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Hues and Cries: Colour Changing Condoms and Chlamydia Vaccines

16 Jul, 15 | by shaworth

Journal readers may be interested in the paper by Stary et al in last month’s edition of Science magazine, which reports on early trials of a mucosal, killed vaccine against Chlamydia.

 Chlamydia remains one of the most common sexually transmitted infections in the UK, and creates a significant disease burden with the associated risk of pelvic inflammatory disease and infertility. Recent surveillance reports suggest that the worst affected area in the UK for chlamydia is Hackney, in London. Previous efforts to produce a vaccine in the 1960s were halted after the treatment arm was found to be more susceptible to the disease.

 For the time being, the prospect of a vaccine appears remote, given that the current trials have only been performed on mice, and it remains to be seen whether this route produces useful immunity in humans.

Meanwhile, much consternation has resulted from the colour-changing condoms presented at the TeenTech awards, which were reported in the lay press as being a real thing which have actually been invented. Those working in sexual health can breathe a sigh of relief that the product is not available to buy, and then idea is merely a hypothetical use of ELISA technology to detect mucosal antibodies to common sexually transmitted infections. It remains to be seen whether this is even a feasible use of the technology suggested; however credit is due to the students for bringing the topic of sexually transmitted infections and the use of condoms to prevent them to the attention of consumers.

Good Vibes: The FPA’s Novel Funding Strategy

3 Jul, 15 | by shaworth

The UK Sexual Health charity The Family Planning Association (FPA) is eighty-five years old this year, but its decision to broaden its funding opportunities by opening up an online shop specialising in sex toys proves that age is no barrier to experimentation.

Set up in 1930, the FPA originally provided clinical services to the people of Britain when the NHS did not, but over time it has broadened its range to include the provision of education materials, lobbying for abortion and contraception rights, and leading campaigns to improve equality in sexual health for marginalised groups.

In these more recent and austere years, the charity has been forced to close some of its services: the sexual health advice line (excluding Northern Ireland) closed in 2014, and has remained so due to funding deficits. Nevertheless, the charity has decided to embark on a bold and ambitious venture, entering into the world of on-line shopping. In partnership with Rolesar Limited, it has opened FPA Pleasures.

In the broader sense, charities supplementing their donation income through the sale of new goods is not new, and usually these are themed around the charity’s mission, such as the plethora of boat-related gifts in the Lifeboats’ launch stations-cum-gift shops, or supportive of their ideals, so the the idea of the FPA branching into sex toys is at least following a well-trodden path.

Whether the venture is successful or not remains to be seen. To pardon the expression, there is stiff competition in this market from LoveHoney, and high-street purveyor of cut-price perversion Anne Summers to name but too. What makes the FPAPleasures shop stand out however, is its visible commitment to inclusiveness, a reflection of its values as a charity. There are images of older models and models demonstrating same sex relationships, which gives the store-front a welcoming feel for all. A short stroll through the menus reveals a advice for those who have disabilities, including non-physical ones.

How much income from the site will be generated remains to be seen, but if you’re interested in helping the FPA make it through the next eighty-five years, a treat for yourself via FPAPleasures might be a helpful move.

ESC 14th Congress in Basel

25 Jun, 15 | by shellraine, e-Media Editor

BaselThe 14th Congress and 2nd Global Conference of the European Society of  Contraception and Reproductive Health will be held in Basel from 4th – 7th May 2016.

The First announcement invites abstracts to be submitted by 15th November for presentations, free communications and posters

The UK has many members and always has a significant presence with many contributions in all sessions. There is a significant reduction for members so consider joining, if not already, and book a place before 15th January 2016 for an even greater reduction – €520 compared to €850

For more information visit the website at http://www.escrh.eu/events/esc-events/2016

ellaOne® (ulipristal acetate) training roadshows

22 Apr, 15 | by shellraine, e-Media Editor

HRA Pharma UK has announced that, now that ellaOne® is available in UK Pharmacy without prescription, it will be launching a comprehensive training programme to support the introduction into pharmacy.

Part of this programme includes seven interactive workshops which will take place at venues across the UK. These workshops will provide a summary of information regarding ellaOne®, and explore how the new option fits into current provision of emergency contraceptives in pharmacy. A full toolkit will be available to assist the team during future consultations. Attendance at the workshops can be used towards continuing professional development accreditation records.

