Welcome
26 January 2021 (Issue 63)
Welcome to the first edition of the Sexual Health, Reproductive Health & HIV Policy eBulletin in 2021. It has not been an easy start to the new year with the sector once again having to meet the challenges of maintaining essential sexual and reproductive heathcare services and HIV services in the face of yet another national lockdown.
Whilst the COVID-19 pandemic continues to put a huge strain on the sector, it has also led to a transformation in the way many services are used and delivered. In this month’s eFeature, Dr Jonathan Lord throws the spotlight on abortion care and examines the impact telemedicine and the temporary approval of the home use of pills for early medical abortion (EMA) has had on women and abortion care services. The Government approved the home use of pills for EMA at the start of the pandemic in March last year, when in-person access to healthcare was limited. It is now consulting widely on whether this temporary change should be made permanent. You can find information on how to submit to consultations in England and Wales below.
Other items to look out for in the round-up include: a letter to Matt Hancock from key sector organisations asking for clarification on the timeframe for the publication of the National Sexual and Reproductive Health Strategy; the landmark report from the HIV Commission on how England will end new cases of HIV; PHE’s report assessing the initial impact of the COVID-19 pandemic on sexually transmitted infections, HIV and viral hepatitis in England; updated FSRH guidance on essential SRH services during the third national lockdown; preliminary findings from the Natsal-COVID study and THT’s new sexual health resources for trans and non-binary people.
And finally, a reminder that this year's National HIV Testing Week will run between 1- 7 February 2021. The campaign will encourage people to test for HIV at home during the COVID-19 pandemic with the message ‘Give HIV the finger: a finger-prick test is all it takes’
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eFeature
Medical abortion via telemedicine – a revolution in patient-centred care?
Dr Jonathan Lord is Medical Director of MSI Reproductive Choices UK and a Consultant Gynaecologist at the Royal Cornwall Hospitals NHS Trust. He also co-chairs the British Society of Abortion Care Providers (BSACP) and RCOG abortion taskforce.
In this month’s eFeature Jonathan shares findings from a recent large scale study showing how the use of telemedicine for early medical abortion has the potential to revolutionise abortion care for women and girls. He argues that with clinical outcomes equivalent to in-person care and greatly improved access for patients there is compelling evidence to make telemedicine a routine part of abortion care.
>See eFeature by Dr Jonathan Lord
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Policy development and guidance
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Government consultation on home use of pills for EMA
The Government is seeking views on whether to make permanent the current COVID-induced temporary measure allowing for home use of pills for early medical abortion up to 10 weeks gestation for all eligible women. The consultation includes a range of questions, including how the permanent home use of pills for EMA could have a differential impact on groups of people or communities. Consultations are currently open in England (closing date 26 February) and Wales (closing date 23 February). A similar consultation by the Scottish Government on future arrangements for EMA at home closed on 5 January 2021.
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Legal action on lack of abortion services in NI
The Northern Ireland Human Rights Commission has initiated legal action against the Secretary of State, NI Executive and Department of Health for Northern Ireland for failing to commission and fund abortion services in Northern Ireland, leading to a vacuum for many women and girls seeking such services. The All Party Parliamentary Group on SRH (APPGSRH) also held a meeting in December to examine the lack of commissioning and resourcing for abortion services in Northern Ireland.
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Tampon Tax abolished
On 1 January 2021, the Government abolished VAT on women’s sanitary products. The move honours a government commitment to scrap the tax after leaving the EU and is part of a wider strategy to make sanitary products affordable and available for all women.
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Period Products (Free Provision) (Scotland) Bill
Scotland has become the first country in the world to embed free access to period products into law. MSPs unanimously approved the Period Products (Free Provision) (Scotland) Bill at the end of in November last year. Schools, colleges and universities must make period products freely available, and the Scottish Government has the power to make other public bodies provide period products for free.
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Government backing for landmark HIV Commission Report
The Independent HIV Commission has published its findings and recommendations on how England will end new cases of HIV, following 18 months of extensive evidence gathering. The report, launched on 1 December 2020, sets out 20 action points for ending new transmissions in England by 2030. Key recommendations on new targets, the need for more testing and reporting to Parliament have already been accepted by Government. The actions outlined in the report will be the basis of how England will achieve the 2030 goal.
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Change to blood donation rules for men who have sex with men
The Government has announced changes to blood donation rules with a move to individualised risk assessments for all potential donors. This is the result of a review of the three-month deferral period for gay, bisexual and other men who have sex with men. Eligibility for blood donation will now be based on behaviours rather than blanket rules based on gender or sexuality. This move will mean men who have sex with men who have had the same partner for three months or more will be able to give blood from summer 2021.
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Integrated Care Consultation
The consultation period for submitting views on proposals from NHS England and NHS Improvement on the next steps for building effective integrated care systems across England closed on 8 January 2021. FSRH has responded to the proposed legislative options for ICSs, including calling for single accountable commissioner for women’s health at ICS level and national level accountability for commissioning and outcomes in women’s health.
