Sex can be fun, say Imtyaz Ahmed-Jushuf, Angela Robinson and George Kinghorn, but STIs can destroy young lifes
The national sexual health and hiv Strategy, released for consultation in July 2001, was long overdue. The earlier onset of sexual activity in the young, and the rising number of lifetime sexual partners made almost inevitable the worsening of sexual health in England during the past decade, manifest as the rapid increases in incidences of sexually transmitted infections (STI), HIV, and unwanted pregnancies.
Cases of gonorrhoea and chlamydia, most of which occur in the under 25s, have doubled over the past five years. Many infected people, especially women, have no symptoms - hence the "silent epidemic". Yet, left untreated, complications can ensue including ectopic pregnancy and pelvic inflammatory disease (PID) that can lead to infertility in one in three affected women.
Syphilis, whose long-term effects cause premature death and serious disability, is now spreading from uncontrolled outbreaks in Manchester, Brighton and London. Syphilis and other STI hasten the spread of HIV infection, which has also shown record numbers of cases being diagnosed in 2001, with women being the fastest growing affected group.
Genitourinary Medicine (GUM) clinics provide rapid, open access, non-judgemental and confidential services for the treatment and prevention of STIs including HIV infection. The UK network of GUM clinics liase closely with each other to ensure high clinical standards, especially in the notification and treatment of partners of infected persons. They have been largely responsible for ensuring that levels of STIs and HIV in the UK have remained lower, until now, than in the rest of Western Europe and the USA. However GUM service provision is inequitable across the UK, with some areas having no or only part-time services. All clinics are under severe pressure to cope with the unprecedented current levels of demand, and a serious problem of access to services is now evident across the country.
Attendances at STI clinics doubled in the last decade. They further rose by 14 per cent between 2000 and 2001, and have continued to accelerate through 2002. The most recent survey conducted by the MSSVD and AGUM, showed that the median time to first new appointment had risen from six days in 2000 to 14 days in 2002, with many urban clinics unable to offer appointments for up to six weeks. Currently there are an estimated 40,000 people, mostly young, waiting in excess of 48 hours to be seen at their local GUM clinic. Such delays for the treatment of potentially serious communicable diseases could have disastrous implications for public health. Complications resulting from delayed treatment can also have severe financial as well as human costs. Every time a case of HIV infection is prevented it can save at least £500,000.
A national public education campaign targeted at those aged between 18-30 is planned for the end of this year. The campaign will emphasise the fact that STIs often cause no symptoms, and will encourage young people to make contact with their local GUM clinic to seek screening. Experience in Wales showed that patient appointment times more than doubled following an educational campaign. A similar response to the educational campaign in England could prove counter-productive in our efforts to encourage health-seeking behaviour in young people and for achieving success in controlling the spread of STI and HIV.
GUM specialists welcomed the national strategy. However widespread scepticism remains with regards to the level of commitment of the government in supporting this initiative. Only £47.5 million in total was allocated for its implementation, of which only £5 million has been earmarked for improving capacity in GUM services. This is woefully inadequate.
In order to improve access, GUM services are already undergoing modernisation. Considerable progress has been made through new initiatives, which have included patient process redesign, the adoption of innovative work practices, and enhancing the role of specialist nurses. These have already improved capacity of services significantly. Whilst more can be done in these areas, it is essential that a programme of consultant expansion underpins the modernisation programme. At least 70 new consultant posts need to be created over the next two years to support the modernisation programme. The cost of meeting the current patient waiting list and new demands - amounting to an additional 150,000 new patient care episodes per annum - will be at least £23 million.
There is strong evidence to show that STI can destroy young lives. It is therefore difficult to understand why sexual health is not a NHS and a political priority. It surely needs to be.
