Sexual Health

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Claire Bradford

Introduction

Sexual health is an important part of physical and mental health. It is a key part of our identity as human beings together with the fundamental human rights to privacy, a family life and living free from discrimination. Essential elements of good sexual health are equitable relationships and sexual fulfilment with access to information and services to avoid the risk of unintended pregnancy, illness or disease. - Better prevention, better services, better sexual health – The national strategy for sexual health and HIV (2001)

In 2001, the Government published the national strategy for sexual health and HIV. This was a major milestone: it placed sexual health and HIV firmly on the national agenda and set out an ambitious 10-year programme to tackle sexual ill-health and modernise sexual health services in England.

The aims of the strategy were:

  • Reduce transmission of HIV and STIs
  • Reduce prevalence of undiagnosed HIV and STIs
  • Reduce unintended pregnancy rates
  • Improve health and social care for people living with HIV
  • Reduce the stigma associated with HIV and STIs

Summary of the sexual health strategy targets:

  • Reduce by 25% the number of newly acquired HIV and gonorrhoea infections by the end of 2007
  • By the end of 2004, all Genitourinary Medicine (GUM) clinic attendees to be offered an HIV test on their first screening for sexually transmitted infections (and subsequently according to risk):
    • Increase uptake of the HIV test by those offered it in GUM clinics to 60% by the end of 2007
    • Reduce by 50% the number of previously undiagnosed HIV infected people attending GUM clinics who remain unaware of their infection after their visit by the end 2007
  • Increase the uptake of hepatitis B immunisation in homosexual and bisexual men attending GUM clinics as follows:
    • Uptake of the first dose of hepatitis B vaccine, in those not previously immunised, to be 90% by the end of 2006
    • Uptake of the three doses of hepatitis B vaccine (i.e. the full course), in those not previously immunised, to be 70% by the end of 2006
  • For women who meet the legal requirements, access to an abortion within 3 weeks of the first appointment with the referring doctor

Highlight figures

Sexual Health in 2008 (from the Review of the National Strategy for Sexual Health and HIV)

Sexual behaviour

  • 51% of people said they would always, and 14% said they would never or rarely, use a condom with a new sexual partner.
  • Of men who had sex with another man over the last year, 36% were consistent condom users. 53% had had anal sex at least once without a condom.
  • Frequent use of alcohol and other drugs is associated with high numbers of sexual partners and decreased likelihood of using protection.

Contraception

  • The most frequently used method is the contraceptive pill (27%) followed by the male condom (22%).
  • Only 10% of women under 50 report using LARC as their method of contraception although 45% would use this method if offered.

Pregnancy and abortion

  • The teenage conception rate declined by 13.3% (in 15-17s) between 1998 and 2006.vi
  • Abortion rates are highest in 18-24 year-olds, peaking at age 19 (36 per 1000 women aged 19, compared to 18 per 1000 aged 15-44).
  • 68% of NHS-funded abortions in 2007 took place at under 10 weeks compared with 51% in 2002 (a 33% increase).
  • The proportion of medical abortions has more than doubled in the last five years, reaching 35% of all abortions in 2007.
  • 32% of all women undergoing abortion in 2007 had had one or more previous procedures (28% of Asian women, 48% of Black women).

Sexually transmitted infections

  • Numbers of new STI diagnoses at GUM clinics have risen steadily over the last 10 years. The highest rates are in young people and men who have sex with men (MSM).
  • 16-24 year-olds account for nearly half of all STIs diagnosed in GUM clinics.
  • Men who have sex with men account for a fifth of new diagnoses of gonorrhoea and over half of new episodes of syphilis seen in GUM.
  • 9.5% of women and 8.4% of men aged under 25 test positive for chlamydia when screened.
  • Black Caribbeans continue to have a very high incidence of STIs, accounting for 17% of all gonorrhoea diagnoses though they only comprise 1% of the UK population.

HIV

  • 73,000 people are estimated to be living with HIV in the UK, including one-third who are unaware of their diagnosis.
  • An estimated 43% of those living with HIV are men who have sex with men, and 35% are people born in sub-Saharan Africa.
  • Over 52,000 people accessed care for HIV in 2006, a tripling in numbers since 1997. The increase was greatest in London, but the largest proportionate increases were outside London.
  • Late diagnosis accounts for 35% of HIV-related deaths.xii An estimated one-third of all HIV diagnoses and 40% of those in black Caribbeans and black Africans occur late (CD4 count <200).

Public knowledge and attitudes

  • 79% of people were aware HIV could be passed on by sex between a man and woman without a condom in 2007, 12% less than in 2000.
  • 70% believe that people with HIV deserve the same level of support and respect as someone with cancer, compared to 77% in 2000.
  • One third of people living with HIV in London reported being discriminated against because of their infection, almost half of these saying this had involved a healthcare worker.
  • 40% of young people state that the quality of SRE in schools is poor or very poor.
  • 30-50% of people in secondary schools attracted to the opposite sex have directly experienced homophobic bullying.