Fragmented sexual health system is failing users

The reorganisation of sexual and reproductive health and HIV services in England that occurred when the Health and Social Care Act 2013 handed over commissioning responsibility to local government has led to lack of accountability in a complex, fragmented system that is having a direct, negative impact on patients, according to an all-party group of MPs. Their inquiry has found a lack of proper oversight of the quality and outcomes delivered by commissioners, and a lack of national direction on training and development.

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK – chaired by Baroness Gould of Potternewton and supported by FPA, the Faculty of Sexual and Reproductive Healthcare and the British Association for Sexual Health and HIV – called yesterday for clarification about national accountability, better data linkage, a single funding mechanism across all services, ongoing ring-fenced public health funding, adequate staff training to be specified in contracts and mandatory sex and relationships education in all primary and secondary schools. Baroness Gould said: “A common theme throughout the inquiry was the lack of clarity identifying who is ultimately responsible at a national level for these services, and what powers they have to drive up standards and outcomes across the country.”

The APPG took evidence from the government, Public Health England, Department of Health (DH), Local Government Association, and representatives of royal colleges, charities and NHS trusts across the country. It reported:

• Structural divisions in commissioning between the NHS, public health and social care had a significant impact on commissioning responsibilities for sexual health, reproductive health and HIV.
• There is insufficient national coordination to enable local commissioners to work together effectively in sexual health, reproductive health and HIV. The Health Secretary should clarify and publish a clear accountability structure for sexual and reproductive health and HIV services ‘as a matter of urgency’.
• Clinical commissioning groups (CCGs), local authorities and NHS England need to be accountable for improvements delivered by the service providers they commission for sexual health, reproductive health and HIV.
• Directors of public health and health and wellbeing boards need to work together to improve integration between services commissioned by the NHS (including general practice) and those commissioned by public health.
• Commissioners should use a single funding mechanism, either the tariff or a block contract, across all services to avoid income-driven incentives leading to distortions in provision unrelated to patient need.
• Short-term procurement reduces the incentive to properly train and develop staff and encourages providers to only deliver services to the letter of the contract. Provider contracts must make ongoing education and training mandatory.
• GP data should be linked with other data in sexual health, reproductive health and HIV, to provide a full picture.
• Local authority budget cuts for public health will lead to reductions in the service they commission and create knock-on costs for the NHS. The DH should extend the period of the ring-fence for public health as part of the autumn Spending Review.
• Sex and relationships education should be statutory for all schools including academies and free schools.

Baroness Gould commented: “In transferring commissioning to a local level, it was anticipated that there would be integration and opportunities for joint working – all focused on the specific needs of local communities. In some places these aspirations are being realised and we heard evidence of good practice and successes but, in many areas, these structural changes have created a complex and fragmented system that is not in the best interests of the people who rely on these services.”

Audit shows many high HIV prevalence areas in England are failing to expand HIV testing

Most sexual health commissioners for areas in England with a high HIV prevalence have introduced some form of expanded HIV testing, a study published in the online edition of HIV Medicine shows. However, only a small minority were following national guidance, with just a third having commissioned testing for new registrants in general practice and 14% commissioning testing for people admitted to hospital.

“The results of this audit confirm that routine HIV testing in these settings has been commissioned in only a minority of high-prevalence areas”, comment the authors. “Prioritizing the introduction of routine testing in these settings will be necessary to fully implement national testing guidelines.”

Late diagnosis of HIV is a major concern in the UK. Approximately half of people newly diagnosed with HIV have a CD4 cell count below the threshold for the initiation of antiretroviral therapy (350 cells/mm3) recommended by the British HIV Association (BHIVA) and between a fifth and a quarter of all HIV infections are undiagnosed. Improving HIV diagnosis rates is key to strategies to reduce rates of HIV-related illness and also the continued spread of the virus.

National HIV testing guidelines were issued in 2008 and were endorsed in 2011 by the National Institute for Health and Care Excellence (NICE). These recommend that HIV testing should be expanded beyond traditional settings (sexual health clinics and antenatal services) in areas with a high HIV prevalence – an infection rate of above 2 per 1000. In these circumstances, the guidelines recommend the universal testing of all patients newly registering with a GP, the screening of all new medical admissions to hospital and targeted outreach programmes.

