Sexual Health

It is sometimes difficult to engage people in an objective discussion of sexual health; individuals are often uncomfortable and embarrassed by the subject. CLASH believes we need to break down these barriers and work at encouraging an open and frank dialogue that challenges historical perspectives and acknowledges that sexual health is much more than the absence of infection.

CLASH not only has a role in the development of services but in initiating these challenges and promoting change. Creating a culture and environment in which active and productive discussion becomes the norm. This needs to engage all sectors and aspects of society as players in achieving positive sexual health for all.

CLASH definition - Positive sexual health is a holistic concept that incorporates the following:

  • Exploring the myths and taboos and promoting a change in culture.
  • Developing a wider understanding of sex, sexuality and sexual orientation.
  • Acknowledgment that we all have a role to play in promoting positive sexual health and bringing about change.
  • Promotion of positive, pleasurable, mutually satisfying and rewarding relationships.
  • Encouraging emotional literacy and increased self esteem.
  • Challenging prejudice, stigma and discrimination that can negatively affect sexual health.
  • Enabling and supporting people to claim their own sexuality and to respect the choices and lifestyles of others.
  • Comprehensive integrated health promotion/prevention activity, access to information and education for everyone.
  • Provision of integrated and comprehensive sexual health services.

Background and Context

Sexual health is a significant public health priority in the United Kingdom (UK), and, against a background of rising incidence of the Human Immunodeficiency Virus (HIV), sexually transmitted infections (STI’s) and capacity issues resulting in services not being able to meet demand, there is a strong national policy imperative driving change in sexual health services. In striving for excellence and modernisation in sexual health the core aim is enabling prompt and convenient access to consistent, equitable and high quality sexual healthcare. Sexual health represents a significant health inequality across Blackburn with Darwen, Blackpool, Cumbria and Lancashire, and local drivers must include the development of a greater understanding of need, demand, equity and population changes, which necessitate a responsive service. The consequences of poor sexual health can be serious. Unintended pregnancies, STI’s and specifically HIV can have along lasting impact on people’s lives.

There is no part of the UK that is unaffected by HIV and other sexually transmitted infections, although there are large differences in the impact of the infections in different areas of the country this variation is reflected Pan Lancashire. While the incidence and prevalence of HIV, gonorrhea and syphilis vary considerably, the more common STI’s such as Chlamydia, genital warts and herpes simplex virus are much more uniformly distributed. Regional differences in HIV infections and STI’s highlight the importance of the contribution of local services to prevention. A recent report from the Health Protection Agency (HPA), the body responsible at a national level for communicable disease control, made the following conclusions:

  • There is a continuing high incidence of STI’s in young people.
  • Increasing prevalence of HIV infection, especially in men who have sex with men and in persons from sub-Saharan Africa.
  • There is evidence that heterosexual transmission of HIV within the UK is increasing.
  • Rapid access to diagnostic and treatment services for STI’s remains a major problem with less than half of all genitourinary medicine clinic attendees being seen within the recommended 48 hours. (NB. this is a historic statement there has been considerable progress here)
  • There has been steady progress with some major screening and prevention initiatives.
  • The priority being given to the prevention of sexually transmitted infections including HIV is wholly justified by the high and still rising costs of treatment, and by the severe social costs, especially among poor and marginalized communities.
  • Transmission of HIV and STI’s are not being controlled by current efforts.
  • More needs to be done at a local and at a national level if we are to prevent these infections.

