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Last Updated: Wednesday, 19 October 2005, 16:56 GMT 17:56 UK
Programme transcript

The following is a transcript of Panorama's "Love Hurts", first broadcast on 16 Octoberr 2005 on BBC One at 22:15BST

NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS ACCURACY.


RECEPTIONIST: Good morning, Department of Sexual Health. Can I help you?

GIRL: Ah, can I make an appointment please?

RECEPTIONIST 1: Unfortunately, the first appointment I have here is almost 6 weeks away.

RECEPTIONIST 2: The problem that we have is that the clinics are full to over spilling. DAVIES: This is the story of how a health service dealing with the most personal part of our lives is failing; a story about the devastating impact the UK's declining sexual health is having on many people's lives.

RECEPTIONIST 3: We're not taking any new patients at all at the moment. We just haven't got the doctors in the clinic.

MAN: Gosh, that's... that's over a month away.

RECEPTIONIST 4: Yeah, yeah, it's actually normally six weeks. So that's quite good, really.

DAVIES: ... and a story about how the crisis is being fuelled by the increasingly risky approach we, in this country, take towards sex.

(Night club scene - male stripper)

COMPERE: Come on, get those hands together for Dynamite! (Cheering)

DAVIES: It's ladies' night at The Scandals Pub in Sheffield, and stripper Steve Dynamite is topping the bill. In the pub tonight it 24 year-old Sian Wathen. Normally at work behind the bar here, she's decided to have a girls' night out.

COMPERE: There you are girls, how about that... ?

SIAN: That's quite nice. I want to look like that for my wedding.

FRIEND: Is it? I like them bags.

DAVIES: In just a few days, Sian will go into hospital. Two and a half years ago, she discovered that she'd contracted the sexually transmitted infection, chlamydia from a former partner. Now she's got to have an operation to find out whether that infection has left her infertile.

In terms of fertility, what are your chances of having another child?

SIAN WATHEN

I want them to be high, but I don't know yet. Go into hospital and see how bad my tubes have been affected by it, and fingers crossed that it won't be that bad, but cross that bridge when we come to it.

DAVIES: Do you want to have another child?

SIAN: Yes, definitely, and we've been trying for, like, over two year, with no avail. So, that's why we're being referred to a fertility clinic.

DAVIES: Sian already has a son from her previous long-term relationship, but now she's engaged to Neil and they want desperately to provide a brother or sister for Louis.

What's the most difficult thing about all of this for you?

SIAN: What I'm going through now, because I never thought I'd go through this, especially having Louis, you know? Which makes it harder, because I know, I see him growing up, and he ain't got no siblings, like, and... and he's always asking for them, as well which makes it worse. (Laughs) That's the worst bit, and having to tell people about it, and... because you don't... I mean, everyone thinks it's dirty, don't they? And they've all got their thoughts about it.

DAVIES: It was in Sheffield, at this genitourinary or GU Clinic, that Sian Wathen was first treated for chlamydia. GU Clinics are the main part of the NHS which looks after people with sexually transmitted infections. Sometimes these clinics feel more like casualty departments.

ANDY DAVIES

For obvious reasons of confidentiality, we can't take our cameras into the waiting rooms behind, but I can tell you that they're full, and there's been almost a constant flow of men and women coming into this corridor and then disappearing into the consulting rooms on either side, and to give you a sense of the scale of what's happening here, in this small clinic in just one month alone, they'll see over one and a half-thousand patients. One of the first in today is Ian.

NURSE: Do you want to just lie yourself back now then?

IAN: Lie down?

NURSE: Yeah. Just going to give my hands a wash now. Which way? That way (donning surgical gloves) Okey doke, now I'm just going to have a little look see. I'm going to see if there's any swollen glands here. Just check the testicles and they feel healthy. There's absolutely no discharge there to see. That's brilliant. OK, do you want to hop yourself up.

IAN: Righty ho.

NURSE: There we are, good. Now, if you... if I could get you to pass some urine...

IAN: Oh, thank God! (Laughs)

NURSE: The bit we've been waiting for.

IAN: Oh yes.

NURSE: Now, if you could fill that one up first. Just the first bit of urine you pass, you fill that one up, OK, a little bit into that one, the rest into the loo, but that one... that one first, OK?

IAN: Rightio.

NURSE: Now, once you've wee'd, can you knock on that door and sit down there? Nurse will come in, take some blood, OK?

IAN: Rightio.

NURSE: ... ah, and would you like some condoms?

IAN: Ah, might as well.

NURSE: Yeah, I'll put some out for you, OK? Just give us a knock when you're done.

IAN: Rightio.

DAVIES: Is this the first time you've been to a clinic?

IAN: Yeah.

DAVIES: Was it OK, the experience?

IAN: Yeah, the umbrella thing got me worried, you know, where they say that they shove an umbrella down your Jap's eye, and then... oh, but had to come.

DAVIES: You didn't have the umbrella?

IAN: No.

DAVIES: There is no umbrella, by the way.

IAN: Oh thank God. (Laughs)

DAVIES: Are you worried that you might have picked up something?

IAN: Well, the last girl I had sex with, she tends to sleep around a bit. So I'm a bit worried about that, and also the one a few days about that. So, just thought I'd come and make sure.

