Health of the nation: way forward in sexual health

Abstract

Sexual health is a wide concept encompassing education, health promotion and disease prevention, diagnosis and management of sexually transmitted diseases, screening and counselling for HIV antibodies, management of HIV infected patients, family planning, termination of pregnancy, psychosexual counselling, prevention of cervical and lower genital tract cancers, and sexual abuse. Implementation of The Health of the Nation (1992) will include assessing the current situation, views, alliances and interventions, need for research and development and within alliances setting challenging but achievable targets. The Health of the Nation includes a target for gonorrhoea which is a surrogate for partner change, sexually transmitted diseases in general and HIV infection, and a target for conceptions among those under 16 years of age. These targets need to be adjusted locally and may be staged. All interventions to achieve these targets must be available. Implementation of The Health of the Nation to achieve the main objectives which are to reduce the incidence of HIV infection and other sexually transmitted diseases as well as reducing the number of unwanted pregnancies and provision of effective family planning services will be challenging but sexual health gain will be well worthwhile.

PIP: The U.K. government White Paper "The Health of the Nation 1992" has 5 general objectives involving HIV, STDs, monitoring and surveillance, diagnosis and treatment of HIV and STDs, and family planning and unwanted pregnancy. Specific targets are to lower gonorrhea by 20% by 1995 (from 61 to 49 new cases per 100,000) and to decrease teen pregnancies by 50% by 2000 (from 9.5 to 4.8 per 100,000 girls under age 16). Besides the 36 recommendations made in 1988 in the "Monks" Report for Genitourinary Medicine (GUM) clinics, this paper makes accessibility in every district a priority. A key initiative is production of "Handbooks" to guide managers. Baseline data on the quarterly return (Forms KC60 and KH09) are needed for planning for the local situation. Other sources of data are Hospital Activity Analysis returns, Drug Dependency Units, Family Planning Clinics, and Family Health Service Authorities. The Health of the Nation considers the making of Healthy Alliances between community groups and the GUM clinic and the above institutions a priority. Under research and development the Paper suggests formation of sentinel GUM clinics which would provide more in-depth data. New interventions include staffing and staff training, early morning or late evening hours, hiring sexual health coordinators to promote alliances and development of adolescent medicine.