NATIONAL SEXUAL HEALTH AND HIV ADVISORY COMMITTEE
Minutes of the eleventh meeting held on Tuesday 16 December 2008, Dunedin Room, City Chambers, Edinburgh
Present
Members:
Shona Robison MSP, Minister for Public Health (Chair)
Jenny Bennison
Dan Clutterbuck
Nicky Coia
Anna Glasier
Roy Kilpatrick
Pat Morrison
Alison McCallum
Michael McGrath
Donald MacKay
Fergus McMillan
Mike Palmer
Sandra Patterson
Rob Whiteman
Danny Wight
In attendance
Phil Eaglesham
Mary Cuthbert
Dona Milne
Cheryl Paris
Shirley Fraser
David Goldberg
Jim Chalmers
Apologies
Apologies were received from Paul Flowers, Fiona McKenzie, Christine McGuire and Miranda Harvey
Agenda Item 1: Welcome and Introductions
1. Ms Robison welcomed the members to the eleventh meeting of the National Sexual Health and HIV Advisory Committee. Since the last meeting of the Committee in June 2008 the membership of the Committee had changed to reflect the Scottish Government's efforts to tackle the social and cultural factors associated with sexual health and HIV. Ms Robison invited Members to introduce themselves and explain their interests.
2. The Members noted events which had occurred since the last meeting of the Committee:
· The Sexual Health and HIV Team had been successful in securing funding for a sexual health social marketing campaign. A stakeholder group had been set up to guide this work which would be led by Scottish Government. The Social marketing campaign would begin in Spring 2009.
· Work was underway to develop a national HIV Action Plan. An expert group had been established to inform this work which would be led by the Scottish Government. The Action Plan would not only cover prevention but would also cover care and treatment aspects for people living with HIV. A further update would be included under agenda item 5.
Agenda Item 2: Minutes of the tenth meeting held on 16th June 2008 NSHHAC (2008) 51 and Terms of Reference
3. The minutes of the tenth meeting were agreed.
Matters Arising
4. Dona Milne reported she hadmet with Nadine Harrison to discuss the Quality Outcomes Framework and was pleased that additional sexual health services were now included within the Framework. The Committee noted however that it was still important to continue to work with General Practitioners to encourage and support them to provide sexual health services within Primary Care.
5. The secretariat finalised the sexual health outcomes and circulated them for clearance on 7 August 2008.
6. Michael McGrath raised concern that outcome 4 which detailed that sexual health services should be provided within or near schools would be problematic for denominational schools. Mr McGrath was concerned that Health Boards and Local Authorities would attempt to implement this outcome across the Board and that the recommendation should be written more clearly.
7. Ms Robison noted that the outcome specifically stated that sexual health services should be provided either within schools or near schools (within walking distance) and that this was an extremely pragmatic view. Ms Robison did agree however to highlight the options laid out within outcome 4 to Local Authorities in forthcoming guidance.
Terms of Reference
8. Michael McGrath highlighted that it would not always be possible for him to 'sign up' to every action made by the Committee.
9. Ms Robison noted this point but stressed that confidentiality was extremely important and that members should be able to openly discuss their views and trust that these would go no further. Ms Robison also asked the Committee to note that its role was to provide advice to Ministers.
10. The Terms of Reference were agreed.
Agenda Item 3: Research - Danny Wight NSHHAC (2008) 54
11. Danny Wight highlighted the large amount of work that Shirley Fraser had undertaken in completing the review of evidence available on sexual health. The members noted that the review was a scoping review and that it did not meet the requirements of a systematic review, in its truest sense.
12. Danny explained the background to the review noting that the review emanated from an action contained within Respect and Responsibility to:
· Offer advice on a sexual health research programme for Scotland, in partnership with key policy, research and practice stakeholders in Scotland and elsewhere.
13. The Group noted that while there may be gaps in the evidence the group had used approaches to try and ensure that the review was as full as possible. The review had been a collaborative exercise with thanks going to those who had contributed to it and in particular the key researchers Stephanie Church and Judith Sim.
14. In summary the review revealed that:
· In relation to sexual health inequalities, there are a number of groups which do not appear to have been researched at all or very little whilst others have been extensively examined
· There are still gaps across all population groups identified, particularly in relation to the more holistic aspects of sexual wellbeing and in linking the impact of such issues as mental wellbeing on sexual behaviour
· Some of the population groups are potentially at risk of poor sexual health outcomes but numbers are relatively small compared with other groups
· There is no overarching co-ordination to either commission research on sexual wellbeing or to bring it together under one location to aid public accessibility.
