Alcohol misuse: tackling the UK epidemic - London

Given the private nature and social stigma associated with sexual health, it is vital to improve service
structure to facilitate simple and unrestricted access to treatment and diagnoses. For adolescents, this may
necessitate more young people’s clinics and referral to GUM clinics by school-based professionals
(including school nurses). Community family planning clinics have a key role to play in the prevention of
STIs and are able to target their services directly at adolescents via accessible, drop-in services. 160
Young
people’s perceived barriers to using services might be overcome through clinic or GP visits to schools and
youth settings, or through school visits to the contraceptive service. 173
Increasing the availability of
contraceptive clinic services for young people is associated with reduced pregnancy rates. 173
Services
should be based on an assessment of local needs and ensure accessibility and confidentiality. 173
The increase in infections, pregnancies and high risk sexual behaviour puts considerable demands on the
existing services for STIs and HIV, contraception, abortion and health promotion. In England, clinics for
STIs and GUM departments have seen a substantial rise in attendance over the past 10 years. The length
of waiting times has consequently increased and immediate access is increasingly difficult to deliver. 3
In
1988 the Monks Report set a target for patients with a new problem to be seen in GUM clinics within 48
hours. 195
However, evidence now indicates that waiting times for appointments are on average 12 days for
males and 14 days for females. In large urban areas patients may have to wait for over a month until the
next available appointment. 3
These waiting times pose a considerable threat to public health.
Screening
The government’s sexual health and HIV strategy specifies chlamydia as an area needing development.
Screening may be vital for preventing the transmission of asymptomatic infections. Evidence shows that a
significant reduction in pelvic inflammatory disease can be achieved through screening and management
of chlamydial infection among women. 196
There have been two pilot studies of opportunistic chlamydia
screening of sexually active young women in the UK. These have shown that screening is feasible and
acceptable, achieving high levels of population coverage. The high prevalence of infection found in these
pilot screening programme has lead to the conclusion that screening is likely to be cost effective. Since the
prevalence of infection in partners of positive women is high, effective partner notification is an important
part of screening programmes. 197
Targeted interventions
It has been suggested that, as adolescents are not homogenous, programmes should be tailored to the
group they serve. 173
The frequent clustering of risk among adolescents makes the identification of high risk
groups a sensible strategy in intervention. For example, adolescents who drop out of school will have
special and often complex needs; they may have high rates of risky sexual behaviour, mental health
problems and drug misuse. In light of an association between mental health problems and sexual risk
taking, there may also be potential for exploring the sexual behaviour of young people with depression,
anxiety and other mental health disorders. 180
There is a great need for providing adolescent boys with sound and accessible services. Service provision
has tended to centre on girls with little encouragement or emphasis being made towards boys. One study
of adolescents’ attitudes to sexual activity concluded that the provision of some single-sex sex education,
and a determined effort by community family planning services and primary care to inform teenage boys
of the services available to them, may help to address the imbalances found in attitudes and behaviour
between girls and boys. 159
The strong association between low educational attainment and early motherhood supports the
government’s current strategy to involve education and social services in a bid to reduce teenage
pregnancy. 156
General anti-poverty strategies are likely to influence rates of teenage pregnancy and help
reduce adverse outcomes. 173
British Medical Association Adolescent health 41