The Forum has raised concerns that men’s sexual health could be about to fall victim to the law of unintended consequences.
The current National Chlamydia Screening Project (NCSP) in England recommends that anyone under 25 who is sexually active is tested for chlamydia every year or upon change of sexual partner. But new plans will see screening targeted only at women, with services in community settings such as GPs and pharmacists. Men will not be offered a test unless their partner has chlamydia or they are showing symptoms.
Defeats the object
Chlamydia remains one the most common STIs in England with 59,425 diagnoses in heterosexual women in 2018 and 46,192 in heterosexual men. The impact of untreated chlamydia on women is serious. It includes the risk of pelvic inflammatory disease (PID), ectopic pregnancy and infertility. But men can also develop problems that can damage their fertility. And of course, they can infect their partners. Moreover, since there are often no symptoms of chlamydia, waiting for them to appear before testing rather defeats the object.
Following an External Peer Review of the NCSP, the government has put its proposed change in focus for the NCSP out to consultation. The Men’s Health Forum is concerned that both the benefits of the NCSP outlined in the report and any opportunity to educate men on sexual health will now be lost.
Men’s Health Forum CEO Martin Tod said: ‘We believe this change risks significantly reducing the amount of engagement by the health system with young men about their sexual health. Not enough analysis has been done to understand the wider sexual health implications of this policy change (and to assess the role of the chlamydia screening programme within an overall sexual health strategy) particularly if the engagement by GPs and other health professionals with young men on sexual health issues is reduced by a significant degree and not replaced in some other way.’
The change seems premature given that Public Health England is still awaiting the results of its reproductive health survey amongst men and, indeed, appears to fall outside the context of the government’s own proposed new sexual and reproductive health and HIV guidance published as recently as last December.
The Forum has called for ‘clear proposals to ensure that the health system continues to effectively engage young men in their sexual health via other methods’.
It is urging:
- A gendered analysis of PHE’s survey data to understand the likely impact of reduced chlamydia testing on young men’s attitudes and behaviours;
- Analysis to understand how much this change is likely to reduce the contact of young men with the health system on sexual health issues;
- Analysis of the likely impact of this reduced engagement on all sexual health problems, not just chlamydia;
- Clear proposals to address any shortfall in engagement with young men on their sexual health and any associated harms from that shortfall.
The Forum see the proposal as entrenching traditional beliefs around who is and who is not responsible for sexual health. Martin Tod said: ‘The proposal reinforces the idea that sexual and reproductive health is a matter for women and not a responsibility shared equally by men – even if (as in the case of chlamydia) the consequences are not always equally shared.’
As it stands the Forum could only support the change if there were clear proposals to ‘fill the gap’ left by cutting back on chlamydia screening for men to ensure that the health system continues to engage young men in their sexual health via other methods.
Joined up campaign
If men will not be engaged in their sexual health via chlamydia screening, the Forum calls on PHE should be to replace it with something better in terms of both impact and cost-effectiveness. As a minimum, it suggests GPs should have an annual sexual health consultation or conversation with young men. The Forum also proposes a campaign and action plan:
- Research identifying the scale of the challenge and the priority groups where intervention is most needed;
- Goals set to improve sexual health behaviours and knowledge amongst young men including condom usage and effective use of sexual health services;
- A review of potential engagement methods (eg. condom cards, brief interventions, social marketing and advertising etc.) and channels (eg. GP surgeries, pharmacies, digital incl. online chat and other contact points);
- Refreshed guidance that supports organisations to effectively engage young men in their sexual health.
Sexual behaviour is joined-up. We need a sexual health strategy that is the same. A sexual health strategy that omits men is doomed to fail and, if it implies that sexual health is all the responsibility of women, it deserves to.