Sexual Gonorrhoea Chlamydia
Putting the United Kingdom's sexual health into context:
Recent years have seen mounting disquietude over the UK's sexual health. Concern in this area started to rise during the mid 1990's when there was a notable increase in the incidence of sexually transmitted infections (STIs). Within a five year period (1995 to 2000) numbers of gonorrhoea and chlamydia cases had increased by 102% (10,204 to 20,663) and 107% (30,877 to 64,000) respectively in England and Wales. Furthermore, during the same time frame there was a 34% increase in the number of newly diagnosed STIs in genitourinary medicine (GUM) clinics (PHLS, DHSS&PS and the Scottish ISD(D)5 Collaborative Group, 2001). In addition to escalating STI figures, the number of abortions increased steadily (162,638 to 187,402) over the period of 1995 - 1999 highlighting the growing problem of unintended pregnancy within the UK (ONS, 1999).
An initial examination of figures depicts deterioration of sexual health throughout all age groups. However, during the second half of the 1990's national statistics began to display how rapidly sexual health problems were increasing within the 16 - 24 age group. For example, from 1995-2000 41% of all females diagnosed with gonorrhoea were under the age of 20 and the highest rates of gonorrhoea in males occurred in the 20-24 age group. Furthermore, the highest prevalence of genital herpes was seen in the 20-24 age bracket for both sexes. Throughout this time chlamydia was also reaching problematic levels with approximately 2% (around 2000 cases per 100,000 population) of all 16-24 year old females in the UK being diagnosed with this STI (PHLS, DHSS&PS and the Scottish ISD (D) 5 Collaborative Group, 2001). Additionally, the period 1995-2000 saw the UK named as having the highest rate of teenage pregnancy within Western Europe with 56.8 per 1000 teenagers within the 16-19 age range falling pregnant unintentionally (ONS, 2008).
The declining sexual health of the population prompted policy makers to prioritise this issue. To do this the three governing bodies, within mainland UK, designed and implemented individual strategies, however, each shared a common goal; to tackle the ever rising numbers of STIs and unintended pregnancies.
One of the first initiatives which addressed the worsening state of sexual health was the UK Governments ‘Teenage Pregnancy Strategy'. This strategy not only addressed the factors which contribute to high pregnancy rates but also focused consequences that are faced by young mothers, such as, poor economic well being. In order to tackle rising pregnancy rates the strategy set a target to halve the rate of under 18 conceptions by the year 2010. To do this attention focused on local delivery of services ensuring the availability of contraceptives was well publicised to this group. In addition, importance was placed on schools to provide high standard sex and relationship education (SRE) to increase young people's awareness of teenage pregnancy (The Social Exclusion Unit, 1999).
In 1998 the National Assembly for Wales published the document ‘Better health - Better Wales' which highlighted trepidation regarding rates of teenage pregnancy and STIs within the country (Welsh Office, 1998). In response to these concerns ‘A Strategic Framework for promoting Sexual health in Wales' was published in 2000. The strategy's main aims were to reduce incidence of STIs and unintended pregnancy within Wales; particularly within the under 25's. The strategy also highlighted the importance of providing young people with comprehensive and effective SRE. Further development of this strategy saw the introduction of the all Wales Sexual Health Network. The network focused on increasing knowledge and openness on all sexual issues, in hopes that this would reduce embarrassment and ignorance that helped facilitate high rates of STIs and other sexual health concerns and in turn hasten their decline (National Assembly for Wales, 2000).
Advancements in UK policy continued in 2001 with the Department of Health (DH) releasing ‘The national strategy for sexual health and HIV' for England. Again the strategy focused efforts on lowering STIs and unintended pregnancy rates via effective information and education initiatives with specific mention to target information towards young people. In addition, the report placed a greater emphasis on HIV than in the National Assembly's paper and made a reference to reducing the number of newly diagnosed HIV and gonorrhoea cases by 25% by the year 2007 (DH, 2001).
In 2004 The Scottish Executive ‘Respect and Responsibility' health strategy was launched in order to address the growing concerns about sexual health in Scotland. This strategy took a more social route basing policies firmly around “self-respect, respect for others and strong relationships” (Scottish Executive, 2004 p1). In short, action was directed towards the avoidance of contracting and spreading sexually transmitted infections and towards the avoidance of unwanted pregnancies by promoting the individual's responsibility for themselves and others through specific educative measures including extra SRE in schools, and ‘life long learning' for adults regarding STIs by introducing media campaigns (Scottish Executive, 2005).
Also, during this year the Welsh Assembly Government (WAG) readdressed sexual health problems as part of a holistic approach (‘Health Challenge Wales') to promoting good health in Wales. Part of the ‘Health Challenge Wales' document gave reference to providing extra investment, £7.1 billion, in to GUM in Wales which would help implement wider access to STI testing services ensuring any member of the public who wanted to be tested for an STI would not have to wait longer than 48 hours for an appointment (WAG, 2004).
I have some concerns about the above paragraph. It comes over as though Health Challenge Wales was specifically re-addressing sexual health problems. Sexually transmitted infections was only part of it. Some of this information could be included elsewhere. I am thinking particularly in relation to campaigns to try to promote condom use. I also think the reference the current consultation does not fit here. I think when you are summing up at the very end of the dissertation you could then say something along the lines of the Welsh Assembly Government being aware that more has to be done to improve sexual health and that they have undertaken a consultation process, the results of which are keenly awaited or words to that effect.
Despite the continuing efforts made by all three governing bodies the statistical evidence suggests that some years later there are still problematic levels of STIs and unintended pregnancies within the general population. Additionally, attempts to raise awareness of problems and improve access to sexual health services for young people have seemed unsuccessful in stemming the prevalence and incidence of STIs and unintended pregnancies, as rates of both remain highest in this population (16-24). Evidence for this statement is provided by recent data.
The HPA states that although the 16 - 24 year age group represents only 12 % of the UK population, this age group alone continues to account for over 50% of all newly diagnosed STI cases each year (HPA, 2006). Statistics from GUM clinics (2005) also provides evidence to show that current strategies have been ineffective in reducing the health burden of STIs. For example, chlamydia cases in young males increased by a staggering 81% within the 16-19 age range and females in the same age group also witnessed an increase in chlamydia cases with almost 50% more cases witnessed since the initial implementation of sexual health strategies in England and Wales HPA, 2006). Although unintended pregnancy rates dropped the UK still lags behind the rest of Europe and continues to have the highest rate of teenage pregnancy with 30 in 1000 teenagers becoming pregnant between the ages of 15 and 19 (ONS, 2005). Further more, with only a 13.3% decline in under 18 conceptions the Social Exclusion Units target of a 50% reduction by 2010 seems unattainable (ONS, 2008). Additionally, 20 to 24 year old women continue to account for the highest rate of legal abortions with an average of 29% of all abortions assigned to this group each year (DH,2007). Moreover, Lakha and Glasier reported that even in women who did not undergo termination of pregnancy (TOP) as many as one third of pregnant women in their cohort consider their pregnancy as unintended (Lakha and Glasier, 2006 p 1782).
Summary:
Having looked at past and current statistics regarding rates of STI and unintended pregnancy it is evident there is a problem within the UK population. Furthermore, the evidence shows that young people bear the heaviest disproportionate burden of poor sexual health. Thus there is a great need to address these issues and discover why young people continue to suffer poor sexual health and what can be done to improve this situation. Therefore this dissertation aims to:
- Examine factors that affect the sexual health, with particular reference to STIs and unintended pregnancy, of young people aged 16-24 and attempt to identify how their sexual health may be improved.
In order to achieve this aim a review of the literature was carried out.
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