Priorities for Health: Sexual health
November 2006
Introduction
In August 2006, BMA Scotland conducted a survey of members to identify their priorities for health. Around 600 doctors from all branches of the profession responded to the survey and their priorities for sexual health are reflected in this policy briefing.
Background
Sexual health is not just about the absence of disease or unintended pregnancy but also includes emphasising the positive aspects of relationships and sexuality. BMA Scotland believes that much more needs to be done to improve sexual health services, particularly for young people, and that a significant increase in funding is required.
Sexually transmitted infections (STIs) are an increasing problem in Scotland. Rates of Acute STIs (e.g. genital herpes, chlamydia, gonorrhoea, syphilis, HIV) diagnosed at Scottish genitourinary medicine (GUM) clinics have almost doubled since 1996. In particular, rates of chlamydia among young adults (aged 18 – 24) have increased by more than 500% since 1996 [reference 1].
HIV transmission and other STIs among men who have sex with men are undiminished and there is evidence that heterosexual transmission of HIV is slowly rising. Fast access to GUM clinics remains an acute problem with around half of those attending being seen within the recommended 48 hours [reference 2].
In 2005, there were more than 63,000 new cases attending Scottish GUM clinics [reference 3]. Around 70% of all new episodes are self referrals (the remaining 30% are predominantly referred by GPs).
More than 700 girls under the age of 16 became pregnant in Scotland in 2004. Teenagers from the most deprived areas are three times more likely to become pregnant that their counterparts in the most affluent parts of Scotland. The Scottish Executive has set a target to reduce pregnancies among 13-15 year old girls by 2010 [reference 4].
When the Scottish Sexual Health Strategy was launched in 2004, the Scottish Executive announced £10m funding for a three year period [reference 5]. However, there is as yet no commitment to provide long term sustained funding for these services.
Interventions
Provide sustained funding to support long term objectives in the Sexual Health Strategy
Almost nine out of ten doctors (88.6%) who responded to the BMA Scotland survey said that sexual health should become a long term priority for the next Scottish Parliament. Around 80% of respondents said that increased resources should be allocated to clinical services (primary and secondary care) and investment sustained for the long term.
Without a long term commitment of funding for sexual health services, NHS Boards will be unable to establish services that are sustainable. For example, the current funding for the Sexual Health Strategy runs out in 2007, therefore managers are reluctant to invest in developing services and employ family planning and GUM specialists because there is no future funding to maintain the posts.
Any funding must be specifically targeted to reverse the chronic under-investment in clinics that diagnose and treat people with STIs. A survey of GUM clinics conducted by the British Association for Sexual Health and HIV (BASHH) estimates that a third of the money allocated in 2003-4 to Primary Care Trusts (the English equivalent of primary care divisions of NHS Boards in Scotland) for GUM services is not getting through to clinics and instead, money is being spent on alternative priorities [reference 6]. Without ring-fenced funding, it is likely that this situation will be replicated in Scotland. The BMA believes that funding for sexual health services must be ring-fenced and spending monitored to ensure that the benefits of any investment are not lost.
Targeted sexual health education campaigns should be developed
There is a desperate need to develop a culture where young people can take responsibility for their sexual health. Improved education to empower people to make decisions that are right for them is vital.
Sexually transmitted infections affect people of all ages, although incidence is greatest among those under 25. Access to the right help at the right time is crucial.
Around 70% of doctors who took part in the BMA survey believe that a targeted sexual health education strategy should be developed and introduced. Sex education in schools needs to be improved, introduced at an early age and must cover the full spectrum of STIs. Almost 93% of doctors said that contraception and sexual health education should be provided in schools.
A recent campaign by the health charity DPP: Developing Patient Partnerships found that almost half of 16 to 24 year olds find it embarrassing to talk to their GP or nurse about sexual health matters [reference 7]. Providing young people with information about sexual health services can help them to be more confident about accessing them. More than eight out of ten young people who took part in the DPP survey said they would like to know more about what to expect from a visit and what an STI test involves. Two thirds also said they would prefer to remain anonymous when trying to get help and 78% cited online information as a preferred source of help.
Much greater emphasis is needed on school-based sex and relationship education (SRE). Results from the first UK-based systematic evaluation of school-based SRE were published in June 2002. It found that a high-quality, experientially based SRE programme was rated highly by the young people who received it and that it increased their knowledge and reduced the level of reported regret over first sexual intercourse. However, it had no effect on contraceptive use and sexual behaviour. These results suggest that specific programmes on their own are unlikely to reduce conception rates, but are an essential part of a multi-dimensional approach [reference 8].
Improve access to Genito-Urinary Medicine Clinics and specialist sexual health services
91% of doctors responding to the BMA’s survey said it was important to improve and widen access to GUM clinics.
GUM clinics are best placed to deal with STIs among patients of all ages but there is a desperate need for more of them. At the same time as the increasing incidence of STIs, there has been an increase in public awareness of sexual health which has resulted in more people attending clinics to be tested and treated. This has therefore increased demand and workload, putting even more pressure on limited resources.
Improving sexual health services and tackling waiting times are an essential part of disease prevention as failure to treat infections promptly means that untreated patients who remain sexually active can increase the transmission of STIs.
But at a time of increasing demand for sexual health services, there is continuing evidence of problems accessing them and current capacity is woefully inadequate. Although no official figures exist, the BBC identified that only around half (55%) of GUM clinics in Scotland could provide access within 48 hours [reference 9].
A strategy for investment should focus first on investing in building capacity in sexual health services before embarking upon a national public health information campaign. This would ensure that any increased demand for services can be managed by a service that has the capacity to deal with it otherwise patients would simply face even longer waiting times for diagnosis and treatment of STIs.
The BMA survey found that 85% of doctors believe that specialist sexual health services should be located outwith traditional healthcare environments to encourage access e.g. in youth and community centres.
Doctors are already involved in trying to bring services to young people and there are some excellent examples in Scotland. One such case is the Sorted on Sex initiative in Stirling which runs an off-the-record drop in centre for young people. This service provides information, advice and services at a place accessible to young people who want to take responsibility for their sexual health. Another example is the Sandyford Initiative in Glasgow, an integrated health and social care project providing GUM, reproductive and emotional health services.
Recommendations
In order to improve Scotland’s sexual health, the BMA calls on political parties to:
- Make a commitment for sustained funding to support long term objectives in the Sexual Health Strategy.
- Develop and implement targeted sexual health education campaigns.
- Tackle waiting times.
- Improve access to Genito-Urinary Medicine Clinics and specialist sexual health services.
1. Scottish Health Statistics Sexual Health NHS National Services Scotland, 2005 [www.isdscotland.org].
2. BMA Board of Science Sexually Transmitted Infections Update 2006
3. NHS National Services Scotland Scottish Health Statistics: Sexual Health 2005
4. Scottish Executive Towards a Healthier Scotland – a white paper on health (Edinburgh) 1999
5. Scottish Executive Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health (Edinburgh) 2004
6. Kinghorn GR, Abbot M, Ahmed I, Robinson AJ. BASHH survey of additional genitourinary medicine targeted allocations in 2003 and 2004 British Association for Sexual Health and HIV (BASHH) 2005.
7. DPP: Developing Patient Partnerships is a health education charity working with primary care organisations and the public to make the most of health services and help people manage their health by improving health knowledge and communication [www.dpp.org.uk].
8. Better Health for Children & Young People - HDA Briefing No. 4, June 2004.
9. BBC News Online GU waiting times for the UK, October 2005. Available online: http://news.bbc.co.uk
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk