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International

HIV and Sex Work: The Lancet Series

28 Jul, 14 | by shaworth

This week saw the publication of the new Lancet series, an ongoing series of analyses of research in HIV with a focus on identifying those at risk and collating the data on prevention strategies. Previous parts of the series have looked at men who have sex with men (2012), and general prevention strategies (2008); however the latest part of the series is a detailed look at the burden of HIV prevention in sex workers.

The series is a detailed look at the studies detailing the HIV burden in sex workers who are female, male and transgender, and as such, gives a fairly broad look at the subject area. It identifies the barriers that are faced in attempts to reduce HIV incidence in this population, and it’s clear from the review that decriminalisation of sex work in order to reduce human rights violations and protect sex workers is a key part of the HIV prevention strategy. For many years, sex workers have been marginalised in attempts to prevent HIV, but it is obvious from the high disease burden in this group that sex workers need to be brought into the centre of HIV prevention strategies.

A particularly interesting part of the report concerning female sex workers comes from a representative of the Dutch police force, who discusses the change in legislation that has decriminalised sex work for those adults who are working voluntarily in this sector, allowing the police to focus their efforts on investigating human rights violations against sex workers and children who are working illegally. The fact that they are still unable to effectively target sex workers who are working illegally in the country remains a point of concern, but it’s hard to doubt that the decriminalisation does allow them to focus their efforts to protect those who chose to be employed in this way.

What’s also fascinating about the series is the study of male sex workers, and the findings that not all of these men identify as gay, potentially undermining public health strategies targeting this group that effectively make this assumption. The understanding of the driving factors behind the choice of these men who have become sex workers is paramount at identifying successful HIV prevention strategies. There’s also a short appendix of local terminology for male sex workers, which may be useful for those looking to work in sexual health abroad.

The inclusion of transgender individuals in the study makes for harrowing reading. Transwomen (the study does not include transmen) have a disproprotionate risk of HIV infection, 13.5 times the risk for natal women. The lack of research in this area, along with a lack of research into effective strategies to prevent HIV in this population undermines our efforts in this area, which is obviously not an acceptable situation to continue.

 

ESC – 13thCongress and call for applications for project funding

16 Sep, 13 | by shellraine, e-Media Editor

Mark your calendar:

28 till 31 May 2014
Lisbon, Portugal

First announcement

Check out the first announcement including:

  • programme overview: 8 workshops, 21 congress sessions, 2 debates…
  • abstract submission instructions (deadline 1 December 2013)
  • registration form

Register now

Please find here an overview of the registration fees.
You can now register through the online registration form

General information / Programme overviewCall for abstracts (deadline = 1st December 2013)/ Registration

ESC newsletter

Call for project or course applications

The ESC provides funding to support a project within Europe

The available budget for applications received between 1 August and 31 December 2013 is 30,000 euro. Applications should meet the following minimal conditions:

  • The applicant must be a paid-up ESC member
  • The grant may be used to support an individual, group, institute or organisation with a project related to the aims of the ESC.
  • Examples of projects include: research, audit, review, needs assessment

Deadline for the application period:  31 December 2013

Application Form

 

 

World Contraception Day – 26 September 2013

16 Sep, 13 | by shellraine, e-Media Editor

WCD will be using an umbrella theme for this and future years: ‘Its your life; its your future’. This theme has been chosen as it is forward-looking, positive and empowering.

There are 3 sub-themes:

Your options: where young people can learn about all the contraceptive options available, using a reliable, unbiased source of information.

Your future:  understanding how unplanned pregnancies can happen and how the body changes during puberty

Your partner: learning to talk to your partner about contraception and how to build a trusting relationship based on reliable information

Organisations may choose whether to concentrate on one theme per year or cover all or some of the subjects this year.

A selection of materials are available in the form of a modular toolbox addressing each theme with background information and info graphics. Social media will be used more widely this year and suggested topics for Twitter and Facebook will be made available. There is also a countdown clock.

Campaign materials are available here: http://bit.ly/WCD2013

 

 

 

 

Fall in abortion rate and other news

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

Fall in abortion rates continues

Abortions carried out on women living in England and Wales fell 2.5% to 185,122 last year, Department of Health figures show.

For women aged 15-44, the abortion rate was down 5.4% to 16.5 per 1,000 women – the lowest since 1997.
From information included in abortion forms in 2012, almost half were medically-induced using drugs as opposed to surgery – similar to 2011.
Among under-18s, the abortion rate continued to fall last year.
The number of teenagers having abortions has been on a downward trend for the past five years. Between 2011 and 2012, the under-18 abortion rate fell again from 15 to 12.8 per 1,000.
The Department of Health report on the 2012 statistics said that 91% of abortions were carried out before the 13th week of pregnancy.
It also noted that fewer abortions were carried out on women from other countries, such as Ireland, than in any year since 1969.
Last year, non-residents accounted for 5,850 abortions.

