Category: sexual behaviour

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.

Bacterial vaginosis fact sheet update by CDC

Bacterial vaginosis (BV) is the commonest vaginal infection seen in women. The Centre of Disease Control (CDC) has recently updated its fact sheet on this common condition.

In summary 

BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners and douching can upset the balance of bacteria in the vagina and put women at increased risk for getting BV.

BV can cause some serious health risks, including:

Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;

If you are HIV positive, increasing your chance of passing HIV to your sex partner;

Making it more likely that you will deliver your baby too early if you have BV while pregnant;

Increasing your chance of getting other STDs, such as chlamydia and gonorrhoea.

These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

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.

Project on the role of shame in failure to attend for STI and HIV testing shame approved for funding

The 2013 round of applications for funding has resulted in approval for the following pilot project:

Designing a Research project for understanding the role of stigma and shame in STI and HIV testing 

The project will be headed by Phil Hutchinson, Ph.D. (Man.), M.A. (Man.), B.A. (London), Senior Lecturer in Philosophy, Manchester Metropolitan University.

The aim of the preliminary project is to find the methodology to test the hypothesis: is shame one of the reasons for failing  to attend for STI and HIV testing. The project will be completed within six months involving setting up workshops with groups involved with both patient groups and those sexual health care.

HIV testing in the street: a useful tool for widening coverage

The March issue of the journal STI included an article by Sonia Fernandez-Balbuena and colleagues in Madrid which demonstrated that offering HIV testing on the street  may allow a significant number of hard-to reach populations to offer themselves for HIV testing.

Of 7552 persons in various Spanish cities who were asked to full a brief questionnaire and offered HIV testing 3517 participants (47%) were first-time testers. These included 24% of men who have sex with men , 56% of exclusively heterosexual men and 60% of women. 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM.

The authors concluded that their community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community.

In their view a decisive in decisive factor for almost two of every three persons who had never been tested. was the visibility of the programme.

Sexual behaviour in UK

The National Survey of Sexual Attitudes and lifestyles (Natsal) has been investigating sexual behaviour across a wide range of people, geographical spread and life styles at 10 year intervals since 1990. Natsal is the most extensive, authoritative and accurate investigation of sexual behaviour in the United Kingdom.

The latest report was published as always in the Lancet. The survey shows some interesting changes in sexual behaviour including a narrowing in the gap between men and women in same sex relationships.

Over 15,000 pople were interviewed using validated methodology that minimises bias.  Data were compared between Natsal-1 (1990—91), Natsal-2 (1999—2001), and Natsal-3.

82·1% of men and 77·7%  of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women.

The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16—44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, there was evidence of increased sexual activity and also increase in same sex activity in women.

In women the number of male sexual partners over the lifetime , proportion reporting ever having had a sexual experience with genital contact with another woman , and proportion reporting at least one female sexual partner in the past 5 years  increased since the last report in 2000.

Interestingly the reported number of occasions of heterosexual intercourse in the past month had reduced but there was a reported expansion of heterosexual sexual repertoires—particularly in oral and anal sex—over time.

Also of note: while acceptance of same-sex partnerships increased so did  intolerance of non-exclusivity in marriage  in men and women in the latest survey.

The authors concluded that:

“Sexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life—albeit reduced in range and frequency—emphasises that attention to sexual health and wellbeing is needed throughout the life course.”

Need and acceptability of human papillomavirus (HPV) vaccination in men

HPV vaccination of young women with the quadrivalent vaccine (HPV4) resulted in a dramatic fall in genital warts and cervical cancer rates. However rolling out a similar vaccination in young men has been hampered by arguments that  male HPV4 vaccination programmes exceed cost-effectiveness thresholds.

Unlike the USA and Australia, European countries do not include men in HPV vaccination programmes, instead focusing on achieving expanded coverage among women to promote herd immunity.

Yet there is  evidence that HPV4 vaccination offers substantial clinical benefits to men and is cost effective among men who have sex with men (MSM). MSM have largely been excluded from mathematical models. A recent study in the journal Sexually Transmitted Infections has shown that HPV related conditions such as anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in most European cities. The paper concluded that there is an urgent need to improve sexual healthcare tailored to MSM at risk for STIs.

There is also the argument  for a gender-neutral (universal) approach to vaccination.

In the same issue of STI a meta-analysis shows that there are currently a number of obstacles to acceptability of HPV vaccination in  men. They concluded that Public health campaigns should aim to promote positive HPV vaccine attitudes and awareness about HPV risk in men. The paper recommended interventions to promote HPV vaccination for boys and to overcome  obstacles to HPV vaccine acceptability for men.