DAVIES: So you've had two casual partners in the space of a few days?

MAN: Yeah.

DAVIES: You didn't use a condom?

IAN: No, too drunk. The effects of alcohol, what can I say?

DAVIES: What were the circumstances?

IAN: Well, I was in a nightclub, and I went up to this young lady and said, "Pick me, I'm a love albatross." So I was very, very drunk, and she dragged me off to a dark alley...

DAVIES: And you'd met her for, how long?

IAN: Two hours, and I hadn't really talked to her that much. Think I'd said six words to her.

DAVIES: And that was that? So do you feel as if you're making a responsible move now?

IAN: Well now, yes, but obviously not then.

DAVIES: Every morning in the clinic, it's the same routine: each result is someone's story.

FEM: (going through patients' notes) This is a positive syphilis. We've got another positive gonorrhoea. It's the same again: positive HIV, syphilis, syphilis, chlamydia, positive chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia. As you can see, a lot of chlamydia.

DAVIES: The situation is simply out of control according to George Kinghorn, the director of this, Sheffield's only GU Clinic. He's one of the country's most senior clinicians in GU medicine. He's also an advisor to the government on sexual health.

DAVIES: Does it constitute a public health crisis?

Prof GEORGE KINGHORN, Senior Genito-Urinary Consultant, Royal Hallamshire Hospital, Sheffield

I think it does represent a public health crisis. Sexually transmitted diseases affect many people in this country. Currently at least three quarters of a million people are presenting each year, you know, within England alone, and this is a problem which is only going to increase. If we have untreated and undiagnosed disease out in the community, then it will inevitably spread and more people will be affected.

DAVIES: Across the UK, hundreds of thousands of people have been caught up in this epidemic of sexually transmitted infections, or STIs as they're known. In the last 10 years, the number of people contracting gonorrhoea each year has more than doubled to over 20,000. Diagnoses of chlamydia have trebled, and there's been a 16-fold increase in syphilis. The 'great pox' as it used to be called, is back. No wonder then, that the workload in the sexual health clinics has more than doubled in the last decade. Yet it remains one of the poorest resourced areas of the NHS. Some clinics are just refusing to take on any more patients. Others haven't a hope, right now, of meeting the recommended 48-hour maximum waiting time for appointments so critical to stop patients passing on their infections. To get an idea of the extent of the problem across the country, we decided to call every clinic listed in the UK - over 260 of them - posing as worried people seeking appointments. The early results weren't encouraging.

Secret Recording

(Telephone rings)

RECEPTIONIST: Hello, GUM.

GIRL: Oh, hello, can I book an appointment please?

RECEPTIONIST: Have you been to the clinic before?

GIRL: Ah, no I haven't, but my... my boyfriend's been treated for gonorrhoea and he's told me I should come and get a check-up.

RECEPTIONIST: Right, have you actually got any symptoms yourself at the moment?

GIRL: No, I haven't.

RECEPTIONIST: At the moment, we're fully booked up until the end of next week.

RECEPTIONIST 2: Unfortunately I've got no appointments left for the next 2 weeks, for new patients.

MAN: I've got symptoms now, but you can't take anyone, is that right?

RECEPTIONIST 3: No. Yeah, we're not taking any new patients at all at the moment. We just haven't got the doctors in the clinic.

CLINICIAN: There's no provision in London for sexual health from Friday afternoon 'til Monday morning.

MAN: Oh, right, right. There's nowhere at all?

CLINICIAN: Nowhere, nowhere. If you think it's scandalous, as I do, write to your MP.

DAVIES: Sexual health clinicians know that each treatment delayed risks serious consequences.

KINGHORN: Our waiting time here, which was negligible in... at the end of the 90's has gradually risen so that we're now talking about something like 3 weeks before people can have a routine appointment. That's absolutely unacceptable.

DAVIES: Why does it matter if someone goes a few weeks without getting the treatment?

KINGHORN: One: they're at risk of developing complications, which can have very serious consequences for their future health; secondly, because of the risk of sexually transmitted infection, they're much more likely if they're exposed to catch HIV; and thirdly, it's not just a problem for them, it's a problem for their partners, and it is much more likely that they're going to transmit this infection to other people.

NURSE: That's right, so just my fingers with some jelly on now.

PATIENT: OK.

DAVIES: Delaying the treatment of an STI not only makes patients more susceptible to HIV, and more at risk of infecting others, it can also trigger long-term medical conditions for the person infected.

NURSE: ... now I'm just going to dry the neck of the womb.

DAVIES: Sian Wathen has no idea how long she had chlamydia before she was treated for it, as there were no symptoms for a long time.

SIAN: I just, like, thought, "Chlamydia", and I were like, "Well, what is it?" I'd, like, heard of gonorrhoea, and herpes, and like, thrush and things like that, but it never even crossed my mind to go and get tested for anything because, like I say, I were with someone for, like, three year. So, you don't expect to, do you.

DAVIES: Now Sian's heading into Sheffield's Royal Hallamshire Hospital, accompanied by her mum Lorraine to discover just how much damage that infection has actually caused. In the next few hours, Sian will find out if she'll ever be able to get pregnant again naturally.

