Welcome
19 May 2020 (Issue 59)
Welcome to the May issue of the Sexual Health, Reproductive Health & HIV Policy eBulletin. Nearly two months into the COVID-19 lockdown, key sector organisations are beginning to build a picture of the ways in which sexual health and sexual and reproductive health services are being affected. Both the British Association for Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Healthcare (FSRH) have recently released results from member surveys showing significant disruption to services and workforce capacity.
BASHH reports that 54% of local clinics have closed altogether and staffing is less than half of what it was at the beginning of March. FSRH reports similar figures, with 64% of specialist SRH service providers stating that they had ended or limited the provision of essential SRH services since the COVID-19 outbreak and that nearly a third of the workforce had been redeployed. However, the speed at which those working in the sector have adapted to lockdown limitations has been impressive, with the rapid expansion of telemedicine and online services in many areas to help ease pressure, manage demand and preserve service capacity. Ensuring the needs of the most vulnerable populations are met during this time is highlighted as a concern in the surveys, together with specific service provision challenges including the delivery of routine vaccinations and provision of emergency and long acting reversible contraception (LARC). You can find more information on this in the policy section below.
Other items to look out for in this month’s round-up include: a new FSRH patient guide on accessing SRH services during COVID-19; updated RCOG/FSRH/RCM/BSACP COVID-19 and abortion care guidance to reflect a temporary change in regulations in England, Wales and Scotland to permit telemedicine for early medical abortion; new BHIVA interim guidelines for the management of HIV care during the coronavirus lockdown and new national PGD templates for medicines commonly used in sexual health and reproductive health.
This month’s eFeature is by Dame Inga Beale, Chair of the HIV Commission.
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eFeature
Dame Inga Beale is Chair of the HIV Commission, tasked by leading HIV charities Terrence Higgins Trust, National AIDS Trust and the Elton John AIDS Foundation to make evidence-based recommendations for achieving the Government's goal of ending HIV transmissions by 2030. In this month's eFeature, Dame Inga reaffirms the Commission's commitment to delivering on this crucial task, despite the significant whole system and personal challenges presented by the COVID19 pandemic. She highlights the value of continued engagement with the Commission as it presses ahead with further evidence gathering and analysis and develops final recommendations that will be ambitious and relevant to the COVID-changed world we will be living in. The Commission will publish its findings and recommendations in autumn this year.
>eFeature by Dame Inga Beale
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Policy development and guidance on COVID-19
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At the end of March, professional organisations representing all sexual health, reproductive health and HIV service providers in the United Kingdom jointly published an emergency COVID-19 contingency plan for Government. The plan sets out formal recommendations for the level of Government support needed to ensure these services are equipped to put in place immediate short-term COVID-19 contingency measures, as well as medium and longer-term steps that also need to be taken in the coming weeks and months.
The response to COVID-19 is evolving and guidance from key professional organisations may change as new information becomes available. Below are links to regularly updated COVID-19 guidance and resources.
>FSRH
>BASHH
>BHIVA
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Prioritisation of sexual and reproductive health services during COVID-19
The Association of Directors of Public Health (ADPH) has issued recommendations on the steps that must be taken to maintain the wider public’s sexual and reproductive health during the COVID-19 pandemic. This follows a rapid review of community health services with a view to detailing the elements of each that can be ‘stopped’, ‘partially stopped’, or should ‘continue’.
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COVID-19 Contact tracing
The Local Government Association (LGA) has said that any national plans by government to track and trace COVID-19 should look to utilise the existing knowledge and skills on the ground, including sexual health services which have unique experience and expertise in partner notification and contact tracing. BASHH has begun to survey members to see what current capacity there is and what additional resources would be required to contribute to public health based Coronavirus tracing while also maintaining essential sexual health services.
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COVID-19 resource set for councils and public health
LGA has compiled information and guidance on COVID-19 for councils and public health. It has also published a series of interviews with directors of public health across the country talking about the local response to COVID-19.
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BASHH rapid member survey
BASHH has released results from an ongoing survey of members to understand how sexual health services are being impacted during the COVID-19 pandemic. The survey has found that service capacity has been significantly reduced in recent weeks, with over a third of staff being redeployed. Other challenges highlighted include supporting vulnerable people and the provision of long-acting reversible contraception (LARC) and routine vaccinations.
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FSRH COVID-19 rolling members survey
FSRH has also released interim results from a rolling survey of members which is designed to understand and monitor key SRH service issues during the COVID-19 pandemic. The results show the extent to which essential SRH services have been limited or ended, the impact on SRH workforce capacity and the significant increase in remote consultations.
