Recommendations on Sexual Health Services and COVID-19: the HIV perspective
By Katy Sharrock
The Faculty of Sexual & Reproductive Healthcare (FSRH), British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH) recently jointly released formal recommendations for the Government to ensure sexual and reproductive health and HIV services are able to enact important COVID-19 contingency measures[i]. You can read the full contingency plan recommendations here.
The recommendations include short-, medium-, and long-term steps the Government can take to minimise the impact of the COVID-19 pandemic on health service users. The steps will also prevent further additional burden on primary care and emergency services due to temporary suspension of many ’usual’ sexual and reproductive health functions. At National AIDS Trust we think it’s important to consider how these recommendations could impact people living with HIV and others using HIV prevention and testing services.
The recommendation document identifies a number of potential risks to sexual health, reproductive health, and HIV service users due to a disruption of services. It highlights a potential rise in unplanned pregnancies, STIs, and abortions. We would also point out that reduced access to and disruption of services could result in:
- negative effects on the health and wellbeing of people living with HIV, if their HIV treatment were to be disrupted in any way;
- increased transmission of HIV, if there is reduced access to PrEP, PEP, ART, and condoms;
- reduced access to testing, which could further HIV transmission and contribute to late diagnosis; and
- anxiety in the face of uncertainty about being able to access necessary care.
HIV care is listed in the recommendations as one of the high-priority areas where every measure should be taken to ensure continued delivery of care. They also identify changing prescribing regulations for HIV treatment as a priority, urging “freedom for prescribing of HIV treatment from any service, for it to be delivered in any way possible (e.g. postal) and to remove the needs for wet [ink] signatures on prescriptions which do not meet the e-prescribing criteria”. We would also add that prescribing for PrEP should be subject to the same flexible regulations for those who need it during this time.
The recommendations focus on shifting to provide services digitally when possible, starting with an immediate scale-up of existing digital infrastructure and remote care services and continuing with a longer-term scale up of digital sexual and reproductive health care. The Association of Directors of Public Health (UK) has also released recommendations for essential service provision in different healthcare settings that align with the recommendations from BHIVA/BASHH/FSRH[ii].
On one hand, the vast majority of people living with HIV in the UK were on effective treatment and had suppressed viral loads before the COVID-19 pandemic[iii] and there is no suggestion the UK will have a shortage of HIV medication due to the pandemic[iv]. On the other hand, the capacity of many HIV care clinics has been greatly reduced in order to manage risk and so staff can support the COVID-19 response. In some clinics, this has led to routine viral load testing being put on hold.
People living with HIV who need to self-isolate are facing barriers in accessing their HIV medication as delivery can take time to sort out and receiving support from others would typically require them to share their status, which may be undesirable. Thus, the recommendation that people living with HIV simply continue their current treatment plan to maintain viral suppression[v] relies on addressing barriers to the accessibility of medication. This is particularly relevant to people with other long-term health conditions.
Sexual health services remain open but are operating differently with walk-in services put on hold and appointments essential. The vast majority will be supported via telephone or online services. STI/HIV self-testing kits and postal testing kits are available from some clinics and other services, like Terrence Higgins Trust. However, it will be critical to quickly scale up the availability of these kits to meet increased demand. Decreased capacity of many clinics has also led to reductions in PrEP and condom provision where in some cases it has been assumed that social distancing restrictions make them unnecessary. Such an assumption doesn’t take into account the variety of situations people experience and the continued importance of using harm reduction strategies.
As heartened as we are that HIV care is identified as a service area of the highest priority in these recommendations, it is essential that Government takes them on board and ensures clinicians across HIV, sexual and reproductive health are adequately supported to deliver the best services possible in the current context and minimise negative long-term impact. National AIDS Trust is maintaining our vigilance. Protecting the rights and well-being of people living with or at risk of HIV in the UK throughout the COVID-19 pandemic is vital. Check out our free resources on HIV and COVID-19 here, including legal advice on employment rights.
Katy Sharrock is Research and Policy Advisor for NAT (National AIDS Trust)
[i] “Sexual Health, Reproductive Health and HIV Services: Emergency COVID-19 Contingency Plan Paper for Government” (March 2020). https://www.fsrh.org/documents/sexual-health-reproductive-health-and-hiv-services-emergency/
[ii] “COVID-19 Prioritisation of Sexual & Reproductive Health Services” (April 2020). https://www.adph.org.uk/2020/04/covid-19-prioritisation-of-sexual-reproductive-health-services/
[iii] “Progress towards ending the HIV epidemic in the United Kingdom: 2018 Report” (June 2019). https://www.gov.uk/government/publications/hiv-in-the-united-kingdom
[v] “Coronavirus (COVID-19) and HIV – Responses to common questions from the British HIV Association (BHIVA)” (March 2020) https://www.bhiva.org/coronavirus-and-HIV-responses-to-common-questions-from-BHIVA