ENHANCING SEXUAL WELLBEING IN SCOTLAND - A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: Analysis of Written Responses to the Public Consultation
CHAPTER 10: SPECIFIC ACTIONS TO REDUCE SEXUALLY TRANSMITTED INFECTIONS
10.1 Generally, Health Professionals who commented on this section were largely positive about the proposals relating to reducing STIs and unplanned pregnancies although there were concerns about some aspects of service delivery and funding.
10.2 Although few Individual and Faith Group responses referred directly to the recommendations in this section, it is clear from many of their general responses that many were not in support of making condoms and other contraception freely available to young people.
The Scottish Centre for Infection and Environmental Health (SCIEH) and the Information and Statistics Division (ISD) should monitor and disseminate information on new diagnoses and trends timeously so that appropriate responses can be made at local NHS Board level
Health promotion activities should include skills development in the use of condoms and be reinforced by professionals in both learning and clinical services
10.3 Health Professionals and Equalities Groups were generally supportive of these recommendations. It was noted that,
"Skills development around condom use should not be limited to the practical side of using condoms, but should be suitably broad to include how to negotiate condom use with partners who might be resistant to using them." (Equalities)
NHS Boards should ensure that a range of condoms and lubricants are regularly supplied free of charge to outlets and services targeted at high-risk groups and as part of outreach work
Where contraception is available free of charge for women, condoms should also be freely available to both men and women. The Scottish Executive should explore the feasibility of resourcing NHS Boards to achieve this
10.4 These recommendations were generally supported by Health Professionals and Equalities Groups (although as identified above, not by many Individual and Faith Groups responses).
"Condoms should be freely available and the SE should resource not 'explore' this" (Social Health)
"This is essential. The current lack of availability of free condoms in a diverse range of settings is seriously lacking and a matter of real concern." (Education and Young People)
" [We] strongly support free condoms" (Medical Health)
"We wish particularly to endorse the focus on barrier protection as a frontline mechanism for preventing the transmission of STIs" (Medical Health)
"We recommend that national guidance on condom distribution be delivered to ensure condoms are always issued with lubricant as a national standard as insufficient lubricant is the key reason for condom failure." (Medical Health)
"The Scottish Executive Health Department should amend the regulations to provide for the free issue of barrier contraceptives and the appropriate lubricants from community pharmacies. This inequity of supply fails to exploit the opportunity to the public in accessing these products from the community pharmacy network." (Medical Health)
The Scottish Executive should enable the availability of condoms on prescription for males and dental dams for females throughout the course of their detention in young offender institutions and adult prisons
10.5 It was felt that this proposal was not radical enough as it did not refer to prevention, education, HIV testing etc. It was also suggested that prescription-free clean needles should also be available to prisoners ( see quote paragraph 7.6).
To encourage early diagnosis and treatment and to minimise onward transmission among those aged under 25, the Scottish Executive should fund the availability of the chlamydia postal testing kits developed by Healthy Respect to all NHS Boards if the evaluation evidence supports this
To support primary care in initiating treatment, to assess the impact on laboratory services and to test user and patient acceptability, the Scottish Executive should fund pilot projects in two NHS Board areas (one rural, one urban) of STI diagnostic kits covering chlamydia, gonorrhoea and trichomonas. If successful, these kits should be available nationally
10.6 Health Professionals tended to think that the proposals on chlamydia testing and STI diagnostic kits were not comprehensive enough and should be further developed using all the available resources to do so.
"Proposals on Chlamydia testing are inadequate - rather a comprehensive screening programme should be developed". (Medical Health)
"This is simply inadequate. The Executive should develop a comprehensive national targeted Chlamydia screening programme within a specified time frame (…) Postal testing kits may well be part of this." (Medical Health)
"[There is a] need to monitor and evaluate the postal testing kits." (Medical Health)
"Testing for herpes simplex virus should be included and much more widely available." (Medical Health)
