Gonorrhoea. Syphilis. Words my patients hear and tend to shudder at. But sexually transmitted infections, or STIs, have been around for centuries, unfussy about whose genitalia they infect and ready to wreak whole-body havoc on those who don’t access testing and treatment.
Luckily UK sexual health clinics, like the one I work in, have been providing STI care for years – 100 years in fact as 2017 marks the centenary of the 1917 Venereal Disease Act. The act forbade the unsafe treatment of STIs by the unqualified and complemented the public health (venereal diseases) regulations of the previous year, which demanded free, confidential services to diagnose and treat STIs, and paved the way for the creation of the NHS 30 years later. Both pieces of legislation followed the 1913 royal commission on venereal diseases, which reported during the first world war when STI rates among troops were sky-high and Lord Kitchener’s advice to soldiers was having little effect. “In this new experience you may find temptations both in wine and women. You must entirely resist both.”
This recognition of the need for education, prevention and access to sexual health care marked the start of an incredible journey towards healthy sex and relationships for all. The 1920s saw the production of the first latex condom – a happy alternative to sheaths made of lamb intestine or animal horn. In 1928, Alexander Fleming discovered penicillin, an antibiotic later found to cure syphilis and which remains a first-line treatment for the infection today. In 1960, the oral contraceptive pill was introduced, followed by continuous advancements in family planning that would empower millions of women worldwide. And in 2008, the human papilloma virus (HPV) national immunisation programme was introduced for teenage girls, a vaccination that protects 300,000 young women a year against deadly cervical cancers and highly transmittable genital warts.
In a time of austerity, when sexual and reproductive health budget cuts of more than 20% mean clinic closures and the loss of resources, never has this hard work and progress felt so precious. Reports show sexual health services have been the hardest hit by reduced funding and I see first-hand the effects of this disinvestment. Staff cutbacks, reduced opening hours and fading morale are all grim realities facing my specialty, putting patients at risk, leaving the most vulnerable voiceless and paving the way for more STIs, antibiotic resistance, unplanned pregnancy, sexual abuse and female genital mutilation (FGM).
To celebrate the achievements made over the past century and to illustrate the work left to do, the British Association of Sexual Health (Bashh) has made a short film to remind us of how far we’ve come and how essential it is to protect the rights we have. The film complements a podcast Bashh has co-produced with the National Archives, aptly named A Bit of a Scratch.
Undoubtedly, one of the biggest achievements in sexual health has been the advances in HIV care. The year 1981 heralded the start of one of the greatest public health challenges in history: a virus with no cure and seemingly no rhyme or reason as to whether those infected would survive to their next birthday. The introduction of highly active antiretroviral therapy (Haart) in 1996 transformed a terminal disease into a chronic, manageable condition – a bona fide result of teamwork between patients and professionals who shared the common goal of survival.
The focus is now on rolling treatment out to those who need it and preventing HIV transmission. The recent Proud trial showed the preventative powers of pre-exposure prophylaxis (PrEP), when antiretroviral therapy is taken to prevent acquisition of HIV. A lack of investment means PrEP is still not available on the NHS, despite its use contributing to a 32% reduction in new HIV diagnoses in London’s sexual health clinics. In the absence of funding many clinics, including my own, have set up PrEP centres that provide support and monitoring for people who obtain PrEP over the internet – the cheapest way of getting the drug and avoiding a life-changing HIV diagnosis.
Of further concern are the high rates of undiagnosed infection, with 13% of those living with HIV unaware they have it [pdf]. Thirty-nine per cent of those diagnosed with HIV in 2015 were diagnosed at a late stage, increasing their risk of death tenfold. Where I work in south London, two-thirds of patients are from black and minority ethnic communities, which remain isolated and at high risk of HIV acquisition and late diagnosis. Only a considered, well-funded approach will be able to turn these statistics around.
The need for investment in sexual and reproductive health services is crystal clear. I, alongside the sexual health community, call on the government to be inspired by and to continue the incredible progress of the past 100 years. Too many lives have been lost to preventable situations – there are no excuses to lose any more.
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