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eFeature
A new campaign for National HIV Testing Week
Takudzwa Mukiwa is Head of Social Marketing at the Terrence Higgins Trust (THT) and leads the annual National HIV Testing Week campaign for HIV Prevention England. National HIV Testing Week is underway right now, running from 6-12 February.
In this month’s eFeature, Taku introduces the new campaign, ‘I test’, and explains why and how it was developed.
Read full eFeature
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Policy development & guidance
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Addressing the SRH nursing workforce crisis
Ruth Bailey is an Advanced Nurse Practitioner in Sexual Health in Brighton, and is also Nurse Representative on the FSRH Council. She recently addressed MPs and policymakers at the All Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH) on the nursing workforce issues that impede delivery of sexual and reproductive healthcare (SRH).
In a blogpost for the FSRH website, Ruth sets out these issues and the actions needed to address them. These include: accountability for safe staffing levels; investment in the nursing workforce; parity for nurse pay, terms and conditions including standardised contracts in primary care; commissioning SRH education including backfill for learners; and structured career development that rewards advanced practice.
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Responding to the Hewitt review
The Rt Hon Patricia Hewitt is leading an independent review into the oversight and governance of Integrated Care Systems (the Hewitt review).
FSRH and RCOG responded to the Hewitt review consultation, focusing on the need for the health system to enable women to have improved access to holistic SRH. This means integrating care around the needs of the individual, not institutional silos.
The final report from the Hewitt review is due in March.
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Consultation in Northern Ireland
The Department of Health in Northern Ireland has opened an Equality Consultation on the National Institute for Health and Care Excellence (NICE) guideline on reducing sexually transmitted infections (NG221).
The guidance is locally reviewed for applicability to Northern Ireland and is not a reassessment of clinical or cost evidence. The consultation is open until 10 March.
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Legal challenge against RSE in Wales fails
The High Court has ruled that compulsory relationships and sexuality education (RSE) in Wales is legal. A challenge was brought by a campaign group aiming to stop compulsory RSE lessons.
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Evidence, data & research
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Mother-to-child transmission of hepatitis B eliminated in England
The UK Health Security Agency (UKHSA) announced last week that England has met the World Health Organization criteria for elimination of mother-to-child transmission of hepatitis B virus.
It estimates that 206,000 people are living with chronic hepatitis B infection in England. Since the 1990s, pregnant women have been offered antenatal screening for hepatitis B, alongside HIV and syphilis.
In addition to targeted infant vaccination when women test positive, in 2017 the UK introduced universal infant hepatitis B immunisation at 8, 12 and 16 weeks.
Hepatitis B vaccination is also encouraged for groups who may be at higher risk of exposure to the virus; including gay, bisexual, and other men who have sex with men, people who inject drugs, sex workers, and people in prison settings or immigration detention centres.
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Cervical screening and HPV vaccination rates down
To coincide with Cervical Cancer Prevention Week in January, the NHS issued a plea to women to come forward for cervical screening. Statistics from NHS England show that nearly a third of people eligible for cervical screening have not been screened – around 4.6 million across England.
UKHSA also published statistics on human papillomavirus (HPV) vaccination, which show that vaccine coverage among secondary school pupils is down.
HPV vaccination and cervical screening are key tools in eliminating cervical cancer. Jo’s Cervical Cancer Trust published a report in January setting out the opportunities and challenges in ending cervical cancer in the UK. Workforce pressures and inequalities in the uptake of HPV vaccination and cervical screening were identified as the biggest challenges. HPV self-sampling was thought to be the biggest opportunity.
Dr Ranee Thakar, President of RCOG, said, “The report sets out key opportunities to reduce inequalities and actions to tackle cervical cancer [...]We join Jo’s Trust in calling for Government action to embrace these opportunities and eliminate cervical cancer in the UK.”
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Reproductive health indicators updated
The Office for Health Improvement and Disparities (OHID) has updated the sexual and reproductive health profile indicators, used in local and national datasets. The updated indicators include those relating to abortion and contraception.
