Memorandum by the National Aids Trust
(NAT) (WP 107)
I am writing to present some points which I
hope can be taken into account by the Health Committee as part
of their inquiry into the Public Health White Paper.
I am sure the Committee's analysis of the sexual
health component of the White Paper will be informed by its current
inquiry into New Developments in HIV/AIDS and Sexual Health. Having
listened to the evidence presented to the Committee during that
inquiry, I felt it important that NAT also contribute to your
consideration of the White Paper to reiterate for the record some
of our major concerns. I realise that this letter comes after
your deadline for evidence but I hope it can nevertheless inform
your questioning and your final report.
We believe there is much to welcome in the White
Paper with respect to the broader sexual health agenda, including
the target of a 48-hour waiting time for GUM appointments, the
commitment of an extra £300 million to improve sexual health
services, and targets for gonorrhoea and chlamydia. There are
also, however, missed opportunities which we hope the Committee
will bring to the attention of the Secretary of State.
1. HIV
1.1 On the day of the White Paper's publication
NAT pointed out that HIV was almost absent from the document.
Discussions since then have confirmed this to be a major disappointment
and concern throughout the HIV sector. For HIV to be mentioned
only three or so times in passing in the whole document sends
out entirely the wrong signal when new diagnoses have been increasing
over the last few years by up to 20% per annum, over a quarter
of positive people are unaware of their status and there are significant
increases, for example, in the percentage of gay men reporting
high risk sexual behaviour with casual partners (from 6.7% to
16.1% 1998 to 2003).
1.2 Although there is general discussion
of health inequalities in the White Paper, there is no focussed
analysis of the health needs of gay or bisexual men or African
communities.
1.3 There is a well-documented and recognised
problem of the performance management of sexual health within
the NHS. With HIV sidelined in the White Paper, with no explicit
HIV-related core or developmental standards in "National
Standards, Local Action", there is a real question as to
whether PCTs have the necessary incentives to tackle HIV.
1.4 Drugs budgets for WV treatment will
continue to increase and there is evidence that this is at the
expense of HIV prevention work. We believe the Secretary of State
should be challenged on the goal contained in the National Strategy
for Sexual Health and HIV to reduce new HIV infections by 25%
by the end of 2007. How has the Public Health White Paper contributed
to achieving this goal? There is a promise to improve accessibility
to GUM clinics but this is an inadequate response to the seriousness
of the situation.
1.5 We need a clear message from the Government
that HIV is at the top of its public health agenda. We also need
increased funding for HIV prevention and the necessary incentives
from the centre to ensure that HIV is prioritised at the local
PCT level and effectively performance managed.
2. SEXUAL HEALTH
CAMPAIGN
2.1 We welcome the sexual health education
campaign planned for later this year. Details of its content remain
unknown. We were pleased to hear Melanie Johnson tell the Committee
that she thought its scope should extend beyond the 18 to 25 age
range. We are looking for confirmation that the campaign will
include appropriate reference to HIV. It is vital that there is
an understanding in the general population that HIV remains a
serious and life-threatening communicable disease and that people
are equipped with accurate information on risk and safer sex.
3. PRIMARY CARE
AND SEXUAL
HEALTH
3.1 We welcome the determination to roll
out sexual health provision into the community through primary
care settings. The Committee has already explored the deficiencies
of the current GMS contracts in relation to sexual health and
we believe a review of the GMS contract should take place in the
near future to ensure the contracts are consistent with the aims
and messages of the White Paper.
3.2 There are also significant implications
for clinical knowledge of HIV, for confidentiality and for training
to avoid HIV-related stigma and discrimination. As sexual health
provision, including HIV testing, is made more widely available
there must be a clear and properly funded training strategy to
ensure primary care is a well-informed, safe and supportive environment.
4. SEX AND
RELATIONSHIPS EDUCATION
(SRE)
4.1 Whilst the White Paper includes a commitment
to improve SRE, the failure to make SRE in its fullest sense a
compulsory part of the National Curriculum perpetuates inequalities
amongst schoolchildren, with some attending schools which prioritise
PSHE and its SRE component and others attending schools which
ignore these subjects.
4.2 We believe that PSHE should be a compulsory
part of the National Curriculum and should include age-appropriate
information on sexual health and relationships, HIV (including
HIV-related stigma and discrimination), sexuality and homophobia.
February 2005
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