Local sexual health services are in decline — we should all be very worried

Muffled giggling and coy, fluttering eyes from across the desks of schoolchildren and teenagers, drawn out by a teacher’s authoritative address to the class: “Today we’re going to learn about safe sex.”

Our individual memories of sex and relationships education will vary from person to person, even if experienced in the same school, same class or within a distance of heat radiated from blush-red cheeks. These moments don’t prepare us for the rigmarole of actually having sex, just the medical basics to make Ofsted believe we’re prepared for the future.

Ofsted might not be prepared for the classroom chatter around anal sex, masturbation and fetishes, but it’s still doing something, though the bare minimum, to ensure our system is giving a bit of an idea about bedroom stuff.

It’s become so much more important to reinforce this very basic ‘condoms-and-coils conversation because of the declining quality in sexual health services in the local community. Sex education is the gatekeeper for a labyrinth of information, with much of the hallways and corridors protected by the humble, council-run sexual health clinic.

Or so it has been, until recent times when these services have seen a dramatic decline in funding and improvements. The Local Government Association’s recent report on the declining state of local sexual health services should be read by anyone who takes an interest in good and healthy sex. My worry, as someone with a keen interest in local government, is how the report will be swept into a wider debate around funds, budgets and public service delivery.

Why should we be worried about these services closing? These concerns may not be new, but even if you aren’t sexually active, watching the decline of these clinics and drop-in centres should register a semblance of concern for issues of health, society and equalities.

Firstly, a well-resourced sexual health services network does exactly what it says on the tin. It tests and treats sexually-transmitted infections, supports young people with contraception, pregnancy testing, abortion and provides help for victims of sexual violence. Thus, calling it the ‘clap clinic’ is a misnomer and unhelpful for recognising how useful these services are for our health.

But there’s a bigger picture here. Giving a good service in these facilities is essential for wider public health and wellbeing.

Stopping the spread of illnesses such as chlamydia, gonorrhoea and syphilis isn’t only an act of individual treatment, but ridding people from potential complications if they were to leave it untreated, or spread the infection further. STIs can, and do, cause immense medical problems, sometimes leading to long-term disabilities and even deaths. Having a service which is free at the point of use, non judgemental and flexible for accessing is saving lives and misery.

Sexual health clinics aren’t well-resourced enough to provide adequate maternity and pregnancy care — however much they should be — but their role in testing, advice and delivering abortion and miscarriage care, is underappreciated in public and social health discourse.

Unplanned pregnancies are, for some, a blessing. For others, they represent a choice for people, the likes of which cannot be downplayed for impact on mental health, considerations of finances, work and relationships. If sexual health clinics were to completely disappear, accessing the guidance, direction to other services, and ultimately if chosen, for abortion, the impact on public wellbeing would be a serious challenge for tackling health and social inequalities.

The LGA, in my opinion, didn’t fully recognise the wider impact of the closure of services on people who become pregnant. They didn’t reflect on the personal costs that are incurred from unplanned pregnancies, not just financially, but mentally and socially too. Local government has such a crucial role in supporting the wellbeing of its residents that it feels somewhat alarming that the LGA hasn’t been brutally honest about what this could mean, both to its populations and to its own services. Some people don’t want babies and closing these clinics makes life harder for them. Simply put, it’s a risk to all.

Secondly, if you close the clinics, you’re closing your doors to young people who need advice about good, healthy sex. While we shouldn’t expect the walk-in clinic to provide every direction for bedroom-or-otherwise action, having access to free condoms, STI testing, guidance about forms of contraception and referrals to other services, is essential in supporting young people.

The social argument for supporting these clinics is clear for young people’s wellbeing. As mentioned earlier, they’re also an authority for safeguarding on issues of sexual violence and domestic abuse. According to the OHID, cases reported by these services increased by 795% between 2019 and 2021. The data also suggests an alarming rise in reports on cases of child sexual exploitation for the same time period, with a 103% increase presented in the sombre context of the final report from the Independent Inquiry into Child Sexual Abuse.

It’s also notable that a large rise in consultations for STI testing and treatment in sexual health clinics have been for people over 60, with the largest proportional increase for treating gonorrhea and chlamydia from a study in 2019.

Reporting these cases is an act of treatment for their horrific experience, though never truly cured, as well as prevention against seeing it happen again. Clinicians are guided by our experiences, which have skyrocketed if the attendance data is to be believed: over four million consultations at sexual health services in 2021 alone, an increase of 36% on records from 2013. These consultations aren’t just about health, they’re an agency of justice too.

An inquiry from the All-Party Parliamentary Group for Sexual and Reproductive Health earlier this year backs this promotion for better reporting and commissioning, through highlighting the need for greater access, integrated care, and addressing inequalities for marginalised groups.

Thirdly, the importance of these services to LGBTQ+ people cannot be understated. Again, I would criticise the LGA’s report in this area for not writing on how essential it is to support local queer communities with non judgemental and easy to access health services for tackling infections and diseases such as Monkeypox, HIV, and hepatitis. The government’s own efforts to tackle Monkeypox have been so weak and ‘voluntary’ in their public outreach and engagement, securing enough vaccines, and training health clinicians to support those infected with the virus. Local government has been on the frontline for delivering Monkeypox vaccines and to see these services decline through a political decision of budget cuts, is fuel for the bonfire of discussions on how austerity has killed.

Sexual health services are also frontline warriors in supporting LGBTQ+ people with HIV testing, treatment through PrEP and PEP, and in giving guidance and advice on safe sex and chemsex, which the LGA rightly highlighted in their report. HIV diagnoses have declined in recent years thanks to the growth in coverage for treatments like PrEP and PEP, but the decline in services risks reducing the capacity for delivering such an important, transforming treatment, especially for LGBTQ+ people. The World Health Organisation’s recent guidelines on sexual health treatment for LGBTQ+ people recommended prioritising reaching out and supporting communities to ensure services reach them — clearly the government hasn’t taken this one onboard.

Those red-blushed cheeks from secondary schools no doubt return when walking onto the premises of a sexual health clinic. It shouldn’t be embarrassing to need to use these services, indeed, with greater funding and resources their improved access to communities may even dispel the unfair flushes of guilt and remorse that many may feel.

I opined earlier of my worry that the LGA’s report would situate the decline in sexual health services in a wider argument on local government funding. With the population ageing, councils are dedicating more of their resources to adult social care and amenities which reflect demographic change. There’s a risk that through this view, councils will be forced to deprive sexual health services of funding to prop up their budgets. This isn’t necessarily their fault — a balanced bankbook has become impossible to achieve with so much pressure.

This is a problem which councils simply can’t afford to handle alone and charities, civil society groups and the very basics of sex education in schools can’t supplement. Without adequate funding for services of this importance, public health is at risk of even more danger. Good, healthy sex is more than an orgasm — it’s propped up by this infrastructure which helps prevent our sex lives from turning into nightmares.

You can read the Local Government Association’s report here.