Sexual Health Quarterly Bulletin Available online at: www.cph.org.uk/expertise/sexual-health/

Issue 40 September

2013

Department of Health Update by Andrea Duncan

Sexual Health Improvement Framework DH, PHE and the Sexual Health Forum are currently co-producing an implementation plan and indicator set to support the annual review of progress against the Sexual Health Improvement Framework, which was published in March 2013. Transition Arrangements We continue to work with colleagues in Public Health England and in other commissioning organisations to help to support the new commissioning arrangements for sexual health. DH has recently produced a service specification for integrated sexual health services for local authorities (LAs). LAs are able to use all or part of this service specification when commissioning services from existing or new providers. The specification can be used with the DH’s non-mandated standard contract for public health services, or with other contracting mechanisms. We have also produced a short document setting out some key principles to help commissioners and providers hold discussions to put in place cross charging arrangements. Both these documents have been produced in partnership with key stakeholders such as PHE, the Local Government Association (LGA), the Association of Directors of Public Health, the Faculty of Sexual Reproductive Health (FSRH) and BASHH and can be found on the following page of the www.gov.uk

website https://www.gov.uk/government/publications/public-health-services-non-mandatory-contracts-and-guidance-published. PHE and DH are currently working on a short document around clinical governance, to assure local authorities that the providers they commission sexual health services from, have the appropriate procedures in place. Repeal of the HIV Testing Kits and Services Regulations (1992) DH announced that the sale of HIV self-testing kits would be legalised in the UK from April 2014 when the current regulations would be revoked. The availability and sale of HIV self-testing kits will be subject to existing quality assurance standards included in the In Vitro Diagnostic (IVD) Medical Devices Directive (98/79EC) which deal with the safety, quality and performance of in vitro diagnostic medical devices. HIV testing kits are in the highest category and will be subject to the highest level of scrutiny. Inline with existing requirements the IVD Directive manufacturers must include in their instructions information directing users to clinical testing services in the event of a reactive result. It is not yet know if the testing kit approved in the US will meet the quality assurance requirements for sale in the EU. The announcement on 15 August also included changes for healthcare workers with HIV.

Contents Department of Health Update Cheshire & Merseyside Sexual Health Network Update Cumbria & Lancashire Sexual Health Network Update Greater Manchester Sexual Health Network Update Public Health England Update Now & Then: Three Decades of HIV in Merseyside News & Events

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On behalf of the nine Cheshire and Merseyside Local Authorities, the champs public health Collaborative Service is leading work across Cheshire and Merseyside regarding the key deliverables of ‘Cross Charging’, ‘Emergency Hormonal Contraception’ and a ‘review of commissioned sexual health services’. Review of Commissioned Sexual Health Services (Lead: Collette Walsh, St Helens) A review is currently taking place of the sexual health services commissioned across Cheshire and Merseyside involving the thorough exploration of the patient journey. This review will be used to ensure that local people have access to modern, integrated services that are both fit for purpose and value for money, to improve quality and inform future commissioning decisions. Sexual Health Tariffs and Cross Charging (Lead: Susie Gardiner, Liverpool) A piece of work is being undertaken

to review sexual health tariffs and the cross charging model(s) in place across Cheshire and Merseyside, with a view to understanding the scale of cross charging that is taking place and making recommendations for future options. Emergency Hormonal Contraception (Lead: Sue Forster, St Helens) Across Cheshire and Merseyside a group of experts which included Consultants in Reproductive Health, Consultant in Public Health, Sexual Health Commissioners, Medicines Management and champs support have been meeting to discuss an Emergency Hormonal Contraceptive (EHC) pathway for Cheshire and Merseyside. The work started because different pathways for EHC have been introduced and or recommended across Cheshire and Merseyside and there have been debates about the relative merits of the pathways at some groups. The main issues related to two different drugs licensed for the first 72 hours after unprotected sex, one which costs £6 (Levonorgestrel -

Levonelle) and one costs £17 (Ulipristal Acetate - EllaOne). There is a debate about which is most effective and should be used as first line treatment. Currently two meetings have taken place and there was active debate about the effectiveness and cost effectiveness. A paper is currently being developed which will be presented to the Directors of Public Health across Cheshire and Mersey which will recommend a way forward for EHC pathway, particularly in relation to the delivery of EHC in pharmacies, walk-in-centres and general practice. For further information please contact: champscommunications@wirral.gov.uk

Cheshire & Merseyside Sexual Health Network Update by Cheryl Yeardsley, Commissioning Improvement Programme Officer

National HIV Testing Week (22-29 November) The week is part of the DH funded HIV Prevention England programme delivered by Terrence Higgins Trust and their partner organisations who will be promoting the benefits of regular HIV testing for men who

have sex with men (MSM) and African communities. DH, PHE and NHS England plan to write to GPs, primary care teams and hospital trusts in October to alert them to the week, which may have an impact on their services.