Investigators wanted to assess the level of adherence to these guidelines and to see if there were any obstacles to the expansion of testing.

Between May and June 2012, the investigators contacted sexual health commissioners in the 40 English primary care trusts (PCTs) with a HIV prevalence above 2 per 1000. There was an 88% response rate (35 of 40).

All the respondents were aware of the testing guidelines and the majority (80%; 23 of 35) has introduced some form of expanded testing.

In most cases, this was testing in the community (51%; 18 of 35), followed by testing in general practice (49%; 17 of 35) and testing in hospitals (37%; 13 of 35). However, only four PCTs (11%) had commissioned expanded testing services in all three settings.

Areas with especially high prevalence were more likely to have commissioned services. All but one of the PCTs with a prevalence above 5 per 1000 (92%, 11 of 12) had commissioned some form of expanded testing. More worryingly, a third of PCTs with background prevalence between 2-3 per 1000 had commissioned any form of expanded testing and only 33% had introduced testing at GPs, with just one commissioning testing in hospitals.

When the investigators examined adherence to the specific recommendations of the guidelines, they found that only 31% of PCTs (11 of 35) had commissioned routine testing of new registrants at GPs. Moreover, only a small minority (10 to 20%) of GP practices in these areas participated in expanded testing. In a fifth of PCTs, testing was limited to high-risk groups. PCTs in London, compared to PCTs elsewhere in England, were somewhat more likely to have commissioned the routine testing of new GP registrants (38 vs 18%). HIV testing was incorporated into general sexual health screening at GPs in 17% of PCTs (6 of 35).

An even lower proportion of PCTs had commissioned the routine testing of new admissions to hospital (14%; 5 of 35).

Over half of PCTs (51%) had commissioned community testing via outreach programmes carried out by charities and the voluntary sector. This testing targeted high-risk or marginalised populations including men who have sex with men (six PCTs), African people (four), sex workers (two), people who inject drugs (one) and the homeless (one). Settings for community testing included saunas, polyclinics, pharmacies, prisons, churches and health centres.

Almost all PCTs (94%; 33 of 35) cited lack of resources as a barrier to introducing expanded testing, with two-thirds (23 of 35) also stating that the re-organisation of the NHS was an obstacle. Approximately 75% of commissioners (26 of 35) expected the rate of HIV testing carried out in their area to increase over the next year. None expected a decrease.

“Modelling of the UK HIV epidemic has shown that higher rates of testing combined with timely initiation of antiretroviral therapy can result in reduced HIV incidence”, write the authors. They note that most respondents had introduced some form of expanded testing, “however, only a minority covered the two medical settings mentioned in national testing guidelines…new registrants in general practice…and general medical admissions.” The authors conclude that recent organisational changes in the NHS make it important to monitor “changes in the commissioning of testing over time”.

HIV TESTING WEEK

Did you know it’s National HIV Testing week from 25th? – If you’ve never had a HIV Test and had sex at least once, without a condom, then YOU need a test!

Check out the details of HIV Testing week and remember, you can pop in to LASS for a free and confidential rapid HIV test.  It only takes a few minutes to get the result.  Call us on 0116 2559995 if you’re interested.

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Free Training Sessions (June – September 2013)

Here is the programme of free training from LASS to run from June 2013 to September 2013. All sessions include group discussions and some include guest speakers. To enrole, please contact us on 0116 2559995 or email training@lass.org.uk.

HIV AND BELIEF

Thursday 20th June: 10.30 am – 1.30 pm

The need for more sessions to discuss HIV and Belief was identified at a workshop in February 2013.  This session will further explore the issues linking HIV & Belief, considering perceptions and experiences of stigma. The session will look at ways of empowering ourselves to break down HIV & HIV related stigma in the context of different beliefs and faith influences.

HIV BASICS

Monday 1st July 1.30 – 4.30

Elementary information about HIV, transmission, risks, testing and statistics. This will be of interest to anyone who currently has limited knowledge about HIV.

HIV & Relationships

Tuesday 23rd July, Tuesday 13th August, Tuesday 3rd September 2 – 4pm

There will be several sessions on the theme of HIV & relationships with the objectives of exploring different topics including:

• Disclosure – talking about HIV Status with different people in your life
• Sexual Health Q & A
• Sero-discordant relationships
• Getting tested as a couple
• Family relationships and knowledge

You can come along to one, two or all of them – what ever works for you.

