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Lifestyle & behaviour - Sexual health overview
Overview of sexual health
The World Health Organisation (WHO)
definition of sexual health is "A state of physical, emotional, mental and social well-being related to sexuality; not merely the
absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual
relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and
violence. For sexual health to be attained and maintained, the sexual rights of all persons must be protected, respected and fulfilled".
Although the above definition encompasses not only physical but also emotional, mental and social well being, this first update of
the London Health Observatory's (LHO) sexual health web pages concentrates predominately on the physical aspects of sexual health in
four key areas: Sexual behaviour and lifestyles, sexually transmitted infections including HIV, access to services and what works with
respect to improving sexual health. It pays particular attention to young people and the importance of education for prevention of
sexual ill health, men who have sex with men and better access to services.
There is a high human suffering cost associated with sexual ill health. STIs cause unnecessary ill health and deaths which could be
avoided by better education, earlier diagnosis and treatment. Unwanted pregnancy also has a significant human and life changing impact
on individuals - especially amongst teenagers. Termination of unwanted pregnancy can have a lasting physical and psychological impact
on the patient leading to further health problems in the future.
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The importance of sexual health in London
In a number of key areas London has significantly higher levels of sexual health problems than the rest of the UK, for example:
- In 2003, about one in every two syphilis diagnoses, one in four chlamydia and more than one third of all gonorrhea infections
in England, were in London.
- Londoners bear the highest burden of HIV in England - with 20,000 Londoners receiving treatment in 2003. It is estimated that
there are a further 8,600 Londoners with undiagnosed HIV infection.
- London's teenage pregnancy rate shows no sign of decline, unlike the national rate.
- Some risky sexual behaviors such as multiple sexual partners, are more common among Londoners than elsewhere and are increasing.
- Young people aged 16-19 have experienced the highest rises in sexually transmitted infections (STIs), especially chlamydia.
The extent of sexual health problems in the capital has in turn led to pressure on sexual health agencies including contraception,
abortion and Genito-Urinary Medicine (GUM) services. (see Access to services)
Sexual health problems in London are also characterised by their uneven impact on the population with evidence of a significant
health divide:
- Although there has been a welcome recent fall in teenage conceptions in 19 London boroughs including some inner city areas, this must be set against an increase, or no change, in other boroughs.
- Men, especially men who have sex with men, are disproportionately affected by sexually transmitted infections and HIV.
- The biggest rise in HIV in recent years however, has been through heterosexual intercourse. Nearly all these infections
have been among Black Africans, three quarters of which were acquired in Africa.
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Sexual health in the white paper 'Choosing Health'
Sexual health has been identified as one of the key national priorities for action in the
White Paper 'Choosing Health'.
The key commitments on sexual health are:
- New national campaign targeted at young men and women to ensure they understand the real risk of unprotected sex and
persuade them of the benefits of using condoms to avoid risk of sexually transmitted infections (STIs) or unplanned pregnancies.
- New national campaign targeted at young men and women to ensure they understand the real risk of unprotected sex and
persuade them of the benefits of using condoms to avoid risk of sexually transmitted infections (STIs) or unplanned pregnancies.
- Supporting implementation of the Teenage Pregnancy Strategy, in particular through action in neighbourhoods with high
teenage conception rates.
- Committing new capital and revenue funding to modernise the whole range of NHS sexual health services, communicate
better with people about risk, offer more accessible services and provide faster access to treatment. This
table
provides indicative distribution of the 2006/7 Choosing Health White Paper funding for sexual health for London's PCTs.
- Ensuring faster access to GUM services such that appointments are offered within 48 hours of contacting the service
(target 100% by 2008).
- Accelerate implementation of a national screening programme for chlamydia to cover the whole of England by March 2007.
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The london-wide sexual health framework
The importance of sexual health in the capital is also reflected in the pan
London sexual health framework agreed by London's five strategic health authorities. The framework was drawn up prior to the White
Paper's publication. The main objectives proposed by the framework are:
- Improving London's public health through the promotion of good sexual health and the prevention of sexual ill health.
- Improving access to London's sexual health and HIV care services.
- Improving the patient experience of people using sexual health services in London.
The framework sets out seven standards to be achieved between 2005-2008 in support of the above objectives:
- A reduction in the rate of growth of teenage conceptions. By 2008
- A reduction in the rate of growth of STIs. By 2008
- A reduction in the level of undiagnosed HIV. By 2008
- An increase in the level of HIV, hepatitis B and syphilis screening amongst pregnant women. By 2005
- A maximum 48-hour waiting time and agreed minimum standards for NHS funded GUM services. By April 2006
- A minimum of 70% of pregnancy terminations taking place within a 10 week gestation period. By April 2007
- An improvement in the patient experience amongst people using sexual health services. By April 2007
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Useful organisations
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