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Sexual health services ‘close to crisis’, experts warn

Experts have warned sexual health services in England are “very close to a crisis” with clinics forced to ration the amount of free condoms they give out.

It comes amid a rise in sexually transmitted infections (STIs) in young people, which they said should be normalised in order to break down barriers.

Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV, appeared in front of the Women and Equalities Committee (WEC) on Wednesday as it looked at reasons for the rise in STIs, particularly among those aged 15 to 24.

England’s chief medical officer Professor Sir Chris Whitty and children’s commissioner Dame Rachel de Souza were also witnesses at the one-off evidence session.

Sir Chris said there are about 199,000 cases of chlamydia a year, as well as about 82,000 cases of gonorrhoea, about 26,000 cases of genital warts, and 8,500 cases of syphilis.

However, he warned “large numbers of people carry these infections without knowing about them”, so the figures are the “bottom end of the range”.

When asked how sexual health services are coping with increased demands, Dr Dewsnap said: “I don’t like to use the word crisis but we are very close to a crisis.

She added: “Access isn’t good enough. There’s no doubt about that. And there’s no doubt that that is as a result of reduced funding.

“So we’ve had a real terms funding reduction of about £150 million over the last 10 years going to all sexual health services. And that has meant that ultimately there are less staffing clinics, because the vast majority of our budget goes on staff.”

Dame Rachel said a reduction in school nurses has also added to the problem, as well as inadequate sex education in schools.

“One of the ways we were so successful in the past in these areas was that children could just walk in. So they’d often be signposted by a school nurse.

“We’ve got 35% fewer school nurses than 10 years ago. They were often the trusted adult in school who would send you off to this. And you cannot just walk in. Children are telling me all the time they are not able to get access, they are not able to get appointments.”

She added: “The problem is, if you’re learning about sex from Tik Tok, and you’re watching porn, nobody uses a condom.

“They’re getting inaccurate information from unreliable sources, rather than from where they should be getting it.”

When asked if there should be a national campaign about STIs tailored to young people, Sir Chris said he would prefer a more targeted approach.

“I don’t think it necessarily should be a national campaign, because I think the drivers of this are very different in different communities,” he told the committee.

He advised to “double down on the basics” and reinforce “the importance of condoms or other barrier methods”.

However, Dr Dewsnap said many clinics have to ration free condoms.

“People do use them if they’re available free, and people do still ask for them,” she told the WEC.

“But in many clinics, unfortunately, as horrific as this sounds, we ration how many we give.”

Sir Chris also said the normalisation of STIs and better education for parents could also be effective.

“I think that the first thing to do is to is to normalise them,” he said.

“Because the danger is, people think only bad people and people who are not like their friends get sexually transmitted infections, rather than just to say, ‘look, this is just a normal thing that happens a lot in lots of different places’.

“The second thing is, I think we need to help, in the context of schools, parents to see sexually transmitted infection information not as something which is a threat, and which will make it more likely that their children, their peers, will behave in ways that they don’t want them to, but rather as a safeguard against them being exploited by people who are not caring for them.

“I think we really need to make that positive case for people who are understandably nervous on this.”

When asked about antibiotic resistance, Sir Chris said gonorrhoea is “the infection where the biggest worry is”.

“Gonorrhoea is, in the UK and internationally, one of the most highly drug-resistant organisms we have,” he added. “So we’re down to a very limited number of antibiotics now which can be used – previously we’d have had a much wider range.

“Fortunately, this hasn’t translated into drug resistance for most of the other antibiotic-treatable sexually transmitted infections, at least not to this level.

“But if we are really in deep trouble at the moment we do need some new antibiotics or some new way of approaching.”