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19. STIs -  age no barrier (resolution)

Public Health Forum

That this meeting of RCN Congress requests Council to lobby for a campaign aimed at older adults (45-64) to highlight their increasing risk of sexually transmitted infections.

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Progress report

Council Committee: NPPC
Committee decision: New work
Council member/other member/stakeholder involvement: Lors Allford, Susan Fern
Staff contact: steve.jamieson@rcn.org.uk , jan.maw@rcn.org.uk

This item had 98% voting for the resolution and required a new task and finish group to discuss how to raise the profile of the issue and consider lobbying activities to ensure the sexual health needs of older people are addressed. Members of the task and finish group are:

The group has agreed the following objectives for the work:

  1. raise the profile of this issue through articles in the media
  2. lobby key stakeholders for a campaign aimed at older adults to highlight their increasing risk of sexually transmitted infections.

Progress on the first objective includes an article Never too old for a sexual infection by Linda Bailey, published on 23 July 2010 by BBC News Health - read it here.

Progress on the second objective was paused until after the public health White Paper Healthy lives, healthy people - the strategy for public health England was published on 30 November 2010, as this has a big impact on sexual health provision. During 2011, the Department of Health will also publish documents that build on the proposed new approaches to public health set out in the White Paper, including a more detailed paper on sexual health and teenage pregnancy (Spring 2011).

While the proposed changes set out in the White Paper relate to England, the Secretary of State is committed to working with Scotland, Wales and Northern Ireland.

It is clear that the new coalition Government has recognised that sexually transmitted diseases (STIs) continue to rise, and highlights chlamydia in the 15-24 year old group as the most affected. Also acknowledged is the link between alcohol misuse and sexual health risk-taking behaviour. The White Paper also aspires to work toward an integrated model of service delivery to allow easy access to confidential, non-judgemental sexual health services (including for sexually transmitted infections, contraception, abortion, health promotion and prevention).

Sexual health issues are raised throughout the public health White Paper, with the inclusion of sexual health in the Healthy lives, healthy people - transparency in outcomes outcomes framework for public health (specifically Domain 4 and chlamydia diagnosis rates and late stage presentation of HIV infection), and in the Healthy lives, healthy people consultation on the funding and commissioning routes for public health section 3.16.

However, there is no specific reference to the rising rates of STIs amongst the older population, or the role that international travel plays in the STI increase in the older age group, where older single travellers deliberately visit countries to engage in sexual activity and in places where STI rates are high. The Family Planning Association recently put out its first campaign specifically targeting those over 50 years old.

The RCN will be responding to the consultation on the White Paper and its supplementary consultation documents during 2011 and beyond. A public health White Paper sub-group has been set up to respond to the consultations. The need to target specifically rising STIs in the older population will be specifically included in the RCN responses as an area that needs consideration/action for the new commissioning boards under the umbrella of the HWW Boards.

In February 2011, a sexual and reproductive health clinical expert was appointed to the RCN Public Health Forum to lead and steer work relating to the sexual and reproductive health activities undertaken by the forum.

Debate report

This lively debate focussed around the increasing number of older adults with STIs and how their needs are being ignored in terms of information and awareness.

Initially speakers reacted strongly to the wording of the debate and the inclusion of the age bracket ‘45-65 years’, with comments such as ‘what happens after 64?’ and ‘are we past our sell by date at 65?’ being greeted warmly by the floor.

A procedural item was consequently raised and passed amending the wording of the debate to take out the reference to the specific age group. The proposer explained that it referred to the ages canvassed for statistics provided in the background information rather than a belief that sex ceases after 64.

Carmen Lisbey of the Derby Branch stated that the assumption that sexual health belongs to young people was not true, “STIs don’t distinguish between 18 and 80 year olds,” she said.

David Jones of Greater Bristol Branch raised a query as to whether statistics actually reflected an improvement in diagnostic techniques rather than a real increase in the numbers of older people with STIs, but added that as someone firmly within the 18-24 age bracket he did not want to believe older people didn’t have sex.

Nearly all speakers were in favour of the resolution, reflecting the opinion of Congress which passed the resolution by overwhelming majority.

FOR 398 – 98.03%
AGAINST 8 – 1.97%
ABSTAIN 2

Background

The National Service Framework (NSF) for Older People makes no reference to sexual health issues while the National Sexual Health Strategy explicitly focuses on the prevention of sexually transmitted infections (STIs) in younger people and the reduction in teenage pregnancies.
However, research based on data from 4,445 diagnoses made in people aged 45 and over at genitourinary medicine (GUM) clinics in the West Midlands between 1996 and 2003 found that men and people aged 55 to 59 were significantly more likely to be affected by an STI than others across the group; most of the people diagnosed were straight men and women.

The most commonly diagnosed infection among the over 45s was genital warts – accounting for almost half (45 per cent) of the diagnoses – while herpes was the next most common (19 per cent). Women aged 45 to 54 had the highest rates of STIs for their sex, while men aged 55 to over 60 had the highest rates for theirs. Cases of chlamydia, herpes, warts, gonorrhoea and syphilis all rose sharply between 1996 and 2003.
A team at University College London Hospital's Centre for Sexual Health and HIV Research found that a high proportion of people do not use condoms when sleeping with a new partner for the first time The researchers concluded that, instead of targeting public health campaigns primarily at young people, the importance of condom use must be promoted to all age groups.

Research by Olowokure et al. (2008) has found that current public health policy and sexual health programmes do not adequately cater for older people, and that sexual risk-taking behaviour is not confined to young people.

National and local health promotion and social marketing campaigns on sexual health are primarily targeted to appeal to young people in the 16 to 24 age group, while sexual health clinics appear to be aimed at welcoming only people in this age group.

While the incidence of newly diagnosed STIs in older adults (aged 45 to 64) is a small proportion of the total number of STIs, numbers are increasing year on year. For example, there was a 93 per cent rise in the diagnosed incidence of gonorrhoea in women aged 45 to 64 between 1999 and 2008, and since 1999 the increase in diagnosed incidence of syphilis in men in the same age group has increased 22 fold (HPA). Furthermore, sexual health clinics do not appear to be aimed at welcoming people in this age group.

In 2009, those aged 45 and over comprised 6 per cent of the workload at GUM clinics throughout Scotland and accounted for 4 per cent of all acute STI diagnoses. Work to define and address the sexual health needs of older people is to be undertaken by NHS Health Scotland, in conjunction with other stakeholders, and linked with older people’s strategies developed by NHS Boards. In Northern Ireland the DHSSPS Sexual health promotion strategy and action plan 2008-2013 commits “to develop a phased sexual health public information campaign which is accessible to all groups” and while implicitly acknowledging the risk to older adults, has not prioritised this group. In Wales work to redress these issues is taken forward through the Strategy for Older People in Wales 2008-2013 and the Sexual Health and Wellbeing Strategy 2009-2014 (both Welsh Assembly Government).

References and further reading
Gott M (2004) Are older people at risk of sexually transmitted infections? A new look at the evidence, Reviews in Clinical Gerontology, 14(1), pp.5-13.

Bodley-Tickell A, Olowokure B, Bhaduri S, White D, Ward D, Ross J, Smith G, Duggal H, and Goold P (2008) Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system, Sexually Transmitted Infections, 84(4), pp.312-317.