Policy context
Current policy
In 2011, the Scottish Government brought together Sexual Health, Human Immunodeficiency Virus (HIV), Hepatitis C and Hepatitis B policy into The Sexual Health and Blood Borne Virus Framework (2011-2015). This Framework provided a joined up approach to tackling poor sexual health and blood borne viruses (SHBBV) in Scotland and set out five high-level outcomes: (1) fewer newly acquired blood borne virus and sexually transmitted infections, and fewer unintended pregnancies; (2) a reduction in the health inequalities gap in SHBBV; (3) people affected by blood borne viruses lead longer, healthier lives with a good quality of life; (4) sexual relationships are free from coercion and harm; (5) a society where the attitudes of individuals, the public, professionals and the media in Scotland towards SHBBV are positive, non-stigmatising and supportive. The Framework built on the success of the Hepatitis C Action Plan (Phase II) and Respect and responsibility: Strategy and action plan for improving sexual health as well as further developing the HIV Action Plan in Scotland. An updated framework, covering the 2015-20 period, was published in September 2015. The framework's original outcome relating to teenage pregnancy has now been integrated into Scotland's first ever strategy on Pregnancy and Parenthood in Young People (2016-2026), published in 2016. It aims to reduce pregnancies in women aged under 18 years and, where pregnancy does occur, to provide additional support to young parents, to reduce the cycle of deprivation that can be associated with early pregnancy. The fundamental causes of early pregnancy and the inequalities that result from it are addressed via the strategy's focus on actions targeting wider social and environmental influences. The strategy's outcomes framework and actions are underpinned by the UN Convention on the Rights of the Child, the Scottish Government's Getting it Right for Every Child approach, and five guiding principles: young people at the heart of actions, applying the social determinants of health model, multi-agency approach and leadership, creating positive opportunities, and evidence-informed.
Following the COVID-19 pandemic in 2020, the Scottish Government developed a recovery plan: Reset and Rebuild: A Recovery Plan for Sexual Health and Blood Borne Virus Services, which was developed alongside NHS and third sector partners and highlighted the impacts of the pandemic on Sexual Health and Blood Borne Virus (SHBBV) services ahead of a bigger review of the SHBBV Framework in 2022. This plan identified four key aims which will underpin a range of priority actions in 2021/22: to re-establish a comprehensive range of SHBBV services across Scotland; to understand the impact of the pandemic on people with SHBBV service needs; to address and begin to mitigate the SHBBV inequalities that the pandemic will have exacerbated or created; and to ensure that the innovations and service redesigns in response to the pandemic are evaluated, that learning is shared, and local or pilot projects are scaled up where appropriate and successful.
Data, indicators and monitoring
NHS Scotland National Sexual Health System (NaSH) is the clinical management system that was developed to support sexual health services throughout Scotland. This is part of the NHS Scotland National eHealth Strategy.
Data on indicators for the five outcomes under the current framework can be found here
The Health Care Improvement Sexual Health standards originally published in 2008 were reviewed and updated via stakeholder consultation. Publication of the new standards is anticipated in 2021.
Current policies relevant to sexual health
HIV and PReP in Scotland
On 10th April 2017 Scotland became the first of the UK nations to approve the provision of pre-exposure prophylaxis (PrEP) by the NHS to prevent HIV. The Scottish Medicines Consortium (SMC) announced that the drug Truvada® was deemed a cost-effective treatment to prevent the transmission of HIV and was to be made available through the NHS in Scotland. PrEP began to be offered through sexual health clinics across Scotland in July 2017.
On 1st December 2020, the Scottish Government announced their plan to eliminate HIV transmission by 2030.
Further information can be found here
Access to contraceptive pill without prescription
Following a successful trial in the Lothian and Tayside areas, in November 2021, the Scottish Government approved a scheme that will allow community pharmacies to give out three-month supplies of the progestogen-only pill without prescription. It is hoped this will help to bridge the gap between emergency contraception and long-term contraception. Further information can be found here.
