Memorandum by PACT (HA 23)
Please accept the contribution of the Providers
Association for AIDS Care and Treatment (PACT) to the "New
InquiryNew Developments in HIV/AIDS and Sexual Health".
PACT is an independent subscription based organisation made up
of HIV provider units from across the United Kingdom representing
the views of clinicians, health professionals and managers.
1. Support the campaign of the Terrence
Higgins Trust and the All Parliamentary Group on Aids to add HIV
infection to those sexually transmitted infections exempt from
the Overseas Patient charges. This support is based upon Public
Health (reduce infectiousness from HIV and associated conditions
eg MDRTB) and economic (ie less cost to treat with Antiretroviral
drugs in outpatient setting, than wait until patient develops
an infection such as PCP or CMV and requires expensive emergency
inpatient admission) grounds, as well as humanitarian.
2. Reinforce the need to concentrate resources
on preventing onward transmission of HIV and STI infection, through
compulsory PSHE in schools, targeted Public Health campaigns,
Chlamydia screening across the whole of the United Kingdom and
increased access to "Rapid Testing" and "Point
of Care Testing" diagnostics in the community (especially
HIV antibody testing in primary care).
3. Increased screening in the community,
utilising new diagnostic technologies, will identify and separate
"Asymptomatic" and "Symptomatic" patients
at the earliest point of access. Early diagnosis will improve
referral patterns and access to main GU Centres of Symptomatic
patients, develop integration of primary care and acute services
and increase overall efficiency of capital and human resources.
4. The Health Committee recommended increasing
access to GUM clinics and described the crisis in their funding,
their fabric and their staffing levels. The governments own figures
suggest the situation is worsening, there has been no targeted
improvement of the buildings and consultant expansion has not
increased. A study by Kinghorn et al in Int J STD AIDS
in October demonstrated the failure of DoH monies to reach frontline
services in England because of the failure of PCTs to pass on
the targeted funding.
5. There is no published Sexual Health strategy
in Scotland or N Ireland and this is unacceptable.
6. STI epidemiology is rising alongside
teenage pregnancy and a falling age for Coitarche. If the governing
bodies of each nation accept that this constitutes a Public Health
crisis with major economic effects on NHS expenditure (eg from
Infertility, Cervical Neoplasia, infectious Obstetric/Paediatric
complications and the costs of Anti-retroviral Therapy) then surely
an integrated and coordinated Public Health approach, based on
accessible medical services, prevention and treatment and contact
tracing are the keystones that history teaches us will work in
reducing sexual ill health.
7. Where has been the promised impetus to
funding the increased delivery of contraceptive care and STI asymptomatic
screening in primary care? The lack of development of networks,
including GUM and contraceptive specialist services alongside
community screening facilities was much promised in the English
strategy and much talked up elsewhere-the health committee should
highlight the failure to develop this pivotal aspect of modernisation
of integrated services.
8. Consistent flaws are emerging in the
structure and process of commissioning Sexual Health and HIV services
across the UK. The fragmentation of the commissioning base into
small locally focused PCT's is failing to address the challenges
of delivering national Public Health based Sexual Health and HIV
services. Local cost pressures and a failure to identify the activity
and disease drivers for Sexual Health and HIV within mainstream
contracts is contributing to the restriction of funding and a
lack of strategic thinking and vision around these services. These
pressures are creating ever greater tensions between Commissioners
and Provider Units, which are leading to the break down of the
Public Health ethos that underpins "Open Access" services,
a restriction on access to services and the development of a "postcode
lottery" for treatment and care. Managed clinical networks
and the integration of Sexual Health and HIV commissioning is
now an urgent priority if we are ever to achieve the recommendations
set out by the Committee.