The British Pregnancy Advisory Service (BPAS) said the drop in the number of teenagers experiencing an unwanted pregnancy could reflect improvements in access to contraception for young people.

In older age groups the fall in abortions could indicate that women are better able to avoid unplanned pregnancy in the first place, it said.

DH publishes “Integrated Sexual Health Services : National Service Specification”

This national service specification is provided to help local authorities to commission effective,high-quality, integrated sexual health care . It covers the rationale for commissioning effective and easy to access services and the objectives of service provision, key outcomes to consider, a description of what should be offered at various levels of service, professional and other quality standards covering sexual health, and the need to work in partnership with other services such as termination of pregnancy, general practice, and mental health services.

National curriculum review

From February to April a public consultation on the government’s proposal for the reform of the national curriculum in England was launched. The DfE has published the consultation report and government response. Having considered the responses to the consultation the government has published updated versions of the national curriculum framework and is now seeking feedback on this – deadline 8th August.

Responding to the publication Jules Hillier, Brook’s Deputy Chief Executive, said:

“Brook welcomes the inclusion of compulsory sex and relationships education in the National Curriculum, which means that secondary schools must provide young people with the education we know they very much want and need. It’s now up to schools to put this policy into action by ensuring that all children and young people are given high-quality SRE that puts young people at its heart. Getting this right will contribute to young people’s wider health and wellbeing and help them prepare for safe healthy, happy relationships. We look forward to supporting schools to do this.”

 PRAC recommendation on Diane 35 and generics

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee (PRAC) has concluded that the benefits of Diane 35 (cyproterone acetate 2 mg / ethinylestradiol 35 micrograms) and its generics outweigh the risks in a specific patient group, provided that several measures are taken to minimise the risk of thromboembolism, including new contraindications and warnings.

The Committee adopted the recommendation following a thorough review in which it sought expert advice and considered feedback from healthcare professionals and users of these medicines.

 

July Journal published as Impact Factor soars to 2.1!

20 Jun, 13 | by shellraine, e-Media Editor

The July edition of the Journal is now available online and includes:

Venous thromboembolism and COCs: an ongoing saga

This ongoing controversy recently resulted in the decision of the French authorities to withdraw the combined oral contraceptive (COC) containing ethinylestradiol (EE) and cyproterone acetate (i.e. Diane 35®) from the market. This consensus statement from 26 international experts in contraception concludes that “Both epidemiological data and clinical trials must be taken into account when best practice is defined. Regulatory restrictions of previously registered methods should only be made after careful assessment of all the available evidence”. See page 156

Serum CA125 for ovarian cancer screening

This timely commentary raises questions about the widespread use of screening women with non-specific symptoms by measuring serum CA125 levels, following the publication of the NICE guideline on ovarian cancer in 2012. The authors acknowledge that there are barriers that prevent women with symptoms associated with ovarian cancer from presenting to their general practitioner. However, the authors also point out that this will lead to increased use of CA125 in general practice and raise concerns about how women with raised CA125 in the absence of evidence of any disease should be managed. See page 160

Ovarian cancer symptom awareness and help-seeking behaviour

Ovarian cancer symptom awareness is low in the UK, and varies widely between symptoms. In this study, Low et al. identify variables that may be implicated in a longer time to help-seeking for possible ovarian cancer symptoms, and highlights the need for more in-depth research into the factors related to time to help-seeking in real-world situations. See page 163

Fertility preservation decisions faced by women with breast cancer

This article presents a contemporary summary of fertility preservation techniques available to women of reproductive age with breast cancer. It offers unique insights into the difficult treatment decisions coupled with the difficult fertility preservation treatment decisions that these women face. The article highlights a number of themes that influence the decision-making process for these women. Egg and embryo banking appear to be the fertility preservation treatment of choice. Finally, this work may assist health care commissioners when deciding funding priorities within a health economy such as the NHS in the UK. See page 172

Correlates of unprotected sex in drug-injecting women

This study demonstrates that despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg in Russia is low. Programmes to investigate and improve contraceptive use, including condoms, among this vulnerable group of women are needed and might benefit from addressing alcohol misuse. See page 179

Contraception in a university environment

This is a very simple real-life observational study of a cohort of young, nulliparous women in a university-based general practice choosing and continuing with long-acting reversible contraceptive methods (LARCs) as their first line method of contraception. This article urges the health professional reader to consider offering this ‘fit and forget’ method of contraceptive to our younger population as a matter of routine. See page 186

