Yesterday's grim statistics from the health protection agency on the continuing rise in sexually transmitted diseases should come as no surprise. As last year's devastating report from the Commons select committee on health documented, sexual health services are poorly resourced, critically under-staffed and dangerously demoralised. From sex education in schools (too biological, too little, too late), through contraception services (too few and too restricted) to diagnosis and treatment at genito-urinary medical clinics (too irregular with too many long waits) the service was reported to be in "a shambles".
We live in a society in which young people are saturated with sexual messages though not, alas, in the classroom but through much coarser forms of the media - billboards, television, films, magazines and newspapers. Many parents still cannot talk to their children about sex, schools are still restricted from being properly engaged, and successive governments have refused to properly invest in sexual health services. In an era in which ministers are constantly invoking the need for public services to respond to consumer needs, over one third of the 256 sexual infection clinics are open only for three days a week and only one is open on a Saturday.
Unlike other categories of disease, patients suffering from sexual infections tend to keep quiet about the state of the service because of the stigma that still clings to their condition. The dilapidated buildings that house the clinics - 80% in need of refurbishment - is further proof of the low priority the service is given. Open access is virtually unknown. Even for urgent cases waiting times average 12 days with general check-ups requiring eight weeks. Many people continue having sex while they wait. Is it any wonder infections are increasing?
Yesterday's report shows a 4% overall rise amounting to some 700,000 new in fections in 2003. Once again the steepest rise (28%) was in syphilis, though total numbers remained small (1,500). More serious was the 9% rise in chlamydia, which can lead to infertility in women. The true total will be much higher than the 90,000 diagnosed because a majority of the infected have no symptoms. Today when the chief medical officer releases his annual report, we will learn how many extra HIV infections there have been. Last year the total number of HIV/Aids cases was estimated to be 50,000, one third of whom were unaware of their infection.
Ministers have not stood still but need to be bolder. In response to the select committee's report there was an extra £11m last year for clinical services (the committee wanted £30m) and a further £15m this year, though some was siphoned off for other causes. There is a sexual health and HIV strategy under which there has been extra screening and 10 draft standards drawn up. The public health white paper due this autumn will include a beefed-up sexual health chapter.
What is missing is a proportional response. The current prevalence of sexually transmitted diseases is at its highest level since the inception of the NHS 56 years ago. There are some signs in yesterday's statistics that the rise is levelling off, but no sign that total infections are in retreat. This will only be achieved by an across-the-board reform that ensures sex education (including advice on relationships) is included in the core of the national curriculum; more is invested in contraception services; the shortfall in clinical staff is made up; and the government becomes committed to ensuring patients 48-hour access to diagnosis and treatment. Twelve-day waits are absurd. What should not be ignored are the savings. Preventing unplanned pregnancies saves an estimated £2.5bn. Reducing HIV infections would save even more.