SIAN: I feel sick.

DAVIES: If the infection hasn't blocked her fallopian tubes completely, there's still a possibility they can be made to function again.

RECEPTIONIST: What name is it?

SIAN: Sian Wathen.

DAVIES: Some research suggests that women who experience one episode of chlamydia have a 5 percent chance of developing problems like infertility. That risk increases significantly if treatment is delayed.

PROFESSOR LEDGER: Sian, hi, nice to see you.

SIAN: And you.

LEDGER: Sian's mum, hello. Professor Ledger, nice to meet you. Hello there.

DAVIES: Bill Ledger will operate on Sian today. He's one of the country's leading fertility specialists.

LEDGER: We talked about this in the outpatients. So, what we're going to do this afternoon, is give you anaesthetic, once you're asleep, cut a little hole under the tummy button, and two just in the hairline here, put the camera inside and have a look at the tubes, the womb, the ovaries; make sure everything is healthy, or not, and if there is damage there, through the other two little ports, we can put instruments to try and relieve the adhesions, cut away the scar tissue, and possibly open up the tubes and restore your fertility. OK? Cool, right, we'll be back for you later on. All right then? Fine, thanks Sian.

SIAN: Yeah, OK.

DAVIES: What's been going through your head today?

SIAN WATHEN

Everything, absolutely everything. I didn't think I were bothered about going down into theatre actually, but I realise now I am.

DAVIES: But hopefully everything will be sorted today.

SIAN: Hopefully.

DAVIES: Hopefully. Have you thought about this a lot over the last few years?

LORRAINE WATHEN

Yes. It's... it's got to me, because it's got to her. I can see when she's depressed. She's going to say different things to her friends, than what she's going to say to her mum, but knowing that she's... she gets upset that she's a very good... she covers up well. (Laughter) Very well, like she's laughing now, and inside she's really crying but she's... she has been very depressed, see? So it is... See?

[placing comforting arm around Sian who has begun to week]

SIAN: I'm alright.

SANDRA LAVER: [leafing through notes] Chlamydia, chlamydia, chlamydia, chlamydia, chlamydia, chlamydia...

DAVIES: The scale of the chlamydia problem is now so extensive in Britain, that it's thought as many as 1 in 10 sexually active people under the age of 25, carry the infection. In just that age group alone, that's nearly half a million people, which is why the government is now rolling out a national screening program aimed at encouraging all sexually active 16 to 24 year-olds to get themselves tested for chlamydia. It's a problem that affects as many men, as it does women.

BOY: Basically, I had unprotected sex with a girl, things started to clear up, I still had the discharges and urine problem.

NURSE: It's shown that it's a little infection with a little germ called chlamydia. Have you heard of chlamydia?

BOY: Yes, I have.

NURSE: Yeah, yeah, it's quite a common infection, and it's a common thing to cause those sorts of symptoms, very, very easy to treat. So we'll be able to give you some treatment today, sort that out.

DAVIES: What proportion of people who are suffering from chlamydia do you think are not detecting it, are not aware of it?

Prof GEORGE KINGHORN, Senior Genito-Urinary Consultant, Royal Hallamshire Hospital, Sheffield

I think that, say, three quarters of the people of the people who are infected with chlamydia are going to be without symptoms and are totally oblivious to the fact that chlamydia is present.

DAVIES: We're talking hundreds of thousands.

KINGHORN: We're talking about hundreds of thousands who are unaware that they are carrying an organism which could have very important consequences for their future health, but also very important consequences for the future health of any sexual partner.

DAVIES: Every morning, the staff stock up the clinic's consulting rooms, but as many infections as they treat today, they know that outside on the streets of Sheffield, tomorrow's workload is being lined up with predictable ease. [Night Scenes]

DAVIES: Part of the reason that this country's sexual health is in such dramatic decline, comes down to the simple fact that as a nation, in the last few decades, we've just been taking more sexual partners and more sexual risks at a much earlier age. How times have changed.

"In Your Interest", RAF training film, 1944

The most important rule, is perhaps the most obvious one: don't go out drinking in mixed company. If you stop to think for a moment, a girl who allows herself to be picked up by strangers and doesn't mind drinking with them isn't likely to be too particular. Quite possibly she's infected already. If she isn't - that's luck.

DAVIES: When that film was made, 60 years ago, the average age at which men first had sex was 20; for women it was 21. Now, it's 16 for both. Then, nearly half of all women, and one in five men lost their virginity to either their fiancÚ, or spouse. Now, not even 1 percent do. Studies show that casual sex has become far more acceptable in recent years: something which this country's flourishing night time economy is stimulating rather nicely it seems.

[girls laughingly baring boobs and bums in street]

DAVIES: We all know Britain's in the middle of a drinking boom at the moment, and it's a familiar story: people going out on Saturday night...

GIRL: Hi! Hi... What's it for?

DAVIES: It's a program about sexually transmitted infections.

GIRL: I've had clap.

GIRL 2: Oh my God, you're up North! (Laughter)

DAVIES: Have you?

GIRL: I'm clean! (Laughs)

GIRL: Yeah, yeah, I have, yeah. I were 13 years-old, and it nearly ruined my life.