HIV & the Law

Thursday 8th August 10am – 1pm

A session to discuss the current situation about HIV & The Law – with information from the recent Keeping Confidence workshop organised by Sigma Research and Birkbeck College.

Please note that sessions will start promptly and late comers may not be admitted to the session.

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Neneh Cherry – I’ve Got You Under My Skin

NATURALLY, music affects the body and mind in many wonderful ways. Music affects human thoughts, feelings and behaviors  Just its rhythm affects the body, making the pulse and respiration to flow in tune with the music’s beat or rhythm.  Music can relax or energise an individual, and affect some of  us deeply, in a personal way.

What is more, research has also shown that music has a profound effect on the human body and psyche. As a matter fact, there’s a growing field of health care known as music therapy, which uses music to heal.

As a resource which shares with you HIV and Sexual Health articles, it’s about time we started sharing HIV from other angles.

Introducing “Music Monday’s”!

Over the next few weeks on Monday nights, we’ll bring a featured HIV or sexual health awareness track from over the years and we’ll start it right now with Neneh Cherry!

In 1990 the Red Hot Organization, a non-profit organisation dedicated to fighting HIV/AIDS though pop culture released “Red Hot + Blue”, featuring contemporary pop performers reinterpreting several songs written by Cole Porter. It sold over a million copies worldwide and was heralded as one of the first major HIV/AIDS benefits in the music business.

“I’ve Got You Under My Skin” was written by Cole Porter in 1936, it was nominated for the Academy award of Best Song. It became a signature song for Frank Sinatra and in 1966, became a top 10 hit for the Four Seasons. Since then, it has gone on to be recorded by many leading pop artists and jazz musicians.

Neneh Cherry’s reworked version of I’ve Got You Under My Skin was released as the lead single for the album in the UK and Europe.  Video follows, stay tuned because next week it’s all about sex!

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Unsafe Sex in the City

Tonight, BBC3 will go behind the scenes of a sexual health clinic for a new four-part documentary, Unsafe Sex In The City.

The documentary explores the dangers faced by young people who have unprotected sex and follows the stories of patients whose passionate encounters have led to physical and emotional anguish.

The programme goes behind the scenes of a sexual health clinic in Manchester, with staff recounting traumatic stories as well as sharing humorous anecdotes about their efforts to protect youths from sexually transmitted infections.

The show isn’t typical family viewing, but parents of teenagers and sexually active people may want to consider it.  Tonight’s patients include 22-year-old Kervin, who forgot to “strap up” before a one-night stand; a pink-haired 17-year-old who doesn’t believe in monogamy or protection; and a smooth-talking womaniser who’s far less full of himself after being interrogated and prodded by a no-nonsense nurse.

A BBC spokesman added: “BBC3 are excited to have access to one of the country’s busiest sexual health clinics.”

The show airs tonight at 9pm on BBC3, repeated at 12:15am on Thursday morning (25th) – Then again on Saturday 27th at 3:05am – or view it on BBC iPlayer.

 

WE’LL BE WATCHING TONIGHT WITH TWITTER!

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TRADE Sexual Health – 160 People Tested at Leicester Pride 2012

Trade Sexual Health is a HIV & AIDS prevention charity based in Leicester for people living in Leicester, Leicestershire and Rutland.

They provide free and confidential advice and support to anyone who identifies as gay, lesbian, bisexual, men who has sex with men or women who has sex with women.

The city of Leicester has the fastest-rising HIV rate in the east Midlands and the sixth-highest in the country.

Leicester GU accompanied Trade on site providing HIV tests for the community alongside other activities.  LASS would like to say a big thank you, and congratulate Leicester GU with Trade for achieving 160 Kwik Prick, Rapid HIV Tests for the community.  Here’s an update on their day, from Trade:

Breaking Record! 160 People Tested at Leicester Pride 2012

Now at the forefront of sexual health, Trade Sexual Health joined forces once again with Leicester GUM Clinic to provide the Trade Health & Wellbeing Marquee at Leicester Pride 2012!

Our nationally recognised Trade GU clinic at Leicester Pride tested a record 160 people. All 160 had a full sexual health screening beating last year’s 136. With infection rates increasing, and undiagnosed HIV on the rise, this was a fantastic achievement, Thank you to the 160 people who tested.

