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Sexually Transmitted Infections

12.58 pm

Jane Griffiths (Reading, East): I am pleased to have secured this debate on such an important subject, although I would rather not have had to do so. In February, the British Medical Association published a report entitled "Sexually Transmitted Infections". It brought together an up-to-date summary of the situation with the most common sexually transmitted infections—STIs—in the United Kingdom. The information in the report was not new, but it was shocking. The number of new episodes of acute STIs diagnosed in genito-urinary medicine clinics in England, Wales and Northern Ireland rose from 887,760 in 1995 to 1,185,285 in 2000.

To give a couple of examples from that report, uncomplicated gonorrhoea increased by 31 per cent. in males and 26 per cent. in females between 1999 and 2000. Diagnoses of chlamydia have risen dramatically since 1993. Between 1999 and 2000, cases rose by 20 per cent. in males and 17 per cent. in females. It is accepted that the increase in diagnoses is as likely to be the result of increased testing and awareness as it is of increased transmission. However, the report further stated the sustained rise in diagnosis of acute STIs in the past six years, which is probably attributable to the increasing practice of unsafe sexual behaviour, especially in young heterosexuals and gay and bisexual men. The increase in the numbers of STIs is worrying and it is important that something is done, because having a STI is damaging.

The dangers of unprotected sex, such as the possibility of pregnancy and other problems, are well known, although apparently not by young women and young gay or bisexual men. Informal surveys suggest that many of them think that such issues simply do not apply to them—they do not feel at risk. However, there are further dangers from unprotected sex. If left untreated, either because of ignorance or because the infection is asymptomatic, as is often the case with chlamydia, those infected risk damage to their fertility or even death through ectopic pregnancy or other complications.

What information do we have about the problem? A study of 3,860 sexually active women in the United States attending sexual health clinics, family planning clinics or school health centres—women who, because of their attendance at such establishments, are more likely to look after their own health—found that, over a 33-month period, 31.2 per cent. of those under 25 were infected with chlamydia, compared with 9.6 per cent. of those over the age of 25. Worse, the majority of those cases were asymptomatic and the women concerned simply did not know that they had the disease.

On the Ectopic Pregnancy Trust's good website at it states that

suggests that

Since chlamydia is so widespread, one might think that infection would be accepted as one of the risks of being sexually active and that people would get

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regularly checked. Sadly, a survey of women in Scotland with a current or recent diagnosis of chlamydia found that most women thought that STIs were not relevant to them. The diagnosis came as a shock. The women felt that there was a stigma attached to attending the GUM clinic and found it extremely difficult to disclose their infection to current and previous partners. Evidence suggests that, the younger the woman is, the less confidence she will have about making a disclosure of infection and discussing it with current and previous partners. Such stigma is likely to promote the spread of STIs such as chlamydia.

The problems highlighted by the survey are worse when considered in the context of a recent survey carried out by PatientView, the Terrence Higgins Trust and the British HIV Association, which asked 100 consultants about the treatment of patients in GUM clinics. It found that more than 40 per cent. of people needing sexual health appointments had to wait more than a week to be seen and that more than one in 10 have to wait longer than a fortnight. That is worrying in the light of evidence suggesting that the longer patients wait for an appointment, the less likely they are to turn up. Thus, infections are likely to spread.

In my constituency of Reading, for obvious reasons it is almost impossible to acquire figures on the number of people having unprotected sex. To get some idea one needs to examine evidence that might provide a clue as to the nature of the problem. The dangers of unprotected sex for young women in Reading are real and present. The area covered by Reading borough council has the sixth highest number of teenage pregnancies in the south-east. Between 1996 and 1998, there were 107 conceptions in young women under the age of 16, which is almost double the average of 57 conceptions for Berkshire. For under-18-year-olds, Reading borough council's area has a conception rate of 436 compared with a Berkshire average of 280. When the survey considered the conception rate per 1,000 of people aged 15 to 17 in the same period, it was 62.5—the highest in the south-east. That is a worrying statistic for my constituency.

There is a part of Reading, which I shall not name, that sends pupils to a popular and well-respected secondary school in my constituency. One in eight young women in that area will become pregnant. I remember that when I was at school a long time ago—in the late 1960s—a girl in my year became pregnant and left school as a result. There was quite a scandal and fuss. According to the statistics, of the pupils attending that school in my constituency, three a year will fall pregnant. That is evidence that much unprotected sex is taking place in Reading. That is worrying for our public health.

I am grateful for information from Dr. Alan Tang of the Florey unit, which is the genito-urinary clinic in the Royal Berkshire hospital in my constituency. It has a waiting time of two weeks for a routine referral and a week for urgent cases. People at the unit think that that is too long. Those waiting times measure the period from a referral to a diagnosis, or possible diagnosis. They completely leave out of the picture those who did not appear at the clinic or did not know how to represent their symptoms so that the urgency or otherwise of their case could be determined. It is thought at the Florey unit that chlamydia, HIV and other STIs are increasing at the same rate as in London.

