Two years ago Terrence Higgins Trust partnered with the British Association for Sexual Health and HIV (BASHH) to release the State of the Nation report. It provided a snapshot of our sexual health in England and focused on where unacceptable barriers and challenges still exist - including around inequality. The ability to access sexual health information and services is a key requirement for individuals and society to maintain wellbeing. For many years there has been a lack of ambition to proactively improve the sexual health of the population at a national level. To address this, a key recommendation in the report was the need for an inclusive national sexual and reproductive health strategy for England. This strategy was committed to by the UK Government in October 2019, but well over two years later we have seen little progress towards its publication.
The COVID-19 pandemic has of course had an impact. However, the pandemic also shone a light on the inequalities that are also at the heart of vulnerability to poor sexual health across the country. The full impact of the pandemic on wider public health is yet to be fully understood. But we do know that if the sexual health of the nation is to improve we need a fully funded and inclusive sexual and reproductive health strategy now more than ever.
Before the pandemic, the rates of many sexually transmitted infections (STIs) were soaring. Gonorrhoea was at its highest level since the end of the First World War and syphilis had increased threefold in less than 10 years.
With COVID-19 impacting access to testing and reducing sexual contact, decreases in STIs were seen in 2020. Although the UK Health Security Agency are clear that STIs are still circulating at a high rate, there is a real opportunity to take advantage of the disruption COVID-19 caused and step up action to keep STIs in check.
For this to happen the strategy must address key areas. For instance, the priority for tackling chlamydia, by far the most common STI, has been downgraded by Government. The National Chlamydia Screening Programme will now only test young women, with the aim of the programme no longer to prevent infections but rather to prevent the worst outcomes in women such as pelvic inflammatory disease and infertility.
This lack of ambition around sexual health comes at a time when there should be no room for complacency. New STIs such as MGen are emerging and antibiotic resistance is ever on the rise. Already this year we have seen transmission within London of a strain of gonorrhoea resistant to the antibiotic ceftriaxone (the last remaining treatment for gonorrhoea), as well as an outbreak of extensively drug-resistant sexually transmitted shigella.
COVID-19 has disrupted sexual health services with access severely curtailed. BASHH are clear that more action is needed to support sexual health services to meet the high levels of demand that they still face, as well as the need for a clear plan for the sexual health workforce – both now and in the future. And, as always, there is the question of investment. With no real increase in funding for local government public health budgets (that pay for sexual health services) announced in last year’s spending review, where will the funding come from for the much-needed injection of cash into the sexual health system?
A national sexual and reproductive health strategy must have equality at its heart. The impact of STIs is not uniform, with young people, gay and bisexual men and certain racially minoritised groups being disproportionally affected. STIs are highly stigmatised and being vulnerable to poor sexual health can have a lasting impact on both your physical and mental wellbeing.
The publication of the sexual and reproductive health strategy is keenly awaited and must be released as a matter of urgency. However, without the meaningful engagement of civil society and community organisations as part of its development, there is a danger that the strategy will fall short in meeting the needs of those who need it most. As it did with the recent national HIV Action Plan, we are calling on the Government to fully engage with sexual and reproductive health community organisations to help shape a world-leading and fully inclusive sexual and reproductive health strategy that works for all in society.