Welcome
13 October 2022 (Issue 73)
Welcome to the October issue of the Sexual Health, Reproductive Health & HIV Policy eBulletin. We start with some good news: monkeypox numbers have started to decline. The drop in diagnoses appears to be the result of behaviour change and vaccination. Many people have worked hard on the frontline response, including sexual health clinics and community organisations, and this has largely been unfunded work. In this edition, we highlight advocacy efforts calling on the government to take action to support services and ensure monkeypox numbers continue to decline.
Other items to look out for in this month’s round-up include: new data on contraception services; new data on HIV and STIs in England and Wales; surveys on eliminating cervical cancer and meeting unmet sexual health needs; and the FSRH student essay prize.
In this month’s eFeature, reflecting on World Mental Health Day, Strategist and Consultant Amy McKeown explores the mental health impacts of unplanned pregnancy.
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eFeature
The mental health impact of unplanned pregnancy and the right to abortion
This year’s theme for World Mental Health Day on 10 October was ‘Making mental health and wellbeing for all a global priority’.
In this month’s eFeature, Amy McKeown – a Strategist and Consultant focused on mental health, health and wellbeing and women’s health – explores the mental health impact of unplanned pregnancy and reflects on the importance of the right to choose.
This article is funded by Bayer and the author has received an honorarium.
Read full eFeature
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Evidence, data & research
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Further updates on monkeypox numbers
The latest updates from the UK Health Security Agency (UKHSA) show that numbers of new monkeypox cases are declining. The current outbreak of monkeypox in the UK was first identified in May 2022.
At 10 October, there had been 3673 confirmed or highly probable cases in the UK. Of these, 94 were in Scotland, 34 in Northern Ireland, 46 in Wales and 3499 in England. The majority of people diagnosed with monkeypox in this outbreak have been men who have sex with men.
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New data on HIV and STIs
UKHSA has published its annual data on HIV and sexually transmitted infections (STIs).
There were 2955 new HIV diagnoses in the UK in 2021 – a small decrease from the previous year.
The number of people having HIV tests remained lower than in 2019 (pre-COVID) except for among gay, bisexual and other men who have sex with men, where the rate of testing is higher.
There were 311,604 diagnoses of new STIs in England. This is a 0.5% increase from 2020, but a decrease of 33.2% since 2019.
This includes 51,074 diagnoses of gonorrhoea (up 1.7%), 7506 diagnoses of syphilis (up 8.4%), and 159,448 diagnoses of chlamydia (down 1.2%).
Ian Green, Chief Executive of the Terrence Higgins Trust (THT), called on the Government to publish its Sexual and Reproductive Health Action Plan and to properly resource the monkeypox response, which is impacting sexual health service provision.
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New data on contraception services
NHS Digital has published new data on contraception provision through sexual and reproductive health (SRH) services in England. The data show a 4% fall in contraception-related contacts with SRH community services in 2021/22 compared to 2020/21.
The statistics show an increase in the uptake of long-acting reversible contraception (LARC) overall, including in primary care. However, LARC prescriptions in primary care are still down 12% compared to 2019 (pre-pandemic) levels.
Provision of emergency contraception through community SRH clinics has increased from the previous year, but is still below pre-pandemic levels.
Dr Janet Barter, President of the Faculty of Sexual and Reproductive Healthcare, (FSRH), said, "We are pleased to see that contraceptive provision shows some signs of recovery both in SRH services and primary care. However, it is still deeply concerning to see that recovery is far from optimal, with long-acting reversible contraception, the most effective methods to prevent unplanned pregnancies, still lagging behind pre-COVID levels, particularly in primary care."
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Regional data on STIs
UKHSA has published new reports presenting data for 2020 on STIs for four UK regions – northeast England, Yorkshire and Humber, East Midlands and West Midlands.
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New data on Shigella
UKHSA has published new data on sexually transmitted Shigella, up to quarter two of 2022.
The number of reported cases of sexually transmitted Shigella reduced significantly in 2020, likely due to COVID-19 restrictions. While numbers have not returned to pre-COVID levels, diagnoses have increased. Between quarter three in 2021 and quarter two in 2022, diagnoses of sexually transmitted Shigella increased from 67 to 152.
Antimicrobial resistance continues to be a significant concern.
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Trial of antiviral as monkeypox treatment
Oxford Population Health and the Nuffield Department of Medicine at the University of Oxford have started a trial of the antiviral medication tecovirimat as a treatment for monkeypox.
