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September 2018 
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 Sexual Health, Reproductive Health & HIV Policy eBulletin
Supporting those working for high quality sexual health, reproductive health and HIV services 

 Welcome 


27 September 2018  (Issue 49)

Welcome to the September issue of the Sexual Health, Reproductive Health & HIV Policy eBulletin. Last week the Advisory Group on Contraception (AGC) reported findings from its 2018 Freedom of Information (FOI) audit to all 152 Local Authorities in England, showing almost half of all councils have reduced or closed sites delivering contraceptive services since 2015. At the beginning of the month the Local Government Association (LGA) also reiterated that some council’s sexual health services are ‘stretched to the limit… with a real risk of increased waiting times and deteriorating patient experience’. Key organisations, including Faculty of Sexual and Reproductive Healthcare (FSRH) and Association of Directors of Public Health (ADPH) have pointed to evidence that investing in contraceptive services delivers a return on investment and warned that cuts to the public health budget must be reversed to enable council's to continue to protect and improve the public's sexual and reproductive health (see full item on ACG report below).

Key parliamentary select committees have also been busy over the past two months with announcements that the Health and Social Care Select Committee will be conducting a new inquiry into sexual health and the Women and Equalities Select Committee will be undertaking inquiries into abortion law in Northern Ireland and into the health and social care needs of LGBT communities.

Other items to look out for in this month’s issue include: the Government announcement that it will legalise the home-use of the abortion drug misoprostol in England by the end of the year; publication of 2017 HIV data confirming that new HIV diagnoses in the UK are at the lowest point since 2000, having fallen for a second year in a row; a new contraceptive services Return on Investment (ROI) tool from Public Health England (PHE) providing evidence that every £1 spent on contraceptive services saves £9 across the public sector; and results of an FPA survey on sexual consent published as part of Sexual Health Week (this week! 24-30 September).

In the  eFeature this month, two young people, Toby and Elise, give us their take on the DfE’s new draft guidance to support the introduction of compulsory RE in primary schools and RSE in secondary schools.

Finally, thanks to everyone who completed the eBulletin survey - we will be reviewing your feedback in the next few weeks.

Please forward the eBulletin to colleagues and networks who may find it useful and may want to subscribe to it on a regular basis

eFeature


The Department for Education (DfE) consultation on new draft guidance to support the introduction of compulsory Health Education, Relationships Education (RE) in primary schools and Relationships and Sex Education (RSE) in secondary schools draws to a close at the beginning of November.  In this month’s eFeature we hear from two young people, Toby and Elise, aged 17 and 16.  Toby and Elise give candid accounts of their own experience of sex education as well as their views on what they consider to be important elements of the draft guidance. Both are hopeful that the changes will mean young people across the country will be better supported to enjoy safe, healthy and happy relationships.

Toby and Elise have been actively involved with Brook and other sexual health organisations, helping to develop the Brook/Family Planning Association’s (FPA) Young People’s Manifesto on RSE, presenting their views on RSE in Parliament and more recently working with Brook and the Terence Higgins Trust (THT) on the draft guidance.
>Toby & Elise eFeature
 

Policy development and guidance

Government approves home-use of early medical abortion pill


The Government has announced that it will legalise the home-use of misoprostol in England by the end of the year.  Under the plans, women will be able to choose whether to administer misoprostol, the second drug used to effect an early medical abortion, at home rather than at a clinic. The decision has been widely welcomed by medical bodies and other campaigners and follows similar moves in Scotland and Wales.  The Department of Health and Social Care (DHSC) has indicated that it will work closely with partners to implement this change quickly and safely, including developing clinical guidance for all professionals to follow when providing the treatment option to women.
View DHSC press release
See FSRH & RCOG response
FPA response
BPAS response

Outcome of review into harassment and intimidation outside abortion clinics


The Secretary of State for the Home Department, Sajid Javid, has confirmed that the Government will not be introducing national buffer zones to deal with the harassment and intimidation women face while accessing abortion services.  The Secretary of State said the Government acknowledged the negative impact these activities can have, but that introducing national buffer zones would not be a proportionate response at this stage.  The Government will publish information on the current legal remedies – such as Public Spaces Protection Orders – that are available to councils to tackle the issue locally and will keep the matter under review. Ealing Council, which introduced the first UK safe zone outside one of its clinics in April, fear the decision to leave action in the hands of local areas could lead to a postcode lottery where some women are protected and others are not.
See written statement to Parliament
Joint RCOG/FSRH statement
BPAS statement
FPA statement
Ealing Council statement