GIRL 2: I'm clean. (Laughs)

DAVIES: What did you have?

GIRL: Clap. (Laughter)

DAVIES: What was it diagnosed as technically, do you remember?

GIRL: Chlamydia.

GIRL 3: Hi mum! (Laughter)

DAVIES: Did you have it? No, seriously.

GIRL: I did yeah. Yeah, I'm serious.

GIRL 2: Yeah, she really did.

GIRL: Chlamydia and a baby at 13, it's not clever. To all those people out there, don't do it.

DAVIES: Never has a generation seemed so at ease about discussing their sex lives in public. We spoke to a group out clubbing one night in Sheffield.

Do you think that generally more people, your age group, are having more casual partners than, say your age group 10 years ago?

CAMERON HARRIS

I've been single for two and a half years, so if you break it down, like, I've had - what? - like maybe, like, max 20, like..15 sexual partners in that time, and actually, if you work that out, that's really not that much. That's like maybe one every two.. two and a half months.

MAN 2: But then sheer volume of sex, you've probably had less than people who've been in a steady relationship

HARRIS: A lot less.

DAVIES: How many of you, sitting around the table, have had casual sex, and not used a condom.

HARRIS: Yeah.

GIRL: Yeah.

MAN 2: Not really casual sex. (Laughter)

MAN 2: Yeah, yeah, yeah.

DAVIES: How widespread do you think that is?

HARRIS: Well, to be honest, I think everyone believes in protected sex when they're sober, but I have to say that, like, when you go out to a club and when you come back pissed at 3 in the morning, and so... do you know what I mean? It's, sort of, logical thought goes out the window, and I think, do you know what I mean? It gets to a stage where you're like, "Have you got protection?" And it's like, "No," and it's just like, do we really want to stop, and you don't, and it's just like, well, OK.

CHRIS HAMMOND

At the end of the day, if you've.. if you've had a very boring week of five days, you're without a partner, every single television program you watch talks about sex, every magazine that you read mentions sex, and you get to Friday night, and you haven't really got much of a life that you're interested in, and the only thing that you want to do on Friday is get rid of the idea that you have to go back on Monday. So you get yourself as drunk as you possibly can. By the time you're on your twelfth pint, staggering down the road, and women are wearing the shortest skirts that you've ever seen...

MAN: It's their fault, isn't it? (Laughter)

HAMMOND: ..opening their legs..

GIRL: (shrieks)

MAN: I was going to say, yes.

HAMMOND: What are they on about, I don't know. So you're walking down the road. As a man, like, what do you do? And as a woman, you want to go home with the nearest man, the nearest woman, and you want to sleep together, and the last thing you want to care about, is whether or not you're going to get an STD.

(Phone ringing)

LAVER: What, you mean an earlier date? I haven't anything any earlier, with you not having any symptoms. Obviously, if it was an emergency, then maybe I would put you into one of the emergency clinics.

DAVIES: And so in the morning, the phones at Sheffield's GU Clinic start ringing and ringing again, and the test results keep stacking up.

DAVIES: How many calls have you had this morning?

10am

LAVER: I would say 30 to 40, possibly.

DAVIES: But it's... it's like this every day here, the phones?

LAVER: Every day, every day, yes. This is not a particularly busy day, not too busy. Excuse me a moment. Hello, GU Medicine. We usually leave it that we would only contact you if there's a problem, OK. So if you haven't heard from us within a week, you can take it that everything's absolutely fine. Is that OK? OK, bye.

DAVIES: Do you feel sometimes as if you're fighting a losing battle down here?

SANDRA LAVER, Reception Manager, GU Clinic

Very much so. It doesn't seem to matter how many clinics we put on, it doesn't seem to be able to reduce the waiting time. We still seem to be, on average, waiting three weeks for an appointment time, and we keep seeing, you know, well we're seeing 60 patients on one morning - 60 new patients. So it seems relentless sometimes.

GILL BELL: Hello, it's the health adviser speaking, can I help? We can certainly make an appointment for you to have a check-up at some point, but I can't give you an emergency appointment, you know, before... before Friday.

DAVIES: No area of public health in the UK has suffered such a decline in recent years, as sexual health, and it's the poorest, and most vulnerable members of society who are feeling it most sharply.

GILL BELL, Nurse Consultant, Sexual Health Advising, Royal Hallamshire Hospital, Sheffield

To get access to a service where there's a big waiting list, you need to be quite assertive, you need to be persistent, you need to have good communication skills to get you... to get yourself through on the phone, and to make the case that you need to be seen urgently.

DAVIES: It's that sad state of affairs that you've got to be articulate or bloody-minded to get yourself a decent sexual health service?

BELL: Exactly, that's why you can't have these waiting lists, because... because it becomes survival of the fittest.

FEM: (Recording) We apologise for the delay, all our lines are busy. You are 11th in the queue. (Disconnected phone)

DAVIES: When we called every GU Clinic listed in the UK, we gave them three scenarios: one as a patient seeking a routine appointment; two is patients needing urgent attention...

Secret Recording

RECEPTIONIST: The problem that they have, is that the clinics are full to over spilling.

