Are cuts to public health budgets undermining years of progress on sexual health? Labour’s Baroness Gould and Lib Dem Lord Paddick urge the government to think again.
Sexual health cannot be allowed to go backwards. We need real leadership from Westminster, warns Baroness Gould
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The NHS is there to care for us when things go wrong and help us get better. Sexual health is different: it is there to ensure that we have good sexual health care throughout our lives. Over the past two decades we have seen huge strides in improving sexual health care.
Rates of teenage pregnancy are at the lowest level since records began. HIV is no longer the life sentence it was in the 1980s, and the rise in social media and technology has improved people’s awareness of the dangers of unprotected sex.
But we are now in danger of seeing that progress undermined.
Unintended pregnancy rates are still too high, particularly in older women, and 50% of pregnancies are unplanned.
More people are being diagnosed with sexually transmitted diseases, with rises in the rates of herpes, syphilis and gonorrhoea, and HIV rates soaring among at-risk groups. And progress in introducing sex education in schools has stalled.
These challenges are compounded by the duplication and fragmentation of the commissioning of sexual health provision, creating a lack of clarity as to who is ultimately responsible for maintaining and improving services across the country.
People visiting a sexual health service will think it is an NHS service. The transfer of responsibility to local government means it is susceptible to the pressures and strains on their budgets.
The government’s decision to cut public health budgets by £200m, with the prospect of further cuts to come, presents an additional challenge. These cuts are short sighted and will put greater pressure on an NHS which is already under huge strain.
The Advisory Group on Contraception has estimated that last year’s cut could lead to an additional cost to the NHS of £250m, wiping out any of the savings ministers had planned to make in the first instance.
There are many examples of councils striving to improve sexual health care for their communities, but there are others which are buckling under the strain, leading to a spike in teenage pregnancy rates and the closure of contraception clinics, most notably the internationally respected Margaret Pyke Centre. Women of all ages should be able to access high quality, open access, confidential sexual health services.
Some authorities have defunded all HIV support, removing services that are vital to many people with HIV, including coping with new diagnosis, peer support adherence to medication and safer counselling.
Following considerable trials and deliberation to test the effectiveness of providing pre-exposure prophylaxis (PrEP) to at-risk groups to prevent them acquiring HIV, the decision by NHS England to shelve the proposition was met with outrage, which resulted in NHSE last week saying “they will carefully consider its position on commissioning PrEP”. The sector will rightly continue to exert pressure and hope there will be a change of mind.
Sexual health cannot be allowed to go backwards. We need to see real leadership from Westminster and Whitehall to change the nature of the debate about how we improve sexual health in this country.
It is a national issue, and we cannot stand by and do nothing.
Baroness Gould of Potternewton is a Labour peer and Chair of the Sexual and Reproductive Health in the UK APPG
We know PrEp works, writes Lord Paddick. So why is the government burying its head in the sand?
There is a pill that can stop HIV. It’s called pre-exposure prophylaxis, or PrEP, and it’s taken once a day by HIV negative people who are at high risk to prevent transmission. We know it works, clinical trials have proved it; we know it’s cost effective and other countries are using it to achieve our goal to eliminate HIV.
Despite this, NHS England scrapped their decision-making process for PrEP in March – giving us what can only be described as a political ‘sop’ that is too little too late and not realistic HIV prevention. Now, after uproar from the HIV sector including Terrence Higgins Trust, the NHS may be reconsidering their decision.
While we continue to wait, people remain at risk of HIV who would otherwise have been protected. The reality is eight gay men are infected with HIV in the UK every day, and despite our best efforts, more and more people are becoming HIV positive in this country with each passing year.
The groundbreaking PROUD study demonstrated that PrEP reduced the risk of HIV infection by 86% for men who have sex with men (MSM), with 100% protection seen when taken as prescribed during the trial.
The study also showed virtually no difference in reports of condom use and no difference in rates of other sexually transmitted infections – contradicting the claim that access to PrEP would encourage risky sexual behaviour.
In San Francisco – where PrEP has been given free to high-risk gay men since 2012 – the rates of HIV have plummeted, changing the face of this epidemic. Last year the World Health Organisation recommended that countries provide PrEP in order to meet its 90-90-90 target (90% of people living with HIV know their status, 90% of them are on anti-retroviral drugs and 90% of them are undetectable). France now provides PrEP through its healthcare system too, informed by the PROUD study. Isn’t it time we did the same here in the UK?
PrEP will also save money: HIV treatment is needed daily for life, costing £360,000 per person over a lifetime, PrEP is only needed in periods of risk, costing a maximum of £4,000 a year, per person. This figure is likely to decrease substantially when the patent for Truvada, the drug used for PrEP, expires next year.
PrEP gives us another option in our arsenal against HIV, alongside condom use.
We know it works, we know it can be cost-effective – are we going to bury our heads in the sand and ignore it?
The great challenge of the generation before us was to maximise life expectancy and quality for those who were HIV positive. We have achieved this. Let us now turn our attention to the great challenge of this generation – prevention.
We can’t afford not to provide PrEP on the NHS.
Lord Paddick is a Liberal Democrat peer