Contraceptive Services Audit report 


The Advisory Group on Contraception (AGC) has recently published findings from its 2018 Freedom of Information (FOI) audit of all 152 upper tier local authorities in England. The findings indicate an increase in the number of councils reducing sites delivering contraceptive services and a year-on-year reduction in spending on sexual and reproductive health services. Nearly  half of all local councils (49%) have reduced, or plan to reduce, the number of sites commissioned to deliver contraceptive services since 2015 and two-thirds have cut their SRH budget since 2016/17. Sexual and reproductive health organisations, including FSRH, FPA and Brook, have raised serious concerns about the impact of these continuous cuts on women and contraceptive services.
See AGC report
ADPH statement
FSRH statement

Commentary on DfE draft guidance on Health Education  and RSE


Both the Sex Education Forum and the PSHE Association have given useful overviews of the draft guidance on compulsory Health Education and RSE currently out for consultation until 7 November.  All those working in this area are encouraged to respond to the consultation.
Read SEF article
Read commentary from PSHE Association

High Court ruling on HIV drug Truvada 


The UK High Court has overturned Gilead’s patent extension on Truvada, the HIV drug used for pre-exposure prophylaxis (PrEP).  The decision will mean that unbranded, generic versions of the drug can be legally supplied and will have a significant impact on cost and affordability.  HIV organisations have welcomed the ruling and urged NHS England to consider the routine commissioning of PrEP.
NAT response
THT response

Parliament

New Sexual Health inquiry


The Health and Social Care Select Committee has launched an inquiry into sexual health in England. The inquiry will cover the commissioning and delivery of sexual health and contraception services, standards, prevention, workforce and funding, as well as action at national and local level to improve sexual health and sexual health services. The Committee has put out a call for written submissions from interested stakeholders, with a deadline of 1 October 2018.
Read HSC Committee news release about the inquiry
Access the written submission form
See statement from BASHH

Abortion law in Northern Ireland inquiry


The Women and Equalities Select Committee has launched an inquiry into abortion law in Northern Ireland (NI).  The inquiry will seek evidence on the experiences of women who have tried to access abortion care in NI as well as the views of the public, women, and medical and legal professionals in NI on current law and potential reform.  It will also consider the responsibilities of the UK Government for taking action to reform abortion law in NI.  The deadline for submission is 10 December 2018.
Read parliamentary news release on the inquiry
Access written submission form

Health and social care and LGBT communities inquiry  


The Women and Equalities Committee has also recently launched an inquiry to consider whether the health and social care needs of lesbian, gay, bisexual and transgender (LGBT) people are being met effectively.  The Committee will consider LGBT health inequalities and discrimination in health and social care services, as well as identify priorities for the new National Adviser for LGBT healthcare announced in the Government’s recent LGBT Action Plan. Written submissions from interested stakeholders should be with the Committee by 5 October 2018.
Read the news release on the inquiry
Access the written submission form

Infected Blood Inquiry


Preliminary hearings opened earlier this week for the independent public statutory inquiry into the use of infected blood. The Inquiry will examine a number of key issues including why men, women and children in the UK were given infected blood and/or infected blood products; the impact on their families; how the authorities (including government) responded and the nature of any support provided following infection. Click the link for more information.
Infected Blood Inquiry website

Sexual harassment in education: briefing paper


The House of Commons Library has published a briefing paper on sexual harassment in education. The briefing gives an overview of the relevant policies that schools are expected to have in place and recent policy developments in England. It covers: keeping children safe in education guidance; advice for schools on sexual violence and harassment; behaviour and bullying policies and relationships and sex education and PSHE.
Download briefing paper from parliamentary website

Service standards & guidelines 

NICE Quality Standard on Sexual Health consultation


The consultation period for the draft quality standard for sexual health closed on 20 September 2018.  The quality standard covers sexual health across the lifecourse with a focus on reducing sexually transmitted infections (STIs).  It does not cover contraception for the prevention of conception or harmful sexual behaviour.  The final quality standard is due to be published in February 2019.
View draft Quality Standard for Sexual Health
Access related documents on NICE website