DAVIES: Even for people just wanting a check-up, it's recommended they're seen within two working days, but of the clinics who could offer us a routine appointment when we called, the average waiting time was 2 weeks, the longest was 9 weeks.

RECEPTIONIST: Right, you might be surprised at the timing here.

GIRL: Right.

RECEPTIONIST: 3, 4, 5, 6, 7 weeks away. I think you may find this with a lot of clinics you ring...

Full results of our survey at bbc.co.uk/panorama

RECEPTIONIST: Unfortunately the first appointment I have here is over 6 weeks away.

MAN: Ah, alright.

RECEPTIONIST: I know it's shocking. Is it an urgent problem you have?

RECEPTIONIST 2: We have a little bit of a waiting list.

GIRL: Oh, OK.

DAVIES: We also found that many clinics, nearly 1 in 5, had resorted to restrictive booking systems. Most of these clinics only allowed the patient to book a few days in advance making it a fight for the few places on offer.

RECEPTIONIST: The way our appointment system works, is that you book on a Monday morning for the following week, and they all went this Monday gone, within about 2 hours of the phone line going on.

RECEPTIONIST 2: If you can try calling back tomorrow morning at 8:45 to book yourself for Friday.

GIRL: Do you know how busy it will be when I call back?

RECEPTIONIST: Ah, it will be really, really busy, because this guy just said he's been ringing me since yesterday, he's just finally got through to me today.

RECEPTIONIST 3: I'm afraid the way we actually work, you have to ring us on a Tuesday morning. We open at 9, and we book you in for the following week.

DAVIES: Each year, three quarters of a million people in Britain will use a clinic like this one. They represent a huge consumer block within the NHS, and yet, of course, they're the least visible of all. If something goes wrong here, these patients would rather suffer in silence, than write a letter to their MP or local newspaper, advertising the fact that they may have an STI, and it's this almost complete lack of a patient voice which takes the pressure off politicians from prioritising this area of public health.

DAVIES: In fact, it was 8 years ago, when Labour came to power that sexual health was actually removed from the list of key national health priorities. It then took the government 4 years to publish a national sexual health strategy, but it's a strategy which has struggled to have an impact.

Since the government produced its national strategy on sexual health 4 years ago, has the situation improved or worsened?

Prof GEORGE KINGHORN, Senior Genito-Urinary Consultant, Royal Hallamshire Hospital, Sheffield

It's worsened, and it's worsened because the strategy was announced without there being the additional resource to carry through what are the requirements... what the requirements to improve sexual health in this county.

DAVIES: Do you accept that it was a mistake to de-prioritise sexual health in 1997?

CAROLINE FLINT, Member of Parliament, Public Health Minister for England

I think when we came in '97, we had a whole number of health priorities that were facing us, that the public were very concerned about, and you know, I'm not going to, you know, turn round now and say that, you know, that was the wrong decision, because I think we were faced with other issues, in terms of cancer, in terms of other need too.

DAVIES: But do you realise how much damage that decision to de-prioritise sexual health has caused? Do you know how many women have become infertile as a result? Do you know how many relationships have been destroyed as a result of people developing STIs?

FLINT: We are at a point now, in 2005, where we finally have, for the first time ever under any government, a strategy that is going to directly try and support local services and deal with these issues, and hold local services to account for what they provide, and whilst I accept... I accept that maybe governments should have done more in the past...

DAVIES: You do accept your government should have done more?

FLINT: I... whilst I accept this is an issue, where...

DAVIES: You do accept that?

FLINT: I accept this is an issue where governments over decades should have looked at this issue. I also understand that when you're dealing with health, there are a number of other competing priorities that governments have to address.

DAVIES: Sian's operation to see whether a sexually transmitted infection has made her infertile, is about to begin.

LEDGER: Right, we're going to drift you off to sleep now gradually, OK? All you need to do for me is concentrate nice and slowly on your breathing. You don't have to do anything special, and you'll drift off to sleep fairly quickly, all right? As I say, about 30 seconds, that's usually all it takes.

Prof BILL LEDGER, Head of Reproductive medicine, Royal Hallamshire Hospital, Sheffield

The aim for this afternoon is firstly just to make an assessment of how bad things are in... are the tubes healthy? Look at the uterus, look at the ovaries, and then, if there are adhesions from chlamydia around the tubes, sometimes it's possible to surgically resect them and restore tube patency and help her get pregnant.

DAVIES: So that she can conceive naturally?

LEDGER: So that she can conceive naturally. You never quite know until you go and look at these cases exactly what it's going to be like.

DAVIES: Much of the operation will involve an internal examination using a fibre optic camera lens. It gives a graphic picture.

LEDGER: So when you pout the lens in, it mists up. We have some stuff which is very similar to what you put on your specs when you go skiing. So Andy, we're getting a look now at the state of these tubes, and what we see is an ovary, which looks normal, with a follicle, which is normal...

DAVIES: That's what you're touching there?

LEDGER: Yeah, the white thing there is the ovary, that's OK, but you see this filmy stuff around the ovary? That's minor adhesion, you see? That shouldn't be there. That's inflammation from chlamydia that's caused that. This stuff shouldn't be there. That shouldn't be there, yeah? Paul, if you'd like to put some dye in please.