The latest profile statistics show that demand for Long-Acting Reversible Contraception (LARC) has increased, with 37.3% of women aged under 25 and 53.4% of women aged over 25 citing a form of LARC as their main method of contraception. This is an increase of 35.1% for under 25s and 22.8% for over 25s since 2019.
However, although demand for LARC is increasing, provision within SRH services and GP practices has not yet returned to pre-pandemic levels. The reduced provision of LARC within GP practices is disproportionately affecting women from deprived backgrounds.
Dr Janet Barter, President of FSRH said, "It is concerning to see that Long-Acting Reversible Contraception (LARC) provision is not yet back at even pre-pandemic levels, despite increasing demand. Access to the full range of contraceptive methods, including LARC, is a fundamental right. A combination of funding cuts and fragmented commissioning services means that care is not structured around women’s needs, negatively affecting access to essential healthcare."
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Funding SRH research
FSRH has announced that it will invest directly in SRH research this year. Working in partnership with Wellbeing of Women, FSRH will co-fund two entry-level scholarships.
The awards will fund pre-doctoral researchers in an SRH project. They are intended to enable SRH professionals to have exposure to a research environment and potentially enhance an application for a research fellowship (PhD or MD). More details about the awards process will be available later in the year.
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Births in England and Wales
The Office for National Statistics (ONS) has released its latest summary data tables relating to live births and stillbirths in England and Wales in 2021. The data include births by sex, age of mother, whether in a marriage or civil partnership, percentage of non-UK-born mothers, birth rates, and births by mothers' area of usual residence.
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CQC publishes annual maternity survey
The Care Quality Commission (CQC) recently published its annual maternity survey, based on the experiences reported by people who gave birth in February 2022. Overall, at a national level, people's experiences have deteriorated in the last five years.
Responding to the results, RCOG welcomed findings of improvements in maternal mental health support, and that most respondents (80%) said midwives 'always' listened to them at their antenatal check-ups.
However, it acknowledged the fall in levels of satisfaction, and highlighted the significant issue of workforce shortages in the NHS and the impact this is having on people's experiences of care.
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Access to injectable HIV medication
The British HIV Association (BHIVA) conference heard three presentations from the National HIV Nurses Association (NHIVNA) describing the difficulties in accessing injectable antiretroviral therapy.
Delegates heard that the criteria for injectables were so strict that very few patients are eligible for them, although they might benefit from access.
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Preconception health of migrant women
OHID has published an analysis of preconception indicators among women who are likely to be migrants.
The analysis is designed to increase understanding of health inequalities experienced by mothers in this group. It includes social factors, previous pregnancy-related conditions, health conditions, and behaviours.
OHID says the analysis can be used to inform work to improve the health of migrant women preparing for pregnancy, during pregnancy and between pregnancies.
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Progress report on the Women’s Health Plan Scotland
The Women’s Health Plan was published by the Scottish Government in August 2021. It aims to improve health outcomes and services for women and girls in Scotland, with an intersectional approach and focus on reducing inequalities.
The six priority areas are menopause, menstrual health, endometriosis, abortion and contraception, postnatal contraception, and heart health.
In January, a report was published setting out progress against the short- and medium-term actions in the plan.
Good progress has been made in all the priority areas. Of particular note, all community pharmacies in Scotland are now able to provide access to a three-month supply of bridging contraception (a short-term supply of contraception which bridges the gap between emergency and longer-term contraception) following a consultation with a pharmacist.
Other updates include new online resources on menopause and menstrual health and the launch of a £250,000 research call to improve treatment and management options for endometriosis.
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Women’s Health Champion for Scotland appointed
A key action for the Women’s Health Plan was to appoint a Women’s Health Champion; last month the Scottish Government announced that Professor Anna Glasier OBE has been appointed as the first Women's Health Champion for Scotland. Professor Anna Glasier is a world expert on emergency contraception and a leading figure in women’s health and sexual and reproductive health.
Her role will support progress on the Women’s Health Plan, working with partners in the public and third sectors. Anna said, "I am honoured to have been invited to champion Women's Health in Scotland and am eagerly looking forward to starting in the role and making progress with the medium- and longer-term actions".
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Updates from the APPG SRH
The APPG SRH recently shared an update on its activities over the past year. It reflected on key events in SRH in 2022, including success in supporting telemedicine for early medical abortion and commissioning abortion services in Northern Ireland.
