Sexual Health and Wellbeing for Wales 19th March 2010 Sexual Health and Wellbeing for Wales Dr Marion Lyons

Sexual health and Wellbeing for Wales, 2009 – 2014 Aims: Increase sexual health and relationship literacy Improve access to good quality sexual health services Reduce the number of unintended pregnancies, particularly among teenage girls Reduce the rates of STIs and HIV Improve the health and social care of people living with HIV Reduce the number of new diagnoses of sexually transmitted Hepatitis B and the number of people at risk Strengthen the monitoring, surveillance and research of the population's sexual health and well-being Dr Marion Lyons

How far have we to go? Increase sexual health and relationship literacy 2006 Health Behaviour in School Children showed that Wales has one of the highest proportions of 15 year olds reporting having sexual intercourse (out of 34 countries) Teenage conception rates high, STI rates high in teenagers Estyn’s report 2007 on the provision of SRE showed wide variation in the quality and impact of teaching of SRE Economic, social and cultural influences all impact on the sexual health and wellbeing Dr Marion Lyons

Increase sexual health and relationship literacy Future tasks: WAG to develop and publish updated guidance for the delivery of sex and relationships education in schools PHW to profile sexual health of the population and undertake targeted awareness raising campaigns Dr Marion Lyons

How far have we to go? Access to good quality sexual health services AOF 2010/2011 Target 24 Sexual Health Services To ensure that all patients have access to core sexual health services (HIV and sexually transmitted infection testing and routine contraception advice*) provided by appropriate specialists within 2 working days. Dr Marion Lyons

Access to good quality sexual health services Future work: Diagnosing Urogenital Chlamydia trachomatis and Neisseria gonorrhoea with an amplified DNA assay on self-taken vaginal swabs and first-catch urine Improve access to services in rural areas Review availability and provision of LARCs across all service providers Dr Marion Lyons

How far have we to go? Reduce the rates of STIs and HIV Between 2007 and 2008 the numbers of new cases of syphilis, uncomplicated Chlamydia, herpes and warts diagnosed in GUM clinics in Wales all continued to increase. However, the numbers of new cases of uncomplicated gonorrhoea and hepatitis C diagnosed have continued to decrease. The number of new cases of hepatitis B also decreased in 2008. Dr Marion Lyons

the enhanced surveillance scheme by month by region, 2002 to 2008 Cases of infectious SYPHILIS reported to Public Health Wales CDSC through the enhanced surveillance scheme by month by region, 2002 to 2008 Of the 119 cases reported in 2008, 78% (93 cases) were in men who reported having sex with men. This compares with 71% of reported cases in 2007 and 59% of reported cases in 2006. In 2008, 18 men and eight women (22% of cases) reported acquiring syphilis through heterosexual sex (Figure 7). With the exception of a peak in 2006 (40% of cases), the proportion of cases reported acquiring syphilis through heterosexual sex has varied between 22% and 29% since 2002. Dr Marion Lyons

Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales on form KC60 per 100,000 population: teenagers and all ages, 1994-2008 In 2008, there were 403 episodes of uncomplicated gonorrhoea and 177 epidemiological treatments of suspected gonorrhoea reported from GUM clinics in Wales (19 new cases per 100,000 population). Two episodes of gonococcal ophthalmia neonatorum were reported by GUM clinics in Wales in 2008 (Table 8a).   The number of cases of uncomplicated gonorrhoea reported by GUM clinics in Wales in 2008 was lower than the previous years (Table 8a), and represents a decrease of 11% since 2007 (Figure 8). This continues a general decrease in reported cases since 2004. Fifty-four of the 274 episodes (20%) of uncomplicated gonorrhoea reported in males in 2008 were in men who have sex with men. This compares to 89 (28% of infections in men) in 2007 and 81 (22%) in 2006. The majority (36%) of the episodes of uncomplicated gonorrhoea (61 female; 44 male) reported in 2008 occured in those aged 20-24 (97 and 47 cases in females and males respectively) (Table 9). The clinic in Cardiff continued to report the highest number of cases of gonorrhoea (134 in 2008), but the number had decreased from a total of 146 in 2007. Most clinics reported a decrease in cases between 2007 and 2008. Dr Marion Lyons

