Standards for comprehensive sexual health services for young people under 25 years

Abstract

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.

School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities

“…43 Only one of the lower-quality studies, the evaluation of the Massachusetts Condom Availability Program, reported a statistically significant result in relation to recent sexual activity, which was lower in the intervention group than the control group. 58 Of the studies which only reported lifetime, not recent, sexual activity, the higher-quality Brazilian evaluation reported slightly higher increases over time in the intervention group than in the control group in the proportion of both male and female students who had ever had sexual intercourse, but these differences were not said to be statistically significant 50 (for details, see Appendix 2, Table 28). Only two of the lowerquality studies reported results that they identified as statistically significant.…”

“…58 For details of the individual projects, see Appendix 2, Table 26. More general information on the nature of the services represented by the projects is included in Appendix 3.…”

“…42 In Massachusetts, a methodologically weaker study found that the mean number of lifetime sexual partners was the same (at 2.8) in students at senior high schools with and without condom availability schemes. 58 Seven studies provided information relating to age at first intercourse. Only two lower-quality studies reported statistically significant results, in both cases suggesting that the presence of an SBHC was associated with a delay in first intercourse: male students in the intervention school in Dallas, and female students in the intervention school in Jackson, were significantly older at first intercourse than their opposite numbers in the control schools (see Appendix 2, Table 29).…”

“…55 • An intensive contraceptive continuation programme introduced into existing SBHCs in Baltimore. 56 • Five condom availability schemes (in Los Angeles County, 57 Massachusetts, 58 New York City, 59 Philadelphia 60 and Seattle…”

“…61 Five projects were not identified by the electronic searches: the Massachusetts, 58 New York City, 59 and Philadelphia 60 condom availability schemes, the St Paul Pregnancy-Free Club 52 and the Bodyzone Project. 51 At least one publication relating to each of the remaining 21 projects was identified by the electronic searches.…”