For further information please contact: Andrea Duncan Programme Manager, Sexual Health & HIV Andrea.Duncan@dh.gsi.gov.uk

Department of Health Update continued

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Network members continue to meet regularly from Cumbria, Lancashire, Blackpool and Blackburn with Darwen. We are sharing best practice and efforts around needs assessment, following Cumbria’s Sexual Health Needs Review, and Blackburn with Darwen are developing work around social values.

Open Access Arrangements and the Integrated Sexual Health Tariff Over the last few months there has been a significant increase in cross-charging for out of area sexual health services and work is continuing to agree the criteria required for payments to be made. Cumbria now has a fully integrated sexual health service in place and the intention is to remain on block payment, for which quality outcome indicators are being finalised. Lancashire, Blackpool and Blackburn with Darwen have agreed with their providers to adopt the non-mandatory GUM tariff from 2014. Post Transition Update Sexual Health Strategies are under development across Cumbria and Lancashire. Cumbria’s strategy has been submitted for Cabinet approval following agreement by the county’s newly formed Sexual Health Expert Reference Group. A sub-group has also been developed and will meet quarterly to monitor performance against key sexual health indicators, share best practice locally and identify and mitigate potential issues. Primary Care A primary care sexual health audit is taking place in Cumbria and will map

sexual health service provision and competencies. A long acting reversible contraception (LARC) training project is also under way, in conjunction with the manufacturers of Nexplanon, to improve primary care competence and confidence around sub-dermal implants. This will ensure that more women across the county have access to the full range of contraceptive methods. Looked After Children A comprehensive Sexual Health and Relationships Prevention Strategy has been developed for looked after children and young people in Cumbria, following an OFSTED/CQC inspection during in 2012-13. This will provide training, guidance, support and a sexual health referral pathway, specifically for foster carers and professionals who work with these children.

Child Sexual Exploitation A campaign has recently launched in Lancashire to raise awareness of Child Sexual Exploitation. It is is multi-agency project working with local communities to tackle the issue. More information is available here: http://www.lancashire.police.uk/cse A new website for young people (www.trusted2know.co.uk) will be launched in September to provide help and advice on a range of topics, including child sexual exploitation.

Calendar Key dates, such as Sexual Health Week, World Contraception Day and National HIV Testing Week, will be promoted with local media and partner organisations. They will help raise public awareness of sexual health issues, and Cumbria will also promote the single point of access:

For further information please contact: Cathryn Beckett-Hill Public Health Project Development Manager E: cathryn.beckett-hill@cumbria.gov.uk

Cumbria & Lancashire Sexual Health Networks Update by Cathryn Beckett-Hill On behalf of Lancashire, Cumbria, Blackpool and Blackburn with Darwen

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Greater Manchester Sexual Health Network Update by Neil Jenkinson, Wendy Alam, Sarah Doran & Diane Cordwell

Collaborative Commissioning Framework Greater Manchester Directors of Public Health have tasked the Greater Manchester Sexual Health Network (GMSHN) to work with commissioners to develop a collaborative commissioning framework for sexual health services in Greater Manchester. Several workshops have taken place over the past few months to develop this work. The Directors have approved the recommendations to: continue to support the existing collaborative commissioning contracts and arrangements; support the work already in progress to review and commission the GM contracts for HIV Prevention and Support Services; support the short, medium and long term plans to collaboratively commission other sexual health services, such as Specialist Young People’s Services and Integrated Sexual Health Services; endorse the development of a GM agreement of how GM sexual health commissioners will work together to collaboratively commission services and identify how sexual health leads can contribute to GM work on a fairer shares basis. Directors of Public Health have also agreed to continue to support the GMSHN to lead and take the collaborative commissioning of sexual health services work forward. Prevention Framework There are Greater Manchester wide multi-lateral contracts in place for the Lesbian and Gay Foundation (LGF), George House Trust (GHT) and Manchester Action on Sexual Health (MASH). Some GM areas also commission the Black Health Agency (BHA). Manchester City Council is the lead commissioner for the collaborative

