Why is it an issue?Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.
Improving sexually transmitted infection rates and unintended conceptions present a significant challenge to commissioners and providers of sexual health services in Wakefield District. It is not enough to provide excellent sexual health services in Wakefield to treat infections; we also need to bring about a behaviour change so that our Wakefield population reduce their risk of contracting a sexually transmitted infection and make positive proactive choices about contraception.
In Wakefield we have seen rates of Sexually transmitted infection (STI) including diagnoses of the human immunodeficiency virus (HIV) increase greatly in the last 5 years. This is in line with national and regional trends.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- HIV diagnoses are slightly lower than the national average (1.0 per 1,000 compared to 1.8) as are diagnoses of gonorrhoea (21.0 per 100,000 compared to 30.8) (HPA Area Profiles, 2010).
- However, the percentage of persons diagnosed with HIV late is slightly higher than national rates (56.3% compared to 51.3%) though not significantly so (HPA Area Profiles, 2010).
- The number of diagnoses of gonorrhoea infections in GUM clinics per 100,000 population is lower than the national average (21.0 compared to 30.8) (HPA Area Profiles, 2010).
- The number of chlamydia diagnoses per 100,000 individuals aged 15-24 years is higher than the national rate (2692.3 compared to 2219.1) (HPA Area Profiles, 2010).
- The number of diagnoses of syphilis infections in GUM clinics per 100,000 population is approximately the same as the national rate (5.2 compared to 4.8) (HPA Area Profiles, 2010).
- The number of lab confirmed cases of gastrointestinal disease per 100,000 population is worse than the national average (366.8 compared to 328.9) (HPA Area Profiles, 2010).
- Wakefield had one of the highest testing rates for Chlamydia in the country (18.2%), together with a significantly higher rate of young people who tested positive (8.4%). However, according to the Health Related Behaviour Questionnaire, significant proportions of both male (up to 55%) and female (up to 41%) Year 10 pupils knew nothing about Chlamydia or its risks (CYPJSNA, 2010).
What’s the trend and what can we predict?
- The teenage conception rates for under 18s in Wakefield and District decreased steadily from 56.5 per 1000 females aged 15-17 in 1998 to 49.3 in 2009. This was a percentage change of -12.8 compared to Yorkshire and the Humber (-16.9) and the national average for England (-18.1).
- The percentage of repeat abortions for under 25s in Wakefield and District increased from 23.5% in 2007 to 24.7% in 2009. This was a percentage change of 1.2 compared to Yorkshire and the Humber (1.2) and the national average for England (1.1).
- The percentage of under 25s screened for Chlamydia in non-GUM settings in Wakefield and District increased from 19.1% in 2008/09 to 33.3% in 2010/11. This was a percentage change of 14.2 compared to Yorkshire and the Humber (6.9) and the national average for England (9.3).
- The percentage of under 25s tested positive for Chlamydia in non-GUM settings in Wakefield and District decreased from 11.5% to 5.9% in 2010/11. This was a percentage change of -5.6 compared to Yorkshire and the Humber (-2.2) and the national average for England (-4.1).
- The percentage of patients diagnosed late with HIV in Wakefield and District decreased from 42.9% in 2007 to 18.8% in 2009. This was a percentage change of -24.1 compared to Yorkshire and the Humber (-2.7) and the national average for England (-1.4).
- The number of people accessing HIV-related care in Wakefield and District in 2010 was 216, 3,494 in Yorkshire and the Humber and 69,424 in England.
- Increased or sustained investment in sexual health services will enhance the downward trends in teenage conception rates and patients diagnosed late for HIV. Increased investment in contraceptive services would also reverse the upward trends in repeat abortion rates.
- However, reduced investment would lead to a reversal of the downward trends in teenage conception rates, repeat abortion rates and percentage of patients diagnosed late for HIV. Reduced investment in prevention would also increase the transmission of Chlamydia, HIV and other sexually transmitted infections, especially in the population of people with undiagnosed HIV.
What are we doing and what can be done differently?
- Implement the vision for future commissioning of sexual health services in Wakefield as outlined in the Sexual health Commissioning Review Document.
- Reprofile the commissioning resource so that there is more resource to support media, governance, prevention targeted outreach and locally accessible services.
- Define an appropriate procurement route to secure the right providers of sexual health services and manage risk. Consider working towards a single overarching service specification and governance framework with each service providing different aspects of the holistic service specification.
- Explore the adoption of a local tariff utilising the work of the London Public Health programme.
- Increase choice and prevention by working towards 70% of service delivery being locally accessible, targeted and outreach and focused on prevention, testing and early diagnosis. This could be achieved over a 5 year time scale; year 1 (2011/12) 25%, year 2 30%, year 3 40% year 4 55% and year 5 70%.
- Develop the sexual health network to increase clinical engagement, to identify a clinical champion to lead this network and the overall leadership for overarching governance of sexual health in Wakefield.
- To work towards a single point of telephone contact for all sexual health services, working with the regional hub development.
- Consider self referral for TOP services to reduce any time delay between GP/CASH contact and referral. To consider a pilot for over 25yr olds to access self referral.
- Work on greater integration with other services e.g. alcohol to make the sexual health service more holistic and focused on putting the person at the centre of the design. Also opportunities for brief interventions in all services and from sexual health services to be considered.
- Increase training available to our sexual health workforce so that clinicians are dual trained and can provide STI testing and treatment as well as contraception and to build this in to future service specifications.
- Target bespoke services to groups of people who have a specific vulnerability to STIs and or unintended pregnancy. Service providers will work pro-actively to prevent STIs and unintended pregnancy and to prevent transmission of STIs. To offer immediate access to contraception and point of care STI screening where appropriate and to refer in to CASH or GU services as appropriate.