DAVIES: Are the tubes blocked?

LEDGER: I'm just going to test it now, OK. So run the dye through please. You see, poor old Kim is having to use high pressure to get anything to happen, and I'm looking for blue, and we're not getting any. The tubes should be passing blue dye, but because of all that adhesion it's blocked. So what I'm going to do, is free these adhesions a little bit, but because she's got blockage all the way along the tube, it's not going to work. The procedure was straightforward. It took 20 minutes from start to finish, and I think we have an answer. It's not going to be the answer that Sian wants to hear.

DAVIES: It's going to be pretty hard for her to take.

LEDGER: We're sent on courses these days, on breaking bad news. They don't ever help in real life, I don't think. You just have to be honest with people, and at least having spoken to her beforehand, she's kind of prepared for this news, I think, but yes, it's going to be bad news when she gets it.

DAVIES: Do we know how many women are going through these types of operations, due to a chlamydial infection in Sheffield?

LEDGER: Oh, well there are 4 of us consultants in this kind of practice, and we will see a case like Sian's, each of us, at least once a month, probably more. So, you know, in this one hospital, we will be doing perhaps a hundred cases a year, right now, of people that get this far.

DAVIES: The speed with which chlamydia has been spreading in Britain is being matched by a similar rate of increase in the most devastating STI of all: HIV. Machines like these are detecting almost 7,000 new cases of HIV every year. That's nearly treble the rate of 10 years ago, and although new drugs have revolutionised management of the virus, they don't work for everyone. In Britain, around 500 people still die from HIV related conditions each year. A few floors up from where Sian is recovering, George Kinghorn pays a visit to one of his HIV patients.

KINGHORN: Pretty ghastly this morning, I hear?

KARL: Not anything specific, just like, aches and pains and headache and things, but where it came from, I don't know.

KINGHORN: Temperature hasn't gone up yet though?

KARL: No. I haven't had any temperatures really.

DAVIES: The big rises in HIV are due mostly to migration from countries with HIV epidemics, as well as from continuing infections among the gay community, but gradually there are more cases of heterosexual infections being acquired within the UK.

Karl, can you describe your condition to me?

KARL COOK

Yeah, I've got full-blown AIDS, and now I've developed... I'm allergic to sunlight, I'm partially-sighted, and I've also got, I think they call it Kaposi's Sarcoma, which is basically skin cancer.

DAVIES: What is going to happen to your health in the future? Is it possible to say?

KARL: Yeah, it either remains the same, or it gets worse. I'm one of these people that, unfortunately combination therapy, doesn't really work on.

DAVIES: The image of someone, such as yourself, with advanced HIV, with AIDS in a hospital bed, has virtually disappeared off our TV screens. Do you think that has been a factor in fostering this environment, if you like, where people are taking greater risks with their sexual health?

KARL: I'm not sure actually. I think that's... it's probably a good thing that you don't see people all the time in... in hospital beds, because it's... it's not that culture anymore, you know, we're not all laid in hospital beds all the time being really ill.

DAVIES: But people can't ignore the fact that HIV still kills people in Britain.

KARL: Oh God yeah, yeah. It's... you know, it's... I see people here. I mean, I think I'm bad, but sometimes I see people here that are worse than I am, you know, at a worse stage than I am. So, it's not... it's not just the odd individual. There are a lot of people are still very sick, you know.

DAVIES: Principally aren't those groups still most at risk of developing HIV gay men and migrants from Africa?

Prof GEORGE KINGHORN, Senior Genito-Urinary Consultant, Royal Hallamshire Hospital, Sheffield

Well, we've seen, with gay men, we now know that over two thirds of the new infections with HIV and... in this country, and certainly in this city, occur in people who are heterosexual. Now, a number of those people have been infected abroad, but we are seeing rising numbers of people who acquire this infection within this community by so-called 'normal' heterosexual intercourse, where they did not perceive that they were at risk.

DAVIES: It was a series of government ads 20 years ago that had a profound effect on sexual behaviour in Britain. The high-profile, some would say, apocalyptic "Don't Die of Ignorance" campaign kept Britain's HIV levels among the lowest in Europe. Not just that, there was also a sharp drop in the rates of some of the most common sexually transmitted infections. Everyone it seemed, was suddenly taking greater care.

USE A CONDOM, IT'S SAFER

MORE PARTNERS, MORE RISK.

Surprisingly, given the ever-increasing sexualisation of today's society, and the steady growth in STIs over the last 10 years, the government's been rather coy about confronting the general public over the issue of sexual health. Though finding the right message to get across has never been easy.

"In Your Interest", RAF training film, 1944

It's not my business here to enter on a discussion of morals, but I do suggest to you that it is the experience of most reasonable men that promiscuous sexual behaviour rarely leads to any durable happiness.

DAVIES: The paucity of high-profile campaigns on the subject has only helped nurture the present climate of risky sexual behaviour as witnessed by the latest visitor to the clinic.

GILL BELL: Is it... you've had your final check to make sure you're infection's cleared up?

OXLEY: Yeah.

BELL: I think it was Laura you saw last time. She talked to you about whether there was any possibility of getting in touch with anybody else who might have been involved in it, and you were going to go and see if you could find anybody. There was a couple of people that you mentioned. How did you get on with...?

