The Royal College of Physicians of Edinburgh welcomes the opportunity to offer evidence to the Health Committee on its "Inquiry into new developments in HIV/AIDS and Sexual Health Policy" and offers the following brief comments to inform their discussions:

  1.  The campaign by the Terence Higgins Trust and the All Parliament Group on AIDS to exempt all sexually transmitted infections (STIs) from overseas patient charges should be supported. There are strong public health, economic and humanitarian reasons for this including the reduction of HIV infections and associated conditions and the containment of costs by avoiding emergency inpatient care and expensive antiretroviral drug treatments.

  2.  There is a need for a national strategy to promote initiatives designed to reduce the onward transmission rates for HIV and STIs. Such initiatives should include compulsory education in schools, targeted public health campaigns, UK wide chlamydia screening and improved access to diagnostic testing in the community.

  3.  A recent article in the International Journal of STD and AIDS, reporting a study by Kinghorn, suggests that previously targeted funds for GUM services in England may not be getting through to front line teams. The infrastructure and staffing levels in GUM are not improving despite previous reports of a crisis in the service. This must be investigated.

  4.  Although the Health Committee is primarily concerned with England, there is no finalised Sexual Health Strategy in Scotland or Northern Ireland and efforts through clinical and political networks to address this would be welcome and mutually supportive.

  5.  The trend indicators for sexual health continue to show rising infection rates, increasing pregnancy and reduction in the age of coitarche. This is a public health crisis that results in significant spending across the health services in infertility, cervical neoplasia, and infectious obstetric/paediatric complications and antiretroviral therapy. An integrated approach to improving accessible diagnostic services, prevention measures, treatment and contact tracing are essential if these trends are to be reversed.