Sexual Health and HIV strategy 2001 - Essay Example

? SEXUAL HEALTH AND HIV STRATEGY 2001 The paper discusses a health care policy, which is the Sexual Health and HIV Strategy 2001 of the UK and analyses the impact of the policy on the issue of rising rates of unwanted pregnancies in teenagers up to 20 year olds. The intricacies of the policy and statistics on UK’s unwanted teenage pregnancy are also detailed. Finally, the positive role of the strategy for curbing teenage pregnancy rates is described. 1. Introduction The first national strategy to modernize sexual health and to provide HIV services in the country to address the rising number of HIV and sexually transmitted infections (STIs) cases was introduced in 2001. The hazards of poor sexual health are dangerous because unintended pregnancies and certain, sexually transmitted infections can create long lasting effects on one’s lives. The number of people visiting the genito-urinary medicine (GUM) clinics increased by 100% in the last decade and currently, the cases are more than a million in a year in the UK (Department of Health (2011). There exists a clear link between social environment, poverty and sexual ill health (Clements et al, 1998). Impact is also visible on minority ethnic groups and gay men. Furthermore, there have been deviations in the sexual health of people across the country which is not satisfactory. The Sexual Health and HIV Strategy 2001 created a need to raise the level of services in coordination with the principles of NHS plan. HIV is incurable and a life threatening condition and the use of certain drugs can improve the lifespan of infected individuals but it presents severe challenges related to the care, treatment and support, and this strategy recognizes these issues (Dennison, 2004). 2. The Role of Groups in the Formation of the Strategy The Department of Health strives to bring progress in the health and well-being rates in England and wants to make it better in health care and other such values. The Secretary of State for Health in 2001 came out with novel goals for health and social care aimed at 5 primary points (Department of Health, 2011): Patient-led National Health Strategy Coming out with best health scenarios Responsible and autonomous health system Public health improvement Bringing about greater reform in social care The 2001 strategy was to get the service providers and representatives participate. There was a major role for voluntary organizations as well, especially in the field of HIV. An effective partnership with voluntary organizations, service providers and representatives were important. A commitment period of ten years along with a strategic move rendered greater results. Investment of about ?47.5 million extra was set aside for the coming two years to cater to the needs of the scheme (British Medical Association, 2000). The strategy has been successful, as it has definitely brought down the inequalities in sexual health, especially for teenagers (DCSF, 2010). There will be place for advanced, effective and dedicated services that comes without the pressure of sex illness like HIV (CRD, 1997). The 2001 strategy has gained more support through public opinions. The last strategy implemented by the government took up the views of the service users, representatives and the public as a whole, along with stake holders and those involved in the public health field. In order to strengthen the strategy and develop it the best way, the help of professionals and service users was essential. A wide range of professionals and health experts attended the six consultations conducted in England (Department of Health, 2003). The Department of Health supported events like the Brook and the African HIV Policy Network and Terrence Higgins Trust Lighthouse. The National AIDS Trust, FPA and the professional bodies controlling the spread of HIV were identified as a key priority in the Chief Medical Officer’s Infectious Disease Strategy (Bearman and Bruckner, 2001). Getting Ahead of the Curve was the other key stake holder through whom the Department of Health benefited. NHS had a limited delivery option and benefited out of the development of the action plans and also helped in reaching out to more number of people all over the world. This was a great step towards bringing down the health inequalities overall. The main issue that was a challenge to the health inequalities was that of the improvement in sexual health. The scheme also set out the plan as to how the local levels of the health area were looked after. The Department of Health ensures to provide local levels of the health along with the NSFs in the areas where it is required (Department of Health, 2011). Diabetes NSF had links to sexual health problems and Department of Health is looking forward to the Children’s and Long-Term Conditions NSFs as well. The program addresses the development and implementation of national sexual health training strategies where the training