Tony Fraser, General Manager of HRA Pharma UK and Ireland, commented, “As a company committed to improving women’s healthcare, HRA is delighted that ellaOne® is now available direct from pharmacies across the country. Our training programme will ensure that supply under the supervision of the Pharmacist can be made with confident recommendations about all the emergency contraceptive options available, allowing more women to take control of their own reproductive futures”

Workshops will take place at the Britannia Adelphi Hotel in Liverpool on 22nd April, the Royal College of Surgeons in London on 23rd April, the St Johns Hotel in Solihull on 28th April, the Marriott Hotel in Leeds on 29th April, Hendon Hall in London on 30th April, the Hampton By Hilton in Croydon on 6th May and will conclude at the Hilton Temple Patrick in Belfast on 14th May. Places are still available so for further information, contact: ellaOnepharmacist@precision.email

The True Cost of HIV Treatment

7 Apr, 15 | by shaworth

Last week saw the first pre-election debate between the leaders of major UK political parties. Seven were invited: Conservative, Labour, Liberal Democrat, Greens, UKIP, Plaid Cymru and the SNP, resulting in a set that looked like a strange, suited parody of a quiz show. No one is sure who really won, and we won’t find out what the nation really thinks until the 7th of May, when the election is due to be held.

Despite having no clear winner, one soundbite emerged from the chaos: Nigel Farage’s assertion that foreigners make up most of the new diagnoses of HIV in the UK, at the cost of £25,000 each per year. For those of us following the pattern of gaffes and trip-ups occurring in the UKIP camp, this statement is one to add to that long list.

The truth is somewhat more complicated. HIV treatment is dependent on stage and resistance patterns, so an average is not really reflective of the true financial burden. Nevertheless, the MEDFASH HIV Standards of Care helpfully costed the average lifetime cost of treatment to be between £135,000 and £181,000, with an average cost of service provision for those on HAART at £15,000. The overall cost of HIV treatment is rising, due to the longer survival times, but the provision of antiretroviral treatment has been shown to be cost effective. Between £4,000 to £13,000 can be saved in indirect costs when HIV progression is halted.

With regard to the HIV diagnoses in the UK, the Department of Health statistics show that in 2013 (which is the latest year data is available) 2292 new diagnoses were British (ie born in the UK) and 2698 new diagnoses were in people born elsewhere, so for once, he’s not wrong by a margin of around 400 people.

Subsequently, a YouGov poll of 1900 people suggested that around half agreed with Farage’s suggestion that immigrants should not have access to treatment on the NHS until they have spent 5 years in the country, and a similar number seemed to express agreement with his views on HIV treatment on the NHS, albeit with a very leading set of questions. The fact that the US has double the prevalence of HIV with a privatised healthcare system; however, would suggest that this is perhaps not the greatest public health plan. There are still a quarter of HIV infected people in the UK unaware of their diagnosis, potentially spreading the virus to others without realising. If this is the situation with free testing and treatment, one wonders what effect of marginalising and stigmatising the diagnosis as a burden on the NHS will have.

Sue Capstick – Queens Nurse.

26 Mar, 15 | by shellraine, e-Media Editor

One of the first sexual health nurses in the country to be given the prestigious title of Queen’s Nurse (QN) by community nursing charity The Queen’s Nursing Institute (QNI) hails from Lancaster.

Sue C

As reported in the Lancaster Guardian, Sue Capstick is service manager for Lancashire Care NHS Foundation Trust’s Contraception and Sexual Health (CaSH) Service. Sue said:

“It was an honour to find out I had been awarded the title of a Queen’s Nurse. “The CaSH service is committed to providing excellent care to the people in Lancashire.“The team work together to continually develop new and innovative ways to ensure people receive the highest quality of care. I am proud to be part of such a dedicated and compassionate team and look forward to continuing to improve the sexual health for people in the future.”

A Queen’s Nurse is someone who is committed to high standards of practice and patient-centred care and Sue’s career demonstrates her dedication to the field of sexual health nursing.

She began her nursing career in 1980 and has worked as a sexual health nurse for over 30 years. In that time she has worked in Africa developing sexual health and HIV programmes as well as being a member of a sexual health nursing advisory panel at the Department of Health, developing the competencies required to work in this specialty.

For the past few years Sue has been leading a piece of work in Blackburn which is focused on providing information to women about the various contraception methods available to make informed choices and as a result avoid unwanted pregnancies. The title is not an award for past service, but indicates a commitment to high standards of patient care, learning and leadership.

Nurses who hold the title benefit from developmental workshops, bursaries, networking opportunities, and a shared professional identity.

Sue is the third member of staff at the Trust to be awarded the title . A ceremony will be held later this year in London for the Queen’s Nurses to be presented with their awards.

