CONTACT TRACING from STIs - Feb. 1999 Vol. 75 No. 1

Editor : How pleasing to read that someone has had the courage to raise the controversial topic of contact tracing. I have always had a suspicion that, one day, genito-urinary medicine would meet itself head on in a desperate attempt to evaluate financial cutbacks with efficiency of its public health role.

It is not surprising to find poor results in studies concerning contact tracing. Potterat’s reflection that outcomes are possibly disappointing owing to "poorly trained and motivated staff working in a difficult environment ... ....." is surely a mirror reflection of the profession of health advisers working in the United Kingdom today. They had their jobs enhanced at the advent of HIV and AIDS, and were held up as the saviours of the NHS’s pathetic attempt at a counselling service. They were the only people who had an inkling about the meaning of "counselling" and were put into teams whose direction was, by nature of this new disease, poorly defined. Now as budgets diminish, dreams of professional training in elite centres have become a dwindling hope and their professional need undermined. In an attempt to save money, some shortsighted managements have given clinic nurses a couple of weeks scant training to turn them into part-time health advisers. How long before it is proposed the two weeks training will dispense with medical staff? Perhaps if the general practitioners offered this fortnight’s training to practice nurses, there would no longer be a need for genito-urinary medicine clinics?

With their clinical grounding, nurses frequently make extremely good health advisers, but only after professional training in one of the specialist centres where courses have been devised and recommended by SHASTD. It is my opinion that it is not adequate to merely offer in-house training for a couple of weeks if a comprehensive contact tracing and counselling service is required. If contract training is to ever to recover as a national resource, let alone develop in the future, it has to be in the hands of the representative bodies of genito-urinary medicine physicians to liaise with health advisers over their future and is probably better not dealt with at local levels.

If, as Ratcliffe and Clarke suggest, contact tracing is to become effective, it must move into a wider perspective and meet the challenges of community screening. This should include not only contraceptive health but also gynaecology and general practice where it could become a daily working tool to combat the poor detection of chlamydia and pelvic inflammatory disease in those areas.

Alongside these suggestions, SHASTD should be encouraged to develop research in health advising and be encouraged to work more closely with GUNA, AGUM and MSSVD so that important areas of expansion can be properly incorporated and co-ordinated at a national level. Subsequently, management will comprehend the need for health advisers, integrity and pride will be restored to those who work in the job, and maybe contact tracing will once again be a useful tool of genito-urinary medicine.

E. HISCOCK

64 Eastern Wylde Green

Birmingham B73 5NX

1 Ratcliffe K, Clarke J. Contract tracing - where do we go from here? (Editorial) Sex Transm Inf 1998. 74:313-15

2 Potterat JJ - Contact tracing’s price is not its value. Sex Transm Dis 1997:24:519-21