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In Reading, the greatest increases in STIs have been in genital warts, chlamydia, which has increased by 50 per cent., and HIV. The Florey unit operates an appointments system. It is aware that clinics in Slough and London have tried a walk-in system, which on the face of it might appear attractive. People do not have to make that embarrassing telephone call and do not have to wait; they can just turn up. However, long queues tend to form at such clinics. That is a sign of the level of demand for such stigma-free service. There is corresponding evidence that some people who join the queue do not reach the front—they give up and go away. The consequences, both for those people and for general public health, will emerge much later.

Dr. Tang and those at the Florey unit are working to increase the unit's size to cope with the growth in the number of cases with which they deal. There is an appeal to raise funds for that, which I strongly support. A bid has been made for a greater allocation to the Royal Berkshire and Battle hospitals national health service trust, so that the unit can continue to provide the service that the people of Reading, East deserve. For some reason, fund-raising for a genito-urinary clinic is not as easy as it is for a scanner. I wonder why that might be.

The number of people with sexually transmitted infections is rising significantly. In Reading, there is a serious problem with teenage pregnancy. Those problems are due to an increase in unprotected sex and they affect young women and gay or bisexual young men in particular. That is the problem; what can we do about it? In the mid-1980s, the threat of HIV/AIDS was new. Who can forget the advertisements on television and the leaflets that came through our doors? The level of sexually transmitted infection was then lower than it is now. The campaign and other information around at the time are credited with having played a part in that.

I would like the Government to launch another public awareness campaign about the dangers of unprotected sex. The campaign should focus on those most vulnerable to STIs and teenage pregnancy. Following the publication of the British Medical Association report in February, I tabled early-day motion 919, entitled "Sex and Death". It called for several measures, mostly those suggested by the BMA. One measure called for was for storylines in soaps watched by young people to feature STIs. Mersey Television should be congratulated. "Brookside" has had a storyline about Jackie Farnham and her ectopic pregnancy and the Ectopic Pregnancy Trust worked with the television company on that story.

I am even more pleased with Mersey Television for its storyline in "Hollyoaks", which has a younger audience than "Brookside". It concerned gonorrhoea and the consequences of unprotected sex. I am enjoying what is happening. Last night, I was interested to see which character was thought to have been the source of the infection. It is not always the usual suspects. The period that it takes to develop the storyline for such programmes means that it is unlikely that they carried them as a result of my early-day motion or even the BMA report. I also declare an interest as an unpaid founder trustee of the Ectopic Pregnancy Trust.

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The Department of Health has been running pilot screening programmes for chlamydia in Portsmouth and the Wirral. For the past 15 years, a massive campaign has taken place in Sweden to educate and screen the population. Chlamydia is now rare; it is about 3 per cent., down from 15 per cent., and there has been a reduction in ectopic pregnancies for all ages, most markedly in women under 30. It is those younger women whose ectopic pregnancies are most likely to have been caused by chlamydia—although that is not the only cause of ectopic pregnancy.

The official view is that 50 per cent. of ectopic pregnancies are directly caused by chlamydia. That information from Sweden means that, for women under 25, almost all ectopics are due to a current or very recent infection. One in 100 pregnancies is ectopic. Thankfully, an increasing number are detected early and can be removed. In some such pregnancies, the foetus dies on its own. In all cases, however, there is damage to the fallopian tubes and the woman's fertility. Ectopic pregnancies kill up to 10 women a year and many result in emergency hospitalisation and a period of physical and emotional recovery for the woman. As well as the trauma caused by such a major operation, the fertility of women who have been hospitalised will have been seriously damaged.

Even a cold cost-benefit analysis of the cost of an education and screening programme, such as that in Sweden, compared with the later cost to the health service of ectopic pregnancy and other consequences of chlamydia supports the widening out of a screening programme to the whole United Kingdom. I ask the Minister to support an extension of the screening programme nationwide. As well as being good in cost-benefit terms, extending such a screening service fits with the philosophy of trying to reduce the number of health interventions and to move to a preventative health strategy.

I am grateful to Councillor Catherine Wilton from Reading borough council for passing me details of the recent report of the Office for Standards in Education on sex education. It showed that education about STIs is receiving less attention than in the past. Even though infections such as HIV remain a significant health problem, young people perceive it as less of a concern and that is contributing to the lack of use of condoms by those who are sexually active.

I am pleased that, as a result of the Ofsted report, my hon. Friend the Minister, who is responsible for public health, said

There is worry that that is not the approach being taken by all schools in Reading. Concerns have been expressed to me that some schools are teaching sex education in a mechanical way and not putting sex in the context of relationships, respect and the importance of contraceptive services.