prevention contracts, with Public Health Manchester leading this work. GM sexual health commissioners are now working together to commission revised HIV prevention contracts ready for April 2014. The GMSHN are working with the team on the national Halve It Campaign, aiming to halve the proportion of people diagnosed late with HIV (CD4 count <350mm3) by 2015 and halve the proportion of people living with undiagnosed HIV by 2015. The Halve It team plan to interview key stakeholders in GM to inform the work plan for the campaign locally. Sexual Health: Taking Responsibility Conference The GMSHN is holding a Conference and Sexual Health Awards Event on Friday 11th October 2013 at Bredbury Hall, Stockport. The “Sexual Health: Taking Responsibility” Conference will cover the new roles and responsibilities and the future challenges and opportunities for sexual health services. The conference is aimed at elected members, Health and Well-being Board Members, Local Authority Commissioning and Contracting colleagues, Public Health England, Clinical Commissioning Groups, NHS England - Local Area Team members and Sexual Health Professionals. The Sexual Health Awards will celebrate the achievements of sexual health work in Greater Manchester. For further information please visit our website at: www.sexualhealthnetwork.co.uk. Public Health England Conference 2013 The GMSHN presented two poster presentations at the first Public Health England Conference at Warwick in September. The first poster described the work in GM to increase LARC by

introducing a training programme on fitting and removal of sub-dermal implants. The second described the GMSHN’s work on child sexual exploitation (CSE), including the development of a CSE risk assessment tool for use in sexual health services. These posters are available on the GMSHN’s website or by clicking on the following links LARC Training Programme Poster and CSE Poster.

Cross-charging When the allocations in respect of the ring fenced public health budgets were announced in January 2013, the Advisory Committee on Resource Allocation recommended the development and agreement of charging where services are provided to other authorities’ residents. The DH supported this recommendation as a system of cross-charging is essential for fair and transparent payment systems. More recently, the DH, Local Government Association, the Association of Directors of Public Health and Public Health England have endorsed some key principles to encourage a consistent and equitable approach to cross-charging and billing for out of area service users. As it is for local determination how the cross charging arrangements will work, the GMSHN is to undertake an impact assessment for sexual health services (GUM, CASH and Young People’s Services) and is working with commissioners to consider options for cross charging in GM.

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Greater Manchester Sexual Health Network Update continued

Sexual Health Tariff The DH has been working with Pathway Analytics to develop a new tariff for sexual health services and the intention was to shadow the currency in 2013/14. To inform decision making on the introduction of the tariff in GM, all sexual health services should be shadowing the new sexual health tariff and inputting data into the Pathway Analytics system. The GMSHN are funding an intensive package supporting commissioners and providers to ensure they are confidently using the system and that accurate data are inputted. A Brief on Commissioning Sexual Health Services in Greater Manchester The GMSHN has been producing quarterly commissioning briefing documents to address a number of transitional issues relating to the transfer of responsibility for commissioning sexual health services to local government, NHS England and Clinical Commissioning Groups. These documents are a useful reference guide for elected members, Health and Well Being Group members and Local Commissioners. The latest commissioning briefing document can be accessed on the GMSHN website or at ABC Briefing No.2.

Chlamydia Screening Programme update

GM as a whole reached the current diagnosis rate of 2,300 per 100,000 of the population for the first quarter with 50% of local authorities having

achieved the 2,300 diagnosis rate or above. RUclear? for Q1 achieved a treatment rate of 96.7% against the national standard of 95% with a partner notification rate of 0.7 per index rising to 0.8 per index for partners that cannot be married back to an index case. Postal kits continue to be popular and in Q1 RUclear? had an overall return rate of 64% (2,544 kits returned from 3,983 requested).