The PLATINUM trial is investigating whether tecovirimat, which is commonly used to treat smallpox, can shorten the recovery time for people with monkeypox. Most people with monkeypox anywhere in the UK are eligible to join the trial.
The British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) have endorsed a letter to clinicians encouraging them to refer patients to the trial.
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Policy development & guidance
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Renewed calls for action on monkeypox
Last week, BHIVA, FSRH, BASHH, the Association of Directors of Public Health (ADPH) and the English HIV and Sexual Health Commissioners Group wrote jointly to the Government calling for action on monkeypox. A separate joint letter asks commissioners to take a pragmatic approach.
Unfunded assessment, treatment and vaccination work related to monkeypox has placed a significant burden on sexual health clinics since the outbreak began in May. This has been displacing other clinical activity (on average, 25-30% of activity) and the letter to the Government sets out the consequences of this and the urgent need for funding to reduce the risk of further serious impacts.
THT, National AIDS Trust (NAT) and PrEPster have launched a campaign calling for more funding and support to be provided to the UK monkeypox response. An online platform supports people to email their MP about the issue.
They are asking that the UK Government: get the vaccine and accurate information on monkeypox to all those who need it; name a person responsible for monkeypox in the UK and give them the means to respond; and fill the gaps in services displaced by monkeypox.
Last month, FSRH, the Royal College of Nursing, the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists released a joint statement following a survey of their members. The survey found that monkeypox is impacting SRH services, diverting clinical capacity and hampering women’s access to basic SRH care. The statement calls on the Government to resource SRH services adequately, so that they can effectively support the efforts to tackle monkeypox and ensure everyone is able to access the SRH care they need.
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BASHH endorses the People First Charter
BASHH has formally endorsed the People First Charter, which promotes person-first language in HIV and sexual health to help prevent stigma and discrimination.
The charter sets out recommended terminology changes and commitments, including calling for materials relating to HIV and STIs to use people-first terminology, and asking reviewers of scientific abstracts and papers to ensure appropriate terminology is used.
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FSRH statement for World Contraception Day
FSRH published a statement to mark World Contraception Day on 26 September, calling for everyone to have access to the full range of contraceptive methods as part of high-quality SRH.
The statement reiterated the goals set out in the FSRH Hatfield Vision, focused on improving access and standards of contraceptive care.
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THT policy statement marks Black History Month
THT has published a policy statement to mark Black History Month.
It sets out THT’s vision for a system that is anti-racist and focused on sexual wellbeing, and the steps needed to see better outcomes for people of Black heritage. These include: provision of PrEP (pre-exposure prophylaxis against HIV) in primary care; opt-out HIV testing outside London; a focus on return and retention in HIV care; making HIV and STI testing easier and more accessible; action on antibiotic resistance; and investment in improved sexual health services.
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FSRH statement on the climate crisis
FSRH has issued a new position statement acknowledging the climate crisis and committing to reducing our impact on the planet.
It stresses that the climate crisis threatens the health of populations in the UK and globally and has a disproportionately harmful effect on women’s health and wellbeing.
FSRH urges national and international leaders to fulfil their promises from COP26 and beyond to limit global warming and to promote gender transformative climate action.
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Telemedicine for early medical abortions made permanent
The Government has formally announced that the provision of early medical abortion care via telemedicine will be made permanent in England from 30 August, following a vote in Parliament in March.
The new legislation allows for both courses of abortion medication to be taken at home for gestations of up to nine weeks and six days.
FSRH and the Royal College of Obstetricians and Gynaecologists (RCOG) strongly welcomed the decision.
The option to take abortion medication at home was introduced during the COVID-19 pandemic and was found to be safe and to improve waiting times. Welsh and Scottish Governments have already confirmed that the option to take medication at home will continue.
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New Secretary of State for Health and Social Care
Liz Truss became Prime Minister on 6 September 2022 and appointed a new cabinet. Thérèse Coffey has replaced Steve Barclay as the new Secretary of State for Health and Social Care and has an additional role as Deputy Prime Minister.
Robert Jenrick and Will Quince were appointed as Ministers for State in the Department for Health and Social Care, and Caroline Johnson and Neil O’Brien were appointed as Parliamentary Under-Secretaries.
