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A survey was undertaken to determine the importance of confidentiality of sexual health clinics to young people, and their preferences for service provision. A questionnaire was given to school attenders in year 9 (age 13-14 years) at four comprehensive schools. Class leaders assisted students with literacy or language difficulties. Two hundred and ninety five questionnaires were distributed and all were returned (male 143 (48.5%), female 152 (51.5%). In all 199 (67.5%) had never used sexual health services. The importance of confidentiality (asked in two differently worded questions) was rated as 8.84 and 8.59 (mean) on a scale of 1 (not important) to 10 (very important), 166 (56.3%) rated confidentiality as most important feature of service and 254 (86.1%) were more likely to use a service if it was confidential; 161 (54.6%) would not use service if it were not confidential. Two hundred and sixty-six (90.2%) would give honest answers in a confidential service; 186 (63.1%) would not attend if they thought that child protection services would be informed; 136 (46.1%) would not want general practitioner informed of attendance; 209 (70.8%) would like regular sexual health check ups; 150 (50.8%) would prefer a young people clinic, but only 105 (35.6%) prefer a 'one-stop shop'. This study shows that confidentiality is extremely important to young people considering using a sexual health service. It is the first UK study to show that if confidentiality is lost, young people may not attend, or may not be honest when they utilize a sexual health service. This is particularly relevant at the moment in light of the threat to confidentiality for young people attending sexual health services.

This document is a first response to the need to develop sexual health services for young people on a single site whilst awaiting research from pilot studies of 'one stop shops' suggested in the Sexual Health and HIV strategy. It is a document which is intended to be a tool to use for those wishing to set up a service providing testing for sexually transmitted infections and provision of contraceptive services for those under 25 years. It is not intended that such a service would replace existing specialist or general practice care but complement it, allowing clients to choose the service most appropriate and acceptable to them, with close links and clear pathways of care for referral between services. This paper should be used as a template when initiating and monitoring a clinic but some of the standards may not be achievable without significant financial input. However, economic limitations should not detract from striving to achieve the best possible care for those most at risk from sexually transmitted infections and unwanted pregnancies. For example, not all clinics will be able to provide the recommended tests for the diagnosis for gonorrhoea and chlamydia immediately, but should work towards achieving them. Although the upper age limit in this document is defined as 25 years, some providers may wish to limit clinics to those under 20 depending on local needs. Detailed information on specific issues such as consent and confidentiality, provision of contraception, investigation of non-sexually transmitted vaginal infections and sexually transmitted infection management and diagnosis are referenced and we recommend these are accessed by the users of this document. Many of the references themselves are live documents available on the worldwide web, and are constantly updated. The Sexual Health and HIV Strategy has now been published and these standards are aimed at those who wish to provide a level 2 sexual health service for young people wherever the setting e.g. genitourinary outreach clinic, contraceptive services, general practice. This document is a starting point to be reviewed and updated as new research becomes available, as the Sexual Health Strategy is implemented and with further input from providers of care (family planning, general practice, genitourinary medicine, gynaecology and paediatrics) and service users. All service providers must maintain a high quality of care and have networks both with those who provide more specialized services (Level 3) and Level 1 services. This document is an initial attempt to ensure that there is equity of clinical provision wherever a Level 2 sexual health service is provided and should be a useful tool for those setting up or monitoring services.

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Objective: To evaluate the presence and extent of autonomic dysfunction in HIV infected individuals of one ethnic group. Design: Prospective, age-sex matched study. Methods: 25 patients (seven asymptomatic (HIV), eight AIDS related complex (ARC), 10 AIDS) and 25 controls were recruited from patients and staV at the Aga Khan Hospital, Nairobi. Autonomic function was assessed by measurement of pulse rate variability on standing, rest, deep breathing, Valsalva manoeuvre, isometric exercise, cold face test, and mental stress. Blood pressure was measured during standing, supine resting, and on Valsalva manoeuvre. CD4 count was correlated with number of abnormal test results. Results: 21 patients had at least one abnormal test of autonomic function compared with one control (p<0.0001). There were significant diVerences between AIDS patients and controls for supine heart rate (p<0.001), Valsalva ratio (p=0.05), and cold face test (p=0.05), and almost significant results for mental stress (p=0.051). Evidence of autonomic hypersensitivity was found in response to exercise and/or mental stress in some patients with HIV or ARC. No diVerence was found in blood pressure measurements. Abnormalities in autonomic function occurred at all CD4 counts and all patients with four abnormal tests of heart rate variation had a CD4 count less than 300 ×10 6 /l. Conclusions: There is evidence of substantial autonomic dysfunction in AIDS patients compared with controls and mild abnormalities in the majority of HIV infected patients studied irrespective of CD4 count. Autonomic hypersensitivity may precede loss of function in some cases. (Sex Transm Inf 1999;75:264-267)

There is theoretical plausibility for sexual transmission of Ebola virus but there has been no evidence of this occurring. Further research is needed to consider if sexual activity contributes to the epidemic in order to inform individuals with regard to avoiding acquisition or transmission by those recovering from Ebola virus disease.

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