RUclear? jointly presented a poster with the Sexual Health Network at the recent Public Health England conference on the development of pathways for identifying young people at risk of being sexually exploited. The RUclear? Programme has recently been commissioned to provide HIV, chlamydia and gonorrhoea home testing to Hull and East Ridings, this new service is due to commence in October. For more information visit the website: www.ruclear.co.uk

Visit our website: Further information about the Greater Manchester Sexual Health Network and our contact details can be found on our website: www.sexualhealthnetwork.co.uk

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North West - Sexual Transmitted Infections Surveillance Dan Hungerford, Epidemiology and Surveillance Scientist and Roberto Vivancos, Consultant Epidemiologist: Public Health England, Field Epidemiology Services North West

Shigella epidemic in England and Wales with potential outbreaks in MSM In 2011 and 2012 the Health Protection Agency reported increases in diagnoses of two Shigella species; Shigella flexneri and Shigella sonnei which are non-travel associated. Shigellosis, also known as bacillary dysentery, is caused by Shigella species and in the UK most cases are associated with foreign travel due to food or water contaminated with human faeces. However, outbreaks of both Shigella flexneri and Shigella sonnei among men who have sex with men (MSM) have been reported recently in England. 1-3 In 2013 in England and Wales diagnosis of non-travel associated Shigella sonnei in men and women is higher than in the same

period in 2012; as is the diagnoses of non-travel associated Shigella flexneri in men.4

As previous outbreaks have been reported in MSM, further investigations are on-going to ascertain the extent of potential sexual transmission. In the most recent increase of non-travel associated Shigella flexneri from April 2013 to 18 September 2013, 83% of diagnoses were in men and were predominately of serotype 3a.4 Anti-bacterial resistance profiles of 3a and 3b serotypes will be examined in any investigations. Gonorrhoea diagnoses in the North West In the North West in quarter 1 2013 gonorrhoea diagnoses continue to increase and are higher than the same period of 2012. There is significant variability across

locations; most local authorities have seen a decrease or minimal change in gonorrhoea diagnoses (Figure 1). However, Manchester (150 to 200), Liverpool (61 to 85), Halton (9 to 23), Preston (9 to 26) and Ribble Valley (3 to 10) have seen increases. These increases appear to be across all sexual orientations, with no noticeable change in the proportion of diagnoses of heterosexuals or MSM. For further information please contact: Roberto Vivancos: roberto.vivancos@phe.gov.uk Dan Hungerford: daniel.hungerford@phe.gov .uk

Further information is available from the HPA website http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Shigella/ Information for MSM is available on the Terence Higgins Trust website. http://www.tht.org.uk/informationresources/otherstis/shigella/ 1. Morgan O, Crook P, Cheasty T, Jiggle

B, Giraudon I, Hughes H et al. Shigella sonnei outbreak among homosexual men, London. Emerg Infect Dis 2006; 12:1458-1460.

2. Borg ML, Modi A, Tostmann A, Gobin M, Cartwright J, Quigley C et al. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011. Euro Surveill. 2012;17(13):pii=20137.

3. Health Protection Agency. Outbreak of UK acquired Shigella flexneri in men who have sex with men. HPR 5 (40), 7 October 2011.

4. Labbase 2. Public Health England, 18 September 2013.

Figure 1. Gonorrhoea diagnoses at GUM clinics in quarter 1 (January – March) by local authority of residence, North West England, 2011-2013 (Source: GUMCAD)

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Now + Then: Three Decades of HIV in Merseyside

By Elaine Brown, Heritage Project Worker

Now + Then: Three Decades of HIV in Merseyside is a two year Heritage Lottery funded project being led by Sahir House, Merseyside’s HIV support and information centre. Over the course of the last 30 years HIV has brought together people from a rich diversity of backgrounds but whose stories are unheard. The local Merseyside journey with HIV is one that has largely gone unrecorded. This project will mark three decades of HIV in Merseyside by exploring local people’s stories and how communities in Merseyside responded to the challenges of HIV. It will involve the collection of oral testimonies from a range of people including people living with and affected by HIV, community activists, voluntary and public sector health and social care staff and researchers. Key themes for the project include: the impact of HIV on people’s lives in the context of medical, social and political developments; community responses and activism; experiences of stigma, discrimination and empowerment and; the development of community and professional support services.

A record of this journey, involving the voices of the people who are infected or affected by HIV, is important to show what is possible when communities and professionals come together and

how current challenges have their roots in the past. There has never been a project like this in Merseyside and it will create an important legacy for those who are living with HIV and for those who have been lost to the virus. The project will produce an exhibition, book, art work, an online resource and permanent archive collections in the North West Sound Archive and Liverpool Archives. Project partners include the North West Sound Archive, Liverpool Archives, National Museums Liverpool and oral historian, Dr Emma Vickers (Liverpool John Moores University). We will be working with National Museums Liverpool to create an exhibition drawing on the audio-visual and heritage materials collected during the project. We are looking for people willing to be interviewed to share their own stories about HIV and Merseyside. Are you living with or affected

by HIV? Have you lost someone to HIV? Have you worked with or

supported people living with or affected by HIV?