requirements for professional involved in the area is provided and more people are benefited out of this modernization effort (Department of Health, 2011). It emphasizes on the needs to train the relevant sources and not just those in the health sector. Furthermore, The National Workforce Development Board and Workforce Development Confederations are the two local bodies connected to the scheme (Department of Health, 2001). There were few issues regarding providing responsibility to that of Primary Care Trusts (PCTs) but Department of Health encourages the participation of other PCTs as well (Department of Health (2011).There has been commissioning of tool-kits to these PCTs as a support factor. A consortium was formed for the purpose and the size varies according to the concerned areas. Additionally, transitional facilities were made to protect the Commission of Special Services that includes HIV treatment and care. For the current year, the PCT is expected to take care of the current agreements for the financial year and are negotiating other with Regional Specialized Commissioning Groups (Department of Health, 2011). 3. Aims of Sexual Health and HIV Strategy The main aims of the Strategy were to prevent transmission of STIs and HIV, prevent the extend of STIs and undiagnosed cases of HIV, limit the rate of unintended pregnancies, promote health benefits for people who suffer from HIV, generate awareness to reduce the stigma of STIs and HIV. These aims were included in the strategy which proposed to (Department of Health, 2001) provide clear information regarding prevention of STIs and HIVs, ensure the evidence base is available for prevention of HIV and STIs, define a target for reducing the number of new HIV infections, develop mechanism to provide sexual health services which should involve people who are working for primary care settings and providing a collaborative plan to jointly work to deliver a comprehensive service to the patients, evaluate the advantages of integrated sexual health and include pilots for primary health care youth service, promote one stop clinics for teenager health and primary care teams having specialist members for providing care and guidance in sexual health. The strategy addressed the issues regarding the need for development and training of the workforce into the HIV and sexual health services, hence providing a full fledged scheme for reducing mistakes to prevent patches and poor coordination. The strategy also explained the models of new standards and services for easy and fair access. 4. Unwanted Pregnancies in Teenagers Up To 20 Year Olds In Western Europe, UK has highest teenage birth rate. Teenage pregnancies are becoming a social phenomena and the US is the only other country with such high rates of teenage pregnancies (Department of Health, 2001). The problem of teenage pregnancies is further higher in economically poor regions. In 2002, a report found half of the pregnancies of teenagers less than 20 years of age, were from 30% of most deprived people in the region and 14% occurred in 30% least economically deprived regions (Dennison, 2004). The most deprived population showed highest conception and by 2008, the underage conception rate in England and Wales showed a reduction by 13% as compared to 1998, proving the success of the Sexual Health and HIV Strategy 2001. More than 60% of the pregnancies resulted in legal abortions which is the highest number of conception statistics, since 1969 (DCSF, 2010). Similar results have been shown in other findings. Teenage pregnancy cases are also found high in Kingston upon Hull, Nottingham, Doncaster, Middlesbrough, Barnsley, Manchester (highest), Bristol, Sandwell, Stoke on Trent, North East Lincolnshire, Bradford, and Blackpool which are the low GCSE exam success regions (Klein, 2006). Additionally, in a 1997 study, it was found the north and south regions showed dissimilar results in conception rate under 20 (British Medical Association, 2000). The highest rate was found in north of Britain and lowest in the south, which reflected a high rate of abortion. London had a high rate of abortion and conception as well. Teenage pregnancy is significant public health issue because there are many short term and long term problems associated with it (Department of Health, 1990). Alarmingly, the rate of teenage pregnancy is 30 per 1000 in the age from 15-19 in the UK, which is relatively higher as compared to other European nations. There has been a steady decline in the rates in the past 20 years, while the rate in the US is 55 per 1000 (Klein, 2006). People are now more sexually active at a younger age and in the UK, the age of being sexually active has is reduced to 17, while 40 years earlier, the age was 21 for women and 20 for men (DCSF, 2010). In the UK, the use of contraception in sexually active teenagers is low as compared to parts of Europe. 