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Access to Contraception Inquiry: progress update
The All-Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH) has published an update on progress against the recommendations set out in the 2020 Women’s Lives, Women’s Rights inquiry report.
The report collated the findings of the Inquiry into Access to Contraception, which revealed that women were finding it increasingly difficult to access contraception that suits them.
The new update report found that, since then, there has been some progress, but there remain a number of areas where progress needs to be made.
It highlights five key areas: policy leadership at a national level; funding; commissioning structures; workforce capacity; and addressing inequalities in access.
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RCOG response to scrapping of Health Disparities White Paper
There have been reports that the new Health Secretary, Thérèse Coffey, has scrapped the Health Disparities White Paper.
Dr Eddie Morris, President of RCOG, expressed his concern. He said, "This decision, if taken, will completely undermine the commitment to tackling disparities in the Women’s Health Strategy for England...We have always been clear that a life-course approach to improving women’s health includes addressing wider social determinants of health, which this white paper could recognise and address."
Over 155 members of the Inequalities in Health Alliance (IHA) have signed a letter to the Health Secretary, stressing that a cross-government response is necessary. It states that, otherwise, "the Department for Health and Social Care and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in".
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Service standards & guidelines
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New FSRH guideline on progestogen-only pills
FSRH has published an updated Clinical Guideline on Progestogen-only Pills.
This guideline provides evidence-based recommendations and good practice points for health professionals on the use of progestogen-only contraceptive pills.
FSRH has also launched a progestogen-only pills national benchmarking audit. The audit is primarily focused on those working in primary care but will be useful for those in specialist services and other settings. UK members should complete the audit by 25 November 2022.
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Second doses of monkeypox vaccine offered
In the context of limited vaccine supplies, the Joint Committee on Vaccination and Immunisation (JCVI) was asked to consider how best to use available doses of the monkeypox vaccine (brand names Imvanex and Jynneos).
UKHSA had modelled the impact of either giving a second dose to people in the highest-risk group, or giving a first dose to people in a wider group.
In September, the JCVI announced it had decided to endorse UKHSA’s proposal of prioritising second doses, while continuing to offer first doses to people in the highest-risk group.
In order to make the most of the available vaccine supply, some clinics are using fractional dosing, administering a smaller amount of the vaccine intradermally (under the top layer of skin). By using it in this way, each vial can be used to vaccinate four people.
Earlier this month, there were reports that UKHSA had recommended the purchase of further doses of vaccine, but that this was blocked by the new Health Secretary, Thérèse Coffey.
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STI and HIV indicators updated in profiles
The HIV and STI indicators in the sexual and reproductive health profiles have now been updated with the most recent data. The profiles were developed by the UKHSA and the Office for Health Improvement and Disparities (OHID) to support health monitoring and local public health systems.
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Reports & other resources
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HFEA report on the fertility sector
The Human Fertilisation & Embryology Authority (HFEA), the UK regulator of fertility treatment and human embryo research, has published its annual State of the Fertility Sector report.
It reports that almost 90,000 treatment and storage cycles were carried out during 2021-22 and less than 1% of these cycles resulted in problems. The report concludes that people accessing fertility care from licensed clinics can be confident of receiving safe care.
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Local government: case studies on women’s health
A series of 12 case studies from the Local Government Association highlights work being done in local government to support women's health.
They include work done in Suffolk to improve sexual and reproductive health for women with learning disabilities; a campaign in Newcastle to improve uptake of cervical screening in ethnic minority, trans and non-binary communities; and work in Liverpool to set up a network of women's health hubs.
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Recommendations for ensuring HRT supply
The Government's HRT Taskforce has presented key recommendations for future management of hormone replacement therapy (HRT) supply. The recommendations are to be taken forward by the Department of Health and Social Care to help ensure HRT supply meets demand.
Access to HRT has improved in recent months after several actions were taken, including issuing serious shortage protocols (SSPs) to limit dispensing to three months’ supply and allow the supply of alternative products.
Core recommendations from the taskforce include continued use of SSPs and continued dialogue with industry.
The British Menopause Society (BMS) welcomed the recommendations.
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HIV Prevention England conference
The HIV Prevention England conference took place on 30 September.
Florence Eshalomi MP, Co-Chair of the All-Party Parliamentary Group on HIV & AIDS spoke at the opening of the conference, setting out four next steps. She called for: action on monkeypox; opt-out HIV testing in all high-prevalence areas; PrEP provision in primary care; and the publication of the Sexual Health Strategy with more funds for sexual health services.