OXLEY: One of them's not on the same number, so I can't get in touch with them, and one I've text and I've no reply back from, so...

BELL: Right, OK, OK...

DAVIES: Lee is 31. He comes in for regular checkups at the Sheffield clinic. A gay man, he's just been successfully treated for chlamydia.

How do you think you picked it up?

LEE OXLEY

No idea. (Laughs) Ah, probably just stupidness, not using protection properly.

DAVIES: But normally you would use a condom?

OXLEY: Yeah, definitely, yeah.

DAVIES: Do you think people are taking more risks, within the gay community at the moment with their sexual health?

OXLEY: Definitely, yeah. The word 'bare-back' is just springing up... it's like unprotected sex. It's springing up all the time, in chat rooms on the internet, you can get off with somebody in a club, and they'll ask you outright, "Are you into bare-backing?" So, yeah, definitely.

DAVIES: Bare-backing?

OXLEY: Yeah.

DAVIES: And that... it's just sex without a condom?

OXLEY: Unprotected sex, yeah, yeah.

DAVIES: Is that quite common?

OXLEY: There is loads of it about.

DAVIES: Are you surprised by that, given the impact that sexually transmitted infections - particularly HIV - have had on the gay community?

OXLEY: Definitely, because the gay community was totally blamed when HIV came out. I think they took more precautions and listened to it more than anybody else, and it seems to have just gone the other way now.

DAVIES: Across the road at the clinic Georgina Brooks comes in for her check-up, she's equally concerned about the behaviour of young heterosexuals.

GEORGINA BROOKS

I think people don't even realise what you... what... they're doing it, yeah, fair enough. They're having a shag here, there and everywhere, without a condom on. They don't even think about the consequences afterwards.

DAVIES: I mean, the figures show that people are having sex at a much younger age. Their first sexual encounter at a much younger age. Do you think that's true?

BROOKS: I know! Where's all the dating gone!? Yeah, it is true, yeah, it is true.

DAVIES: Where has all the dating gone?

BROOKS: It's gone isn't it. Where has it all gone? Going to the pictures, a kiss... get a kiss goodnight, and that's it, go home. Bloody hell, it's gone.

DAVIES: How would you describe relationships now?

BROOKS: It's all about sex, it's all about sex.

DAVIES: The need to educate young people about the risks associated with sex is acute. Sian, like many in her situation had never even heard of chlamydia before she contracted it, and now she's about to find out how much damage it's done to her.

LEDGER: Sian, hi, wake up! I think probably you're going to stay tonight, and then I'll come and talk to you again tomorrow morning, when you're a bit more wide awake, all right? But, you had your laparoscopy, no problems, all was straightforward, and the womb and the ovaries are pretty normal. You've got adhesions in the pelvis, and also up the top of your tummy which will be from chlamydia, right, and I can't get any dye to go through your tubes, and we tried hard, all right? So I think the reason that you're not getting pregnant is because the tubes aren't working, and the way around that is to put you into the IVF program, and we can do that, and we're good at IVF in Sheffield, and we get good results, and it's not as hard as people think, yeah? But it... there's not a chance, really, that with operations we're going to get your tubes working again and get a pregnancy naturally, OK? But it doesn't mean you can't have more children. No, here we go, here you go, come on. It's bad news, but I hope it wasn't too unexpected, because we did talk before, didn't we? Yeah? All right, so think on, and we'll talk it through tomorrow.

SIAN: Thank you.

DAVIES: The government has now acknowledged that it has a major public health problem on its hands. 300 million pounds of extra funding has been promised to help reduce waiting times, to run safer sex campaigns, and to promote initiatives like the chlamydia screening programme It may sound like the perfect rescue package, but in the clinics, there is some unease.

For a start, there are major concerns about the government's new 50 million pound ad campaign aimed at promoting safer sex, and supposed to be hitting our screens this autumn. The problem is, many GU clinicians fear that the campaign, however well-intentioned, will drive even more people into their clinics, and worsen an already critical situation. So they've actually asked the government to delay the campaign.

GILL BELL, Nurse Consultant, Sexual Health Advising, Royal Hallamshire Hospital, Sheffield

All clinics are concerned that we're not able to meet the demand that we already have quickly enough, and any campaign will stimulate the demand for sexual health checks, and that's an excellent... that's a very good thing, but it becomes self-defeating if those people who were inspired to take a responsible step and get themselves checked out find that they can't get access to the service that they want... that they need, they might not... they may not try again.

DAVIES: The government had told Panorama that the campaign was planned for this autumn. It revealed this week, that it would now be running next spring.

When is the campaign going to be...?

FLINT: Early... early March 2006.

DAVIES: So it's been delayed?

CAROLINE FLINT MP, Public Health Minister for England

No, it hasn't been delayed. I think it's very important we allow some time for the money to get through to local areas so they can use that...

DAVIES: Is it┐?

FLINT: I think it's important to give an opportunity for that to bed in, but then I think it's very important to recognise that the campaign has to be right as well. This will be the first major sexual health campaign since those of the 80's in relation to HIV and AIDS, and as a new minister coming in, I wanted to make sure that those messages were right, and it was going to do a good job.