4.1 Concerns Teenage pregnancies raises a number of health risks such as toxemia, anaemia, hypertension, eclampsia, difficulty in labour and longer labour, the birth of babies having a small gestational time period ((Klein, 2006). This raises health risks to the babies and raises the risk of mortality. A pregnant teenager generally takes an unskilled job or takes up semi-skilled job, since often teenage mothers drop out of education and this has an impact on the social and personal costs, affecting the overall economic cycle of the teenage mother (Department of Health, 2011). 4.2 Risk Factors Studies indicate teenage pregnancy is higher in other counties as well in people belonging to low socio-economic class having poor educational qualification, resulting in dropping out of school (Department of Health, 2011). Teenage pregnancy is generally associated with poor education or work or training, history of sexual abuse, involvement in crime and varying mental health issues. There are multiple risk factors which are associated with it. Interestingly, there exists a geographical distribution of such pregnancies where the highest rate of teenage pregnancies is found in poorest regions. What’s more, certain ethnic populations are at a higher risk (West Sussex Health Authority, 2001). In teenagers, contraception such as pills and condoms do not provide the desired rate of success and if a regular contraception method does not work or is missed, the emergency contraception is often underused by the teenagers ((DCSF, 2010). 4.3 Factors Causing Teenage Pregnancy The causes of teenage parenthood are not simple to understand but three factors have been found common: Poor expectation - Poor expectation of getting a job and education is a major reason for getting pregnant where the teenagers find no reasons for not getting pregnant (Tones and Tilford, 1994). Ignorance - The second reason is ignorance when the youngsters lacks the accurate information related to pregnancy, contraception, STDs (sexually transmitted diseases), relationships and the meaning of being a parent (Tones and Tilford, 1994). Only 50% of the youngsters in the age of 16 to 20 years use contraceptives while they start having sex, while in Denmark, Netherlands and the US, the rate is 80 percent. Confusion - The confusing images of society, media and open environment towards sex gives a wrong message to teenagers who feel it is a normal activity and most of the parents and public institutions are not ready to speak about sex and expectations regarding sexual activities (Department of Health, 1990). A teenager quoted once as saying that it sometimes appears sex is compulsory and contraception is prohibited in peers groups. 4.4 The Ways to Handle the Problem There are many factors which contribute to the problem of teenage pregnancies and the strategies to prevent it should be dependent on individual factors which can break the chain of events at various points. National Campaign There is a need to generate awareness related to the issue in society among parents, teenagers and professionals who can help to change the attitude towards teenage pregnancy and a new structure can be created through the coordination of local plans and national plan stating a clear accountability in this regard. The Department of Health in the UK created an action plan (The National Teenage Pregnancy Strategy) to get the desired goal of preventing pregnancy under 18 years by 2010 and independent advisory groups were created at the national level to control teenage pregnancy to monitor the strategy and advise the government. The first national strategy named - National Strategy for Sexual Health and HIV (July 2001), was formed to prevent and regulate the sexual ill health (Department of Health, 2003). The poor sexual health, STIs and unintended pregnancies has many consequences and lasting effects on lives of people. The unprotected sexual intercourse results in conception in 90 percent of the cases and in a single case of unprotected sex with infected person, there is 30 percent chances of getting infected from genital herpes, while there exists 30 percent to 50 percent risk of Chlamydia, and 1 percent risk of acquiring HIV (Raneri and Wiemann, 2007). 5. The Impact of the Strategy on Unwanted Teenage Pregnancy The scheme of action comprised some of the definite obligations on the goal, which also included the creation of a cross-government scheme in order to attend to the discrimination meted out to people with HIV or STIs. This job created the plan for cross-government schemes offered by Teenage Pregnancy Strategy, especially inculcating the knowledge on relationships, sex, HIV, STIs. HIV Commissioning Toolkit and sexual issues were circulated in order to support and develop the implementation of PCT and local program plans (Department of Health, 2001). The scheme included several areas like connection to the Local Modernization Board, HIMP and other local authority schemes, aiding people, renewing neighborhood, teenage pregnancy, mental health, communicable disease, misuse of substances, bringing