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Putting HIV in Public Health

posted: 02/11/2010

Public Health will soon have a major shake up in England as part of the new government’s NHS changes. What needs to be in any public health policy that is HIV and sexual health friendly? Better sexual health is one of the public's top three health priorities. This is not surprosing, England has one of the worst rates of poor sexual health in Europe.

Public Health Manifesto
Leading national sexual health and HIV organisations have drawn up a manifesto for better public HIV and STI health. The British HIV Association, National AIDS Trust and others have published an expert’s guide and better public health action list for the government.

HIV and sexual health services will soon be reorganised in England’s NHS. The new National Commissioning Board, GP commissioners and Local Authorities will need to work together in the new NHS system for HIV and STI prevention, treatment and care.


The public health manifesto for HIV sets out the good it will do, the things that need most attention, what needs doing, and the cost of NOT making HIV and sexual health a public health priority.

 

 
1. The benefits of improving sexual & reproductive health and HIV
  • Health economic - The NHS bill for lifetime HIV treatment is rising by £1 billion each year. Preventing one new HIV infection saves over £350,000
  • Health benefits – early diagnosis of HIV and other sexually transmitted infections (STIs) cuts treatment costs and the number of new infections
  • Reducing Health Inequality – Poor sexual health is much more common amongst people who are already vulnerable because of youth, gender, ethnicity, sexuality, or poverty. Existing inequalities are worsened by HIV stigma, poor sexual health and teenage parenthood
  • Impact on societal and economic well being – The social cost of poor sexual health is high:
    - Failure to diagnose HIV infection on time leads to avoidable serious illness and early deaths
    - HIV is a long term condition, but people with HIV age sooner, and have poorer health
    - Teenage parenthood reduce the life chances of young people
    - undiagnosed STIs cause long term and life threatening problems
  • Unintended pregnancy, STIs and HIV are avoidable by changing behaviour
    - Unlike many other areas of public health, STIs and HIV can be reduced through good quality prevention work, prompt treatment and partner notification, bringing rapid benefits to the NHS, the individual, and our community.
2. Improving sexual & reproductive health and HIV health outcomes

Priorities:

  • reduce avoidable HIV deaths, ill health and onward HIV transmission by cutting late HIV diagnosis
  • reduce the high numbers with Chlamydia by screening young people
  • cut the numbers with other STIs, including gonorrhoea and genital warts
  • fewer births to young women

Being able to see a clinic within 48 hours is critical. There is strong evidence that open access to sexual health services within 48 hours is crucial to controlling STIs.

3. What needs to be done

Support people to take responsibility for their sexual behaviour, through:

  • local and national public health programmes that influence positive behaviour change
  • improved Sex & Relationships Education in schools and in the home
  • providing education and information for those attending sexual health services
  • access to sexual health vaccination and screening programmes
  • access to good quality, evidence based sexual health information and advice services
  • encouragement to contribute actively to both the management of their own sexual health and wellbeing and to the reshaping of community and social norms.

Transform sexual & reproductive health and HIV services by:

  • ensuring that effective, quality services are cost effective by better linking into community health and primary care services
  • ensuring that all services are part of a local clinical network for the best care 
  • joining sexual health and reproductive healthcare so that people use both at once
  • encouraging self management
  • offering more choice of services
  • 48 hour access to treatment and care so people get the level and quality of care they need
  • ensuring health staff are well skilled and trained.

Effective leadership and commissioning by ensuring:

  • sufficiently skilled commissioners working within a consistent framework of service standards and outcomes
  • proper coordination of commissioning for sexual & reproductive health & HIV
  • services across the National Commissioning Board, GP commissioners and Local Authorities; this should ensure that services are commissioned at the most appropriate level in the new NHS system
  • high calibre leadership from those individuals and organisations responsible for commissioning
  • national leadership and comprehensive independent public health surveillance.
4. The cost of NOT improving sexual health & HIV
  • the economic cost to the country of more STIs, HIV and unintended pregnancies
  • the human cost as people suffer from avoidable infections, illness, premature mortality and from unintended pregnancies
  • the social cost of poor sexual health harming communities that already have poorer health.

We want better Public Health

It is not surprising that a government survey in 2010 found that the public iin England rate sexual health as one of our three most important public health priorities.

The real challenge and opportunity is for Government, civil society and the public to work together, as part of the ‘Big Society,’ to make this a reality.

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