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New patient guide on SRH services during COVID-19
FSRH has produced a guide for patients to help them stay informed about contraception and abortion services during the COVID-19 pandemic. The guide is designed to be used and distributed by healthcare professionals who want to support patients to understand their contraceptive options during the pandemic. The guide covers key changes to SRH services and provides guidance on how to access a range of services, including LARCs, abortion care and emergency contraception. Please share the guide with patients and colleagues who may find it useful.
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Provision of contraception by maternity services after childbirth
The Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and FSRH have jointly published a series of recommendations for women to access contraception in maternity units after giving birth. The organisations state that, with access to sexual health and primary care contraceptive services significantly reduced as a result of the COVID-19 outbreak, maternity services are well placed to provide effective post-partum contraception before discharge.
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Updated Coronavirus infection (COVID-19) and abortion care guidance
The Department of Health and Social Care (DHSC) and the Welsh and Scottish Government have all now issued new and temporary regulations to permit telemedicine for early medical abortion (EMA), allowing women to take mifepristone and misoprostol at home to limit the transmission of COVID-19 and ensure continued access to early medical abortion services. Although abortion is now legal in Northern Ireland the same measures have not yet been introduced (see next item). The COVID-19 and abortion care guidelines from RCOG, FSRH, RCM and BSACP have been updated in line with this change in policy.
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BPAS telemedicine service for women in Northern Ireland
In Northern Ireland, abortion care is now lawful and limited emergency abortion services have been set up in order that women do not have to travel outside Northern Ireland to access abortion care during the pandemic. However, telemedical abortion care is not permitted under the regulations introduced in March this year. In response to this, the British Pregnancy Advisory Service (BPAS) has launched a telemedicine abortion service for women up until 10 weeks’ gestation in partnership with healthcare professionals in NI. The service will be provided under regulation 11(2)(b) of the Northern Ireland abortion regulations which allows clinicians to provide abortion by telemedicine for the purpose of preventing grave, permanent injury to the woman’s physical or mental health.
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COVID-19 adult antiretroviral (ART) guidance, May 2020
The British HIV Association (BHIVA) has recently published new interim guidelines specifically for the management of HIV care in the UK during the coronavirus lockdown. The guidance makes recommendations for maintaining care in the context of social distancing and additional pressures on NHS services.
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What to do if you are HIV positive and admitted to hospital with COVID-19
BHIVA has issued advice for people living with HIV who are admitted to hospital with COVID-19. The advice is in response to questions from the HIV community.
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Guidance on sex, social distancing and COVID-19
BASHH has released guidance for the general public on sex and social distancing during the COVID-19 pandemic.
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Directory of COVID-19 support services from HIV community organisations
BHIVA and the National AIDS Trust (NAT) have created a directory of COVID-19 support services offered by HIV community organisations, in response to requests both from clinics and members of the HIV community. This central directory will be updated regularly with information about new organisations or changes in services offered.
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HIV COVID-19 Network briefings
NAT is coordinating and producing fortnightly updates from the voluntary sector on the impact of COVID-19 on people living with HIV. Two briefings have been released to date covering issues such as service changes, barriers and marginalisation and employment and welfare.
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Terrence Higgins Trust at Home
THT has developed a suite of online services in response to the COVID-19 outbreak. This includes free counselling for people living with HIV, STI tests by post and online and telephone advice service. It has also started a new ’No Hook-Ups’ campaign to highlight the message that during lockdown you are your safest sexual partner.
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HIV Self-Test Scotland
HIV Scotland and Waverely Care have launched a new national HIV self-testing service giving people a free, quick and easy way to get an HIV test. The service is funded by Gilead and supported by a number of NHS boards across Scotland. It has been rapidly developed to give people in Scotland a way to get a HIV test during a time when services are restricted due to COVID-19.
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Rapid evaluation of digital health products during the COVID-19 pandemic
The COVID-19 pandemic has led to the rapid implementation of many digital health products. This guidance explains why it is important to evaluate these products and what evaluation approaches might work best in these circumstances. The guidance is part of a series of resources published by PHE to help anyone developing or running a digital health product, including a service, campaign or other intervention
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Sexual health in lockdown: experiences from 56 Dean Street
In this blog for HIV prevention England (HPE) Dr Diarmuid Nugent looks at how 56 Dean Street, one of London’s busiest sexual health, contraception and HIV care clinics, has adapted to the COVID-19 pandemic.
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COVID-19 and the global provision of SRH
This blog from Dr Annabel Sowemimo, a member of FSRH’s International Committee, reflects on what COVID-19 means for global SRH provision. It looks at potential impact on marginalised groups in areas such as contraception, abortion, HIV and antiretroviral medication.
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Podcasts on SRH and women’s health during COVID-19
In these 3 half hour podcasts, Dr Diana Mansour, Vice President of FSRH, and GPs Dr Anne Connolly & Dr Sarah Gray talk about aspects of women's health and SRH delivery and how to approach them in line with COVID-19 guidelines from FSRH and the Primary Care Women's Health Forum.
