Memorandum by the Terrence Higgins Trust
(SH 82)
1. INTRODUCTION
1.1 Thank you for the opportunity to give
evidence to this review of the effectiveness of the national strategy
for sexual health and HIV.
1.2 The Terrence Higgins Trust (THT) is
the largest HIV charity in the UK. We provide HIV care and sexual
health promotion services to people with HIV and HIV prevention
programmes for those communities most at risk—gay men and
African people in the UK. Through our care services, research
and client involvement work, we are in a unique position to comment
on the effectiveness of and challenges facing national plans that
aim to affect the sexual health and HIV status of people throughout
the UK.
2. FACT AND
FIGURES
2.1 The UK currently has the highest rate
of sexually transmitted infections (STIs) since the NHS began,
and they continue to rise dramatically. Between 1995 and 2000:
— Gonorrhoea, chlamydia and syphilis
rates all rose by more than 100 per cent[1]
— In 2001, approximately 4,100 new
HIV infections were diagnosed; more than in any year since records
began[2];
2.2 Meanwhile, GU services and the HIV voluntary
sector are struggling to meet client need:
— THT has found that over 40 per cent
of people needing sexual health appointments have to wait more
than a week to be seen, and 1 in 10 have to wait more than a fortnight[3];
— Clinic workload has increased by
34 per cent in 5 years[4];
— Uptake of THT services has increased
between 10 per cent and 500 per cent in the last two years[5].
2.3 A survey by THT and PatientView found
that GPs are reporting problems
— Collaborating with specialist HIV
services;
— Understanding complex issues of confidentiality
and HIV[6].
2.4 In the same period, the government has:
— Removed sexual health and HIV as
a core priority for action;
— Removed ring fencing from HIV prevention
funding;
— Devolved commissioning power to local,
non-specialist PCTs;
— Issued the draft national strategy
for sexual health and HIV but not provided, or indicated an intention
to provide a corresponding National Service Framework that could
transform principle into practice.
3. ANALYSIS
3.1 The recent dramatic rise in the number
of STIs, combined with unprecedented levels of HIV diagnoses make
it clear that sexual health and HIV are health issues that require
urgent, prioritised action from central government. It is sadly
ironic that, as prevalence has increased, the government has undertaken
a range of reforms within the NHS that have actively de-prioritised
sexual health and HIV. These have had the effect of undermining
the national strategy before it has had time to take effect.
3.2 The government has provided all PCTs
with a wide range of targets and priorities for general healthcare
provision as well as four specific clinical priorities (cancer,
CHD, mental health and older people). Given this government emphasis
on performance within the NHS, it is clear that anything outside
this framework is unlikely to be a priority for PCTs as they struggle
to establish themselves. The voluntary sector, whose services
have never been in such high demand, are at particular risk in
this new climate.
3.3 THT welcomes the aims laid out in the
draft strategy but recognises that without active guidance, most
usefully through a National Service Framework (NSF), they will
be difficult, if not impossible to achieve. A NSF would ground
the aims of the strategy in practical guidance and give teeth
to the upcoming commissioners' toolkit, by
— Setting national standards and providing
practitioners with service models for a defined service;
— Putting in place strategies to support
implementation;
— Establishing performance milestones
against which progress within an agreed time-scale will be measured.
3.6 Intentions spelt out within the draft
strategy to encourage greater involvement in sexual health and
HIV testing and treatment by generic healthcare providers, particularly
GPs, add to the concern around PCT capacity. The difficulties
even HIV friendly GPs continue to face require training and guidance
that springs from an in-depth understanding of a complex medical
and social issue. Given the already high demands placed on PCTs,
there is an urgent need for the government to issue clear guidance
for training for all primary care staff and agreed good practice
guidelines for GPs and dentists. These would be best developed
in consultation with HIV organisations.
3.6 GU clinics are already under immense
strain and there is nothing to suggest that demands on their services
will not increase. Increased prevalence of HIV and other STIs;
spiralling drug costs; increased client numbers as a result of
the national awareness campaigns proposed in the draft strategy;
and confusion around PCT commissioning arrangements mean that
this situation urgently requires an unambiguous lead from central
government; something that is unlikely to happen without sexual
health and HIV being re-prioritised at the highest level.
4. RECOMMENDATIONS
4.1 To most effectively underpin and support
the draft strategy, the government should:
— Reprioritise sexual health and
HIV.
— Develop a National Service Framework
for sexual health and HIV.
— Issue HIV training and good practice
guidelines for generic healthcare providers.
— Review levels of investments in
GU services against projected trends in STI and HIV prevalence.
June 2002
1 Sexually Transmitted Infections in the UK: New
Episodes seen at Genitourinary Medicine Clinics, 1995-2000,
Public Health Laboratory Service, 2001. Back
2
Source: Public Health Laboratory Service. Back
3
THT/PatientView/BHIVA survey of GU consultants, 2001. Back
4
Sexually Transmitted Infections in the UK: New Episodes seen
at Genitourinary Medicine Clinics, 1995-2000, Public Health
Laboratory Service, 2001. Back
5
Terrence Higgins Trust Annual Report 2000-01. Back
6
Managing HIV: a new role for GPs, PatientView in collaboration
with Terrence Higgins Trust, 2001. Back
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