaluation

23. Girls love thoughtful boys...

24. Better Services GUM ‘Pump priming’ money to improve GUM £33 million over last 2 years Includes £15m capital investment for premises GUM development pilots Peer review process 48 hour GUM waiting time indicator

25. Better Services Chlamydia Screening 10 sites announced in September 2002 Announcement of 16 new areas in January Over 1/4 of PCTs now part of the programme Phase 3 to be announced later this year Additional investment in chlamydial NAATS technology across pathology networks in England

26. Better Services Termination of pregnancy services Performance Indicator measuring the percentage of NHS- funded abortions up to and including 9 weeks gestation. Strategy standard of a MAXIMUM 3 weeks waiting for an abortion. £5million investment to reduce waiting times and improve access. Medical abortion pilots to widen settings where this can be performed.

27. Improving Services Contraceptive Services Expert Advisory Group established Action Plan to improve access to services and range of methods NICE Guideline on long term methods Development of ‘spend to save’ arguments

28. Improving Services General: Published recommended standards for HIV treatment and care Developing similar sexual health standards covering STIs and reproductive health Commissioning toolkit published Evaluating models of one-stop shop services to assess benefits and cost effectiveness

29. Taking the Work Forward National initiatives and support Locally there remains a need to: Identify need Prioritise resources Be strategic Participate Be visionary

30. Future Developments Public Health White Paper Children’s NSF

31. Conclusion Tackling sexual health is a major undertaking and we will not see changes overnight Action by Government alone will not be sufficient to achieve the Strategy’s aims Government remains committed to tackling sexual health through the Strategy and recognises that it is vitally important we do so

32. Acknowledgements Ms Andrea Duncan Team Leader Sexual Health Services Department of Health