NICE Quality Standard consultation on School-based Interventions


NICE has opened a consultation inviting comments on their draft quality standard that assesses interventions in primary and secondary education to promote the health and mental wellbeing of children and young people. The consultation closes on 9 October 2018.
Get more information from NICE website
View draft Quality Standard

NICE Quality Standard on Endometriosis


NICE has recently published a new quality standard on endometriosis. The standard covers diagnosing and managing endometriosis in women, including young women aged 17 and under. It describes high-quality care in priority areas for improvement.
View Quality Standard on NICE website

Draft Standards for Online and Remote Providers of SRH Services


FSRH and the British Association for Sexual Health & HIV (BASHH) have jointly developed pioneering draft standards in response to the rapid expansion of providers of online Sexual Health (SH) and Sexual and Reproductive Health (SRH) services throughout the UK. The Standards are to be used as a benchmark for all providers of online SH & SRH services and as a tool for the commissioning of these services.  The draft standards are out for consultation until 2 October 2018.
View Draft Standards
Consultation Feedback Form

Service Standards for Medicines Management in SRH Services 


FSRH has published an updated version of their service standards for medicines management in SRH services.  The updated version includes practical guidance on how to maintain safety, cost-effectiveness and security in relation to medicines management and includes standards on remote and online prescribing.
Download the updated Standards from the FSRH website

Service Standards on Obtaining Valid Consent in SRH Services

FSRH has also published updated service standards on obtaining valid consent in SRH services to coincide with FPA’s consent-themed Sexual Health Week.  The standards are designed to assist health professionals working in the field of sexual and reproductive health service provision. Essential areas covered include training in seeking and obtaining valid consent, explaining risks to patients, treatment of children and young people and advice and consent for multimedia and education purposes.

Download the Standards from the FSRH website
FSRH blog on updated standards

Evidence, data & research 

Annual HIV data release


Annual data published by PHE on 4 September show that new HIV diagnoses in the UK are at the lowest point since 2000, having fallen for a second year in a row. The report - Trends in new HIV diagnoses and people receiving HIV-related care in the UK: data to end of December 2017 - reveals that new diagnoses decreased by 17% in 2017.  The reduction was concentrated in gay and bisexual men and is mainly attributed to a combination of increased testing rates and improved uptake of treatment.
View PHE press release
See annual report
Response from BHIVA
Response from THT
Response from NAT

Tuberculosis in England: 2018 


PHE has published its annual report of tuberculosis (TB) in England, presenting data to the end of 2017. The report reveals that the number of people in England diagnosed with TB is at its lowest level since 1990, with a 9% fall in diagnoses between 2016 and 2017.  The report covers TH-HIV co-infection and HIV testing.
See PHE press release
View report

Spotlight reports on STIs: 2017 data


PHE has published spotlight reports for 2017 data for sexually transmitted infections in East of England, South-East and London.
See East of England report
See South East report
See London report

Quarterly conceptions to women aged under 18 (Quarter 2, 2017)


Data for the number of conceptions to women aged under 18 in England and Wales for the second quarter of 2017 were released by the Office of National Statistics (ONS) on 28 August 2018. For England, there has been a 5.7% reduction from a rate of 19.3 per 1,000 women aged 15 to 17 (4,355 conceptions) in the second quarter of 2016 to 18.2 (4,030 conceptions) in the same quarter in 2017. The North West was the only region to show an increase in the quarterly rate compared with the previous year. There is still significant regional variation, with decreases ranging from 15.6% in the East Midlands to 1.3% in the South East. 
See Q2 conception data on ONS website
FSRH press statement

Contraceptive Services Return on Investment (ROI) Tool


PHE has published a contraceptive services ROI tool to help policy-makers and commissioners understand the relative value of spending in this area compared to other public health interventions.  The tool comes with an accompanying analysis report detailing how the tool was constructed and presenting the main results, including that for every £1 invested in contraceptive provision in England there is a £9 saving over a ten year period.
View ROI Tool
See economic analysis report

Reports & other resources

Health Profile for England 2018


PHE has recently published a new Health Profile for England report, giving a comprehensive picture of health in England today and into the future. The profile covers life expectancy, major causes of death, mortality trends, child health (including teenage pregnancy), inequality in health, wider determinants of health and current health protection issues (including HIV and other STIs).
View PHE press release
See full report

