Sexual healthcare services are in crisis in this country. The word was not used lightly by the select committee on health in their report last week. GUM (genito-urinary medicine) clinics are staggering under the burden of soaring sexually transmitted diseases. And the worst global pandemic in the history of mankind, HIV/Aids, continues its devastating progress in Africa.
Are these things linked? Up to a point, yes. But is that a reason to pull up the drawbridge on fortress UK, barring immigrants and refugees from sub-Saharan Africa and other places where HIV/Aids is common?
The parlous state of affairs in sexual health in the UK is now being blamed on immigration and asylum seekers - the NHS is about to collapse under the strain, a Sunday paper said. Granny won't get her hip operation because the hospital is spending the money treating people from abroad with HIV.
The truth is that the GUM clinics are the Cinderella service of the NHS, hidden away, massively underfunded and overworked. HIV is certainly putting a strain on some of them, but so is chlamydia, a sexually transmitted bacterial infection now turning up in one in 10 young women between 16 and 25, and one in five in some deprived areas. It can have terrible consequences, causing scarring on the fallopian tubes, which leads to infertility, and yet there are no symptoms.The growing awareness of it, however, is leading more and more young women to seek testing.
So the GUM clinics are now dealing with about 70,000 cases of chlamydia a year, and vastly more young people are coming for testing. It takes up a lot of time, even though treatment with antibiotics is easy and swift. Meanwhile, ancient sexual infections are also soaring: gonorrhoea increased by 86% between 1996 and 2001 in England, and syphilis rose by 500% in the same period.
HIV infection in this country is following the same sort of upward curve. In 2002, when all the final figures are in, the health protection agency believes there will have been 6,500 new infections. At the end of 2001, there were an estimated 41,200 adults living with HIV. Young gay males, among whom the epidemic was virtually completely contained in the 1980s, are now a minority of new cases. Most are heterosexuals, many are women and half were infected abroad.
Of the 3,200 who became HIV positive last year while abroad, the health protection agency says an unknown number were UK residents who had unprotected sex while visiting. The rest have come to this country to work, join family or claim asylum.
Did they come specifically to get treatment for their HIV infection on the NHS? Doctors say no. Steve Dawson, who runs a GUM clinic in Slough, where many people have settled after arriving at nearby Heathrow airport, says: "I've had 200-300 new cases in the last couple of years, most from sub-Saharan Africa. Maybe one or two would have been aware of their status prior to coming. Others have fallen sick or become aware because of antenatal screening."
Nick Partridge, chief executive of the Terrence Higgins Trust, which supports those with HIV/Aids, says the vast majority have no idea. "Our experience is that all of them find that diagnosis a complete shock. They have not come here to seek treatment but as a student or to take up a job offer or to join their family." Most Africans diagnosed HIV positive in the UK are women, sometimes picked up when they go for antenatal screening, sometimes when a child falls sick and is found to be infected.
There is no doubt that the rising number of HIV infections is putting increased strain on the GUM clinics, which must manage the patient's complex drug treatment. On a combination of antiretroviral drugs, which cost between £7,000 and £12,000 a year in the UK, the patient can live well and industriously for many years, but they must be monitored and encouraged to look after themselves. The total cost of their care is estimated at about £15,000 a year.
This burden falls disproportionately on the clinics - dispersal policies mean that some clinics may suddenly find they are getting far more HIV cases than they used to see. But the biggest problem the GUM clinics have is general underfunding. Colm O'Mahoney, chairman of the Association for Genitourinary Medicine, says they have been given £47m over several years under the government's sexual health strategy. The cost of getting on top of chlamydia alone, he says, would be £80m a year. So there are waits of up to six weeks for angst-ridden young people who have plucked up the courage to visit a GUM clinic. "Nobody with a sexually transmitted disease will complain about even the most appalling service," says Dr O'Mahoney. "We have been jumping up and down but we are just labelled another bunch of whingeing consultants."
Ultimately, GUM clinics need money to treat people, not an immigration ban. HIV/Aids is huge in sub-Saharan Africa, but a growing problem in Russia and eastern Europe as well. And it is far from under control. The crisis in our sexual health services is all the more reason for the UK to step up efforts to help tackle the global pandemic that is washing our shores.
The global epidemic has run out of control in many parts of the world, says Mr Partridge. "That is bound to be reflected in the movement of people to this country coming here for legal and proper reasons and to make a contribution to our economy."
· Sarah Boseley is the Guardian's health editor