DAVIES: Then there's the issue of the 130 million pounds the government says it's giving the clinics in England to modernise the service. Will all of it get through? Recently, 18 million pounds of emergency funding was similarly allocated to GU Clinics, but Parliament's Health Select Committee heard that a third of that funding had been siphoned off by local health trusts to pay for other services. Clinicians are worried it could happen all over again.

FLINT: It's up to local providers, local commissioners and the strategic health authority to make sure the money goes to the services. In the local delivery plans for the first time, they have to have attention to sexual health needs. We have said the three issues they really have to focus on are: chlamydia testing, reductions in gonorrhoea, and 48 hour access to clinics. Now, Strategic Health Authorities and PCTs will be assessed on whether they deliver that or not. So it will be quite an unwise Strategic Health Authority to not use money and then not reach those targets, because then understandably, I think that is right for local people, and for myself to question why.

DAVIES: The clinics will need all the money they've been promised if they're to meet the government's 3-year target of giving everyone in England an appointment within 48 hours. They can't even achieve that at the moment for emergencies. When we called the clinics posing with severe symptoms of an STI, a staggering 27 percent could not offer an appointment within 48 hours. Some suggested we either go elsewhere for treatment, or wait over a week to get seen.

(Phone ringing)

Secret Recording

RECEPTIONIST: You obviously have got signs of a possible infection, so I have to see you. However, our problem is that we don't have any space at this moment to see you as an emergency.

RECEPTIONIST 2: Hello?

MAN: Hi.

RECEPTIONIST 2: I'm afraid there's no one to do assessments this morning. The best thing I can suggest is I can either give you the clinic number, to try one of those, or it's best to go to your GP at the moment.

Full results of our survey at bbc.co.uk/panorama

RECEPTIONIST 3: We're just so busy.

GIRL: Really?

RECEPTIONIST 3: Uh huh.

GIRL: ... and there's no chance that something will come up before then?

RECEPTIONIST 3: I mean, we can take a note, and if we get any cancellations we can give you a ring.

DAVIES: Do you accept that we have a public health crisis on our hands?

FLINT: I would think it was a crisis if the government wasn't doing anything about it. The fact is, we recognise that this is a very serious problem. I can't say it more plainly than that. We have had rising rates of sexually transmitted infections over a number of years. We have had a situation for a number of years, under many governments, that quite frankly sexually sexual health has been a Cinderella service, and it's why we're putting the investment in, but also making sure that we're creating the levers at a local level, so that people can make sure that the delivery is happening for them in their communities.

SIAN: That's not going to mark my worktop is it?

NEIL: Oh it, dries and wipes off.

DAVIES: Sian's back home after her operation, and fit enough to cast a critical eye over fiancÚ, Neil's attempts to retile the kitchen.

SIAN: What's that you broke?

DAVIES: I mean, when we last saw you, you were, I mean, you were in tears, Sian. You were devastated at the news. You've had some time to think. Are you feeling more optimistic now?

NEIL BAILEY & SIAN WATHEN

SIAN: Yeah, yeah. I'm upset... I'm still upset that I can't do it naturally, and my fears were more on you, weren't they? Like, what he'd think, and how he'd react to it, and whether he'd still want to be with me, because I couldn't conceive naturally, or that were my main worry, and it's been all right.

DAVIES: And what was your reaction?

NEIL: I were good gutted. I do want my own family. I don't... I love Sian, and as long as I'm with Sian, I don't care if we have kids or not, but I'd love to... I would love to start a family with her. Yeah, we've already got Louis, and I treat Louis as my own. One of our own - be different then.

DAVIES: Neil, what do you know about IVF treatment?

NEIL: Nothing. I ain't got a clue about it, I just know it costs money.

DAVIES: Do you know how much money?

NEIL: They say about two and a half grand, don't they? I've read things in the paper where people have paid up to a 100,000 pound trying to have kids.

DAVIES: I hope you don't mind me asking, but can you two afford IVF treatment?

NEIL: We'll have to save up. We'll be all right, won't we?

SIAN: Yeah, there's no price on a child's head, is there?

NEIL: No.

DAVIES: Sexual behaviour has undergone far-reaching changes in Britain in recent years. That such fundamental change always risked boosting STI levels, seems to have been lost on the policymakers. Perhaps it was embarrassment, conflicting priorities, or the absence of a patient voice. The challenge facing the government now is to rebuild the Cinderella service they once de-prioritised and to find new ways of talking to younger generations about taking care of their sexual health.

RAF FILM: And now, one last word: if you hear of someone you know becoming infected, don't shun him like a leper, or worst of all, adopt that holier-than-thou attitude towards him. If you have any influence with him, get him to see the medical officer as soon as possible. Don't forget, he's probably feeling very, very miserable, and at such a time, a man needs his friends.

DAVIES: There's more information on sexual health on our website, where you can also watch recent Panoramas on broadband and find out about next week's programme, a story about a seven year old boy called Kurt.

If you've been affected by tonight's program, and would like information or support, please call the BBC Action Line on 08000 566 065, that's 08000 566 065. Lines are open 7 days a week, from 7:30am until midnight. All calls are free and confidential.

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