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Inquiry: Delivering core NHS and care services during the pandemic and beyond
On 22 April 2020, the Health and Social Care Select Committee launched an inquiry into the planning and delivery of core NHS and care services during the pandemic and beyond. BASHH and BHIVA have jointly submitted evidence to the inquiry setting out the impact of COVID-19 on sexual health and HIV services and outlining key measures that need to be put in place to support services through the pandemic.
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Unequal impact: COVID-19 inquiry
The Women and Equalities Select Committee has launched an inquiry to investigate the different and disproportionate impact that the COVID-19 pandemic, and the Government’s response to it, is having on people with protected characteristics under the Equality Act. FSRH has responded to the call for evidence outlining the ways in which vulnerable girls and women have been impacted by changes to SRH service provision during the COVID-19 pandemic.
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The Missing Link: HIV and Mental Health
A report by a cross-party group of parliamentarians on HIV and AIDS has warned that mental health services are failing to meet the needs of patients with HIV. People living with HIV are twice as likely as the general population to have a mental health illness in their lifetime and failure to address this could lead to increased infections and negatively impact on progress towards ending the epidemic.
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Service standards & guidelines
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National reproductive health PGD templates
FSRH has been working with the Specialist Pharmacy Service (SPS) and other specialist stakeholders to produce national Patient Group Direction (PGD) templates for medicines commonly used within reproductive services. The templates are aligned with current national guidance and it is hoped that they will save time and significantly reduce workload of commissioners and services by avoiding unnecessary duplication of work across the country. The PGD templates will need to be authorised for use within the local service and can be adapted to reflect local policies, commissioning arrangements if necessary.
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National sexual health PGD templates
BASHH has also been working with SPS to produce national PGD templates for medicines commonly used within sexual health services.
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Evidence, data & research
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Conceptions in England and Wales: 2018
Annual conception data for England and Wales was released by the Office for National Statistics (ONS) on 4 March 2020. The latest 2018 data shows that the overall conception rate fell to its lowest level since 2004, while the proportion that led to a legal abortion increased to its highest point since records began in 1990. For the third consecutive year women aged 40 years and over was the only age group where the conception rate increased. Conception rates for women under 18 years decreased for the 11th year in a row, although there remain significant variations in progress and rates between local areas.
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Indicators related to under 18 conceptions, pregnancy and birth: May 2020 update
Indicators related to under 18 conceptions, pregnancy and birth have been updated in the Child and Maternal Health Profiles and Sexual and Reproductive Health Profiles. The profiles give data at a local, regional and national level to inform the development and provision of family planning, antenatal and maternity care.
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Reports & other resources
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New HPE briefing: HIV Treatment as Prevention
HIV Prevention England (HPE) have updated their Treatment as Prevention (TasP) briefing. This paper covers the scientific evidence for TasP, information on viral suppression, the impact within the community and the ‘U=U’ movement and the public health impact.
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Providing coordinated care for people living with HIV
This policy briefing from NAT provides evidence of the outcomes of poorly integrated and coordinated care for those who are living with HIV and with other long-term conditions. It shows how models of healthcare are starting to respond to new demands and identifies principles for delivering responsive integrated care.
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Feminist Scorecard 2020
The Women’s Equality Network Wales and Oxfam Wales have launched the second edition of the Feminist Scorecard. The scorecard covers six key policy areas and charts Welsh Government’s progress since 2019 towards achieving equality for women and girls. FSRH welcomed the inclusion of gender health inequalities as a key policy area for action by the Welsh Government.
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Key learning from Let’s Talk.Period Project
This blog from Brook highlights 5 key takeaways from its Let's Talk.Period Project launched in October 2018 to tackle period poverty in seven areas across England.
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New Porn handout from Brook
Brook is adding to its suite of resources to support professionals to deliver quality RSE. Its new porn handout explains porn and the law and gives young people advice on how to spot unhealthy habits.
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LGBT+ Terminology Guide
Brook's young volunteers worked with the LGB&T Partnership to produce this free comprehensive terminology guide to support and encourage open conversations about sexuality and gender.
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The Sexual Health & HIV Policy eBulletin was originally developed and published by MEDFASH.
It continues to be compiled and edited by Helen Christophers on behalf of FSRH and coalition partners. If you have any comments on the eBulletin or eFeature or suggestions for topics you would like to see covered in future eFeatures please get in touch (ebulletineditor@fsrh.org).
You can access previous eBulletins and eFeatures via the links below:
> eBulletin archive (MEDFASH) > eFeature archive (MEDFASH/FSRH)
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FSRH and coalition partners do not accept responsibility for the content of linked websites/items included in this eBulletin and do not necessarily endorse the views expressed within them.
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