10.7 However, Social Health Professionals appeared more supportive of the principle of postal-testing for STIs..
"We welcome the proposal to make Chlamydia postal testing kits available. However, full recognition should be given to the additional pressures this will create for laboratories." (Social Health)
"(Organisation) supports this recommendation and would extend this to more targeted testing for U25s for a range of STIs" (Equalities/Social Health)
"This is an area of grave concern and out services need to respond in this way" (Social Health)
The Scottish Executive should address inequities in STI treatment costs for patients attending general practice and other sexual health services
Each NHS Board inter-agency sexual health strategy should demonstrate progress made in implementing the HIV Health Promotion Strategy. The National Sexual Health Advisory Committee should report on progress as part of the annual review of this strategy
10.8 One comment relating to the above recommendation was as follows:
"We disagree with this point and would like the HIV Health Promotion Strategy to be revisited in partnership with a wide range of voluntary sector organisations, many of whom are leading HIV support services across Scotland. The document is based on evidence from 1999 and since then demographics in Scotland have changed. For example, unprotected anal intercourse has emerged in the last 3-4 years as a major issue for MSM and this is not reflected in this strategy." (Social Health)
NHS Boards should work with agencies for people living with HIV to explore the potential for expanding their role beyond HIV and include proposals in their inter-agency sexual health strategies
10.9 It was noted that:
"We endorse these statements regarding HIV" (Social Health)
"The strategy needs to state more explicitly its support for community-based action and support. It would be useful to reiterate the finding of 'an Evolving Strategy' (1995) that the voluntary sector and in particular community-based and self-help groups are best placed to undertake much of the health promotion activity need in HIV and sexual health" (HIV agency)
"We welcome these proposals. With regard to 4.48 (Organisation) believes that HIV agencies have generally built up expertise in talking about HIV as a sexually transmitted infection and that this expertise could usefully be used to talk about other sexually transmitted diseases … We believe that all agencies involved in the care of people, young or old, should play a role in helping create a culture where sexual health is openly discussed." (HIV agency)
"(Organisation) recognises the clear need for multi-faceted services but feels it is very important to maintain specialist HIV services" (Equalities/Social Health)
"A community response to these needs is best co-ordinated by people living with HIV. In this respect, self-help organisations are useful avenues for ensuring the views of people with HIV inform the development of services" (HIV agency/help group)
To minimise barriers to HIV testing, the Scottish Executive should publicise clear guidance regarding the reporting of negative HIV tests for insurance purposes
"[The recommendation] is especially welcome, given the recent rises in HIV prevalence" (Education and Young People)
10.10 It was also noted that,
"The strategy needs to ensure that testing for HIV and STIs is not communicated to insurance companies via patient records." (Medical Health)
Lead Clinicians should ensure that HIV testing is offered to all GUM clinic attendees not known to be HIV infected who present with a new STI. This offer should be made in the context of the HIV test being presented as a routine, recommended test. Reasons for non-uptake should be recorded
10.11 There was support for offering HIV testing to all those attending GUM services but it was noted that as many people travel to neighbouring health board areas especially in the big cities to access services, funding mechanisms should reflect this. It was also suggested that HIV testing should be offered in family planning and reproductive health clinics as well as GUM clinics.
10.12 It was suggested that it is unlikely that more than 30-40% of people with what was described as an "acute" STI will accept HIV testing, but that the target for offering it should be extended to those attending for STI screening or as at risk of an STI. Several respondents noted that a key issue to tackle in relation to the up-take of HIV tests is stigma.
"There is a need to focus on removing stigma to encourage people to be tested and treated" (Social Health)
"Reasons for low uptake are as much to do with perceived fears of stigmatization, lack of personal appreciation of risk and concern over life insurance and medical confidentiality as they are to do with clinicians failing to offer or recommend a test". (Medical Health)
10.13 It was also noted that,
"The strategy tends towards a 'normalisation' of HIV testing. From the point of view of [HIV] positive people, HIV testing is not 'normal' and cannot easily be normalised. What is required are improved resources and services in testing centres." (Equalities)
To facilitate access to sexual health services and the development of a more integrated approach, Lead Clinicians should ensure that all HIV patients have access within their main clinic to at least Tier Four sexual health services
10.14 Clarity was sought as to what was meant by 'main clinic' and whether this referred to the Lead Clinician's main clinic, the main HIV Clinic or the patient's main clinic?