Category: Sexual health services

Sexually abused children should be offered HPV vaccination

Should children exposed to sexual abuse be offered human papillomavirus (HPV) vaccination alongside screening for sexually transmitted infections? A recent article in the Lancet argues for a yes answer.

The WHO defines childhood sexual abuse  as the involvement in sexual activity of a child under the age of 18 years who did not give informed consent or is not developmentally prepared.

The global prevalence of childhood sexual abuse is estimated to be 8–31% for girls and 3–17% for boys. The true figures are probably nearer the upper figure.

According to a review, parents were the perpetrators of about 45% of cases of childhood sexual abuse in the USA, and other relatives were responsible for a further 19%.  Others included figures of authority such as priests and teachers. Survivors of such abuse are often hesitant to report such incidents because of shame and fear of retribution. Thus, the incidence and prevalence of childhood sexual abuse is almost certainly underestimated. Read more

Daily pri-exposure prophylaxis (PrEP) prevents HIV infection in high risk gay men

Daily HIV medicine taken by men who have sex with men (MSM) reduces risk of HIV infection by 86% as was reported by Molina J-M, and colleagues in the ANRS Ipergay trial  at the Conference on Retroviruses and Opportunistic Infections held in Seattle, USA in 2015 (23LB.).

Molina et al reported the final results of a three year study which randomised MSM who were negative for HIV to either take daily HIV prophylaxis with two anti-retroviral drugs in a single tablet immediately or deferred for 1 year.

The study showed that those taking the drugs on a daily basis have a 86% reduction in the risk of being infected by HIV than MSM not taking the drug (p=0.0001). The trial was stopped in October of 2014 and all participants in the  deferred group were offered pre-exposure prophylaxis (PrEP)

As a Lancet editorial commented:

The science is now clear: oral pre-exposure prophylaxis (PrEP) with a coformulation of tenofovir disoproxil fumarate and emtricitabine (Truvada) significantly reduces the risk of HIV infection among individuals at high risk of HIV infection.

The news that PrEP has shown consistent efficacy among those who take it as prescribed should be a cause for celebration, and galvanise action to ensure access to PrEP for those who could benefit the most. But almost 3 years since the US Food and Drug Administration approved tenofovir–emtricitabine for PrEP little is being done on implementation.

With more than 2 million new HIV infections every year worldwide, it is time for that to change.

Invitation to workshop: role of stigma and shame in the access to sexual health clinics

A workshop on philosophical aspects of sexual health is being held at

Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom

The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026

Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16

Workshop 2: Shame, Stigma and HIV. Thursday September 17

Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK

Mandatory registration: contact: marie.chollier@stu.mmu.ac.uk

Further information can be obtained from Phil Hutchinson p.hutchinson@mmu.ac.uk

 

 

One in ten men in Britain report paying for sex sometime in their life – a national study

The National Survey of Sexual Attitudes and Lifestyles (NATSAL) is a survey of men and women carried out in the Britain every 10 years. It remains the most extensive and accurate study of sexual behaviour in a carefully selected population of men and women in the UK that reflect the population of sexually active individuals.

Natsal-3 is a  sample survey of 15,162 men and women (6,293 men) aged 16–74 years, resident in Britain, undertaken between September 2010 and August 2012. Participants were interviewed using a combination of face-to-face, computer-assisted, personal interviewing (CAPI) and computer-assisted self-interviewing (CASI). The more sensitive questions, including those on paying for sex and sex while outside the UK, were asked in the CASI.  

Kyle Jones and her colleagues reported on the results of the questions relating to men who admitted to have paid for sex. 

Their results show that round one in 10 men in Britain report having ever paid for sex at some time. These men are more sexually active than men who do not report having had paid for sex. They have a higher number of sexual partners, only a minority (18.4%) of which are paid.

They are also more likely to report a diagnoses of a sexually transmitted infection (STI) even when accounting for their disproportionately larger number of sexual partners (which is considered the most important behavioural variable associated with STI diagnoses).

This evidence strongly supports the idea that this subgroup of men are a bridge for the sort of sexual mixing (dissociative mixing) that increases the spread of STIs.

Men who pay for sex (MPS) are most likely to be aged between 25 and 34 years, single, in managerial or professional occupations, and have high partner numbers.