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CMO's Annual Report 2020
The Chief Medical Officer's annual report for 2020 has been published. The report focuses on health trends and variation in England, including the initial impact of COVID-19. Chapter 5 looks at risk factors and health promotion and includes data on teenage pregnancy, STIs and late HIV diagnoses.
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March 2021 Budget
The Chancellor of the Exchequer, Rishi Sunak, has announced that the Government will publish the Budget on Wednesday 3 March 2021. FSRH has submitted representations ahead of the Budget, making a strong case for long-term, sustainable investment in public health and sexual and reproductive healthcare, education and training.
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National Sexual and Reproductive Health Strategy
Key public health and sexual health sector organisations including BASHH, BHIVA, FSRH, Brook and the APPG on Sexual and Reproductive Health, have written to Secretary of State for Health and Social Care Matt Hancock to ask for an update on progress with the National Sexual and Reproductive Health Strategy. The letter asks for clarification and reassurance on a number of issues, including time frame for publication and delivery of the strategy.
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Service standards & guidelines
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The response to COVID-19 is evolving and guidance from key professional organisations may change as new information becomes available. Below are links to regularly updated COVID-19 guidance and resources.
>FSRH
>BASHH
>BHIVA
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PHE offer to support evaluation of sexual and reproductive healthcare during COVID-19
PHE has developed a ‘guided discussion’ to support the evaluation of SRH interventions. The process gives commissioners and providers the opportunity to work collaboratively with PHE to support local areas in evaluating the impact of the changes to SRH provision resulting from the COVID-19 response. Guided discussions will be facilitated by PHE and will be attended by relevant representatives from disciplines working in SRH services (e.g. clinical, nursing and health advisors) and commissioners, either on a one to one basis or in a group. PHE will also produce a summary report for participants following the discussion.
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Ensuring provision of Sexual and Reproductive Healthcare (SRH) services during the third COVID-19 lockdown and beyond in the UK
FSRH has issued updated guidance on essential SRH services during the third national lockdown. It is aimed at all UK commissioners and healthcare providers in primary care and specialist services. The updated guidance supersedes the guidance on service provision during the second COVID-19 wave released in October 2020.
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Updated advice for women seeking contraception, abortion and other sexual and reproductive healthcare during the COVID-19 second wave (NOV 2020)
FSRH has updated its guidance for women who need to access contraception, abortion and other forms of sexual and reproductive healthcare during the second wave of the COVID-19 pandemic. The updated advice includes new information on menopause services as well as updates on contraception, abortion, and emergency removals of long-acting reversible contraception. It also contains useful links for women in all regions of the UK, to help them access further advice and care. The advice can be shared with patients and local communities.
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2019 audit report on NCSP Standards
A recent audit by the National Chlamydia Screening Programme (NCSP) show that time to result notification, time to treatment and partner notification standards have not been met and are worse compared to the 2017 audit findings. The proportion of patients re-tested for chlamydia around 3 months after treatment has increased from 7% in 2017 to 10% in 2019. The report makes recommendations across the Standards to support service improvement.
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Guidance on COVID vaccines for adults living with HIV
The British HIV Association (BHIVA) & Terrence Higgins Trust (THT) have issued guidance on COVID vaccines for people living with HIV. The COVID-19 vaccines are expected to be protective in people with HIV and are recommended. The Department of Health and Social Care recommends that all adults living with HIV should have the vaccines currently on offer, regardless of their CD4 count.
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aidsmapLIVE – Special: COVID-19 vaccines
On 17 December 2020, NAM aidsmap broadcast an aidsmapLIVE COVID-19 vaccines special. Joining NAM’s Susan Cole were sexual health and HIV doctors Rageshri Dhairyawan and Vanessa Apea, House of Rainbow founding Pastor Rev Jide Macaulay and activist Mercy Shibemba. You can also find out about the involvement of people with HIV in the COVID-19 vaccine studies in NAM aidsmap’s new information page.
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Evidence, data & research
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Natsal-COVID study - preliminary findings
The National Surveys of Sexual Attitudes and Lifestyles (Natsal) COVID-19 study team worked with Ipsos MORI to run a web-panel survey of 6,500 people aged 18-59 years across Britain, capturing data on sexual behaviour, sexual relationships and service use during the four months following the first national lockdown in March 2020. Preliminary findings are now available describing changes in sexual partnerships and practices, impacts on SRH services and on relationships, and the extent to which intimacy needs have affected COVID-19 risk.
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The impact of the COVID-19 on sexually transmitted infections, HIV and viral hepatitis in England: Provisional data - Jan to Sept 2020
This PHE report assesses the impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in England. These early findings indicate that the COVID-19 response, including social and physical distancing measures, has led to a re-prioritisation and disruption in provision of, and access to, health services for HIV, STIs and viral hepatitis.