Impact of UKMEC on CHC prescribing

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHCs). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had UKMEC Category 3 or 4 risk factors, particularly BMI ≥35 kg/m2. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower-risk alternatives. See page 190

Financial cost to patients of a suspected ectopic pregnancy

In this article, Unger and colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This article describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. See page 197

Emergency contraception algorithm based on risk assessment

Introduction of a standardised protocol for the provision of emergency contraception (EC) has significantly increased the proportion of women offered an intrauterine device (IUD) as postcoital contraception, particularly in women at high risk of conception. Introduction of ulipristal acetate as an alternative method of EC has resulted in a reduction in the uptake of the emergency IUD. McKay and Gilbert state that this is cause for concern, and further investigation into the reasons behind this decrease in IUD uptake is needed. See page 201

No need for water torture

Cameron and colleagues set out to answer a simple question, namely does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful. See page 207

New monophasic natural estradiol COC

Lee Shulman reviews a new monophasic natural estradiol COC, Zoely®. This COC benefits from the progestogen nomegestrol acetate (NOMAC), which appears to result in good cycle control, with a 24/4 regimen. Since it is monophasic, it also has potential for extended cycle use. The great hope is that natural estradiol COCs will have a lower risk of venous thromboembolism (VTE) than EE-containing pills, but it should be stressed that there is currently no actual evidence for this. Studies are ongoing, but at present these COCs should be treated just like any other from the point of view of VTE. See page 211

Brook/FPA UK Sexual Health Awards 2013

The Journal’s Consumer Correspondent writes about the recently awarded Brook/FPA UK Sexual Health Awards, and opines that awards of this type are a good thing for the SRH profession generally and so rightly should be regarded as a highlight of the sexual health year. See page 219

Plus

An obituary for Dr Alison Bigrigg by Dr Audrey Brown; an organisational factfile on Tommys; a conference report from the FSRH Annual Scientific Meeting at University of Warwick;

And last, but by no means least, the Journal Impact Factor has risen, once again, to 2.1. Many congratulations to Anne Szarewski and her team.

 

Copenhagen Impressions

3 Jun, 13 | by shellraine, e-Media Editor

European Society of Contraception and Reproductive Health
First Global Conference

Global

Highlights of the Congress included:

Crown Princess Mary opening the Congress followed by the amazing Copenhagen drummers                          drummers

 

 

 

Green contraception – estrogen in water an issue, rating methods for their ‘greenness’: hormones, packaging etc.

Lidegaard / Shulman / Dinger – continuing debate on VTE, interpreting research, epidemiology and practical applications.

Emergency Contraception – confirmation that pills have no impact globally on unintended pregnancy rates only IUDs do.

Meeting friends, old and new, from wider across the globe than usual, especially from the Baltic states, Africa and the Far East.

In addition the Board voted to set up a working group to investigate and promote multidisciplinary working across Europe.

bella sky

The startling Bella Sky hotel & conference centre

- especially the, trompe l’oeil, walkway between the 2 towers on the 23rd floor. It goes uphill from Tower 1 to 2 but from a distance appears to go the other way.

 

 

oresund  The Oresund Bridge

- the 5 mile rail and road link between Copenhagen and Malmo

 

 

 

bikesBicycles, bicycles and more bicycles

and particularly proper, separate, dedicated cycle lanes – at times quite scary and felt like being in the middle of the Tour de France peloton without the lycra and wrap-around shades!,

Great open sandwiches (smorrebrod) but hardly any danish pastries.

Herrrings, steak & frites. Not brilliant for veggies.

Good beer but not wine – used by next years hosts in Lisbon as an enticement to go there.

Lisbon

 

 

International Campaign for Women’s Right to Safe Abortion launches new website

29 May, 13 | by shellraine, e-Media Editor

ICWRSAThe International Campaign for Women’s Right to Safe Abortion was launched on the International Day of Action for Women’s Health on 28 May 2012. Now, one year later , it announced the launch of its new website which aims to raise awareness particularly linked to the September 28 Global Day of Action for access to safe and legal abortion.  As well as links on Facebook and Twitter it has a Tumblr Feed, videos and a map graphically showing the world’s diverse abortion laws. It asks readers to endorse its campaign and add to its growing number of supporters – individual and organisations – around the globe.

Help WHO revise its guidelines!

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

The WHO are currently preparing updates to its Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which will be finalized in 2014, and are soliciting feedback from various stakeholders in the field of family planning to inform this process. The goal is to ensure these guidelines remain relevant to family planning policies, programmes and service delivery. To that end, they have created a survey to help prioritize topics to review and to determine which new information to add to the guidelines. In addition they welcome other suggestions on how to improve the guidelines.