After adjusting for the key risk behaviour of sexual partner numbers, these men still report many other sexual behaviours, such as having new foreign partners while outside the UK, less attendance at STI clinic and less condom use. They therefore show an increased vulnerability to STI without taking the necessary precautions.

Interestingly, for some reported behaviours, such as sex partners outside the UK, same sex contact, sex partners found online, and concurrent partners (more than one partner at any time), total and paid partner numbers increase.

This suggests that MPS exhibiting these behaviours have higher lifetime partner numbers than other MPS as well as higher paid partner numbers, putting them at a higher risk for STIs than other MPS.

Call for HPV vaccination for school age boys

In a recent editorial in the British Medical Journal (available only on subscription), Margaret Stanley and coauthors urged the UK government to introduce a gender neutral vaccination programme against HPV in schools for boys and girls aged 12-13 to reduce not only ano-genital warts but HPV-related cancers. These include cervical cancer in women, anal cancers in men who have sex with men and oropharyngeal cancers.

The authors point out that  oropharyngeal cancers have the fastest rising incidence (15% per year) and anal cancer rates in the UK have risen by nearly 300% in the last 40 years..

Transmitting an STI and the law

On May 8 2014 the UK Court of Appeal dismissed the appeal of David Golding against a 14 month prison sentence for transmitting herpes to his partner.

An Editorial in the BMJ by Emily Clarke an colleagues highlights the numerous and  complicated issues that arise from this verdict including:

what constitutes grievous bodily harm,

how you determine that sexual transmission has occurred,

how serious is herpes infection, and

what this judgement means both for health care workers who advise and inform patients on the risks of transmission and on the infected individual and their duty of informing all partners of potential risk of transmitting an infection even during asymptomatic shedding.

The Editorial correctly highlights the dangers of criminalizing sexually transmitted infections and the various problems that arise from this judgement which was based on a law passed 170 years ago addressing totally unrelated issues and at a time when STI’s were not understood as they are today.

Human rights violations against sex workers: burden and effect on HIV

This is part of a series of articles on HIV and sex workers published by The Lancet and freely available.

In this article Michelle Decker et al  reviewed evidence from more than 800 studies and reported on the burden and HIV implications of human rights violations against sex workers.

Abuses of human rights are  perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts.

Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing.

Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law.

The authors conclude that protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing.

Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.

Important new research on lymphogranuloma venereum (LGV) in gay men in the UK

Lymphogranuloma venereum (LGV), previously predominantly a tropical disease, re-emerged in Western Europe in 2003, and has arguably now regained endemic status in many countries. It remains largely contained within in a population of men who have sex with men (MSM) with high rates of other sexually transmitted infections (STIs) including HIV, though a first female case was reported in Sexually Transmitted Infections in 2012.

A recent series of papers in Sexually Transmitted Infections sheds further light on the risk factors for rectal LGV in men who have sex with men in the UK, the key symptoms and ways in which LGV presents to the clinician, and pitfalls in the currently recommended treatment and prevention strategies.

Moreover, microbiological  characteristic of LGV repeaters using surveillance data has convinced Rönn and colleagues that behaviour alone does not explain reinfection, which they see as related to centrality in sexual networks.

Together these four articles add important information on the clinical presentation, epidemiology and treatment of LGV in MSM.

Proposed research on why Somalis do not access sexual health services in UK

STIRF had agreed to fund a project by Steve Wordsworh and colleagues from the Faculty of Health, Birmingham City University  investigating the reasons why Somali refugees appear not to access sexual heaalth services. Below is a brief description of the propsed project:

In the United Kingdom there is an established and growing refugee population that have arrived from Somalia. Despite this, the Somali population are often not included in ‘official’ statistics largely because the community is rarely recognised as a distinct ethnic category.

Because of this we often unaware of the health or social needs of those who arrive in the UK from a Somalia background, therefore it is inevitable that the support and needs of this community is often sadly neglected. So despite a very real need for help and support the uptake of health services is very low.

We are particular concerned with low access to sexual health service from of our local Somali community in Birmingham. So building on expertise in both working with the Somali community and in sexual health, staff from BCU are planning to undertake a study that seeks to explore just what exactly are the sexual health needs of Somali refugees, importantly we will be seeking to gather their views and perspectives directly from the community itself, we aim to found out  what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best support their needs.

Furthermore, it is our intention that that results from this research can be used to inform service provision by identifying barriers to access and any opportunities that may help to overcome them.