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SRH Services, England (Contraception) 2019/20
NHS Digital has published data on Sexual and Reproductive Healthcare (SRH) services in England for the year 2019-2020. The number of women accessing SRH services for contraception has fallen by 8.5% when compared with the previous year (2018/19) and by 22% compared to the last six years (2014/15) during which services have sustained year-on-year funding cuts. The number of women using Long-Acting Reversible Contraception (LARC) and provision of emergency contraception has also decreased indicating reduced access to essential women's healthcare in SRH community clinics.
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Cervical Screening Programme, England, 2019/20
The latest cervical screening statistics for England have been released by NHS Digital. Cervical screening coverage is at 72.2%, a slight increase on last year but still below the national target.
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At-home cervical screening
The UK’s leading cervical cancer charity, Jo’s Trust, is calling for faster action on introducing HPV self-testing kits as part of the cervical screening programme. New research conducted by the charity during the pandemic has found that a third of women would prefer to take an HPV self sample than attend cervical screening with a clinician. Pilot studies looking at the feasibility of home testing kits for cervical cancer are currently being set up in London and Dumfries.
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The Public Attitudes to HIV in Scotland Report
HIV Scotland published findings from the first large-scale survey in Scotland on awareness and attitudes to HIV on 7 December 2020. The report and data come from a survey of 2,023 people in Scotland, with a nationally representative sample and covers knowledge and perceptions, personal experiences and wor
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Improving care for people with STIs and their sex partners in a digital NHS
A team of sexual health experts and scientists have been awarded a £2.5m grant from the National Institute for Health Research (NIHR) to develop a new NHS digital platform to improve care for people with STIs. The project will be led by Glasgow Caledonian University in partnership with a number of other Universities and Trusts.
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New trans-specific sexual health information
THT has produced new sexual health resources for trans and non-binary people following a national survey that shows their needs are not being met. The new tailored health information provides up-to-date HIV, sexual health and contraception information and advice. This includes the impact of hormones and surgery, considerations when taking HIV prevention pill PrEP and how to navigate happy, healthy sex. See the link to online resources below. Print leaflets can be ordered from info@tht.org.uk.
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New edition of HIV & sex booklet
NAM aidsmap has launched the new edition of its HIV & sex booklet. This latest edition has a consistent and clear focus on Undetectable = Untransmittable (U=U) as the most effective means of preventing sexual HIV transmission. HIV & sex is available through the NAM patient information scheme as an online booklet (PDF).
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Contraception choices for black communities
FSRH has received funding from the PHE Sexual Health, Reproductive Health and HIV Innovation Fund to work in partnership with Black communities, UCL and Decolonising Contraception to produce a series of videos directly addressing the concerns and barriers black women and men experience in accessing contraception. Decolonising Contraception, is a non-profit organisation led by people of colour, which aims to raise awareness about the historical and socio-economic barriers faced by people accessing sexual and reproductive care.
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Reformer Thoughts: A new deal for prevention
The January edition of Reformer Thoughts brings together experts from the scientific research community and the health and social care sector to consider the future of prevention in the UK. It includes contributions from THT’s Ian Green on HIV testing and from NHS England’s Mark Gillyon-Powell on eliminating Hepatitis C.
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National HIV Testing Week: 1-7 February 2021
This year's National HIV Testing Week will start on Monday 1 February. The campaign will encourage people to test for HIV at home during the COVID-19 pandemic with the message ‘Give HIV the finger: a finger-prick test is all it takes’. Local organisations are invited to participate by running online and virtual campaign events and promoting HIV testing and prevention services with support from HIV Prevention England.
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December edition of EUROBulletin
The latest edition of the Sexual Health & HIV Policy EUROBulletin is now available. It includes a round-up of policy news from the region as well as an interview with Dr Annabel Sowemimo, sexual and reproductive health doctor and founder of Decolonising Contraception.
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PrEP and the trans community webinar
In December, PrEP in Europe held a webinar on PrEP and the trans community. The webinar combined scientific research for trans people on HIV and PrEP, and the recommendations from PrEP in Europe's recent meeting for European trans advocates. The webinar included presentations by Dr Sari Reisner, Harvard Medical School, Boston; Dr Akarin Hiransuthikul, Department of Medicine, Chulalongkorn University, Bangkok; and Dinah Bons, Trans United Europe, Amsterdam.
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The Sexual Health & HIV Policy eBulletin was originally developed and published by MEDFASH.
It continues to be compiled and edited by Helen Christophers on behalf of FSRH and coalition partners. If you have any comments on the eBulletin or eFeature or suggestions for topics you would like to see covered in future eFeatures please get in touch (ebulletineditor@fsrh.org).
You can access previous eBulletins and eFeatures via the links below:
> eBulletin archive (Since 2017) > eFeature archive (MEDFASH/FSRH)
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FSRH and coalition partners do not accept responsibility for the content of linked websites/items included in this eBulletin and do not necessarily endorse the views expressed within them.
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