Providing intelligence, evaluation and research across a range of sexual and reproductive health related topics to support policy and service planning.
Public Health Institute provides enhanced HIV surveillance for the North West of England, by means of annual reports and an interactive online primary care trust and local authority database. This intelligence along with interactive tools, themed intelligence work and specific data requests is used to plan HIV services and prevention work across the North West of England.
PHI conducts service evaluations, original research and consultancy on a range of subjects including contraception, adolescents’ health, teenage pregnancy, sexually transmitted infections, and sex and relationship education at national and international level. Recent work has also included local rapid sexual health needs assessments, enhanced surveillance of sexually transmitted infections, evaluation of sexual adolescents’ SRH programme in Nepal, evaluations of sex and relationship education and young people’s health and wellbeing programmes and original research examining the links between teenage pregnancy and alcohol use
Sexual and reproductive health Case Studies
Adverse Childhood Experiences (ACEs)
A growing body of research is revealing the long-term impacts that experiences and events during childhood have on individuals’ life chances. Adverse Childhood Experiences (ACEs) such as abuse, neglect and dysfunctional home environments have been shown to be associated with …
Publications for Sexual and reproductive health
Papers for Sexual and reproductive health
BMJ-British Medical Journal, 2016.
We welcome the news item on the role of harm reduction in the ‘fight’ against HIV1 and we broadly agree with the findings of the report The Case for a Harm Reduction Decade: Progress, Potential and Paradigm Shifts.2 Clearly harm reduction for people who inject drugs (PWID) is having a positive impact on HIV in places such as the Ukraine, Nepal and parts of China and Kenya. This is supported by evidence of the long term impact of harm reduction approaches in controlling HIV among PWID in the United Kingdom, Switzerland and Australia. The increased benefits of even a modest proportional shift in resource from the so called ‘War on Drugs’ to evidence based harm reduction policies is a compelling argument. However, in addition to addressing the needs of established drug injecting populations such as heroin and stimulant injectors, we must also get ahead of the curve in relation to emerging patterns of injecting drug use to reduce the number of new cases of HIV. The injection of image and performance enhancing drugs (IPEDs) has been largely overlooked in relation to blood borne virus risks. IPEDs are a collective term for anabolic steroids, growth hormones, other drugs to increase musculature and associated ancillary drugs, together with peptide hormones such as melanotan II (a synthetic melanocortin analogue) and other drugs that are used for enhancement purposes. A recent meta-analysis and meta-regression of 187 studies on anabolic steroid use indicated a global lifetime prevalence of 3.3%.3 IPED users are growing as a client group in many countries with long standing provision of needle and syringe programmes, such as Australia4 and the United Kingdom where many services now report that over half of their clients inject IPEDs.5 Furthermore, in the United Kingdom there is conclusive evidence of HIV being present within this group of PWID, with an HIV prevalence of 1.5%6 amongst men injecting IPEDs, a level that is comparable to that among those injecting opioids and/or stimulants in the UK. Finally, there is evidence that people using IPED are a very sexually active population with low rates of condom use suggesting a risk of HIV transmission through their sexual networks.6 The use of IPEDs and in particular the injection of anabolic steroids by men, must be viewed as a serious public health concern requiring the attention of policy makers. Addressing the needs of emerging and often hidden populations of PWID should be part of the focus for harm reduction interventions. 1 BMJ 2016;352:i1479 2 Harm Reduction International. The case for a harm reduction decade: progress, potential and paradigm shifts. 2016. www.ihra.net/harm-reduction-decade 3 Sagoe D, Molde H, Andreassen CS, et al. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol 2014;24:383-98. 4 Iversen J, Topp L, Wand H, et al. Are people who inject performance and image-enhancing drugs an increasing population of Needle and Syringe Program attendees? Drug Alcohol Rev. 2013;32:205-7. 5 Kimergård A, McVeigh J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 2014;11:19. 6 Hope VD, McVeigh J, Marongiu A, et al. Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open 2013;3:e003207.
Professor Padam Simkhada, Aditi Sharma, Edwin van Teijlingen, Rachel Beanland
Nepal Journal of Epidemiology, Vol 6, No 1, 2016.
Abstract: Background: Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs). Previous reviews have focused on the knowledge, attitudes and behaviour of tourists and acquisition of STIs. Less is known about the impact on tourism operators in countries visited by tourists. The aim of this review is to ascertain factors influencing sexual behaviour between workers in the tourism industry and tourists; exploring the prevalence of sexual behaviour between the two populations, their perceptions of sexual risk while engaging in sexual activities and the knowledge of tourism operators regarding STIs. Methods: A systematic review was conducted. Database searches were performed in Medline/Ovid, EMBASE, Cochrane library and CINAHL for studies published between 2000 and March 2016. Grey literature searches were completed in the NHS database and Google Scholar between 2000 and December 2013. Papers were independently selected by two researchers. Data were extracted and critically appraised using a pre-designed extraction form and adapted CASP checklist. Results: The search identified 1,602 studies and 16 were included after review of the full text. Studies were conducted in nine countries. Findings suggest that STI knowledge, attitude and practice were fairly good among tourists and tourism workers, but there is a need for pre-travel advice for travellers, especially those travelling to low and middle-income countries. Greater importance was given to tourists than to tourism operators and locals interacting with tourists. Studies suggest that as a group both tourist and tourist workers were likely to engage in sexual activities. Overall, both condom use and STI screening were low, among tourists as well as tourism operators. Furthermore, studies reported links between drug and alcohol use and sexual behaviour and risk taking. Conclusion: Although less research appeared to have been conducted among tourism workers than tourists, it does demonstrate the need for education, training and promotion of travel medicine. STI screening, pre-travel advice, travel history in terms of contracting STIs and safe-sex awareness-raising are needed. More and better sexual health education and relevant tourism policies are needed globally.
Pramod Regmi, Edwin van Teijlingen, Vanora Hundley, Professor Padam Simkhada, Sheetal Sharma, Preeti Mahato
Health Prospect Vol 15, No 1, 2016.
In 2000, the United Nations (UN) adopted eight MillenniumDevelopment Goals (MDGs), three of these focused on health although several other MDGs included health-related components such as nutrition and sanitation (1). Overall progress towards the MDGs has been inspiring and specifically the health-related targets, e.g. MDG4 (reduce child mortality), MDG5 (improve maternal health) and MDG6 (combat HIV/ AIDS, malaria and other diseases) have been promising. For example, the global maternal mortality ratio (MMR) has fallen by 44% (from 341 in 2000 to 216 per 100,000 live births in 2015) and under-five mortality in the same period dropped by 53% (2). Despite these achievements, the world has failed to meet these MDG targets for both maternal mortality and under-five mortality, a fact recognised by maternal health practitioners, policy-makers and researchers across the globe (3). Moreover, progress has not advanced equally across the globe, for instance, improvements in MMR have been better in Southeast Asia (69% reduction) and the Western Pacific (64% reduction) (2).