Reported cases of uncomplicated GONORRHOEA from GUM clinics in Wales on form KC60 from 2004-2008 Dr Marion Lyons

Reports of uncomplicated CHLAMYDIA from GUM clinics in Wales on form KC60 per 100,000 population: teenagers and all ages, 1994 - 2008 As in previous years, in 2008 rates of laboratory reports of anogenital chlamydial infection were highest in those aged 15-24 years old (Table 15), at 579 and 1157 per 100,000 population for males and females respectively. Overall rates of anogenital chlamydial infection continued to increase in all age groups except in females aged 45-54 or 55-64 years, where the rates continued a decrease seen since 2005. Dr Marion Lyons

Reports of cases of uncomplicated CHLAMYDIA from GUM clinics in Wales on form KC60 from 2004-2008 Dr Marion Lyons

Reports of cases of ANOGENITAL HERPES SIMPLEX - first attack - from GUM clinics in Wales on form KC60 from 2004 - 2008 Dr Marion Lyons

Reports of cases of ANOGENITAL WARTS - first attack - from GUM clinics in Wales on form KC60 from 2004 - 2008 Dr Marion Lyons

HIV – Source SOPHID data – analysed by HPA 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 MSM 161 166 192 245 274 332 390 453 527 574 IDU 7 15 19 14 18 22 27 26 29 Sex between men and women 71 85 107 154 211 257 280 336 385 417 Blood/Blood products 31 30 28 Mother to child 3 4 8 13 16 17 23 Other/unknown 2 5 11 12 Total 277 302 350 451 550 658 741 874 1001 1082 Dr Marion Lyons

Clinical reports of HIV Clinical reports of HIV* and AIDS in Wales, 1994–2008 by year of diagnosis Dr Marion Lyons

HIV infections by exposure risk 1999-2008 100 200 300 400 500 600 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 HIV infections by exposure risk 1999-2008 MSM IDU Sex between men and women Blood/Blood products Mother to child Other/unknown Dr Marion Lyons

Approximately 100 new cases are diagnosed annually The prevalence of HIV infection in Wales is low – approximately 0.05% of the population have been diagnosed with infection. There is a steady increase in the number of people living with HIV reflecting both an increase in survival and new diagnoses Approximately 100 new cases are diagnosed annually Using data from 2008, we can find no evidence of follow-up in approximately 20% of those with a new diagnosis of HIV Heterosexual risk behaviour accounts for approximately 60% of all new infections, of these 60% were from black and minority ethnic group (BMEG) Infections arise in all age groups with very few infection in those under 20 years of age Dr Marion Lyons

Reduce the rates of STIs and HIV Future work: Review provision of Condom Card Schemes in Wales and develop national standards PHW to profile sexual health of the population and undertake targeted awareness raising campaigns Cognitive behavioural work focusing on risk reduction, sexual negotiation etc can be effective in reducing risk taking behaviour in men who have sex with men (MSM) Deliver multi component interventions for group work Interventions to be targeted at specific sub groups of MSM e.g. those from ethnic minority groups Increase access to testing for HIV in hard to reach groups Dr Marion Lyons

Dr Marion Lyons

Rate of teenage pregnancies by area of usual residence 2001 - 2008 Dr Marion Lyons

Reducing the rate of teenage pregnancies Future work: Use multiagency partnerships to identify the causes of teenage pregnancies and address the underlying risk factors such as low self- esteem and educational attainment Commission easy to access contraceptive services Revise the sexual health service specification to include primary care services Pilot and evaluate a community based intervention (funding secured) Dr Marion Lyons

Develop high level indicators for sexual health Strengthen the monitoring, surveillance and research of the population's sexual health and well-being Develop high level indicators for sexual health Review KC60 and KT31 in light of the integration of services and develop future capture systems and construct a minimum data set for collection of standardised sexual health data across genitourinary medicine, community clinics, general practice and pharmacy Dr Marion Lyons