Home use of misoprostol for early medical abortion
In October 2017, the Chief Medical Officer announced that Scottish Government had approved home use of the second of two medications used in early medical abortion (up to 9 weeks + 6 days gestation), effective immediately. This will be permitted where (a) the pregnant woman has attended a clinic where she has been prescribed mifepristone and misoprostol to be taken for the purposes of termination of her pregnancy; and (b) the pregnant woman has taken mifepristone (the first medication, which ends the pregnancy) at that clinic and wants to carry out the remaining treatment at home. This change aims to improve quality of care, by offering flexibility to women who wish to complete an early abortion at home. Further details can be found here.
Due to the COVID-19 pandemic, from March 2020, Scottish Ministers approved the patient's normal place of residence in Scotland as a place where the first drug (mifepristone) could be administered. Further details can be found here
Access to free menstrual products in educational settings
In October 2017 the Scottish Government announced it would be funding an ‘Access to Free Sanitary Products Programme’, beginning in the 2018/19 academic year. This has involved introduction of a scheme to fund free provision of menstrual products in schools, colleges and universities. This evolving scheme is being developed with the aim of supporting equality, dignity and rights for those who menstruate, and of ensuring that lack of access to products does not impact on an individual's ability to fully participate in education at all levels.
In November 2020, MSPs unanimously approved the Period Products (Free Provision) (Scotland) bill. The bill mandates that: Period products should be available to anyone who needs them, free of charge; Education providers must make period products available free in on-site toilets; Public bodies have a duty to provide period products free. Scotland thus became the first country in the world to make period products free to all.
Further details:
Period Products (Free Provision) (Scotland) bill. Policy Memorandum
Equally Safe
Scotland's strategy to eradicate violence against women was first published in 2014, and updated to its current version in 2016 (with additional contributions from children’s organisations). It was developed by the Scottish Government and the Convention of Scottish Local Authorities (COSLA) in association with a wide range of partners from public and third sector organisations. The aim of the strategy is to work collaboratively with key partners in the public, private and third sectors to prevent and eradicate all forms of violence against women and girls. The accompanying delivery plan sets out the actions the Scottish Government, COSLA and partners will take. It includes a total of 118 actions under 4 priority areas – ensuring that Scottish society embraces equality and mutual respect, and rejects violence; that women and girls thrive as equal citizens; that interventions are early, effective and maximise the safety of women, children and young people; and that men desist from violence and perpetrators receive a robust and effective response.
Further information:
- Equally Safe National Strategy
- Equally Safe Delivery Plan
- Equally Safe Delivery Plan: Year two report
- Relationships, Sexual Health and Parenthood resource: A new national resource for relationships, sexual health and parenthood (RSHP) education for children and young people has been launched in Scotland. The resource can be used in early learning settings, schools, colleges and community-based learning. It is organised to sit within Curriculum for Excellence.
Previous policies that underpin current activities:
- Respect and responsibility: Strategy and action plan for improving sexual health was published by the Scottish Government in 2005. This strategy focused on self-respect, respect for others and building strong relationships and a range of actions were set out to enhance sexual health promotion, education, and service provision. NHS Quality Improvement Scotland (NHS QIS) was tasked with taking forward the development of clinical standards in relation to sexual health services provided by or secured by NHS Scotland. The importance of improving detection and diagnosis of HIV in non-HIV specialties (including Primary Care) was highlighted in improving the detection and diagnosis of HIV in non-HIV specialties (including Primary Care), published October 2007.
- An HIV Action Plan in Scotland, December 2009 to March 2014 was published in November 2009 and aimed to prevent HIV transmission and to provide high quality treatment and care to all those who require it.
- A second phase of this strategy, was published in 2008 and saw the focus shift towards achieving cultural and behavioural change. This second phase details actions across four broad themes: knowledge and awareness; leadership, co-ordination and performance management; standards and service provision; and young people.
- The Hepatitis C Action Plan (Phase II) was designed to improve all services applicable to the prevention of, and design and care of persons with, hepatitis C. In July 2019, the Minister for Public Health, Sport and Wellbeing announced the Scottish Government’s commitment to effectively eliminate hepatitis C in Scotland by 2024.
- The Scottish government has also produced guidance for professionals on Healthy Relationships and Consent.