The APPG SRH will hold its next meeting in Parliament on 7 March, looking at the findings of the SACHA study, a large research project on abortion care.
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Menopause and the workplace
The Women and Equalities Committee, appointed by the House of Commons, published a report on menopause and the workplace in July 2022. In January, the Government published its response, setting out which recommendations it does and does not accept.
The response rejects five of the recommendations altogether and the Committee responded in turn, saying it was a "missed opportunity to protect vast numbers of talented and experienced women from leaving the workforce."
The British Menopause Society (BMS) said, "Whilst we recognise that some of the responses could be disappointing, the BMS believes that these discussions overall, are likely to have a positive effect on the provision of menopause care in the UK.”
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Service standards & guidelines
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New guidance on contraception and HIV treatment
The FSRH Clinical Effectiveness Unit (CEU) has published new guidance on drug interactions between HIV antiretroviral therapy (ART) and contraception.
The guidance includes summaries of the evidence available to inform understanding of drug-drug interactions between ART and contraception, and quick reference tables that provide information on interactions for each contraceptive method.
Key messages include that there are many safe and effective contraception options for people living with HIV; and that healthcare providers should check for potential interactions between contraceptives and individual components of someone's ART regimen.
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BHIVA position statement on mixed infant feeding
BHIVA has issued an interim position statement on HIV and mixed infant feeding.
When someone is living with HIV, BHIVA recommends that babies are fed exclusively with formula milk, to minimise any risk of HIV transmission. However, should someone who has suppressed virus and good adherence to treatment choose to breast/chestfeed, BHIVA's position is that they should be supported to do so.
This interim statement provides guidance on when and how breast milk may be supplemented with formula milk, based on expert opinion following a review of available evidence. Fuller information will be provided in upcoming guidance on managing HIV in pregnancy and postpartum.
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Updated service standard for resuscitation in SRH services
FSRH’s Clinical Standards Committee (CSC) has published an updated Service Standard for Resuscitation in Sexual and Reproductive Healthcare Services, in partnership with the Resuscitation Council UK.
The standard is applicable to resuscitation after collapse during or following a clinical procedure, anaphylaxis to administered medication or provoking agent and collapse related to an underlying medical condition.
The document includes updated Resuscitation Council guidance and updated FSRH guidance on contraceptive choices for women with cardiac disease.
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Reports & other resources
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Report highlights need for safe access zones
FSRH and RCOG have published a report highlighting the need for safe access zones to be introduced around UK abortion clinics, to prevent intimidation and harassment of patients and staff.
Current legal protections are failing to prevent harassment at abortion clinics. The report details the impact that protest activity has on those accessing abortion care.
Protests can also negatively affect the wellbeing of healthcare professionals trying to deliver essential, legal healthcare. One staff member at a clinic in Bournemouth said:
"As staff coming into work it makes it very intimidating parking and walking past protesters. They have followed me to my car before – shouting ‘murderer’ at me. It just fills you with dread leaving and arriving to work."
Last week, peers in the House of Lords passed an amendment to the Public Order Bill to put in place buffer zones around all abortion clinics in England and Wales.
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BMA MEDFASH prize
The British Medical Association (BMA) Foundation is awarding a prize named after MEDFASH, the independent charity dedicated to improving the quality of HIV and sexual health care that ran from 1987 to 2016.
A prize of £2000 will be awarded to a health or social care organisation which has improved the quality of HIV or sexual health care in the UK. Applications must be submitted by 3 March 2023.
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Nurse-led PrEP delivery
In a letter to The Lancet HIV, staff at the 56 Dean Street sexual health clinic in London highlight that a multidisciplinary team approach to providing HIV pre-exposure prophylaxis (PrEP) has been successfully implemented.
At the clinic, nurses, health advisers and pharmacists can initiate and monitor PrEP and consultants support the team. In 2021, there were 40,950 PrEP consultations at 56 Dean Street, of which 37,189 (90.8%) were conducted by nurses.
The authors say the data show that "task-sharing of PrEP provision predominantly by nurses can provide PrEP at high volume, which could not be delivered by medical doctors alone."