New booklet: A long life with HIV


NAM aidsmap has produced a new booklet that provides information on living well with HIV as you get older. A long life with HIV is part of our Living with HIV as you get older range of resources and includes chapters on HIV and your health, health issues, things you can do to look after your health and preparing for the future. 
View the booklet on the NAM aidsmap website

Campaigns & other news 

Sexual Health Week 2018: 24-30 September 


Sexual Health Week is happening now – between 24 and 30 September.  The focus this year is on consent.  As part of the week, FPA have published results of a survey on attitudes about sexual consent.  It has also produced digital resources for educators as well as posters and leaflets on consent and advice for parents and teachers on how to discuss consent with young people. 
View SHW 2018 page on FPA website
Results of survey on attitudes towards consent
Downloadable resources

Other UK countries 

New cervical smear tests rolled out across Wales


The Welsh Government has announced that all smear tests in Wales will look for the presence of high-risk strains of the human papillomavirus (HPV) which cause 99.8 per cent of cervical cancers. Wales is the first UK nation to fully adopt high-risk HPV testing as the first test done on every cervical screening sample. It is being coordinated by Cervical Screening Wales, part of Public Health Wales.
View news release from NHS Wales

Interim report: Pre-exposure prophylaxis for HIV provision in Wales


Health Boards in Wales started providing Pre-Exposure Prophylaxis (PrEP) in July last year through sexual health clinics as part of a three-year study.  This interim report provides an overview of the reported PrEP activity in Wales covering prescription, adherence and acceptability up to the end of June 2018.  No new cases of HIV have been reported in those who started taking PrEP during this period.
See Public Health Wales press release
View interim report

HIV and STI trends in Wales: Surveillance Report, September 2018


The latest sexually transmitted infections (STI) annual report from Public Health Wales shows an increase in the number of STIs diagnosed in Wales, with a total of 12,852 diagnoses in 2017.  There was a 53% increase in cases of syphilis and a 21% increase in diagnoses of gonorrhoea.
View news release from Public Health Wales
Read surveillance report

Judicial review on decision to prosecute NI mother


The High Court of Justice in Northern Ireland has begun hearing a judicial review brought forward by a mother who is facing criminal prosecution for procuring abortion medication for her teenage daughter. A coalition of charities, the FPA, the British Pregnancy Advisory Service (bpas), and the Abortion Support Network (ASN) are intervening in support of the mother’s application. The charities argue that a prosecution in these circumstances would deter women from seeking medical advice if needed because they may fear that they would face criminal punishment and would have a detrimental impact on clinician-patient relationship. 
View press release on FPA website

International

The health and well-being of men in the WHO European Region: better health through a gender approach


This recent report from WHO Europe gives the first overview of men’s health in the Region.  It looks at what lies behind men’s risk-taking and health-seeking behaviour, and emphasises that improving men’s health and wellbeing is best addressed within a gender equality framework.
See WHO news release
View full report
See fact sheet

Situation of child and adolescent health in Europe


This WHO report focuses on several areas where there are concerns about health outcomes for children and adolescents and provides insight into ways in which countries can improve the situation. Areas in focus include mental health, adolescent risk-taking behaviour and sexual and reproductive health.
See WHO news release
Full report

International Safe Abortion Day 2018: 28 September 


International, national and grassroots organisations undertake a range of advocacy activities each year on 28 September as part of a campaign to promote universal access to safe and legal abortion.  This year’s theme is Normalise Abortion: It’s part of our lives.
2018 Campaign Toolkit

The Sexual Health, Reproductive Health & HIV Policy eBulletin was originally developed and published by MEDFASH. 

It continues to be compiled and edited by Helen Christophers 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 (MEDFASH)
> eFeature archive (MEDFASH/FSRH)

Please forward this eBulletin on to colleagues and networks who may be interested. If you have been forwarded a copy of the eBulletin and would like to receive it on a regular basis please sign up here 
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.
Copyright © 2018 The Faculty of Sexual and Reproductive Healthcare, All rights reserved.


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This eBulletin has been produced with financial support from:
The M·A·C AIDS Fund Community Grants Program, M·A·C Cosmetics Inc (UK) and Public Health England
Neither The M·A·C AIDS Fund, nor Public Health England have editorial input or control over the content of the eBulletin.