Sexual Health, Reproductive Health And HIV: A Review Of Commissioning

This report outlines the findings of a 2016 survey, carried out jointly with the Association of Directors of Public Health, which aimed to gain a clear picture of the commissioning arrangements for sexual health, reproductive health and HIV services | PHE


The survey found that whilst there has been progress in improving services and the development of collaborative approaches there is also evidence of structural concerns which have the potential to impede effective commissioning. Key findings from the survey highlight the fragmentation of commissioning, barriers to access for those at greatest risk, increasing financial pressures and patient demand, and workforce concerns.


Sexual health, reproductive health and HIV: commissioning review

Findings and action plan from a national survey of commissioning arrangements for sexual health, reproductive health and HIV. | Public Health England

In 2016 Public Health England (PHE) and the Association of Directors of Public Health (ADPH), supported by NHS England and NHS Clinical Commissioners, carried out a survey of local authorities, NHS England and Clinical Commissioning Groups (CCGs) to highlight areas of challenge within the commissioning framework.

The survey findings form the basis of an action plan published within the review. Appendix 1 provides a detailed analysis of the survey responses and appendix 2 details the action plan to respond to the challenges identified.


Full report: Sexual health, reproductive health and HIV: commissioning review

Sexual health at risk of becoming ‘Cinderella’ service, say GPs

Sexual and reproductive health is at risk of becoming a ‘Cinderella’ service thanks to red tape, and financial and training hurdles facing GPs and their practice teams, the Royal College of GPs (RCGP) has warned.

These issues risk undoing years of improvement in the quality of sexual and reproductive healthcare being delivered to patients – including a halving of teenage pregnancy rates over the past decade and steadily increasing uptake of long-acting reversible contraceptives (LARCs), it says.

The findings of a College consultation, published in a report, Time to Act, show that GPs fear rates of teenage pregnancy and transmission of sexually transmitted diseases will rise – reversing current trends – as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and widening  health inequalities as a result.

Full report: Sexual and Reproductive Health: Time to Act

Story via OnMedica

Deaths linked to Aids have halved in a decade

A report by the Joint United Nations Programme on HIV/Aids (UNAids) showed deaths had fallen from a peak of 1.9 million in 2005 to 1 million last year | BBC News


Image source: UNAIDS

The condition, which is caused by HIV, used to be one of the top 10 causes of death worldwide. It said the “scales have tipped”, with more than half of people getting drug treatment for the first time. An HIV infection cannot be cured – it can only be contained with daily doses of antiretroviral therapy.

Unchecked, it destroys the immune system, causing Aids. At this point people tend to die from other “opportunistic infections” such as tuberculosis. Worldwide, 36.7 million are living with HIV and 53% of them are getting the therapy that gives a near-normal life expectancy.

Contraceptive Method Choice and Initiation in Adolescents and Young Women

The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women | Journal of  Adolescent Health

Methods: For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14–24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts’ contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method.

Results: We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8–31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3–21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling.

Conclusions: Previsit personal acceptability, which was associated with social contacts’ experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent.

Full reference: Cohen, R. et al. (2017) Factors Associated With Contraceptive Method Choice and Initiation in Adolescents and Young Women. Journal of  Adolescent Health. Published online: 13 July 2017


Cuts to sexual health services are putting patients at risk, says King’s Fund

Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned.


The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care. Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising.

Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned.

Problems identified in the Genitourinary medicine services:

  • Public health budgets were cut by £200m (6.7%) in 2015-16

  • Around a quarter of local authorities cut GUM spending by more than 20% between 2013-14 and 2015-16. Around one in seven increased spending by this amount

  • The commissioning of sexual health, reproductive health, and HIV services has been split between local authorities, CCGs, and NHS England, resulting in fragmentation

  • New attendances at clinics rose from 1.6 million in 2011 to over 2.1 million in 2015

“You give a blank sheet of paper to local government to do something really exciting, and then you take the money away”—consultant

Read the full article here

Read the original King’s Fund report here

Screening for Chlamydia trachomatis Infections in Women

Wiesenfeld, , H.C. (2017) New England Journal of Medicine. 376:765-773

Chlamydial infection may result in pelvic inflammatory disease, infertility, and ectopic pregnancy. Chlamydia screening is recommended in sexually active women younger than 25 years of age and other women at increased risk and can be performed on vaginal swabs or urine samples.

Read the full abstract here