Many, many congratulations for a well-deserved award.

European Commission confirms EC access

13 Jan, 15 | by shellraine, e-Media Editor

The European Commission, in a historic ruling, has confirmed the authorisation of the emergency contraceptive, ellaOne® (ulipristal acetate, 30mg), to be accessible direct from pharmacies without the need for a prescription from a doctor. This is the first ever decision of its type regarding any oral contraceptive product applicable to all EU member states, according to national implementation procedures.  This new ruling will empower over 120 million women across the whole EU to gain direct access to emergency contraception (press release available on www.hra-pharma.com).

This legally-binding decision follows an earlier positive opinion from the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP), which concluded that ellaOne® works best if used during the first 24 hours, and can be used safely without a medical prescription. Today’s decision is a further testament to the acceptance of the need for women to be offered improved access to emergency contraceptive options.

ellaOne® will first be available in pharmacy without a prescription in some European countries from next month (February 2015) with a full launch program taking place across the EU during the rest of the year.

I’m Positive: The Game

12 Jan, 15 | by shaworth

I’m Positive: The Game is a text-based adventure game that won the CDC sponsored US Games for Health jam in 2014. Developed by a team of four, with a further medical advisor team, you play as Tim, a young man who receives a life-changing phone call from his ex-girlfriend informing him of her newly diagnosed HIV positive status. The game is available for Windows, Mac OS and Linus. Mobile versions for Android and iPhone are due later in the year. It cannot be played online at present and must be downloaded.

The game aims to mimic the real-life dilemmas and choices faced by Americans who find themselves facing the possibility of an HIV positive diagnosis: can they afford to get tested? What if they do not have insurance? It also allows the opportunity to discuss the misconceptions about HIV address concerns about treatment.

The game’s outcome depends on the choices you make during the game: you can be obnoxious to the ex-girlfriend, and choose to ignore her advice to get tested, which results in you eventually collapsing, contracting pneumonia and dying a year later, or get a test which results in you being given the HIV positive diagnosis. It transpires during the clinic appointment and subsequent interactions with your family that today is your birthday and you have the choice of telling your family during the celebrations about your HIV diagnosis, or not.

Whilst the dialogue of the game can be somewhat awkward, particularly in the clinical part of the game, where it doesn’t reflect how most of us would structure a consultation where we break bad news, and crams a lot of information into a very short consultation, the interactions you have with your ex-girlfriend and family feel similar to that which could happen in reality. This likely reflects the games primary aim as a health education tool, rather than a form of artistic expression, which is unfortunate, as it’s not making full use of the medium.

In style, the game reflects early DOS games, likely playing to the nostalgia of the thirty-something generation, but whether this resonates with younger users remains to be seen as the CDC are not evaluating the success of the game until later this year. It’s possible that those not viewing the game with the tint of nostalgia will find the high contrast, occasionally lurid backgrounds and jarringly cheery electronic background music off-putting, which would be unfortunate. It’s possible to produce low-resolution graphic games which manage to express the artistic and educational aspects of the game successfully, such as Unmanned, a game produced to show the dehumanising monotony of drone warfare, without needing to co-opt retro clichés.

Ultimately, the game is an interesting way of communicating the emotional challenges faced by a positive diagnosis, and explores some of the difficult decisions which need to be made as a result. Whether it proves to be of value will ultimately depend on user feedback, but whilst this may not be perfect, it’s certainly opening up a new angle in health education.

Google, Sex and Censorship

5 Jan, 15 | by shaworth

Men Only Tayside is a sexual health partnership which has developed beween NHS Tayside Sexual Health and Tayside’s Blood-Bourne Virus Managed Care Network which aims to provide unbiased information and sexual health services for men who have sex with men (MSM) and men who have sex with women and men (MSWM) in the Tayside area of Scotland. Recently, they have been the focus of media attention after developing an app, in conjunction with local firm Faff Digital, to support the information on their website.

The Men Only Tayside (MOT) app was accepted by Apple to the Apple Store with the caveat of a mature (17+) rating, but was rejected outright by Google Play, the main provider of apps to the Android market. Reported in the Dundee Courier, Google’s response to the developer John-Paul Thain, was that the app violated their stance on gratuitous sexual content, in essence equating it with pornography. The rejection was appealed, and again turned down.

Looking over their website, the information is succinct and well-presented. They provide information on their campaigns, volunteering opportunities, how to obtain free condoms and sexual health testing in addition to providing a wealth of unbiased information on common sexual behaviours and how to stay as safe as possible if you choose to experience them. It also includes information on HIV diagnosis, local support and legal information.

