BPAS Medical and Nursing Conference: Speakers call for HIV testing in abortion care and for adequate GP funding for contraceptive care
Published 12 December 2008
BPAS’ cutting edge conferences for medical and nursing professionals continue to shape the discussion of sexual and reproductive healthcare in the UK.
On Friday 12 December in London, leading research experts and medical practitioners presented new research and debate, including on:
1: ‘Why abortion providers should provide HIV testing’
Ruth Lowbury, Executive Director, Medical Foundation for AIDS & Sexual Health (MedFASH) will argue at the BPAS conference that HIV testing should be offered in a wider range of healthcare settings.
There has been good progress with increasing HIV testing uptake in GUM (or sexual health) clinics and antenatal services, but other sexual and reproductive health services used by people who may have been at risk of HIV, including those providing abortion, should consider routinely offering HIV testing too. This does not usually happen at present.
The need to increase testing is urgent, because late diagnosis is the most important factor associated with HIV-related morbidity and mortality. Expanding HIV testing into a wider range of settings, and encouraging more patients to be tested, would improve the rate of early diagnosis and improve the outlook for people who are affected. It is recommended that if receiving a positive result, the patient should be seen by a specialist clinician within 48 hours.
Some clinicians believe that lengthy pre-test counselling is required before HIV testing, but Lowbury and others argue that to obtain consent for, and to administer, an HIV test is within the capability of any doctor, nurse, midwife or trained healthcare provider. Ruth Lowbury said
‘Over a quarter of people living with HIV in the UK do not know they are infected. Without a diagnosis, they risk serious illness and death and may unknowingly transmit the infection to others. Having a positive HIV test means they can access specialised treatment and support, with good chances of living a relatively long and healthy life.
‘Even if most women having an abortion don’t have HIV, we owe it to those who do and who are undiagnosed, to provide opportunities for them to find out before it’s too late to benefit from treatment.’
Notes for Editors
For more information on the work of the Medical Foundation for AIDS & Sexual Health please see their webpage. To request an interview with this BPAS conference speaker, please contact the BPAS press office on 020 7612 0206.
2008’s New UK national guidelines for HIV testing call for much wider availability of HIV testing within healthcare. Ruth Lowbury on behalf of MedFASH was part of the guideline development group. This guidance was launched in September 2008 by BASHH, BHIVA and BIS with MedFASH alongside the new MedFASH booklet 'HIV for non-HIV specialists'
2: ‘Why GPs can’t offer patients the best chance to protect themselves against unintended pregnancy’Contraception expert GP Dr Martyn Walling
(Fellow of Royal College of GPs, Fellow of the Faculty of Sexual and Reproductive Health), will present evidence showing that NICE guidance on contraception and Department of Health spending priorities are being thwarted by resource rationing by Primary Care Trusts (PCTs).
Funding and training restrictions mean that GPs are often unable to offer women the most modern, effective long-acting reversible contraception (LARC) methods such the IUS and implants. LARC methods have failure rates of less than 1%, compared to up to 8% for the contraceptive pill and 15% for male condoms in typical use.
Every £1 spent on contraception saves the NHS £11. Despite this, Dr Walling has found that some PCTs are rationing LARC funding to GP practices with thousands of women patients, with some practices funded to fit only one LARC method per month. GPs are also struggling to get PCT funding for training needed to fit LARC methods. Others find that PCTs force them to wait until a new financial year before funding LARCs- meaning patients can wait for months at an unnecessarily high risk of unintended pregnancy.
Dr Walling argues that new policy directives and funding from the Department of Health aimed at increasing LARC use can only be as good as the funding and training given to GPs to enable them to offer them, saying:
‘Evidence shows that Primary Care Trusts are still blocking the greater use of longer-acting contraceptive methods, against the recommendations of NICE guidance issued 3 years ago. This is directly contributing to the high unintended pregnancy rate in the UK.
‘It’s just too costly for GPs to offer these methods if they’re not supported by their PCTs financially to do so. In the end, it’s patients trying to protect themselves from unintended pregnancy who lose out.’
Notes for Editors:
According to the Government, the prevention of unintended pregnancy by NHS contraception services saves the NHS over £2.5 billion a year (Better prevention, better services, better sexual health: The national strategy for sexual health and HIV, Department of Health, 2001)
The 2005 NICE guidance on LARCS recommended that women be given access to LARC methods which are more cost effective than other forms of contraception as well as extremely effective at preventing pregnancy. (http://www.nice.org.uk/CG30)
Research shows that every £1 spent on contraceptive services saves the NHS £11.
Research shows the NHS could save almost £1 billion over 15 years by investing in contraception services and speeding up women’s access to abortion services by just ten days. (McGuire, A. and Hughes, D., The Economics of Family Planning Services, fpa, 1995)
The failure rate for male condoms is 15% according to ‘typical’ use, and 8% for the contraceptive pill. (See Table 2 of ‘Reducing Unintended Pregnancy in the United States’ ‘Contraception’, Editorial January 2008, Association of Reproductive Health Professionals.)
For more information, or to request an interview with a conference speaker, or BPAS’ Chief Executive Ann Furedi, please contact the BPAS press office on 0207 612 0206 or 07788 725 185.