Dr Caroline Johnson MP gave the keynote speech – her first speech since being appointed as Minister for Public Health and Mental Health.
Slides from presentations given at the conference will soon be available on the HIV Prevention England website.
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Half of teachers not confident teaching RSE
A survey by teachers' union NASUWT and children's charity NSPCC has found that almost half of secondary school teachers (46%) do not feel confident about teaching relationships and sex (RSE) education.
RSE is now a compulsory part of the curriculum in England. The majority of respondents (86%) said they need more resources and training.
NSPCC has launched an online course for teachers, alongside 14 lesson plans and a helpline for teachers with questions or concerns around safeguarding.
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Preptrack expands language options
Preptrack is a free UK-based app which aims to support HIV prevention by reminding users when they need to take PrEP medication.
Funding from Public Health Wales has contributed to it now being available in Welsh, and a joint project with London Metropolitan University means it will also be available in French, Italian, Polish, Romanian and Spanish.
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Sexual Health Week
Sexual Health Week was postponed from its original September date and is now running this week: 10-16 October. The 2022 theme is breaking barriers. Brook, the sexual health and wellbeing charity, has a calendar of online and live events, new free resources and exciting collaborations to raise awareness of the barriers people face when accessing sexual health and wellbeing services.
Brook has developed a campaign toolkit and is encouraging everyone to get involved in Sexual Health Week and be creative in interpreting this year's theme.
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Survey: unmet sexual health need
THT is conducting a survey on unmet sexual health need in the UK. They are hoping to hear about how people make decisions about their sexual health and how they use services. Anyone completing the survey will be entered into a prize draw.
Additionally, THT is looking for people to take part in one-to-one interviews. These will take around an hour and participants will be paid £25 for their time. Anyone interested should contact daniela.basuta-hone@tht.org.uk
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Survey: Cervical cancer elimination in the UK
Jo’s Cervical Cancer Trust is asking for views on the opportunities and challenges the UK faces in eliminating cervical cancer.
The short survey is for anyone working in a role related to the prevention or treatment of cervical cancer. This includes immunisation teams, sexual health, general practice, laboratory or colposcopy services and those working in cancer services. It also includes commissioners, researchers, and those working in health policy.
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BHIVA Autumn Conference
The BHIVA Autumn Conference will be held on 25 November in London.
This year it takes a multi-disciplinary approach, involving organisations including the National HIV Nurses Association, the HIV Pharmacy Association and the Children's HIV Association.
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HIV Glasgow conference
The HIV Glasgow conference is taking place as an in-person and online meeting from 23-26 October. NAM aidsmap will be reporting research news from the conference.
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Student essay prize
The FSRH Undergraduate Student Essay Prize 2022 is open for applications until 3 November.
The competition encourages medical undergraduates to engage with new ideas on sexual and reproductive health.
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New FSRH president
The new FSRH President, Dr Janet Barter, took up her role in September. FSRH CEO Gary Waltham said: “We’re delighted to be working with Janet as our new President. Janet has an incredible track record of dedication to the Faculty and to the field of sexual and reproductive healthcare, and her strategic direction will be invaluable as we go forward with our strategy of striving for high quality SRH for all”.
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Leadership changes at THT
Ian Green will step down as Chief Executive of THT early next year, once his successor has been recruited.
Dr Kate Nambiar has been appointed as THT’s new Medical Director, taking over from Dr Michael Brady. Dr Nambiar founded Clinic-T, a sexual health and contraception clinic led by and for trans and non-binary people in Brighton, in partnership with THT, and currently works as a Gender Clinician and Endocrinology Specialist at the Welsh Gender Service in Cardiff.
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The Sexual Health & HIV Policy eBulletin was originally developed and published by MEDFASH.
It is compiled and edited by Greta Hughson on behalf of FSRH and coalition partners. If you have any comments on the eBulletin or eFeature or suggestions for topics you would like to see covered in future eFeatures please get in touch (ebulletineditor@fsrh.org).
You can access previous eBulletins and eFeatures via the links below:
> eBulletin archive (from 2017) > eFeature archive (MEDFASH/FSRH)
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FSRH and coalition partners do not accept responsibility for the content of linked websites/items included in this eBulletin and do not necessarily endorse the views expressed within them.
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