Condom provision for young people

…we need an open and honest sexual and reproductive health culture, in which condom use is simply the norm – the way of all of us, regardless of age, sexuality practice safer sex… …England ranks poorly on condom use among sexually active young people compared to the rest of Europe and North America, and young people have higher rates of both sexually transmitted infections (STIs) and abortion compared with older adults Professor Kevin Fenton, Public Health England C-Card condom distribution schemes Why, what and how

Tri-borough: sexually transmitted infections An estimated 15,500 cases a year are diagnosed by local GUM clinics. Data for 2014/15 showed 8779 new cases. Many STIs are asymptomatic, facilitating the spread of infection; Amongst men, the most common STIs diagnosed include chlamydia, anogenital warts and gonorrhea, whilst in women the most common STIs diagnosed are chlamydia, anogenital warts and herpes simplex; Locally, STI infections are predominantly concentrated in men and young people, with the age profile of men affected slightly older than that of women; Men who have sex with men and Black African and Black Caribbean ethnic groups are also disproportionately affected by STIs, particularly gonorrhea and syphilis.

…young people are more likely to use condoms if they are engaged in discussion as well as shown how to use them, they are more likely to use a service that is convenient and where they feel welcome, and they are more likely to ask for advice on sex and relationships if they don’t feel stigmatised for doing so. Professor Kevin Fenton, Public Health England C-Card condom distribution schemes Why, what and how

Change in approach by commissioning team Some Providers were getting condoms via two routes (duplication) - Some providers were already paid as part of their core contract for some form of condom distribution.  What was found once looking at the data more extensively is that these providers were also registered for the condom scheme and ordering condoms through this route as well.  In 2015 there were severe cuts to the condom budgets. The rationale for cuts in condoms budgets was to ensure of an overall cost savings across the three borough across all commissioning. Some providers were ordering from 3 separate accounts Some providers were ordering large volumes and we could not justify who or where these condoms were being distributed to and we have no evidential data regarding the positive impact this was resulting in. The scheme was refreshed in 2013 and despite attempts to garner this data, it was not shared.  This made it very difficult to argue with senior managers to continue funding at its peak rate when the returns are so low.  5

As an interim measure it was agreed that rather than cut the whole service it will be reduced until a more robust reporting mechanism could be sustained and evidenced.  Also as the sexual health procurement is well underway it may form part of the new service as an additional service the provider manages but this has not been confirmed or agreed yet and may/may not be a viable option.   

Current provision Condom Distribution Training Tri-borough training programme Freedoms service Account set up via a request through the commissioning team Annual budget Currently a variety of services across the three boroughs distributing condoms

Current provision – Condom Distribution Training  To equip staff working with young people, with the skills needed to:   - Discuss sexual health with young people - Distribute condoms, and lube using a consistent approach - Provide sexual health information, advice and signposting to services

Current provision – Condom Distribution Training   How to discuss sexual health issues with young people to include contraception, sexually transmitted infections and HIV. Be able to demonstrate the correct way to demonstrate Condom Teach Understand Sex and the Law Identifying risky sexual behaviour in young people How to effectively signpost young people to the appropriate services How to monitor the distribution of condoms for commissioning purposes By the end of the training participants will have gained knowledge and understanding of:

What do you currently do in your service? What has had an impact on your condom provision? 10

What challenges may we face when engaging with young people about condom use?

What do we need to have in place to strengthen the current model?

Condom Excuses Condoms cut off my circulation. They spoil the mood... I don’t have any infections! Sex doesn’t feel as good… I can’t find one that fits! Ask participants to discuss with the person next to them a response to one of the excuses. I have superb control! If you love me, you wouldn’t ask me to wear one. I’ve already been tested and treated, I can’t catch it again.

Ordering Each organisation that has completed the Condom Distribution Tri-borough training can register to distribute condoms Organisations can register by contacting the Public Health commissioner Theresa McShane: Theresa.McShane@rbkc.gov.uk Each organisation will have an annual budget to spend on condoms

Any questions