5 August 2016
by Sarah Boseley (Guardian)
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Draft guidance from Nice says councils should consider schemes to provide free advice and condoms to halt rise in HIV and gonorrhoea
Local authorities should run schemes to supply young people with free condoms and sex advice in an attempt to curtail the number of sexually transmitted infections, a health watchdog body has said.
They should also consider giving free condoms to gay men, among whom the increase in infections such as HIV and gonorrhoea is of serious concern.
The draft guidance from Nice, the National Institute for Health and Care Excellence, has opened for consultation two days after NHS England lost a high court battle brought by Aids campaigners who want it to pay for drugs to prevent gay men who do not use condoms becoming infected with HIV.
NHS England has said it will appeal, but if it loses it will weigh up the value of the drug, Truvada, which costs about £5,000 a year per person, against treatments needed for other groups, including children with cystic fibrosis.
Nice says condoms need to be more widely accessible to prevent sexually transmitted infections, including HIV, particularly by the 16-24 age group and men who have sex with men. They should be free for those most at risk.
It comes amid concern that the use of condoms is primarily motivated by birth control, rather than their ability to prevent the spread of infections, and are therefore substituted with other forms of stopping pregnancy that do not offer the same protection against STIs.
Approximately 435,000 STIs were diagnosed in England in 2015, including 200,000 cases of chlamydia, says Nice. Syphilis and gonorrhoea rates have risen by 76% and 53% respectively between 2012 and 2015. The Family Planning Association (FPA) has estimated that the cost to the NHS of treating STIs was £620m in 2014. Nearly 4,000 people are infected with HIV in England every year. The lifelong treatment they require costs an average of £380,000.
“We know condoms can protect against many sexually transmitted infections including chlamydia, gonorrhoea and syphilis,” said Christine Carson, programme director of the centre for guidelines at Nice. “The recent increase in rates of gonorrhoea and syphilis among men who have sex with men has been attributed to high levels of sex without using a condom.
“If local authorities and other commissioners can work together to increase condom availability and use among high-risk groups we could significantly reduce the rates of STIs.”
Nice recommends more condom schemes should be set up by local authorities targeted at young people, based on existing models that offer a free supply but tied to sexual advice and counselling. The most common such scheme is the C-card, the most successful of which allows young people to obtain free condoms once they have been through an information and advice session with a trained counsellor.
The FPA said getting condoms to young people was key to tackling STIs. “However, as well as making condoms more easily and widely available, it’s also really important to back that up with education and support and to think about what barriers may exist to people actually choosing to use them,” said chief executive Natika H Halil.
“This should start with statutory sex and relationships education in schools so young people are equipped with the skills and confidence they need to have those important conversations about safer sex with partners.”
Halil added: “Condoms are already available for free in some places but there are always opportunities to reach more people, including in non-traditional health settings.
“It’s also important to reiterate the fact that condoms protect against both unplanned pregnancy and STIs, so even if you are using another method of contraception and don’t think about using condoms, you may be at risk of infection.”