‘A Framework for Sexual Health Improvement in England’ sets out the government’s ambitions for improving sexual health.

Designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. This includes the need for:

• a fall in the number of unwanted pregnancies
•  greater efforts to prevent STIs and HIV
•  an increase in the number of people in high-risk groups being tested for HIV
• building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex
• making sure that all people have rapid and easy access to appropriate sexual health services
• offering counselling to all women who request an abortion so they can discuss the options and choices available with a trained counsellor

Responses to ‘Framework for Sexual Health Improvement’.

 The Sex Education Forum, based at leading children’s charity The National Children’s Bureau, welcomed the publication of the government’s strategy for improving sexual health and its focus on preventative measures, such as good quality sex and relationships education (SRE). However, more needs to be done to ensure all schools step up to the mark, in providing the information, support and advice that children want and need.

FPA welcomes the Government’s long-overdue publication of its Framework for Sexual Health Improvement in England document, which finally provides guidance to local government to help ensure that the nation’s sexual health improves.

Although we support the Government’s formal endorsement of the need to improve areas of sexual health like sexually transmitted infection (STI) and teenage pregnancy rates, we are acutely aware that there is absolutely no guarantee that local councils will actually act on this guidance.

We know from our Unprotected Nation report, released in January, that if the situation worsens, and local government chooses not to invest in sexual health services, the additional cost to the economy is likely to be over £135 billion over the next few years.

Brook

Responding to the publication of A Framework for Sexual Health Improvement in England Simon Blake OBE, Brook’s Chief Executive, said:

“We are pleased that the Framework for Sexual health has been published just in time for the move to local authorities and that there are clear aspirations for the improvement of young people’s sexual health, in particular that all young people have access to confidential services and support.

“We are also pleased to see the ambition that all children and young people should receive good quality Sex and Relationships Education (SRE) at school which we know is vital in preventing abuse and exploitation and promoting positive relationships. However, this ambition will never be realised whilst the Department for Education fails to ensure that every school is required to deliver a comprehensive programme of SRE.

“As we move towards 1st April we look forward to working local authorities to realise these ambitions and improve young people’s lives.”

FAMILY PLANNING 2020 names Director of the global partnership

The Family Planning 2020 (FP2020) Reference Group announced that long time global advocate for family planning and reproductive health Valerie DeFillipo has been named Director of the global partnership. FP2020 builds on the partnerships launched at the London Summit on Family Planning. It will sustain the momentum from London and ensure all partners are working together to achieve and support the goals and commitments announced at the Summit.

“Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination” is the theme of World AIDS Day 2012 on 1 December. Life-saving antiretrovirals have reduced new HIV infections and deaths. The 2015 target of 15 million HIV-infected people on antiretroviral medicines worldwide looks more achievable now than ever before.

World AIDS Day – BMJ special promotion 

The BMJ Group is putting together a special promotional webpage for World AIDS Day on 1st December that will offer a week’s free access to all relevant content published by our full range of journals. Please click here for access

New resources for young people living with HIV 

To mark World AIDS day on the 1^st of December, the Children and Young People HIV Network, based at leading children’s charity the National Children’s Bureau, is sending a message of support to young people with HIV by launching a range of materials to support them in managing life with the condition.

The ‘Your Life’ leaflets and the ‘Studying with HIV’ guidance and LifeLinks resources are all available from www.ncb.org.uk/hiv

More than Half of those with HIV in the UK are Overweight:  The Surprising Issues Facing Those Living with HIV

The British Dietetic Association (BDA) will once again be supporting World Aids Day on 1st December. Early data from the BDA’s DHIVA specialist group audit suggests that more than half of people living with HIV in the UK are overweight or obese, with only about one-in-nine being underweight.

In fact by far the most common issues facing HIV dietitians in the outpatient clinic these days are dyslipidaemia, hypertension, diabetes and osteoporosis, with over 75% of HIV patients Vitamin D deficient. Dealing with these issues is not as straightforward as it might seem, with HIV-specific barriers to lifestyle change emerging.

Members report common themes from their patients, including a fear that deliberate weight loss might lead to others guessing their HIV status (“why are you getting thin – you don’t have AIDS do you?”), and a feeling that being overweight is safer (“I remember how ill and thin I was before starting ARVs and I don’t want to go back there again”). from Alastair Duncan, Chairman of the BDA’s DHIVA (Dietitians in HIV/Aids) specialist group.

