Free condoms to tackle STIs

5th August 2016 – To help cut rates of sexually transmitted infections (STIs) in England, free condoms and female condoms should be made more widely available, according to new draft guidance.

Sexually transmitted infections continue to spread in England – especially among younger adults and men who have sex with men and other high-risk groups. However, condoms can protect people against many STIs, including condoms, HIV and gonorrhoea. Not only can STIs have major health complications for the people who get them – even without symptoms, both chlamydia and gonorrhoea can cause infertility. Untreated syphilis can lead to blindness. Treating these infections costs the NHS staggering sums of money. The Family Planning Association estimates treatment of new STIs excluding HIV cost the NHS approximately £620 million in 2011.

The National Institute for Health and Care Excellence (NICE) has provided the following statistics:

• About 435,000 cases of sexually transmitted infections were diagnosed in England in 2015, including 200,000 cases of chlamydia
• The highest rates of chlamydia, genital herpes and genital warts can be found among young people between 16 and 24 years old
• Between 2012 and 2015, there's been a sharp rise in syphilis (76%) and gonorrhoea (53%)
• The highest rates of gonorrhoea and syphilis can be found in men who have sex with men.

Increasing the availability of condoms

So why are not enough people using condoms? The new draft guidance released today by the National Institute for Health and Care Excellence (NICE) explains that cost can be a major barrier to condom use, particularly for poorer people. In addition, social, cultural and religious beliefs can hinder people from using them because of embarrassment or stigma.

Christine Carson, programme director of the centre for guidelines at NICE, says in a statement: "The recent increase in rates of gonorrhoea and syphilis amongst men who have sex with men has been attributed to high levels of sex without using a condom.

"If local authorities and other commissioners can work together to increase condom availability and use amongst high-risk groups we could significantly reduce the rates of STIs."

In their new draft guidance, NICE is calling for a wider supply of free or cost-price condoms to reduce the rates of STIs. There should be a range of condom distribution schemes to meet the needs of the local population. The guidance is now open for consultation until 16th September.

For adults, NICE recommends local authorities consider distributing free condoms to men who have sex with men and other high-risk groups. It also recommends selling cheap condoms, at cost price, to adults.

Condom schemes for young people

The draft guideline recommends providing condom schemes for young people up to 25 years old that include advice, support and information. However, the document also states that schemes should assess the competence of younger people under 16 years old and others for whom there is a duty of care before providing them with condoms.

The committee reviewing the studies for the guidance looked into unintended consequences. They found that the "studies clearly showed that condom schemes do not increase levels of sexual activity among young people, nor do they reduce the age at which young people become sexually active.

As well as using the current C-Card schemes in operation, the draft guidelines recommend that it is important to integrate "condom schemes with broader services, not just sexual and reproductive health services but, for example, young people' services, education, school nursing and pharmacies."