THE SEXUAL WELLBEING of people aged over 40 and of transgender people should be considered for inclusion in Ireland’s next strategy on sexual health, a report has said.

The independent review of the National Sexual Health Strategy, published on Monday, makes 32 recommendations across a wide range of areas covering sexual health and information.

The review was commissioned by the Department of Health as part of the development of a new National Sexual Health Strategy (NSHS) for Ireland, as the last one ran out in 2020.

It found progress was made across most areas under the last strategy, and recommended actions to combat adolescents’ access to pornography, to support people with special needs to have safe sex and to reduce the frequency of chemsex – sexual activity under the influence of drugs – which it described as a “growing public health concern” in Ireland.

The report said there is a “strong case” for expanding “click-and-collect” services for sexual health home testing kits, which could offer a more discreet option over kits being sent to people’s addresses.

It also said that the next strategy should include advice for people aged over 40 and for the transgender community.

“The current NSHS does not include a strong focus on the sexual health and wellbeing of people over 40 years, and this may be a consideration for inclusion in the next strategy,” the report said in its recommendations.

“As well as the significant wellbeing challenges that are associated with menopause and erectile dysfunction, there is recent evidence in Ireland of an increase in STIs in older age groups.”

It also said: “The next NSHS may consider how sexual health services can most effectively engage with and support transgender people – in the context of facilities that may currently be gender-specific.

“Consideration may be given to bespoke sessional sexual health clinics to accommodate transgender people and address potential challenges and sensitivities.”

The review also found that the implementation of key performance indicators for HIV testing, STI services and contraception services should be pursued.

“This was included in the SHCPP Implementation Plan, but was not fully progressed. The reason for this is not known, but there are clear benefits from addressing this as part of the new strategy,” it said.

A national bacterial STI reference laboratory should also be progressed as “a priority to deliver a national STI diagnostic resource”.

The independent review was carried out by Crowe Ireland Advisory and identified 56 priority actions within the NSHS, assessing 49 as having been successfully completed.

It also sets out 32 indicative recommendations which could be considered for inclusion in the next strategy for 2023 until 2030.

Hildegarde Naughton, Minister of State with Responsibility for Public Health, Wellbeing and the National Drugs Strategy, welcomed its publication.

She listed the improvement of sexual health information, a model of care for STI and sexual health service delivery, building capacity for HIV PrEP, and expanding the free contraception scheme for women as priorities for consideration.

“Given the pace of change in this area of health, the recommendations of the review also provide a strong foundation for future planning and I look forward to supporting future service developments, to be laid out in the next version of the strategy,” she said.

HIV Ireland welcomed the publication of the review of the National Sexual Health Strategy, noting it was timely given the reported rise in rates of HIV and STIs in Ireland.

According to the Health Protection Surveillance Centre, by March 18 there was a reported 91% increase in notified cases of HIV on the same period last year, with a 53% increase in chlamydia and a 187% rise in gonorrhoea also reported.

Executive director of HIV Ireland Stephen O’Hare said the group was “pleased” to see many concerns raised by community organisations and sexual health services reflected in the proposals for the new strategy.

This includes a proposed model of care for HIV and STI services, increased access and availability of PrEP to prevent HIV, and addressing issues relating to chemsex.

“The emphasis must now be on developing a comprehensive, evidence-based, and culturally appropriate National Sexual Health Strategy, incorporating best practices, ensuring adequate resources, and a responsive approach to the evolving landscape of sexuality and sexual health service provision in Ireland,” he said.

Implementation of the strategy is led by the HSE Sexual Health and Crisis Pregnancy Programme.