The Western Isles Sexual Health Strategy 2007

Document:	The Western Isles Sexual Health Strategy 2007 - 2012
Heading:	THE NATIONAL SEXUAL HEALTH STRATEGY -‘RESPECT & RESPONSIBILITY’

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The National Sexual Health Strategy -‘Respect & Responsibility’

Sexual health in Scotland is poor. Sexually transmitted infections (STIs), such as chlamydia, are widespread and increasing, while teenage conceptions are amongst the highest in Western Europe. Thus, for example, reports of chlamydia in people aged under 25, rose from 4753 in 2002 to 5863 in 2003, an increase of 24%. Scotland's rate of births in the 15-19 year-old age group in 1998 was 30.6 per 1,000. This compares with rates of 6.2 in the Netherlands, 8.1 in Denmark and 9.3 in France. Scotland-wide indicators published by NHS Quality Improvement Scotland show that teenagers in the most deprived areas are three times more likely to become pregnant than their counterparts in the most affluent parts of the country.

Promoting positive sexual health is thus a key public health challenge for the Scottish Executive. Sexual health is not just the absence of disease, but includes an intricate range of ethical, moral, cultural and social issues. Improving sexual health requires a holistic approach that incorporates the personal, social, emotional and spiritual, as well as the physical, aspects of sexuality.

To address this, the overarching aims of this strategy are:

1.	to improve the quality, range, consistency, accessibility and cohesion of sexual health services from primary care to specialist genitourinary medicine (GUM) services, in line with the principles of providing services which are safe, local and appropriate;

to support everyone in Scotland, including those who face discrimination due to their life circumstances or their gender, race or ethnicity, religion or faith, sexual orientation, disability or age, to acquire and maintain the knowledge, skills and values necessary for good sexual health and well being; and

3.	to positively influence the cultural and social factors that impact on sexual health.

The strategy is built on the pillars of respect and responsibility and sets out, for the first time in Scotland, a coherent framework for improving sexual health, in a way that is respectful of both children’s rights and parental and personal responsibility, and which recognises religious, cultural and gender diversity.

Through the implementation of this strategy the Executive expects:

1.	to reduce unintended pregnancies and sexually transmitted infections;

2.	to enhance the provision of sexual health services; and

3.	to promote a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context.

The Scottish Executive also identifies the relevant partners and their roles in implementing the ‘Respect & Responsibility’ strategy. Key partners include the Scottish Executive, NHS Boards, local authorities, parents, faith groups, voluntary groups and others.

The strategy instructs partners to work together to:

1.	Improve the quality, range, consistency, accessibility and cohesion of sexual health services from primary care to specialist genitourinary medicine services, in line with the principles of providing services which are safe, local and appropriate.

To support everyone in Scotland, including those who face discrimination due to their life circumstances or their gender, race or ethnicity, religion or faith, sexual orientation, disability or age, to acquire and maintain the knowledge, skills and values necessary for good sexual health and well being.

Ensure that inter-agency local sexual health strategies are developed reflecting the key components of the national strategy, the local planning processes such as Integrated Children's Services, and that ongoing development and implementation is led by a multi-agency, multi-disciplinary strategy group, which reflects the needs of their local population, taking into account the issues that impact on sexual health, especially in relation to inequalities, and utilising the diversity impact assessment process.

4.	To positively influence the cultural and social factors that impact on sexual health.

To facilitate a co-ordinated approach to the integration of sexual health in wider Executive policies and initiatives, a ministerially-led National Sexual Health Advisory Committee - with cross-departmental and a wide-ranging membership - will be established with the aim of advising on policy, and monitoring and supporting the implementation of this strategy.

6.	To deliver a co-ordinated approach to sexual health and ensure that community plans and health improvement plans address the issues that impact on sexual health, especially in relation to inequalities, and take account of the diversity impact assessment process.

To adopt an integrated approach, which links sexual health policy to other related policy areas at both national and local levels, and recognises the wider implications on sexual health, is therefore necessary. In particular, it is important that the principles of equality and respect and accessibility to clinical services and lifelong learning apply to sexual health just as they do to all other aspects of health improvement and care, whatever our race, ethnicity, disability, gender or sexual orientation, age or religion.

8.	To facilitate the delivery of high-quality approaches to sex and relationships education consistent with national guidance, including multi-agency training, through partnership working and involving education authorities, partner agencies, parents and other key partners.

9.	In conjunction with key partners, partners should ensure that resources for sexual health promotion are provided so that good quality and well-resourced specialist services are able to support local initiatives.

10.	To ensure barriers that restrict the use of services, including those affecting rural services, are identified and addressed, and that proposals to improve service access for all populations are identified in the NHS Board inter-agency sexual health strategy.

