Last week, the Secretary of State for Health & Social Care unveiled an ambitious but wholly achievable ambition to end HIV transmissions in England by 2030. Terrence Higgins Trust has welcomed this commitment which could make England one of the first countries in the world to halt new HIV transmissions. However this commitment is just the start and wont be achieved unless urgent action is taken – and sustained. The spotlight on HIV last week also underscored the lack of progress being made on other sexual health issues.
We are seeing rates of some sexually transmitted infections (STIs) skyrocket, in gonorrhoea and syphilis in particular, and the number of chlamydia tests undertaken continue to fall. New cases of gonorrhoea went up 43% since 2013 and new cases of syphilis went up a staggering 148% since 2008. Gay and bisexual men, as well as young people, and BAME communities continue to be most impacted by poor sexual health.
This continued increase in STIs is happening while government figures show demand for sexual health clinics has risen by 13%. At the same time that demand for sexual health services has risen, funding for public health has been continuously cut, with sexual health service budgets being cut by a quarter. The amount the Government allocates to public health also continues to be a meagre 2.8% of the total amount of money the Government spends on health. Demand and budget cuts have resulted in the situation where some clinics are left with no option but to turn people away who are presenting with STI symptoms.
Even with the backdrop of rising STIs and strained budgets, there is no Government action plan. We do not even have national targets to set out what we are trying to achieve around STIs in this country. The last Government framework to improve sexual health in England was published six years ago, was not co-owned by all those organisations who have responsibility for sexual health, and was far too headline – with no concrete suggestions on what needs to happen.
We want to see ambitious targets to tackle STIs and clear direction on how these targets can be met. Crucially this action plan must set out who is responsible for addressing sexual health and how bodies, including the Department for Health & Social Care, NHS England, Public Health England and local authorities can work together on this.
It’s not good enough simply to point fingers at people using dating apps or attitudes towards condom use as being the reason for the increase in these STIs. That’s why it’s crucial for young people, gay and bisexual men, trans communities and BAME communities to be involved in coming up with a clear plan that is informed by their lived experiences.
Funding and access to sexual health services are also crucial if we are to get to zero new HIV transmissions. As well as providing some of the many ways to test for HIV, a number of sexual health clinics are also responsible for providing PrEP through the NHS England PrEP trial. However pressures on resources, coupled with further delays by NHS England in making additional PrEP trial places available has resulted in a cliff-edge scenario in terms of access to PrEP for gay and bisexual men. PrEP, which is nearly 100% effective at stopping HIV when taken as prescribed, is still subject to capped access. Over 50 trial sites are now turning away gay and bisexual men due to being oversubscribed, which places individuals at increased risk of HIV, with some going on to become infected with HIV. We need urgent action on PrEP and ensure the proposed doubling of places happens without further delay so PrEP can be in the hands of those who need it.
Without immediate steps being taken on these points, the Government will be unable to end HIV transmissions by 2030 and we will continue to see rises in STI infections. Terrence Higgins Trust firmly believes this can be averted through undertaking practical measures; creating a national sexual health action plan, properly funding sexual health services, and ensuring HIV and STI prevention tools including PrEP are available to all who need them.
That’s the message I will be delivering when I give evidence the Parliamentary Health & Social Care Committee as part of its inquiry on sexual health.