UNITAID welcomed the good news this World AIDS Day that the number of children newly infected with HIV continues to decline but urges the international community to step up efforts for those children already living with the disease. more from the website

    2012 UNAIDS World AIDS Day Report

The Medical Foundation for HIV and Sexual Health is 25 yrs old (rebranded as MEDFASH). Established in 1987 by the BMA, as an independent foundation, with the aim of improving knowledge and understanding of HIV among health professionals it has grown and spread to encompass all aspects of sexual health.

As part of this celebration the foundation has a new website and has launched its Sexual Health & HIV Policy eBulletin.  MEDFASH Chief Executive, Ruth Lowbury, introduces the eBulletin: it is designed with local sexual health and HIV commissioners and providers in mind. It will give a concise and regular round-up of emerging policy developments, relevant evidence updates and available tools and resources across the field of sexual and reproductive health and HIV. It will also consider the impact the change agenda is having on this area of healthcare through a series of eFeature articles and interviews with those working at both national and local levels. This is particularly useful now at a time when service delivery is changing and many of us will be involved with new (and possibly challenging) ways of working and new communication channels.

Amonst other things the first issue includes: transfer of sexual heath services to local authorities; local transition arrangements; re-tendering of GUM services; Healthwatch England (the new consumer champion for health and care in England); HIV treatment for overseas visitors.

Australia Adopts Herd-Immunity Approach in Fight Against HPV

On July 12, 2012, Australia took a stand to become the first country to provide coverage of the Gardasil® vaccine to boys between the ages of 12 and 13, through a National Immunization Program-sponsored school-based initiative. In her press release, the minister of health, Tanya Plibersek, stated that the government-sponsored initiative was targeted to synergize with the current immunization program in girls to decrease the incidence of human papillomavirus (HPV) infection in the Australian population.

Girls don’t see HPV vaccine as green light for sex

A study by Bednarczyk et al in Atlanta and published in Pediatrics has concluded that HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.

Nurses in Zimbabwe to prescribe HIV drug

Faced with the ambitious target of reaching 85 percent of people in need of HIV treatment by the end of 2012, the Zimbabwean government has announced that nurses will be trained to prescribe and manage antiretroviral (ARV) drug treatment. Experts welcomed the move but warned that nurses would have to be adequately prepared and supported to take on the additional duties. Previously, nurses were allowed only to administer the drugs after a doctor had prescribed them. Now, changes made in the job descriptions of nurses by the Nurses’ Council of Zimbabwe will see them prescribing the medication. Report from HIV/AIDS/Zimbabwe (HAZ)

UK Sexual Health Awards 2013

Nominations are invited in the following catergories:

• Sexual health professional of the year.
• JLS young person of the year.
• Adult sexual health service/project of the year.
• Pamela Sheridan young people’s sexual health service/project of the year.
• Rosemary Goodchild Award for excellence in sexual health journal.
• Sexual health media campaign/storyline of the year.
• Durex community pharmacy award.

More information and nomination forms from fpa/Brook

WHO – 40 years of innovation in sexual and reproductive health

A comment piece in The Lancet by past and present directors of WHO’s Human Reproduction Programme (HRP) discusses the achievements of the Programme since it was established in 1972.

Online First – Evaluation of a community pharmacy delivered oral contraception service

“Anything for the weekend … and beyond, madam?” Community pharmacies increase oral contraceptive uptake

Parsons et al.’s evaluation of a community pharmacy delivered oral contraceptive (OC) service is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Between 2009 and 2011, seven specially trained pharmacists at five pharmacies in South-East London provided OCs under a Patient Group Direction (PGD) during 741 client consultations. The evaluation showed that trained pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need. Nearly half of all consultations occurred following emergency hormonal contraception supply, and nearly half of clients receiving an initial supply of OCs were first-time Pill users. Based on satisfaction questionnaires from a small sub-group, most clients valued this service, were happy about privacy, and would recommend it. Although the primary aim was to reduce teenage pregnancy , and nearly a quarter of clients were aged <20 years, the study shows that women aged 20+ years also require this service and should not be overlooked when formulating policies for service provision.
summary by Walli Bounds, Associate editor

Infertility: Survey shows nearly half of all GPs lack knowledge

Results of a comprehensive patient survey by the National Infertility Awareness Campaign (NIAC) shows that GPs need to be better informed about infertility treatment, including IVF, and the options available when the commissioning of IVF switches to local commissioning groups next year. The NIAC survey found that nearly 50% of GPs lacked the necessary knowledge of infertility and the treatment options available to provide an effective service. This could explain why some patients with fertility issues perceived their GPs as unsympathetic.