Have you been involved in HIV community activism and campaigns?

Have you been involved in developing HIV services?

Have you been involved in HIV-related research?

We’re also looking for HIV-related archive materials – this could be local leaflets, reports, posters, newspaper cuttings, policies, anything HIV-related – if you have anything stored away in filing cabinets or boxes, please dig it out!

Now + Then oral history interview at Refugee Week 2013 event

If you would like more information about the project please contact: Elaine Brown, Heritage Project Worker, Sahir House, Liverpool Tel: 0151 237 3989 Email: elaine@sahir.uk .com

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Sexual Health Quarterly Bulletin

Edited by

Ann Lincoln &

Suzy Hargreaves Sexual Health Researchers Centre for Public Health, Liverpool John Moores

University

Written contributions from:

Andrea Duncan (Department of Health), Cheryl Yeardsley (Champs),

Cathryn Beckett-Hill (Cumbria & Lancashire Sexual Health Network), Neil Jenkinson,

Wendy Alam, Sarah Doran & Diane Cordwell (Gt. Manchester Sexual Health Network), Roberto Vivancos, Dan Hungerford (Public

Health England), Elaine Brown (Sahir House)

Centre for Public Health, Faculty of Education, Health

& Community Liverpool John Moores University,

Henry Cotton Building 15-21 Webster Street,

Liverpool, L3 2ET

Tel: 0151 231 4506 Fax: 0151 231 4552

Email: a.l.lincoln@ljmu.ac.uk Website:

www.cph.org.uk/expertise/sexual-health/

Twitter: @CPH_Research

Editorial Board

Paula Grey

Catherine Quigley Roberto Vivancos

Neil Jenkinson Jane Harris

Suzy C. Hargreaves

News and events

Abortion: Decisions and Dilemmas by Education For Choice This is a one day multi-agency training course on abortion issues. It is for professionals working to support young people around unintended pregnancy in education, health and youth work. This Education For Choice training, equips professionals with the information, skills and confidence to be able to talk to young people about pregnancy and abortion. Individuals wishing to attend Abortion: Decisions and Dilemmas are able to book a place on the upcoming open day in London on Thursday 17 October. For more information and to book a place, visit http://edforchoicetraining.eventbrite.co.uk/ or to commission this training in your area please contact efc@brook.org.uk. Sexual Behaviours Traffic Light Tool This innovative resource helps professionals who work with children and young people to identify, assess and respond appropriately to sexual behaviours. It uses a 'traffic light tool' to categorise sexual behaviours. It has been designed to help professionals think through their decisions and does not replace organisational procedures or assessment frameworks. For further information please follow the link http://www.brook.org.uk/index.php/traffic-lights. Domestic Violence and Young People: Tackling Teenage Relationship Abuse Wednesday 23rd October 2013 10:15am – 4:30pm, Central London In recent years there has been a growing awareness of teenage relationship abuse, with teenage girls now considered to be the group at greatest risk from violent relationships. For further details about the symposium and to book a place please follow the link:

http:/www.publicpolicyexchange.co.uk/events/DJ23-PPE3. Sexual health charities welcome legalisation of HIV self-testing kits Terrence Higgins Trust (THT) and the National AIDS Trust (NAT) have both welcomed the UK Department of Health’s announcement that the sale of HIV self-testing kits is to be made legal. The full article can be accessed here: http://goo.gl/omYKKw.

UK Sexual Health Awards 2014 Nominations for the UK Sexual Health Awards 2014 are now open - celebrating outstanding work in sexual health by professionals, young people, projects and services. Read more at: http://goo.gl/FXCxkg or nominate online at: www.uksexualhealthawards.org.uk. Monthly ‘MOT’ clinic On Wednesday 4th September HIV and sexual health charity Terrence Higgins Trust launched a new monthly ‘Men Only Testing’ (MOT) clinic at its Coventry centre. The walk-in clinic offers rapid HIV testing services in a friendly and supportive café-style environment. The charity hopes that the initiative will encourage more local men to come forward for a test. For further information, please contact: Jenny Cameron, Press Officer Telephone: +44 (0)20 7812 1625 or Email: jenny.cameron@tht.org.uk

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