Pride goers took part in fitness classes, had health checks, accessed information, booked in for a free massage and visited a host of other health and wellbeing stands in the Marquee. As usual Trade brought along a load of resources and goodies and we launched our new health campaign raising awareness of STIs. The willy sweets promoting this campaign seemed to attract a lot of attention.

We managed to give out roughly 3,000 free condoms to those present on the day.

Thank you to everyone who came along; to Leicester Pride, Leicester GU, sponsors, all the volunteers, staff and our committed Board of Trustees, for a fantastic day.
We are confident that we will build on this success and provide an even bigger and better Trade Marquee next year.

– Tradesexualhealth.com

If that wans’t enough Gay Pride for you, we were there too! – Click this to find out more.

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Sexual health teams ‘should offer alcohol advice’

Young people should be given advice on the dangers of alcohol when they access sexual health services, a group of health experts has recommended.

Surveys suggest one in five people who access sexual health services drink too much

The Alcohol and Sexual Health Working Party says the NHS is missing “key opportunities” to tackle the problem.

It suggests alcohol and sexual risk-taking go hand-in-hand.

Meanwhile, government advisers say everyone should be asked about their diet, smoking and drinking habits every time they see a health professional.

‘Multiple partners’

The Alcohol and Sexual Health Working Party was created by the Royal College of Physicians, supported by the British Association for Sexual Health and HIV (BASHH).

Its report says more than 1.5 million young people attend clinics dealing in sexually-transmitted infections (STIs) every year, and surveys suggest one in five attendees consume dangerous levels of alcohol.

Often the conversation is about excusing behaviours – just the language which is used, ‘I got off my face, I got wasted’”

Dr Simon Barton Alcohol and Sexual Health Working Party

“STIs mostly affect young persons under the age of 25 years, and 16 to 24-year-olds are among the highest consumers of alcohol,” the report says.

“People who drink hazardously are more likely to have multiple partners, thus increasing the risk of acquiring an STI.”

The study notes consumption of higher-strength alcoholic drinks has increased, particularly among girls. While men still consume more alcohol than women, young women are more likely to report feeling drunk.

It added: “Earlier alcohol use is associated with early onset of sexual activity and is a marker of later sexual risk-taking, including lack of condom use, multiple sexual partners, sexually-transmitted infection and teenage pregnancy.”

In a sample of more than 2,000 15-to-16-year-olds from the UK, 11% regretted having sex under the influence of alcohol, the report said. Some 82% of 16 to 30-year-olds also report drinking alcohol before sexual activity.

‘Ideal time’

Dr Simon Barton, chair of the working party, wants the government “to support commissioning arrangements” so trained health professionals can challenge behaviour in that “reflective moment” when someone comes to a sexual health clinic asking why something has happened to them.

“Often the conversation is about excusing behaviours – just the language which is used, ‘I got off my face, I got wasted.’ It was if it was happening to them passively,” he told BBC Radio 4’s Today programme.

Everyone knows that alcohol fuels risky sex – so a sexual health check-up is the ideal time to broach the subject”

Dr Janet Wilson BASHH

“We are trying to ensure they reflect on their behaviour.”

Dr Barton said failing to discuss alcohol consumption with a patient accessing sexual health services was a missed opportunity.

“At a time when the NHS is looking to save £20bn, this is a perfect example of quick-win efficiency that could save money in the long term,” he added.

The report – Alcohol and sex: a cocktail for poor sexual health – says all clinicians providing sexual health services should be trained in asking about drinking habits. Patients should also be referred for further support if they need it.

Dr Janet Wilson, president-elect of BASHH, said: “Everyone knows that alcohol fuels risky sex – so a sexual health check-up is the ideal time to broach the subject.”

The NHS Future Forum, which advises the government on its health reforms, wants all healthcare professionals – from doctors and nurses to physiotherapists and pharmacists – to raise lifestyle issues as a matter of routine.

Prof Steve Field, head of the independent body, told the Guardian: “In future if you come for your flu vaccine at a GP’s surgery or pharmacy, the health professional should give you your injection but also use the opportunity to talk to you about your diet, smoking, alcohol intake and how much exercise you’re taking, discuss any anxieties you may have about these, and offer advice and support.”

