Sexual Health and Blood Borne Viruses - Data
Sexual Health
Sexual health is a broad area including the treatment of infections, the prevention of unintended pregnancies and the promotion of positive sexual relationships and wellbeing. Nationally emerging issues include coercion, harm and social media. There is also an ongoing need to recognise and address sexual exploitation and harm.
There is little local data on sexual health relating to the adult population. There has been a particular focus on teenage pregnancy. Most of this work is done by the GIRFEMC (services for children and young people). A priority has been to reduce the number of unintended teenage pregnancies to reduce the number of young women leaving full time education for this reason before the age of 18. This is linked to the overall strategic vision that every child should have the best start in life and grow up being healthy, confident and resilient.
Under 20 teenage pregnancy rates in Scotland and Lothian have continued to decline from the most recent peak of 57.7/1000 women (2007) to 27.7/1000 (2019). Lothian has mirrored this trend. However, the under 16 and under 18 pregnancy rates within NHS Lothian over three year rolling periods, and rates for under 18 pregnancy in Midlothian have been persistently higher than the other 3 local authority areas. The reasons for this are multifactorial but certainly high rates of deprivation in Midlothian are likely to make a contribution.
Teenage Pregnancies (rate per 1,000) for Lothian Local Authority (three year combined for <16 And <18)
Note: This includes all pregnancies in women aged under 18. The rate is calculated using the female population aged 15-17 for 3 year periods.
In 2018, NHS Lothian were the first board in Scotland to offer home misoprostol for early medical abortion, which improves the experience of care for women and reduces the number of unnecessary appointments. In 2020/21 there were 3161 attendances at this service. This is similar to the previous years.
GP surgeries provide support and treatment on a variety of sexual health matters. In addition to this there is a weekly sexual health clinic for young people in Dalkeith in partnership between Chalmers Sexual Health Centre and Midlothian Council. There is a similar service for vulnerable population groups (those affected by homelessness, criminal justice, mental health and/or substance misuse issues) in Dalkeith run in partnership with Chalmers Sexual Health Centre and No.11 with support from Midlothian’s Health Inclusion Team. 45 appointments were attended here in 2020/21. There is currently no similar supplementary service available in the West locality. Out with these clinics and GP support the Chalmers Sexual Health Centre in Edinburgh is the nearest location for sexual health matters.
Access to sexual health services varies across the Midlothian localities with implications for access to health care. Local planning and provision has been impacted by COVID-19. The sexual health clinic for young people in Dalkeith is the only service which continued locally.
There is a need to capture local data on sexual health needs other than pregnancy in order to review and plan service delivery.
Blood Borne Viruses
Blood-borne viruses are viruses that some people carry in their blood and can be spread from one person to another. There are a variety of viruses of which Hepatitis C and HIV have the most serious long term implications. For Hepatitis C there is a new treatment which requires eight to twelve weeks of oral therapy, with very few side effects, that leads to sustained viral clearance in the majority of patients. People with HIV are now able to lead near normal lives with appropriate medication.
Health Protection Scotland publishes data by Health Board
Hepatitis C
235 people were newly identified as hepatitis C antibody positive in Lothian (during 2017), and 259 Lothian patients started treatment for hepatitis C; this includes 53 prisoners. The majority of these are likely to have been infected some years ago, but there is evidence of ongoing transmission in Lothian, particularly among people who use drugs.
Since testing became available in the late 1980s there have been 5,814 persons reported as hepatitis C antibody positive in Lothian (to 31st Dec 2017) and it is estimated there 3,251 people with treated and untreated chronic hepatitis C in Lothian.
The UK Government is signed up to the WHO target to eliminate hepatitis C as a public health problem by 2030. However the Scottish strategy may seek elimination prior to this date.
HIV
1,465 people live with HIV in Lothian (Dec 2017), up from just over 1,000 in January 2010.
The number of new cases of HIV infection in Lothian has been falling since 200594 and in 2017 totalled 99. However, the prevalence of people with HIV is increasing due to decreased deaths, antiretroviral therapies and new cases being diagnosed.
A new and highly effective form of HIV prevention, Pre Exposure Prophylaxis for HIV (PrEP), has been provided in Lothian since July 2017. It is expected that this will reduce incidence of HIV infection among men who have sex with men in Lothian.
There are around 6,110 people living in Lothian with HIV or Hepatitis C infection.