HIV and sexual health should be key health priorities of the UK government, and should be included in all local NHS plans, says the government’s own Independent Advisory Group (IAG) on Sexual Health and HIV.
The IAG’s call to prioritise HIV and sexual health is contained in its detailed response to last summer’s House of Commons Health Select Committee report on the state of the UK’s sexual health and sexual health services.
Established in 2003 as part of the implementation plan for the National Sexual Health and HIV Strategy, the IAG is made up of doctors and other professionals involved in HIV and sexual health services and has a remit to monitor progress on the implementation of the strategy and to recommend actions the government needs to take.
Problems with accessing HIV and sexual health services were highlighted in the MP’s report, and in a strongly worded response, the IAG stressed that “sexual health services should be consistently prioritised to enable fast, efficient access to all who need them. We strongly endorse the report’s recommendation that the government take urgent steps to ensure that access to high quality sexual health services is prioritised and resourced.”
HIV service access is also highlighted as an issue of concern by the IAG, which draws attention to misinformed media coverage of HIV and migration, saying “this is a complex issue and we would welcome an open and transparent examination of it that…involves specialist interest groups who can provide additional expertise.”
Last summer, the MP’s report strongly criticised the “unacceptable standard” of many sexual health clinic premises, and the IAG “strongly recommend that Strategic Health Authorities and Primary Care Trusts…take responsibility for…a two-year programme of multidisciplinary clinic review to assess service capacity, staffing, premises, supporting infrastructure and modernization.”
Sexual dysfunction received little mention in the government’s sexual health and HIV strategy, and the IAG agrees with the MPs that sexual dysfunction should be included in an expanded sexual health strategy, emphasising that “sexual dysfunction, a cause of much suffering for patients, is common, under-reported, poorly managed, and services are often under-funded.”
Concern is expressed by the IAG that recent changes in the funding arrangement for HIV “will place at risk the investment in services over the past 20 years. The IAG is particularly concerned that there should be a commitment to ongoing funding, not one-off, to ensure the availability of appropriate treatment and care for all those eligible.”
To ensure that disinvestments in HIV services does not become a major problem, the AIDS Control Act should be used to ask questions about HIV how resources are being spend, and a review of HIV spending should be published annually by the Department of Health.
There has been concern that recent organisational changes in the NHS will result in a loss of commissioning expertise. The IAG stress that “sexual health and HIV should be included in all Local Delivery Plans, and we recommend that there should be an explicit role for Strategic Health Authorities in ensuring implementation of this.”
Although the IAG agree with MPs that GPs can play an important role in diagnosing and managing sexually transmitted infections and HIV, they emphasise the need for clear guidelines on how “integrated or parallel care will operate between GPs and specialist centres. We recognise the importance of this development but we also see the barriers for patients and doctors in discussing lifestyle and risk…GPs and their teams need education, training and support, all of which require adequate funding.”
The ability of PCTs to recognise the complexities of HIV commissioning and to commit the necessary resources is doubted by the IAG. They therefore suggest “local consortia of adjacent PCTs will be necessary to ensure that additional resources for HIV patients [are] assured without detriment to other services, especially specialist STI services.”
Moving money away from HIV prevention to pay for HIV treatments is criticised by the IAG, which fears that valuable HIV prevention experience and expertise is being lost. They therefore stress, “it is…vitally important that significant emphasis is given to education and health promotion as well as to the provision of clinical services. Guidelines should be given to PCTs to ensure that sexual health promotion is include in local delivery plans.”
The lack of a patient voice in the planning and delivery of HIV, and particularly sexual health services is noted by the IAG, which expresses the hope that the NHS will work to improve service user involvement.
Further information on this website
UK’s sexual health in crisis say MPs - news story