In July 2000, the Department for Education and Skills issued guidance to schools on sex and relationships education. That provided guidance on the content of SRE, lesson plans and case studies. Work has also been taking place in Bristol on a programme that is targeted specifically at boys. The Department for

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Education and Skills has also been seeking to reduce the amount of prescription in the national curriculum where it can. However, it is accepted that some elements are taught in the national curriculum.

The current position with STIs means that the teaching and the content of the teaching of SRE should not only be the subject of guidance. Such education should be part of the national curriculum. I ask the Minister to talk to her colleagues at the Department for Education and Skills about making the teaching of sex and relationships education part of the national curriculum.

Finally, I am pleased to have been part of a Government who have published a draft sexual health strategy. That there was not one in place before is nothing to be proud of, but the BMA report shows the importance of achieving a national strategy as soon as possible. However, a strategy will do nothing unless we implement measures to tackle these problems in a practical way. I look to the Government with the hope that measures such as the ones for which I have called in this debate will be introduced. I want a national screening programme for chlamydia, better and more focused sex and relationship education, and a national education and awareness campaign such as the one launched in the 1980s. It is not about promiscuity or behaviour; it is about ensuring that if people are sexually active, they are safe, and about reducing the number of sexually transmitted infections and the consequential risk of damage to fertility or death.

I look forward to the Minister's reply and to hearing her answers to the points that I have made.

1.15 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate my hon. Friend the Member for Reading, East (Jane Griffiths) on securing this debate and choosing to discuss something that is becoming such a serious public health issue. She mentioned in particular her concerns about chlamydia and teenage pregnancy and covered some of the wider issues relating to sexual health, including an information campaign. I want to try to respond to each of those points in turn.

My hon. Friend is right that the trend of increasing sexually transmitted infections is serious and needs to be turned round. That is why last year we set out the first ever national sexual health and HIV strategy. It follows the teenage pregnancy strategy launched three years ago and looks at sexual health across the board, but primarily in adults. The teenage pregnancy strategy already provides lessons from which we can benefit when looking at the broader issues surrounding adult sexual health.

Since the strategy was launched, there has been a drop of more than 6 per cent. in teenage conceptions in the past two years. There is still a long way to go, but that shows that it is possible to change outcomes. It is not a simple matter, as a number of complex factors are involved, but progress can be made. Tackling poor sexual health is an important part of addressing broader health inequalities. There is a strong link between social deprivation and sexually transmitted infections, abortions and teenage conceptions.

The reasons for the rising trend in sexually transmitted infections are complicated. Young people are at particular risk of catching STIs. There is some

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evidence of greater complacency in attitudes, but equally some evidence that condom use among young men has increased in the past decade. That is why it is important to link the work on STIs with that on teenage pregnancy. In planning for services, we must also recognise that the more that we improve testing and screening services, the more sexually transmitted infections we will find.

Lembit Öpik (Montgomeryshire): On that point, the Minister will probably know that this is national condom week, sponsored by Durex—a campaign that I helped to launch in Cardiff. Will she welcome the message of that campaign, which is simply to say, in a non-judgmental way, "If you're going to have sex, make sure it's safe sex to avoid unwanted pregnancy and reduce the risk of getting a sexually transmitted infection"?

Yvette Cooper : Yes, I am aware of that campaign and I welcome work throughout the community to make people aware of the risks of unsafe sex, with its health and other consequences, and of condom use as well. I shall say a little more in a minute about the work that we are doing on an information campaign. We must also recognise that there are issues relating to HIV prevention too. Although our record on that compares well with that of other European countries, the level of new HIV diagnoses is still a matter of serious concern, with more than 4,000 new cases last year. Sex between men is still the predominant route of infection in the UK, but more than half of the new diagnoses last year were acquired heterosexually and it is estimated that more than 80 per cent. of those were probably acquired abroad. That is why the work of the Department for International Development in supporting HIV programmes overseas, particularly in sub-Saharan Africa, is so important and has so many repercussions in this country.

My hon. Friend the Member for Reading, East asked about a national campaign on the dangers of sexually transmitted infections. I agree that we should have a new national information campaign on the risks of such infections and the problems that can arise from them. We want to start a new campaign for young adults in the autumn and we shall start to invest in that campaign this year. We have already carried out some research into what might make a difference and looked at the national teenage pregnancy media campaign, which has a good evaluation with 70 per cent. of young people being aware of the campaign and having a good understanding of the key information being communicated. The teenage pregnancy campaign already includes information about sexually transmitted infections, particularly chlamydia, but we now need a broader campaign for young adults.

