NHS missing key opportunities to tackle alcohol abuse

A new report from the Royal College of Physicians (RCP) and British Association for Sexual Health and HIV (BASHH) has exposed missed opportunities to tackle alcohol abuse through existing sexual health services.

More than one million young people attend sexual health clinics each year. The report argues that this provides a unique opportunity to communicate key messages relating to alcohol consumption to those who are at risk.

The report highlights clear evidence linking alcohol consumption to poor sexual health, particularly in the young:

  • 82% of 16–30 year olds report drinking alcohol before sexual activity[i]
  • people who drink heavily are more likely to have unprotected sex with multiple partners[ii]
  • 20% of white 14 to 15-year-old girls report going ‘further than intended’ sexually when drunk.[iii]

Despite this strong evidence, there has been little movement towards tackling alcohol abuse through sexual health services.

Dr Simon Barton, chair of the RCP’s Alcohol and Sexual Health Working Party said:

The links between alcohol use and poor sexual health have been recognised for some time, yet the services available do not reflect this clear association. Failing to discuss alcohol consumption with a patient accessing sexual health services is a missed opportunity.

Although services that aim to tackle this problem cannot be effective in isolation, there is a real opportunity for sexual health services to support people both in identifying their behavioural risks and in empowering them to take action.

At a time when the NHS is looking to save £20 billion, this is a perfect example of quick-win efficiency that could save money in the long term.

The report focuses on young people as they are among the highest consumers of alcohol, and have the highest rate of sexually transmitted infections. 16–24 year olds make up just 12% of the population, yet they account for nearly half of the sexually transmitted infections diagnosed in sexual health clinics. 65% of chlamydia infections, 50% of cases of genital warts and 50% of gonorrhoea diagnoses occur in the young.

Dr Janet Wilson, President-elect of BASHH said:

Everyone knows that alcohol fuels risky sex – so a sexual health check-up is the ideal time to broach the subject, to find the one in five young people attending our clinics who are at most risk and give them structured advice around alcohol consumption, referring to alcohol services where appropriate.

Local Authorities will be responsible for public health under current NHS reform proposals, and BASHH congratulates this report for clearly identifying the type of  integrated approach needed to tackle our major public health issues.

Key recommendations from 'Alcohol and sex: a cocktail for poor sexual health' include:

  • sexual health services should provide information that highlights the link between alcohol consumption and poor sexual health outcomes and signpost sources of useful advice on drinking sensibly
  • all clinicians providing sexual health services should be trained in asking about drinking habits through use of a recognised screening tool
  • all sexual health services should develop a robust care pathway to refer patients for further support, including local alcohol services
  • new commissioning arrangements should ensure that the service specifications for sexual health in primary care and specialist services include opportunistic alcohol screening and brief interventions for young people.

These specific recommendations must be underpinned by a population level, evidence based initiatives, as previously advocated by the RCP. These include targeting the price, availability, and marketing of cheap alcohol.

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Notes to editors

For further information, please contact Andrew McCracken, RCP Communications and New Media Adviser, on +44 (0)203 075 1354 / 07990 745 608, or email andrew.mccracken@rcplondon.ac.uk

[i] Bagnall G, Plant MA. HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection. AIDS Care 1991;3:355–61

[ii] Mercer C. Alcohol use and STI risk behaviours: evidence from Britain’s national probability sex survey: the second national survey of sexual attitudes and lifestyles (NATSAL-2). Oral presentation at the World IUSTI Congress, 2009

[iii] Redgrave K,Limmer M. ‘It makes you more up for it’: School aged young people’s perspectives on alcohol and sexual health. Available at www.sexualhealthnetwork.co.uk/research