If it was aiming to provide arousing erotica, then I’m sorry to say that it fails miserably. The MOT app’s content presumably mirrors that of their website, where the nudity on display is a single male nipple (as an android user, your humble blogger is unable to review the app itself…).

The app’s developer believes that part of the problem is Google’s automated app assessment system, which seems to equate any kind of sexual content as being pornographic. As Google is essentially the gatekeeper for Android users to legally download apps, their prudish filtering essentially denies those users access to high-quality, impartial sexual health advice. Whilst it may have legal obligations to prevent the supply of pornographic material to minors, does it also not have a duty of care to those who are legally entitled to engage in sexual behaviours. In the UK, there is no divison between the legal age of consent for men who have sex with men versus those who have sex with women. This age is 16, and Apple’s maturity setting already puts this app out of reach of young men who can engage legally engage in sex with other young men.

The app’s problem relates to the idea of net neutrality, and whether Google has a public duty to allow this information to enter the public domain. Google is not a public body, it’s a corporation in the same way that Facebook, Apple and Twitter are, which means that it essentially retains the right to decide whether it supports certain information provision or not, regardless of whether or not users have a legal right to access this information. Should this be the case? Does Google occupy the same position as a restaurant where a woman wishes to breastfeed? In UK law, this may be the physical property of a company, but has been deemed a public place, and as such, a company is unable to prevent the woman from feeding the infant, regardless of nipple visibility.

Google’s policy, automated and dictatorial, is not a good one. Apple’s confusion between health advice and erotica isn’t either. The problem of private companies acting as gatekeepers of cultural morality is not a new one. Walmart, a supermarket chain in the United States (and who control ASDA in the UK) have a longstanding policy of refusing to stock music which has been labelled with the “parental advisory” sticker indicating explicit content. With their large stake in the market, this puts pressure on artists to avoid lyrics that are controversial, ultimately acting as indirect artistic censorship. Ultimately, our confusion between private company and public body is not good either, and perhaps it’s time for us to start questioning our own stance on the matter.

The Future Is Here

9 Dec, 14 | by shaworth

Most of us, as healthcare professionals, would consider access to the internet to be an essential part of our work, whether this is for communicating with each other or keeping up to date with our field. For patients, the benefits of access to the internet are many. Being able to contact peer-support and information about health issues encourages self-reliance, and being able to receive appointment reminders and results by text or email is the preference of some of our population; however, despite increasing access to mobile phone services, and internet connections, there is a digital divide within our population.

In the UK, 93% of adults had a mobile phone in 2013, according to Ofcom; although it not possible to break this down by social deprivation. It is also not possible to obtain statistics for PAYG versus contract plans. Our use of landlines appears to be static, with subscriptions remaining steady over the last twelve months. It is possible in the UK for those on benefits to obtain reduced landline subscriptions, and reduced rate broadband subscription on top of this via BT. Only 16% of our population live in a mobile-only home, and 77% have access to fixed or mobile (through a dongle) broadband.

In Scotland, the government published a study of internet use broken down by social deprivation in 2012. In those earning over £40,000 98% of the population have access to home internet, but in those earning less than £15,000, this drops to 50%.

A paper by published last month (online first) “Resources: A technology maintenance perspective Cell phone disconnection disrupts access to healthcare and health” by Gonzales et al and published in New Media and Society, discusses the issue of the digital divide and the effect of poverty on access to mobile phones. This small study looked at the US population, and the findings are not wholly transferrable immediately to other populations, but highlight some of the problems faced by those in poverty with regard to the availability of technology. In the US, it is possible for those on benefits to obtain government subsidised mobile phones (nicknamed “Obamaphones”) with reduced pay-as-you-go (PAYG) plans. Landline use in the US is falling, and the population appears to be increasingly reliant on mobile phone use. As demand for mobile orientated services increase, and healthcare providers choose to provide access to services via telephone or internet, this potentially excludes the population who cannot maintain connectivity.

To quote science fiction author William Gibson “The future is here, it’s just not widely distributed yet.” Those in poverty might be able to access equipment that improves their connectivity, but the it is the maintenance of this through equipment and skills that ensures continued benefit. This issue creates a secondary digital divide, with the rich, being able to access the latest technology and education to use it efficiently, gaining the most benefit and leaving the poor behind.

This invisible privilege is an important factor to consider when commissioning services through encourage patients to access information or services through the internet or mobile phones. Services through chew through data and minutes may not be as cost-effective as face-to-face meetings when access through PAYG is considered.

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