11.	To ensure that all clinical services are reviewed against the values and principles identified in this strategy.

Health Outcomes

The Wider Influences on Sexual Health

Economic, social and cultural influences all impact on sexual well being and often give rise to inequalities. In particular, there is a strong link between social disadvantage and early initiation into sexual activity. Those with lower aspirations are more likely to become sexually active at a young age, less likely to use contraception, and therefore more likely to contract sexually transmitted infections and go on to become young parents. The overall rates of teenage pregnancy for the most deprived areas are more than treble than for the least deprived areas. Conversely, those with good educational and employment prospects are more likely to use contraception and more likely to terminate unwanted pregnancies. Planning to avoid unintended teenage pregnancies is closely linked with having a stake in the future, a sense of hope and an expectation of inclusion in society. There are also links to the cultural and social expectations of the lives and experiences of girls and boys.

Drug misuse and the disinhibiting effects of alcohol, the media, and peer and social pressures can all influence sexual behaviour, as can the experience of sexual abuse in childhood. The 2002 Scottish Schools' Adolescent Lifestyle and Substance Use Survey (SALSUS) National Report, commissioned by the Executive, found that 17% of 15-year-old girls and 12% of 15-year-old boys surveyed, reported having had unprotected sex during the last year as a result of drinking alcohol. The same survey found that drug users were more likely to have had underage sex and at an earlier age.

The Media and Mass Communications

Sexual imagery pervades many aspects of modern society and is often used to sell products. Its portrayal of sex and relationships tends to reinforce stereotypes about differing expectations in activities and behaviours, often in a sensational fashion and in a way which ignores the risks associated with sexual behaviour. It can also reinforce the social stigma around sexual relationships and sexual health services and sensationalise the issue. Media messages can lead to pressure and confusion over the realities of relationships and sexuality, particularly for young people, and can imply that casual attitudes to sexual issues are risk free and acceptable.

Yet the media can be a powerful communication tool, with the capacity to provide positive information about sexual health. Thus work with the media will seek to support action to improve sexual health through accurate and balanced reporting, promoting the core values of this strategy, and including the message that abstinence and delayed sexual activity in young people are socially acceptable choices and that sexual relations should be based on self-respect and respect for others.

Sexually Transmitted Infections and Unintended Pregnancies

Sexually transmitted infections, including HIV, affect people of all ages in Scotland, although incidence is greatest among those under 25. High chlamydia prevalence amongst young men and women is of particular concern, albeit the increasing numbers may be, in part, due to more people being tested. These infections can give rise to health complications and affect fertility, placing increasing demands on clinical services that can be prevented through the encouragement of safer sex practices.

Many women and teenage girls experience unintended or unwanted pregnancies. While pregnancy and parenthood are positive choices for some young people, for others unintended pregnancies and parenthood are associated with negative social and psychological consequences such as incomplete education, poverty, social isolation and low self-esteem.

Sexually transmitted infections can result in distressing and costly long-term morbidity in women in relation to ectopic pregnancy, infertility and chronic abdominal pain. Appropriate services for contact tracing are essential for the effective management of these infections.

The Role of Schools

Sexually transmitted diseases, such as HIV infection, chlamydia, gonorrhoea and hepatitis, are damaging but preventable. Public attitudes to sex education need to be addressed. Schools have a crucial part to play in fostering healthy attitudes towards sexual health and relationships education. High-quality sex and relationships education should be delivered in an objective, balanced and sensitive manner by professionals who are trained for this role and who are able to support and complement the role of parents and carers as educators of children and young people.

Health Services

Individuals need accurate, unbiased information, guidance and services if they are to take responsibility for their own sexual well being. Confusion or lack of knowledge about sexual health, or about the range of available services, may discourage or delay attendance and result in poor management of sexual ill-health problems.

Opening times, geographical location, suitability of premises, and perception of the services by users may limit accessibility to sexual health services. Access to services in rural areas raises particular issues such as confidentiality, anonymity and the limited choice of services provided.

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	CO-ORDINATION
	PRINCIPLES AND INTENTIONS
	THE NATIONAL SEXUAL HEALTH STRATEGY -‘RESPECT & RESPONSIBILITY’
	HEALTH OUTCOMES
	NATIONAL TRENDS IN SEXUAL ACTIVITY, SEXUALLY TRANSMITTED INFECTIONS AND TEENAGE PREGNANCY
	THE WESTERN ISLES
	KEY ACTION POINTS
	LOCAL ACTION PLANS
	ACTIONS FOR COMHAIRLE NAN EILEAN SIAR (CNES)
	ACTIONS FOR ‘OTHER STAKEHOLDERS’