sexual health - creating the culture

respect and responsibility for good sexual health

Introduction

Sexual health in Scotland is poor. Scotland experiences some of the highest rates of unintended pregnancies and increasing incidences of sexually transmitted infection compared with Western Europe1. Rates of teenage pregnancy are higher in areas of deprivation than elsewhere2. In the last five years Lothian has seen almost a threefold increase in Chlamydia diagnosis3. Furthermore, HIV prevalence is at an all time high particularly amongst men who have sex with men and those whose infection was acquired abroad4. Evidence suggests that a multi-faceted approach, combining education and information alongside confidential, accessible services, is the best approach to improve sexual ill health5.

January 2005 saw the launch of Respect and Responsibility: a Strategy and Action Plan for Improving Sexual Health in Scotland. The strategy has three broad aims:

One of the biggest challenges recognised by our politicians was how to engage the public, and the professionals working with them, in creating a culture which promotes respect and responsibility and support that culture with high quality accessible education and service provision. By debating what has traditionally been a sensitive subject, MSPs demonstrated that sexual health is something we can and should discuss.

Unlike some new strategies, Respect and Responsibility was accompanied by additional resources; 15 million is available across Scotland which will be distributed via local NHS Boards in exchange for delivery of a long list of actions allocated to the NHS and its local authority partners. These actions are accounted for annually through reports produced by multi-agency sexual health strategy groups at NHS Board level.

Lothian has witnessed an increase in the provision and uptake of education and services, but what contribution is this extra leadership and resources making? Has it helped to create the culture aspired to by our politicians? With leadership comes respect, but also responsibility, often to take risks and try new innovative ways of working. NHS Lothian and its partners are committed to improving the relationships and sexual health of all of our population. It recognises that different approaches are often needed. Here we feature two evidence based initiatives, developed in partnership, that take an innovative approach to meeting the needs of distinct population groups.

1. Creating the Culture: targeted campaigns

NHS Lothian has a track record of tackling sexual health issues going back to the late 1980s and the launch of the Take Care campaign (HIV prevention) and the introduction of a free condom service known as c: card. The c:card service has grown and is still going strong but Lothian's focus on HIV has diminished over the years, mainly due to an increased focus on testing and treatment. There is, however, some concern that in recent years HIV infection rates have started to increase again. NHS Lothian and its partners want to increase awareness of HIV again, particularly amongst high risk groups such as men who have sex with men and have launched a new campaign called "HIV - the Comeback Tour".

2. Creating the Culture: support for parents

There is much talk about involving parents in sex and relationships education and many claim that it is solely the parent's responsibility, not that of the school, to provide this type of education. Evidence shows that parents and families are indeed crucial partners in influencing the future sexual behaviour of their children. However, it is also clear that some parents feel they lack the confidence and skills to talk to their child about relationships and sex. The national health demonstration project, Healthy Respect, is working to change that through its development of Home Activity Resources to improve parent-child and home-school links.

What changes do we hopeto see?

It is intended that both pieces of work will contribute to creating a more open culture where relationships and sexual health can be discussed appropriately. We hope to see a reduction in apathy and increased engagement. Both pieces of work will be evaluated specifically and as part of the overall aims of the sex and relationships strategy in Lothian.

References

1. Scottish Executive (2005). Respect and Responsibility, Strategy and Action Plan for Improving Sexual Health. Edinburgh, Scottish Executive

2. Fraser, S (2005). Promoting a Healthy Respect: What does the evidence support. Edinburgh, NHS Health Scotland

3. National Services Scotland (2005). Setting the Scene. Sexually Transmitted Infections, including HIV, in Scotland, 2004. Edinburgh, NHS National Services Scotland

4. National Services Scotland (2005). Setting the Scene. Sexually Transmitted Infections, including HIV, in Scotland, 2004. Edinburgh, NHS National Services Scotland

5. Fraser, S (2005). Promoting a Healthy Respect: What does the evidence support. Edinburgh, NHS Health Scotland