APPENDIX 4
Memorandum by Dr James Bingham (SH 10)
Dr Bingham is Consultant Physician in
Genitourinary and HIV Medicine at Guy's and St Thomas' Hospital,
London
I am writing this, at short notice, to draw
the attention of the Committee to the situation regarding sexual
health in the Armed Services. In doing so I have not been able
to mention the matter to the Director General of Army Medical
Services, Major General DS Jolliffe. However, I shall copy this
message to him.
I do not know if the remit of your inquiry is
to include the Armed Services but, if it is, might I suggest that
you contact Major General Jolliffe for information concerning
the Army. He could provide you with the information that you might
require and/or put you in touch with the Triservice Adviser, Colonel
Rao.
WORKLOAD PRESSURES
Sexually transmitted infections occur, predominantly,
in the young and most service personnel fall into that category.
However, services for sexually transmitted infections (STIs) are
delivered rather differently in the Armed Services than in civilian
life. There is just one consultant adviser across the three services
and he draws up treatment directives, based on civilian models,
but taking into account operational aspects. Much of the care
at the local level is delivered by specially trained service nursing
personnel who are deployed around the country and the world. Because
of the many deployments of British Forces overseas, at present,
this is putting a considerable strain on the resources available.
British servicemen and women are at risk of a different spectrum
of disease in some tropical countries and, in sub-Saharan Africa,
there is the much greater risk of HIV infection. If the present
rate of deployments continues, this pressure is likely to be maintained
or increased.
SURVEILLANCE
The Army does its best to record the incidence
of disease but these figures are not necessarily included in the
Army Health Report and, as far as I know, are not sent to the
PHLS in Colindale, which collates the figures from the civilian
world.
SEXUAL HEALTH
ADVICE
Of course it is wise to acquaint servicemen
and women about the risks of acquisition of STIs and advice about
this is, I believe, laid down in an Independent Training Directive.
But as with the best-laid plans of mice and men, this may not
always happen.
SEXUAL HEALTH
STRATEGY
The Department of Health has produced a draft
Sexual Health Strategy and it is likely that some advice on its
implementation will be released soon. While the Armed Services
are aware of the Strategy and appropriate committees have discussed
it, there is currently no equivalent Service Strategy. The Army
has recently revised its Sexual Health Patient Group Directives
and there is a recent Surgeon General's Policy Letter on HIV/AIDS.
However, with the likely changes in the civilian world, where
the primary care sector may become more involved with access to
modern nucleic acid amplification diagnostic tests, the Services
may need to review their situation in this respect.
ARMY RECRUITMENT
Finally, the Army is currently spreading its
recruitment net wider than previously and is recruiting from some
Commonwealth countries where there is a higher incidence of HIV
infection than among the indigenous British population. This raises
the spectre of pre-recruitment screening for HIV infection and,
perhaps, other blood-borne infections. The issues affecting a
decision to screen are complex and the matter has not yet been
decided.
I apologise if the Armed Services do not come
within the scope of your Inquiry. However, I would finish by saying
that the Army provides an excellent range of services within a
limited resource envelope. It has a model of care that the civilian
world is beginning to adopt with a well-trained cadre of nurse
practitioners who can work independently around the world.
June 2002
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