Sexual health

What is sexual health

Sexual health refers to a raft of topics relating to gynaecology and urinary medicine (GUM), reproduction and family health and sex and relationship education. Governments are concerned with how people use sexual health services, commonly accessed through GP surgeries, family planning centres, GUM clinics, pharmacies and smaller initiatives such as school nurse schemes. The government is concerned by levels of STIs and unwanted pregnancies and as such policy makers tend to recommend access to contraception, abortion and education services.

Background

Britain's sexual health is not good, with the British Medical Association (BMA) going so far as to warn of a sexual health crisis, driven in part by rising rates of STIs.

Teenage pregnancy rates are the highest in Europe and STI rates also outstrip all but the worst-performing neightbours. In an attempt to reduce the number of STIs and unwanted pregnancies – a stated policy of the Department of Health - contraception is freely available to both men and women on the NHS, although many public health campaigners warn sexual health services are not fit for purpose.

The number of people infected with chlamydia rose by five per cent in 2005, reaching 109,958. It is estimated that up to one in ten young people could now be infected with the virus, making it the most common STI in the UK. Over the past ten years, chlamydia cases have soared by 206 per cent.

Worryingly for sexual health professionals, recent years have seen the return of syphilis. Among high-risk groups, cases of the infection have increased by 1,949 per cent.

Although treatable, STIs like chlamydia are a serious concern for the health service because they can develop into more serious long-term illnesses or conditions such as infertility.

Many STIs are also recognised as favouring the spread of HIV, a considerable concern for public health professionals. It is estimated that 88,627 people in the UK have been diagnosed with HIV. In terms of people still living with the disease, estimates predict 20,000 people with HIV are not aware of their condition, increasing the risk of further infection.

Unlike other health services, abortion is not available 'on demand', either on the NHS or privately. Instead women must obtain the written consent of two doctors and match criteria set down under the Abortion Act 1967.

In 2006, 193,700 abortions were carried out on women resident in England and Wales, 87 per cent of which were provided by the NHS. The DoH says it wants to reduce this number.

The highest abortion rate is among 19-year-olds, with 35 abortions for every 1,000 women. The abortion rate among under-16s is 3.9 per 1,000 women, rising to 18.2 among under-18s.

Despite an ongoing political debate over abortion limits, 89 per cent of abortions took place under 13 weeks and 68 per cent were performed before ten weeks.

One per cent of abortions were conducted because there was a risk the child would be born handicapped.

Controversies

The factors behind Britain's poor sexual health have been hotly debated and no single suggestion provides a complete picture. Christian groups and many on the right-wing complain that culture, and increasingly sex education, promote promiscuity, which in turn makes it more likely people will transmit STIs or experience an unwanted pregnancy.

Others complain current education policies fail to adequately equip young people to promote their own sexual good health and some campaigners argue Britain needs to foster a more open attitude towards sex to encourage safe sexual behaviour. Moving from prevention to cure, a lack of resources for sexual health services has also been blamed for failing to reverse rising rates of infection.

The DoH admits sexual health services need modernising and has set itself targets to cut the number of unintended pregnancies and reduce the spread of STIs. But it is also keen to draw attention towards positive achievements.

The department has judged it to be cost effective to make contraception freely available. For example, free contraceptive pills save £11 for every £1 spent. Some four million people now access NHS contraception services every year, three-quarters through their GP.

The DoH says it wants to improve access further, as well as offering a full range of contraceptives to both men and women. This includes long-acting reversible contraceptives, the greater use of which is now recommended by the National Institute for Clinical Excellence.

Some family campaigners have been opposed to attempts to improve access to contraception, especially among teenagers, arguing it encourages promiscuity.

The British Medical Association (BMA) adopts a more negative view of sexual health services, warning of a sexual health crisis in Britain and calling on the government to urgently reduce rates of STIs. The BMA warns GUM clinics will be unable to cope with rising rates of STIs without considerable government support. GUM clinics saw their workloads rise by nine per cent between 2004 and 2005 and demand shows few signs of diminishing.

The health select committee warned in 2003 that the system was in a "state of crisis" and in February 2007 the BMA said sexual health services were still "woefully inadequate". Despite DoH claims towards improvement, the BMA argues services are in a worse state than 90 years ago. It notes that during World War One, the government oversaw a free, rapid and confidential service to target sexual health. Now, patients can find themselves waiting up to six weeks for treatment, with many continuing to have unprotected sex.

The government maintains access to GUM clinics has improved. This is supported by statistics, but the Health Protection Agency has expressed its alarms at waiting times. An audit in August found 72 per cent of patients were seen within the target of 48 hours, the highest percentage achieved so far. This marks an achievement from the 70 per cent seen on target in February 2007 and 54 per cent in May 2006. Access remains variable across the country, although London is achieving the best service with 81 per cent of patients seen within 48 hours.

The BMA says the DoH must ensure PCTs channel funds into sexual health, warning unrestricted funding boosts will not necessarily filter through to improved services. It also calls for new education strategies to increase awareness of the full spectrum of STIs, as well as learning relationship skills such as negotiation and how to access health services. It argues policy must focus on encouraging people to seek treatment and practice safer sex.

Sex and relationship education is a persistent source of controversy in the UK. Currently, the biological facts are taught through mandatory science lessons. Emotional aspects are taught in personal, social and health education (PSHE), from which parents can withdraw their children.

The Sex Education Forum has said sex education is "too biological" and lessons should place more emphasis on PSHE issues. Childline agrees there is a need for better sex and relationship education. Chastity campaigns imported from America are slowly gaining prominence in the UK. However, they are yet to be officially endorsed and remain a minority concern.

Statistics

Number of people living with HIV in the UK in 2005: 63,500.

Year on year increase in 2005 in the number of people seeking voluntary HIV testing: 80 per cent among homosexual men and 85 per cent among all heterosexuals.

109,958 people were diagnosed with Chlamydia in 2005, a five per cent annual increase.

Statistic 1, 2 and 3 (Source: British Medical Association, 2007).

Quotes

"Current provision for sexual health services in the UK is woefully inadequate."

The British Medical Association, February 2007.

"As long as sex and relationship education remains a non-statutory part of the curriculum there is no way to guarantee that all young people will benefit from them."

Jan Barlow, chief executive, Brook Advisory Centre, 2005.