15. In response to these findings there are 3 key areas which frame the recommendations, these are:
· A research advisory panel should be established which would provide leadership. The panel would be transparent, led by impartial people and should be arms length from policy.
· To concentrate on the highest priority research areas which reflect the gaps in our current knowledge base.
· There is a strong need to efficiently share research findings to stop duplication of work.
16. Anna Glasier raised concern that there was no funding available to carry out the research which had been identified and that if funding was made available we should not only concentrate on researching vulnerable groups.
17. The members agreed that there was a need to identify sources of funding for example using the Chief Scientists Office within the Scottish Government to prioritise sexual health research.
18. It was also noted that funding for training of Doctors could be used and guided for sexual health training but that any research should reflect the main aims of Respect and Responsibility.
19. Sandra Patterson noted that the Association of Directors of Social Work were often asked to comment on research and that this could be another route for dissemination.
20. David Goldberg raised concern that the UK MRC sexual health research programme was ending and that throughout the years there had been a lack of Scottish proposals for Sexual health and those proposals submitted often lacked quality. Any panel established could encourage academics to submit sexual health proposals which may help this.
21. Ms Robison concluded that there was a general consensus in principle to establishing a panel and that those interested parties should contact the secretariat. It was noted that it would also be useful to include members who are not on NSHHAC but who have real expertise and a role to play in research in Scotland.
(Action: Secretariat to take forward and set up the panel)
Agenda Item 4: Social Marketing - Dona Milne
22. Dona explained that the social marketing campaign was not a one off short term campaign but would be developed and sustained over a number of years.
23. It was noted that research had been commissioned and conducted with a view to developing the campaign and had highlighted a number of areas of concern. For example there was poorer sexual health behaviour with higher numbers of sexual partners in lower socio-economic groups.
24. The research highlighted that those surveyed were content with the level of sexual heath knowledge they had however this knowledge was generally not put into practice. This particular point would be further researched as part of the qualitative work. Alcohol was also a very prominent factor in sexual behaviour.
25. The research reported that 16-17 year olds reported more responsible behaviour than those aged 18 to 25. General Practitioners were regarded as most trusted to provide sexual health services and information. Only 25% of those survey trusted the Scottish Government to provide this information.
26. In conclusion the research highlighted that, to those surveyed, sexual health means 'safer sex'.
27. The Scottish Government's challenge therefore was to develop a social marketing approach with associated campaigns that contribute towards a shift in behaviour from knowledge to practice.
28. Ms Robison noted the links with alcohol and poor sexual health outcomes. The members agreed that any campaign should challenge 'social norms'.
29. Dona explained that of the 1045 people who took part in the research, 11% had sex within 24 hours of meeting their most recent sexual partner.
30. It was noted that the Scottish Government should tackle the aspirations of those in Scotland and promote personal responsibility. There is a tension between having a moral position moralising.
31. Ms Robison explained that it was important to support people to be able to make informed decisions and to feel confident and supported by society when they make those decisions.
32. Ms Robison thanked Dona for her presentation and noted that there was a real opportunity to reinforce positive sexual health messages as well as spark conversation and that any social marketing materials would be tested throughout Scotland. She also noted that any comments should be forwarded to the secretariat and would be brought back to the committee in February 2009.
Agenda Item 5: HIV Action Plan - Mary Cuthbert
33. Mary gave an update on the progress being made to develop an HIV Action Plan. Following the recent rise in the number of cases of HIV, it had been decided that there was a need for an HIV action plan. The plan would provide leadership for those working in the field of HIV and would concentrate not only on prevention but would also address the care and treatment of those living with HIV. A recent needs assessment on the care and treatment of people living with HIV emphasised the need to increase early detection of the virus and provide high quality treatment and support for those who received a positive diagnosis. The action plan would incorporate these points as well as tackling increasing transmission and working towards reducing stigma associated with HIV. The action plan would be published in Spring 2009.
Agenda Item 6 - Any Other Business
34. Jim Chalmers asked the group to note that the annual ISD sexual health report was now published and was available in hard copy and on-line. He also noted that ISD had this year produced a digest report which was also available on-line and that he would be most interested in feedback on this report.
35. Roy Kilpatrick noted that he was keen that those accessing sexual health services were aware that their records would now be held electronically. While this system was confidential it was important that people were aware of the level of confidentaility key to them.
36. Roy also informed the committee that BBC Alba were running a Gaelic programme on Thursday 18 December which investigated the culture surrounding sexuality and religion in the Highlands.
Agenda Item 7 - Date of next Meeting
37. Dates for meetings to be held in 2009 would be circulated in due course.
NOTE: 2009 MEETING DATES - 24 February 2009, 9 June 2009, 13 October 2009 - venues to be advised to Members