Sexual health and blood borne virus action plan: 2023 to 2026

Access to services

Overview

The HIS Sexual Health Standards ⁵ state that everyone in Scotland should have 'equitable and consistent access to sexual health care'. To do this, stakeholders must improve the range and availability of sexual health and BBV services offered, and address inequity faced by specific population groups in accessing services.

Scotland should be a place where everyone, regardless of age, location, sex, gender identity, socio-economic background, sexuality, or race, is able to access the right services for the provision of sexual health and BBV care, in a way which suits their needs. Routine sexual health care and BBV prevention, such as contraception advice and provision and routine STI and BBV testing, should continue to be made available through locally accessible primary care services, including general practice and community pharmacy, with opportunities identified to expand provision where appropriate. It is also vital that third sector organisations continue to work with NHS Boards as part of the landscape to providing holistic care.

To achieve this, work is needed to address the barriers to accessing services, including workforce capacity, the impact of stigma, and knowledge about service provision, as well as any additional barriers facing specific groups who might need additional support to access services, such as young people, people who use drugs and those affected by social deprivation. In doing so, we can improve sexual health and BBV care for all people in Scotland.

Sexually Transmitted infection (STI) and BBV testing

Data from Scotland and elsewhere in the UK report sexually transmitted infection (STI) diagnoses, for example gonorrhoea and infectious syphilis increasing, despite testing levels not yet recovering to those observed prior to the COVID-19 pandemic These STI trends are concerning and addressing these is a priority for this Action Plan.

Initiatives such as dry blood spot testing for BBVs through drugs and alcohol services and the provision of home testing kits for HIV have been introduced to make testing easier, more convenient, and accessible to those most at risk.

Scotland does not currently offer national postal self-sampling for STI and BBVs, although local provision is available in some areas. A national project to develop an online STI self-sampling testing pilot, supported by sexual health services across Scotland, has been underway since 2021, with development and limited implementation in several NHS Board areas. As part of this initial pilot NHS Lothian recorded over 1500 self-sampling kits ordered online, with demand significantly higher than availability. Therefore, scoping work is being carried out on the potential for a national service to support the assembly and distribution of self-sampling kits.

Evidence from NHS Wales suggests that the implementation of an online postal self-sampling service (OPSS) has improved access to STI testing, particularly in rural areas and may reduce pressure on face-to-face testing provision allowing resources to be freed up to focus on more complex services. Over the coming three years, work will be undertaken to build on the existing NHS Lothian pilot project with the aim of moving towards a nationwide rollout. Scottish Government will work alongside partners within key national organisations to consider challenges of a national OPSS including IT provision, laboratory requirements and procurement.

As an online service for requesting self-sampling kits for STI testing could increase diagnoses of STIs and BBVs, consideration will need to be given to ensuring that services are adequately prepared to provide care for people receiving positive results from their online test.

Action 6: Scottish Government to work with national organisations to progress the roll out of a nationally available OPSS.