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SECTION ONE: SETTING THE SCENE
INTRODUCTION
Respect and Responsibility: A Strategy and Action Plan for Improving Sexual Health was published in January 2005 after extensive consultation.
It was produced against a background of poor teenage pregnancy rates and rising incidence of sexually-transmitted infections ( STIs).
The document sets out for the first time a framework for improving sexual health in Scotland. At the same time £15 million of additional funding was allocated over the three financial years 05/06 - 07/08 to help implement it.
The strategy is based on the principles of respect for self and for others, on strong relationships and on recognising the diversity of needs and lifestyles of people in Scotland.
Its main aims include:
- Improving the quality and accessibility of sexual health services
- Supporting everyone in Scotland to have the knowledge and information to make choices about sexual health and wellbeing
- Having a positive influence on cultural and social factors that have an impact on sexual health.
The strategy calls for action from different groups, including NHS Boards, local authorities, the Scottish Executive and others.
At publication of the strategy, the health minister Andy Kerr announced he would chair the National Sexual Health Advisory Committee, which is supporting and monitoring implementation.
THE FIRST 18 MONTHS
Substantial progress has been made since the strategy was published. NHS Boards, local authorities, the national committee and others have been putting in place plans to implement the recommendations in Respect and Responsibility. There have also been positive developments - such as new services - which have happened as a direct result of the strategy and the additional funding.
Some of the key achievements are:
- Each NHS Board has appointed a lead clinician and executive director with responsibility for sexual health
- Each local authority has designated a sexual health lead
- Two stakeholder events were held early in 2005 to drive the strategy forward
- All NHS Boards have drawn up and submitted local implementation plans
- All NHS Boards have assessed progress for the first year and their reports will be published on their website.
This report assesses what has happened so far and looks at plans for the future.
WHERE WE ARE NOW
Sexual health in Scotland is poor, with some of the highest teenage pregnancy rates in Europe and with rising incidence of sexually-transmitted infection. In Scotland, as elsewhere, sexual health and wellbeing tend to be worse among more deprived communities. (source: 2004 Health Indicators Report - A Focus on Children, NHS Quality Improvement Scotland)
When the strategy was published, it was acknowledged that there was a need for a broader range of actions to try to improve sexual health. These included improving frontline services for everyone across Scotland, no matter where they live and also creating an environment where people are equipped to make healthy choices.
The number of Chlamydia diagnoses in Scotland increased by 110 per cent between 2000 and 2004, from 7,644 to 16,069. Two-thirds of cases were in people aged under 25.
In 2004 there were 845 diagnoses of gonorrhoea, similar to numbers in the previous four years but 50 per cent more than in 1999. Three quarters of diagnoses were in men, a high proportion of those were men who have sex with men.
In 2004 there were 189 cases of syphilis recorded at GUM clinics. Almost nine in ten of these were men who have sex with men.
There were 364 new cases of HIV identified in 2004, the highest annual total since recording began in 1986. This was probably mainly due to increased HIV testing.
Source: Setting the Scene: sexually-transmitted Infections including HIV in Scotland, 2004.
In 2003-04 the teenage pregnancy rate in Scotland was 42.4 per 1,000 similar to the previous year's figure.
There were 294 babies born to 13 to 15 year olds and 4,984 to 16 to 19 year olds.
The rate of pregnancy varies by Board area. In 2003-04 Tayside, Dumfries & Galloway and Fife had among the highest rates in 13 to 15 year olds while Tayside, Fife and Highland had among the highest rates for 16 to 19 year olds.
Dundee City Council area had the highest rate of teenage pregnancy of the mainland council areas (64.4 per 1,000) while East Renfrewshire had the lowest (19.5 per 1000)
4,044 teenagers underwent abortions or miscarriages, 412 aged under 16.
Source: ISD Scotland
THE RIGHT PEOPLE IN PLACE
The strategy calls for each NHS Board to appoint an executive director and lead clinician for sexual health. This was seen as important in ensuring that work to implement the strategy was focused. Each NHS Board has appointed an executive director and lead clinician with responsibility for carrying forward implementation of the strategy.
Each of Scotland's local authorities was asked to nominate a strategic lead in sexual health. Local authorities have appointed leads from a variety of backgrounds, including social work, education and children's services, depending on local circumstances. All local authorities have fulfilled the strategy's recommendation to appoint a strategic lead.
The names can be found in Annexe A.
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