On Wednesday 11 June 2003 the much leaked in advance House of Commons Health Committee Report on Sexual Health[1] was published. Having been one of just two GPs who gave oral evidence to the Committee, I was not surprised at its findings.
David Hinchliffe the Labour chair of the committee was widely quoted as saying that sexual health in the UK was 'in crisis' and 'We do not use the word 'crisis' lightly'. This remark was prompted not only by the steep rises in STIs (gonorrhoea rates have doubled and syphilis risen by 500% in the past 6 years) but by the breakdown in GUM services to cope with this rise. People were reported as being turned away from clinics and told to come back two weeks later!
In terms of diagnosis the report in its shortest section quite correctly highlights changes in sexual behaviour such as increasing numbers of both serial and concurrent sexual partners, decreased age of first intercourse, increasing numbers of men ever having had sex with other men, increasing numbers of men paying for sex and increasing frequency of anal sex for both men and women.
The prescription for improving sexual health does not lie in modifying these behaviours however but in reducing the risk by greater condom use and more (and compulsory) sex education in schools. No reference at all is made to the increasing evidence of the ineffectiveness of condoms to prevent the spread of the most common STIs such as HPV, HSV and chlamydia[2] and there is no convincing evidence anywhere in the world that the sort of sex education programmes which this report promotes achieve either a reduction in teenage pregnancies or in STI rates. Despite the evidence I presented[3] along with Robert Whelan, the Director of Family Education Trust on the evidence for the effectiveness of abstinence education the report states, 'We see no benefit in preventative approaches based primarily around promoting abstinence'.
What they do promote as a model to follow is the Swedish system of care. This is quite bizarre since the report also states that 'our visits to Sweden and the Netherlands also showed us that the public health problems caused by sexual ill health are increasing rapidly even in countries where such good practice is found'. Quite so. The chlamydia rate in Sweden has risen by 60% in the past four years and rates of STIs are rising at an alarming rate in the Netherlands. Why is their practice then considered 'good' by the committee?
Professing to be wise, this report shows that they are fools.[4] Putting potted plants and wicker chairs in the GUM clinic waiting room may be laudable but the government's blind refusal to tackle behavioural change as a primary prevention priority will mean that sexual health in the UK will be much worse in ten years time in spite of the committee's good work in highlighting the severity of the problem that exists even now.