about educative knowledge on sexual health and relationships and undertaking issues like teenage pregnancy. In order to understand human sexuality, the reasons behind having a particular age for sex are being taught effectively through sex education. Apart from this, a realistic approach for the teachers through plans for lessons, case studies on new PSHE website, using Teacher Training Agency Handbook for initial teacher training, implementation of pilot schemes to SRE teachers, schools of nurses and such areas in SRE schools were adopted to make sure that teenagers are offered the apt services (Department of Health, 2001). Furthering Sex Education and Better Relationships provides support for parents through involving parents in prevention of teenage pregnancy by using best support service ((DCSF, 2010). Young Offender Institutions makes use of the materials created by the Sex Education Forum in order to educate on sex, parenthood and relationships on all offenders. The action plans against discrimination and stigma comes with a plan for education on sex and relationships that helps in prevention of the problem. Teenage Pregnancy Strategy is already working towards the preventive measures over the risk groups and is targeting important groups that include young men, learning disability people and tackling of inequalities in men including development of contraceptives (Lawlor et al, 2001). The Commissioning Toolkit plays a major role in aiding the nurses for evolving their roles in taking care of local contraception services that include convenient access facilities to meet the needs. It also offers a model practice. Gathering of information on those services that provides for free or low cost condoms and developing the schemes is already moving along with that of Teenage Pregnancy Strategy Develop, One Stop Shops Develop (Department of Health, 2011). The different models for the best health service along with providing contraceptives and GUM services is clearly stated in the Department of Health, UK (Klein, 2006).. Youth services, specialist areas and primary team for care that meets the requirements of all is covered under these models. Intention or expression of interest is asked for on these three models as well. The reason behind all these schemes of Sexual Health and HIV Strategy 2001 was to implement and develop better models to face the issue of teen pregnancy. 5.1 Analysis It is not an easy affair to handle teenage pregnancy problems for the government and especially the Department of Health. A slow but steady step with consistently implemented policies has surely been successful in bringing down the unwanted pregnancy rates among teenagers in the UK and thus provides a great remedy to the unwanted pregnancy issue among teenagers in the future. NHS resources and the Department of Health’s Sexual Health and HIV Strategy 2001 have to a great level, improved the sexual health and reduced the unwanted teenage pregnancy in the UK. A major part of the teenage pregnancy is unplanned and many such cases result in abortions and also causes an emotional stress to the family and individuals. In case the teenage pregnancy results in child birth, then it proves to be a greater problem to the health as well as career and educational prospects of the individual, thereby bringing down their lifestyle to a great extent (Raneri and Wiemann, 2007). Even if the parents are competent, children of teenage parents need to go through a lot of adversities and psychological stress during their social life, hence are prone to become teenage parents. The fall in the teenage pregnancy rates is a testament of the successful implementation of the Sexual Health and HIV Strategy 2001. Furthermore, the result of good sex and relationship education (SRE), partly due to the Sexual Health and HIV Strategy, helps teenagers to cope with the pressures regarding sex and how to avoid unwanted pregnancies, since Sex and Relationship Education SRE offers knowledge and skill to avoid teen pregnancies through sexual health awareness (Miller, 1998). It is also clear that the underlying problems in teenage pregnancy like poverty, low lifestyle, uneducated individuals and also poor self esteem is primarily due to lack of aspirations (Department of Health, 2009). Although a small rise in the rate ( 2.6 percent ) of under 18 conception was observed in 2006- 2007, but the rate of 2007 is low by 10.7 percent as compared to 1998 which is the baseline of under 18 pregnancy strategy. The rate of less than under -18 conceptions lowered and teenage births was less by almost a quarter ,but teenage abortions rose by 6.5 percent (Department of Health, 2009). Success of the Sexual Health and HIV Strategy 2001 across the nation has been non-uniform. While one-fifth of the regions accomplished the target of under-18 conceptions by 20 percent (which is double the country’s average), and almost the same rate of local areas have either constant or increasing under-18 