It is clear that the new campaign should not be a repeat of the fear-based HIV campaigns of the 1980s. They took place in a different context and in different circumstances. Evidence suggests that such an approach with the tombstones that we all remember would not work effectively if it were repeated today and that campaigns should be focused on the experience of young people today and the risks that they face. Such an approach must not be prudish or patronising if it is to work. The Government's role is not to tell people how

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to lead their sex lives, but to provide them with information about the risks of sexually transmitted infections so that they can make their own informed choices and understand the risks to their health.

We are planning to start the campaign in the autumn, although considerable work is already being done. However, we must continue to fund separate health promotion work for those most at risk of HIV and separate targeted work in local areas to try to reduce the rate of sexually transmitted infections.

My hon. Friend referred to improving sex education and mentioned the reports of the Office for Standards in Education and the British Medical Association on the importance of improving education in schools on sexually transmitted infections and HIV. Ofsted highlighted good practice and its report will be circulated to schools and local education authorities throughout the country because it sets out some of the issues that can make a difference and contribute to effective sexual relationship education, including matters such as inviting a local doctor to discuss sexually transmitted infections with students, providing a confidential health advice service in schools, and teaching in a context of relationships and not just biology.

My Department is working with the Department for Education and Skills to provide greater focus on sexually transmitted infections as part of the improvements being planned for sex and relationships education. The Ofsted report was commissioned as part of the teenage pregnancy strategy to try to drive up standards in sex and relationships education, but we must go further, including the commissioning of detailed practical guidance for teachers with lesson plans and good practice in education about sexually transmitted infections.

Ofsted also emphasised the effectiveness of specialist sex and relationships teachers and a programme piloting a new scheme to train and accredit such teachers will be available from the autumn through the healthy schools programme.

The issue is extremely serious. Many young women—equally, many young men—are simply unaware of the prevalence of chlamydia, or in some cases of what it is. Screening, as well as information, is important, as my hon. Friend said. Chlamydia is now the most common bacterial sexually transmitted infection in the United Kingdom, with as many as one in 10 young women infected in some parts of the country. Although it is easily treated with antibiotics, my hon. Friend is right to say that many cases are never diagnosed, and that untreated chlamydia in women can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Some estimates suggest that that costs the national health service at least £50 million each year.

That is why we have stated a commitment to a national screening programme for chlamydia. I agree that such a programme needs to be introduced and it will roll out to 10 sites later this year, supported initially by new investment of £1.5 million. It will build on the successful pilot study carried out in Portsmouth and on the Wirral. The programme will primarily target young women, but will also promote greater uptake of testing among young men.

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In future, we will rely on the development of new technology to make testing easier. Some interesting work has been done in partnership with the Ministry of Defence to provide new technology that allows much more rapid diagnosis of chlamydia. Using it, a simple urine test could provide results on-site within 40 minutes. That could lead eventually to a much more effective and rapid screening service that avoided the need for notification of test results by post and return visits for treatment. The project will be funded by a grant of £4.6 million during the next two years from the capital modernisation fund. It is an important and innovative example of cross-Government working, with technology developed for defence being used to improve NHS services as well.

My hon. Friend mentioned genito-urinary medicine services, which I agree face pressure from the rising trend in STIs. We are conscious of that and are considering related issues as part of the implementation of the sexual health strategy. We want to set out an implementation plan and some issues related to GUM services will be a critical part of that. We should also recognise the vital part that primary care trusts can play in implementing the strategy, by commissioning services from GUM clinics and others, and through earlier diagnosis. Primary care trusts could consider prevention, as well as providing and increasing services in primary care. They have a unique perspective across the community, hospitals and primary care, linking the NHS and local authorities, so they give us great potential to develop sexual health strategy in future.

My hon. Friend mentioned issues connected with the teenage pregnancy strategy, which has made some important progress, with a drop in teenage conceptions of more than 6 per cent. However, we need to go further. That partly relates to the same issues, such as improving sex and relationship education, building on the best practice that Ofsted identified and ensuring that standards can be raised across the board.

We must also build on the media campaign, which has so far been effective in terms of recognition, and on broader support for young people across the community by raising their self-esteem, and by providing them with alternative opportunities and information and advice about contraception. The number of youth clinics and health advice clinics for young people has increased by more than 20 per cent., which gives more young people the specialist support that they need.

As my hon. Friend said, there is no single solution for the problem, but action on a range of fronts—on information, services, advice, early diagnosis and improving treatment—can make an important difference. There is evidence of it having an impact in other countries and in other circumstances; and we need to recognise some of the international aspects. It is not something that one partner can do alone. The sexual health strategy is an important way forward. I congratulate my hon. Friend on raising those important matters.

Mr. Deputy Speaker (Mr. Nicholas Winterton): Order. The House congratulates the Minister on the speed of her delivery and the amount of information that she delivered.

We now move to the final debate, initiated by the hon. Member for Orkney and Shetland (Mr. Carmichael).

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