05.02.19
How are we protecting the nation’s sexual health?
Most people become sexually active between the ages of 16 and 24. Without the right advice and measures to ensure good sexual health and wellbeing, this can lead to unintended pregnancies and sexually transmitted infections, writes Professor Gillian Leng, deputy chief executive and director of health and social care at NICE.
Sexual health goes beyond the prevention and treatment of sexually transmitted infections (STIs). It is an important part of a person’s physical, emotional, mental, and social wellbeing.
NICE has played a key role in setting standards for good sexual health. In 2005, NICE published its first sexual health guideline on long-acting reversible contraception. Since then, NICE has produced a whole suite of evidence-based products: seven guidelines; five quality standards; and two interventional procedures.
To show how NICE’s work in this priority area is making a difference, we’ve just produced an impact report on sexual health. As well as showing where we’ve made progress, it also helps to identify areas for improvement.
One area the report considers is contraception. Teenage pregnancies and abortion rates have fallen in the last decade, which is very positive news, possibly because of the wider choice of contraceptive methods and awareness of how to use them effectively. Between 1998 and 2016, conceptions in women under 18 fell by 60%. However, the story isn’t consistent, and data from the Office for National Statistics indicates that rates of under 18 pregnancy vary between local authorities.
Public Health England’s (PHEs) teenage pregnancy prevention framework includes a list of risk factors that are associated with women who are more likely to get pregnant before the age of 18. This includes women who are looked after or leaving care, or those who have experienced a previous pregnancy. NICE’s guideline, referenced in this framework, recommends that additional support should be offered in these situations. This may include one-to-one sexual health advice on all methods of contraception, and on how to prevent STI’s or unwanted pregnancies.
Supporting women to make an informed choice about contraception after childbirth helps to reduce the risk of future unplanned pregnancies. NICE recognised this as a high-priority area for improvement, stating that women should be offered a choice of all contraceptive methods by their midwife within 7 days of having their baby. In 2013, 2015 and 2017, around 90% of women said they have been given information or advice about contraception after childbirth. But with one in 10 women not receiving this support, more work still needs to be done.
In recent years, the number of newly diagnosed STIs has levelled off – but unfortunately there has been a concurrent rise in the number of antimicrobial resistant infections. Partner notification is essential to break the ‘chain’ of transmission. NICE’s guideline recommends that people with a diagnosed STI should be provided with the support to get their sexual partners tested and treated. Data from the NCSP audit report found that in 2017, 94% of people diagnosed with chlamydia had a documented offer of partner notification. Despite this, only 31% of people’s partners attended a sexual health service.
Increasing the uptake of HIV testing is the spotlight of our impact report. Most people who get HIV won’t experience symptoms for many years after the initial infection, which can lead to late diagnosis with poorer treatment outcomes and the increased risk of onward transmission.
With this in mind, NICE published a guideline and quality standard to help increase the uptake of HIV testing. According to PHE’s HIV testing in England report (2017), 84% of people who attended a sexual health service were offered a HIV test. This testing led to 2,323 diagnoses.
However, the overall late HIV diagnosis rate has remained at over 40% for the past five years for people aged 15-years-old and above in the UK. There can be a stigma and fear around having a HIV test, so we need to get to a point where HIV testing is seen as routine practice.
As our report demonstrates, accessible information and services are key to empowering people to make their own decisions about their sexual health. We need to keep up the momentum to ensure those most at risk of unintended pregnancies and STIs get the right support at the right time.
To access the full sexual health report, please go to the NICE website.
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