Calling All Baby Boomers: Get Your Hepatitis C Test

A report issued by the U.S. Centers for Disease Control and Prevention (CDC) recommended that all Americans born between 1945 and 1965 be tested for the hepatitis C virus (HCV). An estimated 2.7 million to 3.9 million people in the United States are infected with this liver-damaging—and sometimes lethal—virus, and many do not know they carry it. CDC calculates that roughly 75% of those infected are baby boomers: 3.25% of people born in that “birth cohort” test positive for HCV, which is five times higher than the rate in adults born before 1945 or after 1965. CDC has determined that universal testing of baby boomers is the most cost-effective strategy for detecting undiagnosed HCV infections.  As reported in Science

New lab for HIV research

The Indian Government has opened the new $12 million HIV Vaccine Translational Research Laboratory in New Delhi. The new Laboratory will aim to recruit around 30 scientists with the goal of creating a new vaccine against HIV, and will work in collaboration with the International AIDS Vaccine Initiative.  As reported in Science

  WHO Guidance – Safe abortion: technical and policy guidance for health systems

The second edition of this guidance has now been published and is available from:  http://extranet.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf

  RCOG – The Initial Management of Chronic Pelvic Pain,  (Green-top 41)

New guidance published in May available from: http://www.rcog.org.uk/womens-health/clinical-guidance/initial-management-chronic-pelvic-pain-green-top-41

RCN – SDI and IUT Accreditation Guidance Documents – Sixth Edition

Accreditation, which is valid for 5 years costs £360 for members and £480 for non-members – re-accrediation is £180 and £240.

Available from: http://www.rcn.org.uk/development/learning/accreditation/LARC_accreditation

“Don’t go in without a skin”

Online condoms and lubes provider the Freedoms Shop (Central & North West London NHS Foundation Trust) has teamed up with Terrence Higgins Trust to launch the Summer Lovin’ campaign – urging gay men across London to use condoms – with a new online health resource. The downloadable resource brings together stacks of health and sexual safety information, presented in a cheeky, accessible way, while Freedoms is providing a half price condoms

Badges of Hope from HIVsport

It has been slightly difficult to find original links between sexual health and the current obsession with the Olympics. Pointing out the obvious – thousands of fit (very), young (mostly) and health (hopefully) bodies all together in a large compound in England’s green (one advantage of all that rain) and pleasant capital – seems somehow trite. Though some of us, who are less fit, might wonder how it is possible to enjoy ‘the only sport without medals’ after collapsing from the effort required to win gold, silver or bronze.

The London Olympic organisers provided 150,000 free condoms in dispensers for the 10,800 athletes at the Games, supplied by Durex which paid for the supply rights. Though it appears there may have been some intruders!

Some ‘olympic’ cities have had an increase in visitors and others a decrease – from reports here the impression is of less people in central London but that may only be commuters deciding to take leave or work from home to avoid the predicted (!) chaos who then found themselves drawn to their TVs as the hysteria and our tally of medals increased. A similar effect was seen in Weymouth where local sexual health teams struggled to find takers for their wares. Perhaps we will have another increase in the birth rate in 9 months time.

Kathy French - Olympic Ambassador on duty at Gatwick

We would like to applaud all those who took part and all those that helped to make it all run smoothly including our friend and colleague spotted wearing the lovely uniform moonlighting as an ambassador.

Effectiveness of Long-Acting Reversible Contraception

From the New England Journal of Medicine: A large (7486 paticipants) prospective cohort study, by researchers at Washington University School of Medicine in St. Louis, to evaluate contraceptive methods has found dramatic differences in their effectiveness. Women who used pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.