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Health & Power
On 30 January, NAM aidsmap launched a new monthly broadcast about health inequalities experienced by people of colour.
Health & Power is hosted by NAM aidsmap's Susan Cole and sexual health and HIV consultant at Barts Health NHS Trust, Dr Vanessa Apea. Each month, Susan and Vanessa will be joined by two guests. Their guests in the first episode were Professor Kevin Fenton, Public Health Director for London, and Professor Bola Owolabi, Director of Healthcare Inequalities at NHS England.
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Mpox (monkeypox) and HIV
NAM aidsmap has published new online information on mpox (monkeypox) and HIV. The information covers transmission of mpox, its symptoms, prevention, vaccination, and treatment.
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Expertise around child sexual abuse
The Centre of Expertise on Child Sexual Abuse (CSA Centre) is running a series of free hour-long webinars to introduce professionals to using its resources in practice.
Three sessions (18 April, 7 June, 9 August) will focus on spotting the signs and indicators of child sexual abuse. Three further sessions (18 May, 5 July, 21 September) will look at speaking to children about sexual abuse.
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Funding uncertainty for public health services
The Local Government Association (LGA) is calling on the Government to urgently publish the Public Health Grant funding allocations which councils will receive from April. The clock is ticking for councils to set budgets and make decisions on renewing contracts for public health services.
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National HIV Testing Week
This year's National HIV Testing Week is underway now, running from 6-12 February.
It is a campaign to promote regular testing among the most-affected population groups in England. Regular testing helps to reduce the number of people living with undiagnosed HIV and those diagnosed late.
For the first time, free HIV home tests are available across England to mark the campaign.
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Call to extend opt-out testing in emergency departments
NHS England has introduced ‘opt-out’ HIV testing in emergency departments in London, central Manchester, Brighton and Blackpool. Where bloods are being taken, patients are also tested for hepatitis B and C, with impressive results. In the first nine months, 360 people were newly diagnosed with HIV or re-engaged in care. For hepatitis C, 269 people were newly diagnosed and 44 returned to care, and for hepatitis B, the numbers are higher again: 675 and 52 respectively. The model works and is saving lives and saving money.
BHIVA has co-signed an open letter calling for immediate expansion of testing in emergency departments to Public Health Minister Neil O’Brien and NHS Chief Executive Amanda Pritchard, from the Chief Executives of THT, National AIDS Trust, Elton John AIDS Foundation, British Liver Trust and Hepatitis C Foundation, and also supported by other leading organisations.
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'Fighting HIV stigma and proud': march, vigil and rally
On Saturday 18 March, thousands of people living with, affected by, or working in HIV will be brought together in a central London march to challenge continuing stigma and negative perceptions. With the theme: ‘HIV has changed — but the stigma surrounding the virus hasn't’, the event is supported by more than 30 national HIV organisations.
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New BHIVA Chair
BHIVA has announced that Professor Yvonne Gilleece has been appointed Chair, taking over from Dr Laura Waters on 20 January.
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New Chief Executive for Public Health Scotland
Public Health Scotland has appointed a new Chief Executive, Paul Johnston, who will take up post in the spring. It follows the retirement of the current Chief Executive, Angela Leitch.
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New Chief Executive for THT
Richard Angell has been appointed as the new Chief Executive of THT and will take over on 1 March when current CEO, Ian Green OBE, steps down. Richard is currently Campaigns Director at THT.
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Mpox and sexual health funding awarded
UKHSA has announced that 14 projects have received short-term funding for engagement and outreach activities aimed at reducing inequalities in sexual health across England.
The projects range from offering vaccinations in community settings to developing an mpox cartoon strip.
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BASHH Spring Conference
The British Association for Sexual Health and HIV (BASHH) has announced that its Spring Conference will be held in Llandudno, 26-28 June. The deadline for abstracts is 31 March.
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CHIVA Conference
The 17th Annual Children’s HIV Association (CHIVA) Conference will take place on Friday 17 March 2023, as a hybrid event.
The conference will explore different issues around perinatally acquired HIV, from infant feeding to adolescent services to ageing with HIV and what this means for younger people.
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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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