National and North West Statistics

  • An estimated 77.400 persons were living with HIV in the UK at the end of 2007 of whom over a quarter (28%) were unaware of their infection.
  • During 2007 there were 7734 new cases of HIV in England, a similarly high figure to the diagnoses made in the previous 4 years.
  • From the mid year report from the HPA in 2008, 496 new HIV and AIDS cases presented to statutory treatment centres in the North West.
  • Figures show that from January to June 2008 Mid year report , 5,157 individuals accessed care in treatment centres in the North West including 496 new diagnoses during 2008.Taken from the mid year report produced by HPA.
  • New diagnoses among Men who have sex with Men continue to increase and over four-fifths of these infections were probably acquired in the UK.
  • Almost a third (31%) of persons newly diagnosed with HIV were diagnosed late in the UK, that is at a point after which therapy should have began (Cd4 cell count less than 200 per mm3).
  • Newly diagnosed cases of sexually transmitted infections (STIs) rose up by 6% in 2007 compared to 2006, the Health Protection Agency (HPA) reported.
  • Almost 400,000 (397,990) new STIs were diagnosed in UK genitourinary medicine (GUM) clinics in 2007 – an increase from 375,843 in 2006 – and a disproportionate number were diagnosed in young people aged 16 to 24 years.
  • One in eight of the population is aged 16 to 24 years, but this age group accounted for 65% of the Chlamydia cases (79,557 of 121,986), 55% of genital warts (49,250 of 89,838) and 50% of the Gonorrhoea cases (9,410 of 18,710).
  • Here in the North West, 46,017 STIs were newly diagnosed in 2007, compared to 43,558 in 2006 and 24,164 10 years ago in 1998. There were slight reductions in syphilis, Gonorrhoea and new cases of HIV infection, but sharp increases in Chlamydia and genital herpes.
  • The National Chlamydia Screening Programme in England screened 270,729 young people in 2007, a 93% increase on the 140,157 screens performed in 2006. 9.5% of young women and 8.4% of the young men who were tested were positive for Chlamydia, resulting in 24,236 diagnoses of Chlamydia in people under the age of 25.
  • Reflecting the national picture, a disproportionate number of the new North West cases were in people aged 16 to 24.
  • Although the number of people living with HIV continues to increase, the figures in this country when compared to others remains relatively low. With improved support and/or medication, people with HIV are living longer with improved quality of life; however this presents a cumulative figure living with a long-term condition.
  • The mid year report for 2008 shows 496 new HIV cases in the North West,2007 data for the North West reports 746 of new cases of HIV and Aids (new cases are defined as HIV positive individuals who have not previously been seen in North West statutory treatment centres prior to January 2007).
  • Mid year 2008, 5157 individuals accessed care in treatment centres in the North West.
  • We do however see a higher incidence of late diagnosis of HIV across the area; this presents specific challenges in relation to targeted prevention activity.

Source HIV & AIDS in the North West of England mid year Report 2008 Centre for Public Health Liverpool John Moores University and Ten years of Monitoring HIV&AIDS in the North West of England July 2007 North West Public Health Observatory Indications of Public Health in the English Regions 6: Sexual Health 2007.

In November 2004, the Government published the white paper Choosing Health: Making Healthy Choices Easier. This paper further acknowledges that the provision of contraception is an essential health care service and plays a pivotal role in protecting against both Sexually Transmitted Infections (STI’s) and unplanned pregnancies.

Sexual ill health costs the NHS more than £700 million a year (Performing Better, Health Care Commission 2007). The cost benefit of contraception is well established and has been estimated at £11 for every £1 spent. It is estimated that the prevention of unplanned pregnancies by NHS contraceptive services already saves the NHS over £2.5 billion a year.

There are a number of strategy documents that inform sexual health service development and delivery by outlining key performance indicators these include:

  • The National Strategy for Sexual Health and HIV (July 2001)
  • Progress and Priorities – working together for high Quality Sexual Health Review of the National Strategy for Sexual Health and HIV SHIAG/MedFASH 2008
  • Effective Commissioning of Sexual Health and HIV Services (June 2003)
  • Recommended Standards for Sexual Health Services (March 2005)
  • National standards, local action; health and social care planning framework 2005/8
  • Teenage Pregnancy Strategy (1999)
  • Choosing Health: Making Healthy Choices Easier (Nov 2004)
  • National Chlamydia Screening Programme in Children, Young People and Maternity National Service Framework (DOH 2004)
  • Every Child Matters – Change for Children (2004)
  • Performing Better Healthcare Commission (July 2007)
  • CHAPS strategy and programme – THT and Sigma research
  • UK National Guidelines for HIV Testing 2008
  • Tackling HIV Stigma and Discrimination DOH Implementation Plan May 2007

Values Underpinning CLASH

Diversity

  • We recognise and acknowledge that individuals and communities have a right to their own spiritual, social, cultural and moral views.
  • Empowerment: We work in partnership to support and enable people to make healthy sexual choices.
  • Ethical practice: Sharing practice, knowledge and expertise is acknowledged as the way of working to achieve objectives and meet the challenges.

Fairness

  • We are committed to treating people fairly, based on needs.
  • Human Rights: People have the right to not have sex, be respected for that choice and still have sexual rights.

Integrity

  • We work towards the highest standards in a caring and professional manner.
  • We believe that the promotion of self-esteem and emotional well-being is important and helps to form and maintain satisfying relationships.

Openness

  • We provide access to information in order to help people understand and influence local sexual health services, interventions and support.

Valuing People

  • We respond to people as individuals and recognise their knowledge, skills and the contributions they make towards achieving positive sexual health.