And from the American Journal of Obstetrics & Gynecology

Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?

The purpose of this study in Colorado was to determine contraceptive continuation and repeat pregnancy rates in adolescents who are offered immediate postpartum etonogestrel implant insertion and showed excellent continuation 1 year after delivery; rapid repeat pregnancy was significantly decreased compared with control participants.

Predictors of long-acting reversible contraception use among unmarried young adults

The objective of the study from South Carolina was to improve the understanding of long-acting reversible contraception (LARC) use patterns among unmarried, young adults at risk of unintended pregnancy. LARC use was associated with older age, high IUD knowledge, and earlier onset of sexual activity and concluded that increasing knowledge of IUD among certain groups may improve LARC use among young, unmarried adults and in turn decrease unintended pregnancy.

Knowledge of contraceptive effectiveness

Another study from St Louis, Missouri looking at 4144 women’s knowledge of contraceptive effectiveness and, not surprisingly, showed many gaps.

Unintended pregnancy and contraception among active-duty servicewomen and veterans

The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.

Antenatal sexually transmitted infection screening in private and indigent clinics in a community hospital system

The study aimed to determine whether clinics that serve indigent patients demonstrate equal compliance with sexually transmitted infection testing guidelines when compared with private clinics in North Carolina. They concluded that clinics serving indigent patient populations had a higher compliance with required testing compared to private clinics. HIV testing in the third trimester remains the greatest need for improvement for all practice types.

International Campaign for Women’s Right to Safe Abortion

The ICMA have launched a new international campaign for women’s right to safe abortion. Individuals and organisations are invited to join the campaign in advance of 28 May, the International Day of Action for Women’s Health. To read more and to register support go to https://www.surveymonkey.com/s/CHH62F5

UNFPA announces ‘Maternal Deaths Halved in 20 Years’.

The number of women dying of pregnancy and childbirth related complications has almost halved in 20 years, according to new estimates released by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Bank.

US regulators vote for approval of PrEP by large majority.

The US Food and Drug Administration (FDA) have taken a decisive step towards approving the use of the combination pill Truvada (tenofovir/FTC) as a prevention method for HIV-negative people. Read more at NAMaidsmap. GlobalData.com reported on 11th May – In a controversial decision on May 10, the FDA antiviral drugs advisory committee backed Gilead Sciences’ drug Truvada to prevent the transmission of HIV. The committee voted in favour of prophylactic Truvada in three populations: HIV-uninfected men who have sex with men (19-3), in HIV-uninfected partners in relationships with infected partners (19-2), and for individuals at risk of acquiring HIV through sexual activity (12-8).  Although awareness of HIV and AIDs has significantly increased throughout recent decades, the disease remains a global epidemic requiring better preventative strategies. Yet the possibility that on June 15 the FDA will approve Truvada for pre-exposure prophylaxis (PrEP) has provoked strong and divided opinions from infectious disease experts and activists. Read more at globaldata.com

Victories for Center for Reproductive Rights

Victory for Honduran Women

On May 17, 2012, the Center for Reproductive Rights held a demonstration on the steps of the Honduran Congress. Their mission: to stop the government from passing a bill that would have imprisoned women for using emergency contraception. Alejandra Cárdenas, Legal Adviser for Latin America and the Caribbean, had planned to personally hand-deliver 730,000 petitions to the Congress signed by activists in more than 80 countries in protest. In a surprise move, Juan Orlando Hernández, president of the Congress, declined to take the petitions—but not because he didn’t hear the massive outcry. In fact, Hernández said he no longer planned to bring the bill up for debate—and even proclaimed support for women’s self-determination. Read more:

Two Groundbreaking Victories in Oklahoma:

Medication Abortion Protected

Judge Donald Worthington permanently blocked a state ban on medical abortion when he ruled that the law was “so completely at odds” with standard medical practice that it “can serve no purpose other than to prevent women from obtaining abortions and to punish and discriminate against those women who do. Read more:

and Oklahoma Personhood defeated

With a unanimous decision by the Oklahoma Supreme Court, the Center for Reproductive Rights has won its legal challenge to strike down a ballot initiative that would have given every fertilized egg the full legal rights of a person. It is not acceptable, they ruled, to propose amendments to the state constitution that are ‘repugnant to the Constitution of the United States.’” If passed, the amendment not only would have outlawed abortion in all cases—including in cases of rape or incest, fetal anomalies, or risk to a woman’s life—but also would have banned many forms of birth control and seriously threatened fertility treatments such as IVF. Read more:

Distress of child war and sex abuse victims halved by new trauma intervention

A new psychological intervention has been shown to more than halve the trauma experienced by child victims of war, rape and sexual abuse. Researchers at Queen’s University Belfast pioneered the intervention in conjunction with the international NGO, World Vision as part of a wider programme to treat psychological distress in child victims of war and sexual violence in the Democratic Republic of Congo (DRC). Read more:

Melinda Gates’ New Crusade: Investing Billions in Women’s Health

Melinda Gates this week pledged billions of dollars to be spent on improving access to contraception. In her many travels she repeatedly met women who were unable to gain access to something which most of the rest of the world take for granted. In an interview with Newsweek she recounted stories from the women many of whom were unable, for example, to get repeat injections of Depo Provera. In July she is teaming up with the British government to cosponsor a summit of world leaders in London, to start raising the $4 billion the Foundation says it will cost to get 120 million more women access to contraceptives by 2020. And in a move that could be hugely significant for American women, the Foundation is pouring money into the long-neglected field of contraceptive research, seeking entirely new methods of birth control. Ultimately Gates hopes to galvanize a global movement. “When I started to realize that that needed to get done in family planning, I finally said, OK, I’m the person that’s going to do that,” she says. More from the Gates Foundation website.

Paper confirms EC IUD failure rate less than 1 per 1000

Authors of the first ever systematic review of all available data from the last 35 years argue that IUDs should be routinely offered and available to those requesting emergency contraception. They found that the failure rate was less than 1 per 1000 when they analysed data from 42 studies involving 7034 women using 8 different IUDs. They also found that 85% clinicians in one study never offered this as an option. In a press release this week one of the authors, Professor James Trussell, said:

“This is an extremely difficult problem to deal with, especially as in many countries women can just go to their local pharmacy to obtain the ‘morning after pill’, but virtually no women know to ask for an IUD and many family planning clinics and surgeries do not offer same-day insertion. Offering same-day insertion would remove a huge barrier to the greater use of IUDs.”

Online First – Postnatal contraceptive choices in HIV-positive women [Duncan et al.]

Gillian Robinson (Associate Editor) writes:

“This paper describes an exciting example of how an integrated contraception and sexual health service can work to provide holistic care for women. This clinic provides women living with HIV with prenatal, antenatal and postnatal care in a community setting. The paper is a retrospective case note review. Uptake of postnatal contraception was high yet more than 20% of women were not seen postnatally. The authors suggest that the reasons for this are explored to ensure all women with HIV receive contraception in the early postnatal period to prevent unwanted pregnancy.”

NAT calls for new health bodies to tackle late diagnosis of HIV

“Halve It”, a broad coalition of leading experts and advocates in HIV and AIDS, welcomes the renewed call by the National AIDs Trust (NAT) for the urgent prioritisation of HIV testing in its new ‘HIV testing action plan’ which provides vital strategic guidance to health bodies on tackling the serious issue of late HIV diagnosis in the UK.

FDA Approves first pill for Heavy Menstrual Bleeding (HMB)

Natazia is a combination oral contraceptive (COC) consisting of estradiol valerate and estradiol valerate/dienogest. The US Food and Drug Administration (FDA) first approved Natazia in May 2010 to prevent pregnancy. On March 14, 2012, the FDA also approved Natazia to treat heavy menstrual bleeding (HMB), making it the first and only OC indicated for this purpose. One interesting thing is that until now we have known Natazia, in the UK, as Qlaira and until now it has not been widely used. More details at Medscape.

UK women misdiagnosing genital infections

To mark National BV Day on 18th April a study found that one in four British women has misdiagnosed themselves on the internet. Researchers found Dr Google is now the first port of call for women with genuine health concerns who are almost twice as likely to check online before consulting a doctor or even talking to Mum. But searching their symptoms online and self-medicating has led a tenth of the country’s women to endure unpleasant side effects as a result of their misdiagnosis.