Sex has got a lot to answer for. The UK is facing a rising demand for sexual health and contraceptive care. Unacceptable levels of sexual coercion and female genital mutilation (FGM) are being reported, sexually transmitted infection (STI) diagnoses are increasing [pdf], and the UK still has the highest rate of teenage pregnancy in western Europe.
Despite all of this, key services are facing monstrous budget cuts alongside so many other sectors of our increasingly weary NHS. This means clinic closures, the dissolution of preventative health programmes, further pressure on already overloaded GP practices, and horrifying long-term financial costs.
In truth, sexual health services have suffered financially for some time. With the implementation of the Health and Social Care Act 2012, responsibility for sexual health funding was allocated to local authorities and these services put out to tender [pdf].
Private companies can bid for control over them, which the government claimed would improve standards “through competition and choice”. In reality, the winning bids are often ones that offer immediate cost-saving rather than long-term financial benefits and the best possible standards of care.
In 2015, the government announced its £200m public health budget cut, resulting in local councils spending millions of pounds less than planned on sexual health services nationwide. Add to this a potential 40% cut in central funding to local authorities [pdf] and you can see how pressure is mounting.
Elizabeth Carlin, president of the British Association of Sexual Health and HIV (Bashh), is one of many specialists to express concern. “Sexual health services play a key role in protecting the health of the nation,” she says. “Coordinated care with sufficient funding is crucial.”
So, what do these services actually do – and what would be the repercussions of service dismantlement?
Let’s start with sexual violence. Approximately 85,000 women and 12,000 men are raped in England and Wales alone every year [pdf]. That’s roughly 11 adult rapes per hour. Over 1,200 victims of FGM were recorded between January and March this year, and unknown numbers of girls and women remain unprotected. Gang violence and grooming are increasingly recognised and the lesbian, gay, bisexual and transgender (LGBT) community remains at risk from stigma and discrimination. Sexual health services identify and support these vulnerable groups every day so the ramifications of reducing access to this support and expertise will be far-reaching and significant.
Recent coverage of NHS England’s decision not to fund the provision to high-risk individuals of pre-exposure prophylaxis (PrEP) – a highly effective HIV-prevention drug – highlighted the extent of our HIV epidemic. About 17% of infected individuals in the UK are unaware of their positive status and an estimated one in 20 men who have sex with men (MSM) aged 15–44 are living with HIV. Sexual health services are responsible for huge proportions of HIV testing, education and specialist care for newly-diagnosed individuals.
STIs remain problematic, particularly in MSM, with a 46% increase in syphilis and 32% increase in gonorrhoea reported in this group by Public Health England [pdf] in 2014. The threat of gonococcal resistance also persists, with the frightening possibility that we could end up with no effective treatment for an infection that affects up to 30,000 people in the UK every year. Expert services are essential to ensure the public is tested, managed and educated to reduce STI transmission and prevent long-term health problems.
Teen conception rates are another important measure of the state of health and society for local councils, yet the UK continues to have the highest figures in western Europe. The Family Planning Association (FPA) 2015 report Unprotected Nation estimates that additional unintended pregnancies due to budget cuts could cost up to £8.3bn over the next five years. That’s coupled with the countless women who will deal with the mental and physical implications of an unwanted pregnancy or abortion. In essence, an unforgivable removal of choice from the UK public.
“We’ve seen evidence of local authorities restricting access – for example, only providing services to under-25s. This goes against the principle of providing open-access care,” says Laura Russell, the FPA’s senior policy and public affairs officer.
This list of problems is by no means exhaustive. While the health budget remains a challenge and all the unpleasant health problems associated with sex are easier to ignore, the government’s failure to openly address these issues, support sexual choice and put their long-vision specs on will only take us back to the times we’ve worked so hard to leave behind.
Let’s just hope they’re ready to confront the repercussions of their actions – warts and all.
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