conceptions rate. Further support has been offered by government offices and the NST, in the areas of high and increasing rates of teenage pregnancy (Department of Health, 2009). The additional funds to supplement the access to contraception has been provided through Section 3.5, which is used to provide sexual health and also to ensure easy availability of contraceptive in places such as FE colleges and schools. A survey by the Sex Education Forum in 2007 depicted 75% of the colleges and 30% of the secondary schools are allowing sexual health provisions and contraceptives, to some extent, and in some cases, it is offered through a broad CASH service offering suggestions, emergency contraception, condoms, STI screening, pregnancy tests and various other forms of contraception care including LARC (Department of Health, 2009). The government’s resolution to make personal, social and health education (PSHE) legal, all through the stages, which includes sex and relationships education (SRE) to guarantee teenagers achieve a comprehensive SRE program, which is consistent across all the educational institutions (Department of Health, 2009). The data of 2008 depicts there has been excellent developments made in improving access to abortion services and more abortions are done at an early stage of pregnancy than before , which include 90% of the abortions in 2008 (Department of Health, 2009). The achievement of Sexual Health and HIV Strategy 2001 since 2001 was made through programs of less than 13 weeks and 73 percent was carried in less than ten weeks. More than this, a growing number was funded by NHS i.e. 91% in 2008 as compared to 78% in 2002 (Department of Health, 2009). Changes in the services were made in many areas, which helped to limit the hurdles to access services and this was reflected in number of women who earlier had abortions. This movement provided more choice in the method of abortion to women where in 2008, 38% of the abortions were early medical abortion in a community based medical setting (Department of Health, 2009). The call to connect contraceptives and abortions with a transparent and quick pathway is considered the best clinical practice and it should be included in the good practice supervision for the commissioning and to promote the provisions of abortion services and contraceptives, which will be available published later in the year (Department of Health, 2009). Steps are also taken to reduce repeat abortions by confirming the national contract for the facilities of NHS Abortions, which includes the need for providers to give women the post abortion contraception and guidance, initiated from 1 April 2009 (Department of Health, 2009). DH joined stakeholders to promote standard service specification which will improve the deliverance of abortions facilities, include contraception and it will also limit intolerable local variations in the model of the service. This outline was used from April 2010. The above given conditions are few activities which we have taken after the first sexual health strategy was released in 2001 (Department of Health, 2009). 6. Conclusion The Sexual Health and HIV Strategy has helped to propagate a more elaborate spectrum of health services that includes GUM clinics, family planning clinics for a community and primary care services for pregnant teenagers, which were not given proper attention prior to the implementation the Sexual Health and HIV Strategy. The strategy also has catered to the requirement of pregnant teenagers for access to sex and pregnancy related information. Thus, the Sexual Health and HIV Strategy has set out the measures to increase the understanding of the issues related to unwanted pregnancies in teenagers for effectively curbing the spiraling unwanted teenage pregnancy rates in the UK. 7. References Bearman PS and Bruckner H (2001) Promising the Future: virginity pledges and first intercourse, American Journal of sociology 106(4):859-912 Buston, K, Williamson, L, Hart, G (2007) Young women under sixteen years with experience of sexual intercourse: who becomes pregnant?, J. Epidemiol. Community Health 61;221–225 Billy, J.O.G., Brewster, K.L., & Grady, W.R. (1994). Contextual effects on the sexual behavior of adolescent women. Journal of Marriage and the Family, 56(2) 387-404 British Medical Association (2000). Consent Rights and Choices in Health Care for Children and Young People. London: BMJ Books, 2000. www.bma.org.uk/cpr Clements, S. et al. (1998) Modelling the spatial distribution of teenage conception rates within Wessex British Journal of Family Planning 24, pp 61-71 Creatsas, G., Elsheikh, A. (2002) Adolescent pregnancy and its consequences European Journal of contraception and reproductive health care Sept.; 7(3) pp.167?172 Communicable Disease Surveillance Centre. (2000) AIDS and HIV infection in the United Kingdom: monthly report. CDR Wkly;10:453–454 CRD (1997). Preventing and reducing the adverse effects of unintended teenage pregnancies, Effective