The forum’s call to make “every contact count” is the centrepiece of a report commissioned by Health Secretary Andrew Lansley, and due to be published next month.

Original Article via BBC News

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Sexual Health Experts Warn Of New Syphilis Threat

Sexual health experts say they are deeply concerned about several outbreaks of syphilis among heterosexual teenagers.

In recent years the infection has been largely confined to older adults, particularly homosexual men.

But clusters of the disease are being seen in Teesside, Hampshire, Rochdale and central Scotland among teenagers.

The British Association for Sexual Health and HIV says there are likely to be other cases going unreported too.

Since the late 1990s there has been a sharp rise in cases of syphilis. Most of these have been in homosexual men, often in their 20s or 30s.

But recently there have been several small outbreaks across Britain of syphilis in heterosexual teenagers – described in detail in the International Journal of STD and Aids.

Any outbreak of syphilis among young people, among teenagers is unexpected. Syphilis shouldn’t be happening in those groups and we really don’t know why it’s there” -Peter Greenhouse Sexual health consultant

It should be stressed that the number of cases described is small – the largest outbreak has been just over 30 in a year – but the reports highlight problems in tracing sexual contacts, raising fears of further undiagnosed cases, and the spread of disease within the wider sexually active population.

Peter Greenhouse, a sexual health consultant based in Bristol who speaks for the British Association for Sexual Health and HIV (Bashh), says these cases must be taken seriously.

“Any outbreak of syphilis among young people, among teenagers is unexpected. Syphilis shouldn’t be happening in those groups and we really don’t know why it’s there. So if we can see a small number of outbreaks in a small number of young people it means there must be others going on as well.”

Martin Murchie, president of the Society of Sexual Health Advisers, agrees that the number of cases diagnosed may just be the “tip of the iceberg”.

He says increasing numbers of people, including teenagers, are arranging to have anonymous sex through social networks. He warns that this is making the task of tracing sexual contacts even harder.

“The way that people meet for sex is very different and changing in society. That in itself can be problematic in trying to trace contacts because some people may change their username that they had originally on the social network site, or the health service itself may not be able to access the social networking site.”

Dr Patrick French, a consultant in Genito Urinary Medicine in London, says there is no room for any complacency. He says syphilis is a serious disease that can lead to heart disease, stroke and dementia, and raises the risk of acquiring HIV.

“The worry is that if syphilis gets into the wider sexually active population of young people it could then become a common and endemic infection. Before syphilis became unusual in the UK in the 1980s it was a major cause of ill health and that’s no longer the case. So it’s a very important infection to try and prevent.”

Many experts fear that sexual health services in England may be hampered by the government’s proposals to move them from the NHS to local council control.

Peter Greenhouse, from Bashh, says: “Some of the services may be privatised or cut down in terms of resources, so we may lose some of our health adviser teams.”

But the Department of Health rejected these concerns.

A spokesman said: “Our reforms won’t fragment sexual health services. Under our plans, the responsibility for most sexual health services will go to local councils. This will allow councils to make crucial links between improving sexual health and their other responsibilities.”

Original Article by Adam Brimelow, Health Correspondent at BBC News

The following video from LiveStrong.com contains more information about Syphilis.

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New MSM Panel report from Sigma Research

This month Sigma Research have undertaken the ninth monthly survey in the Sigma Panel of gay men, bisexual men and other men that have sex with men (MSM) in England and released the fifth Insight BLAST – their fast feedback mechanism to get essential planning data into the public domain.

Insight Blasts have a short turnaround for analysis and output to health
promoters developing and delivering sexual health interventions with, or for
men who have sex with men. The fifth Insight Blast is about “STI screening before your next sexual partner”. It describes how recently MSM have had an asymptomatic STI screen, why they had their last STI screen, and the perceived costs and benefits of screening for STIs when you have no symptoms. The data was collected as part of the eighth Sigma Panel questionnaire in August 2011.

This new Insight Blast and the first four – addressing “HIV testing”: “The
next sexual partner”; “Alternatives to unprotected anal intercourse”; and
“Notifying former sex partners about STI diagnoses” – are all available via
their homepage or at http://www.sigmapanel.org.uk

At http://www.sigmaresearch.org.uk you will also find a
link to the second EMIS Community Report.

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