If you are familiar with the Medical Eligibility Criteria for Contraceptive Use or the Selected Practice Recommendations for Contraceptive Use fill out the survey and give your suggestions for the next edition.

US Judge orders FDA to make Morning-After Pill available over the counter for all

9 Apr, 13 | by shellraine, e-Media Editor

 Judge Strikes Down Age Limits on Morning-After Pill

Plan B

A federal judge has ruled that the Unites States government must make the most common morning-after pill available over the counter for all ages, instead of requiring a prescription for girls 16 and under. The New York Times reported that the decision, on a fraught and politically controversial subject, comes after a decade-long fight over who should have access to the pill and under what circumstances, and it counteracts an unprecedented move by the Obama administration’s Health and Human Services secretary who in 2011 overruled a recommendation by the Food and Drug Administration to make the pill available for all ages without a prescription.

April Journal – 20th Anniversary of the FSRH

9 Apr, 13 | by shellraine, e-Media Editor

Hightlights from this edition include:

The FSRH’s 20th anniversary

It is 20 years since the establishment of the Faculty of Sexual and Reproductive Healthcare (FSRH). In celebrating its anniversary there is much to be proud of, and indeed Community Sexual and Reproductive Health is now a specialty in its own right. Readers should find the story of the birth and rise of the specialty interesting and some will be reminded of ‘old times’, while looking ahead to a bright future. See page 78

Does HRT cause breast cancer? Part 5

Shapiro and colleagues conclude the interesting and enlightening series of articles looking at the evidence around hormone replacement therapy (HRT) and breast cancer risk (page 80). The final part examines the evidence for there being a declining trend in breast cancer incidence as HRT use reduced. Although the two are widely held to be related, they conclude that it is not possible to say either way. In the accompanying
Commentary (page 72), Nick Panay reviews the whole series of five articles and reminds us that optimising the lives of millions of women going through the menopause should be our priority. See pages 72 and 80

COCs and the risk of VTE, ATE and cardiovascular death

Syd Shapiro provides another of his incisive reviews of the latest database study of the combined pill and venous (VTE) and arterial (ATE) thromboembolism risk. Unsurprisingly, he finds many of the same problems as in the other studies, and asks the question why do these studies keep being done badly when the methodological flaws have been so well established? See page 89

“Anything for the weekend – and beyond, madam?” Community pharmacies increase OC uptake

Parsons et al.‘s evaluation of a community pharmacy delivered oral contraceptive (OC) service in South-East London 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. Specially trained pharmacists provided OCs under a patient group direction (PGD), and subsequent evaluation showed that these 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.  See page 97

There’s a tale in this sting – The policing of abortion services in England

What was the background to last year’s Care Quality Commission inspections of all English abortion services? Why were medical and nursing colleagues reported to their regulatory Councils and why is a Metropolitan Police investigation still ongoing? Sam Rowlands’ commentary provides a fascinating and detailed account of the regulatory framework of abortion services in England and the unexpected consequences of a national newspaper’s ‘sting’ operation on certain clinics in February 2012. It suggests that the regulation of abortion goes further than the Law requires and that this is now out of step with progress in abortion practice, leading to unnecessary restriction for women with unwanted pregnancies in accessing the support they need. See page 121

Role of ambulatory hysteroscopy in reproduction

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review aims to summarise the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation. See page 127

LAM: why ignore this useful option?

In this interesting personal view article, the authors explore and elaborate on the reasons why health care providers and the public are hesitant in recommending/adopting the lactational amenorrhoea method (LAM), a valuable short-term postnatal contraceptive option. These include ignorance about the LAM criteria for correct use, mistrust of the method’s effectiveness despite a strong evidence base, inconsistencies in the advice given to breastfeeding women in the UK by health practitioners and public bodies (e.g. the National Health Service, Royal College of Obstetricians and Gynaecologists), and lack of awareness about potential benefits. See page 136

Internet: good or bad?

2013 marks the 30th anniversary of the Internet. Our Consumer Correspondent looks at whether this technological miracle is a ‘good idea’ for the health profession. See page 139

New subcutaneous DMPA injection

Sharon Cameron discusses the new subcutaneous injection of depo-medroxyprogesterone acetate (DMPA), Sayana® Press, which is soon to be released onto the market in the UK. It seems to be very similar to the intramuscular DMPA, but can be self-administered. Unfortunately, this advantage is not being utilised, as this contraceptive method is not yet licensed for self-administration in the UK. See page 75

Psychosocial factors affect semen quality

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. See page 102

The ‘Woman’s Condom’ – will the Chinese go for it?

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of multipurpose prevention technologies, including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman’s Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. See page 111

Latest from JFPRHC

Latest from JFPRHC