Health Care 3(1). NHS Centre for Reviews and Dissemination, University of York Crusaid & Terence Higgins Trust (2005) Poverty and HIV: Lessons from the Hardship Fund DCSF. (2010) Teenage Pregnancy Strategy: Beyond 2010. DCSF, Teenage Pregnancy Unit, DfE, Department of Health (2011) Teenage Pregnancy National Support Team: Evaluation of impact, London: Department of Health, http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_126091.pdf Department of Health (2003) Effective Commissioning of Sexual Health and HIV Services: A Sexual Health and HIV Commissioning Toolkit for Primary Care Trusts and Local Authorities Department of Health (2000) Safeguarding Children Involved in Prostitution. Supplementary Guidance to Working Together to Safeguard Children. London: Stationery Office Department of Health, (1990). Report of the working group to examine workloads in genito-urinary medicine clinics. London: DoH Department of Health, (1990). Report of the working group to examine workloads in genito-urinary medicine clinics. London: DoH. Department of Health, (2001). The national strategy for sexual health and HIV. London: Department of Health; www.doh.gov.uk/nshs/index.htm Department of Health, (2009). Moving Forward: Progress and Priorities – Working Together For High-Quality Sexual Health Government Response to the Independent Advisory Group’s Review of the National Strategy for Sexual Health and HIV, London: Department of Health Dormire SL, Yarandi H (2001). Predictors of Risk for Adolescent Childbearing. Applied Nursing Research; 14:81-86 Downie R.S. et al. (1996) Health Promotion: models and values, (2nd edn) Oxford, University Press Darroch, J. and Singh, S. (1999). Why is teenage pregnancy declining? The roles of abstinence, sexual activity and contraceptive use. Occasional Report No. 1. New York: Alan Guttmacher Institute. www.agi-usa.org/pubs/or_teen_preg_decline.html Dennison C (2004) Teenage pregnancy: an overview of the research evidence. Health Development Agency Hosie, A (2002). Sexual Health Policy Analysis in Selected European Countries, HEBS Klein, R. (2006) The New Politics of the NHS: from creation to reinvention. Oxford: Radcliff Publishing Kirby, D (2007) Emerging answers 2007: Research Findings of Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases Lawlor D.A. et al. (2001) Teenage Pregnancy is not a Public Health Problem British Medical Journal 323 (1428), pp 7326-327 Jolley S. (2001) Promoting teenage sexual health: an investigation into the knowledge, activities and perceptions of gynaecology nurses Journal of Advanced Nursing 36 (2), pp 246-55 Manning, W.D., Longmore, M.A., & Giordano, P.C. (2000). The relationship context of contraceptive use at first intercourse, Family Planning Perspectives, 32(3), 104-110 Miller, B.C. (1998). Families Matter, A Research Synthesis of Family Influences on Adolescent Pregnancy. Washington, DC: The National Campaign to Prevent Teenage Pregnancy National AIDS Trust (2004) The Needs of People Living with HIV in the UK: A Guide O’Mahony C, Carne C, Kell P, et al (2001). GUM Clinic Access Report, personal communication Raj, A., Silverman, J.G., & Amaro, H. (2000). The relationship between sexual abuse and sexual risk among high school students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey. Maternal and Child Health Journal, 4(2), 125-134 Raneri, LG and Wiemann, CM (2007) Social ecological predictors of repeat adolescent pregnancy, Perspect. Sex Reprod. Health Reading Borough Council (2005) Supporting People Commissioning Strategy 2005-2010 Santelli, J.S., Brener, N.D., Lowry, R., Bhatt, A., & Zabin, L. (1998). Multiple sexual partners among U.S. adolescents and young adults. Family Planning Perspectives, 30(6), 271-275 Sigma Research (2000). Vital statistics findings from the national gay men’s sex survey Social Exclusion Unit (1999) Report Teenage Pregnancy. The Stationery Office, London The National Strategy for Sexual Health and HIV Sexual Health and HIV Strategy (2001). Integrated Steering Group United Kingdom. London, PHLS, www.doh.gov.uk/nshs/bettersexualhealth.pdf Tones K. and Tilford S. (1994) Health Education: Effectiveness, Efficiency and Equity London, Chapman and Hall Terence Higgins Trust (2003) Meeting the Rising Challenge: The Growing HIV epidemic and its Implications for Primary Care Trusts Weatherburn, P. et al. (2003) Project Nasah: An Investigation into the HIV Treatment Information and other Needs of African People with HIV resident in England West Sussex Health Authority (2001) Teenage Pregnancy Strategy 2001-2011, Unpublished report. West Sussex. West Sussex Health Authority. Wilson, H. and McAndrew, S. (eds) (2000) Sexual health - foundations for practice. London, Bailliere Walker, J, (2004) Parents and sex education: looking beyond ‘the birds and the bees’, Sex Education Zavodny, M. (2001). The effect of partners’ characteristics on teenage pregnancy and its resolution. Family Planning Perspectives, 33(5), 192-199 Read More