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How to do it
How to set up a remotely supported hub and spoke sexual health service for a military population
  1. M Desai1,
  2. JE Littler2,
  3. M Samuel1,
  4. DP Baker2,
  5. PB Loader2,
  6. SP Singh1,
  7. CS Bradbeer1
  1. 1Departments of Sexual Health and HIV Medicine, Guy's and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Genitourinary Medicine Service, BFG Health Services, Bielefeld, Germany
  1. Correspondence to Dr Caroline Bradbeer, Departments of Sexual Health and HIV Medicine, Guy's and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 7EH, UK; c.bradbeer{at}btinternet.com

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Introduction

Military personnel are considered to be at high risk of sexually transmitted infections due to their being highly mobile, away from home for prolonged periods and often purchasers of commercial sex.1 Indeed, evidence from the USA has demonstrated higher rates of gonorrhoea and chlamydia in active soldiers compared with the civilian population after standardisation for age and gender.2

Having acquired a sexually transmitted infection (STI), military personnel risk onward transmission to the civilian population, including their regular partners. Despite health promotion and provision of condoms, STIs continue to affect military personnel, necessitating measures for their early diagnosis and treatment.

The British Forces in Germany (BFG) community comprises military personnel, their dependents and the civilian support staff. In 2007, BFG comprised approximately 46 000 individuals living in an area approximately the size of Scotland. The number steadily declined to approximately 36 000 people by 2012. This population is generally that of young, fit individuals with a high proportion of children and young people (75% are aged <35 years). Historically, members of the British forces have earlier coitarche, a higher number of sexual partners and report less condom use than their age-matched UK civilians,3 and are more likely to pay for sex.4 In Germany, there is easy access to licensed brothels, and an acceptance of ‘layby lils’, commercial sex workers who trade from roadside camper vans.

In 2007, access to STI services in BFG used a traditional consultant-led model. This centralised genitourinary medicine (GUM) service was provided by a one whole-time equivalent (WTE) consultant supported by three or four WTE specialist civilian/military nurses. Primary care encouraged attendance at the GUM service for all STI matters, including asymptomatic screening, despite patients having to travel considerable distances.

In 2008, the contract for GUM services for the BFG …

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