Sexual health

Sexual health is defined by The World Health Organization (WHO) as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled”.

What do we know?

Sexually transmitted infections are one of the most important causes of poor sexual health due to infectious diseases among young people and if left untreated can lead to long-term health consequences, including fertility problems. However, good sexual health is equally important for people of all ages and reducing rates of STIs in the population is a key preventative public health measure.

Family planning is also an important facet of sexual health. Long acting reversible contraceptives (LARC), while not providing any protection against sexually transmitted infections, are an important method of contraception to plan pregnancies. Increasing prescriptions of LARC has been found by studies to have a positive effect on reducing teenage pregnancies and abortions in the under 20s, however, no significant effect is seen on abortion rate in those over 20.

Figure 1: LARC prescription by GP per 1,000 women of reproductive age in Slough

Graph shows number of conceptions and conception rate per 1000 women aged 15-44 years, by Unitary Authority. Source: Office for National Statistics

(Source: Public Health England Fingertips).

Though an important measure in reducing unwanted pregnancies, LARC do not reduce risk of transmission of sexually transmitted infections.

Chlamydia is the most commonly diagnosed sexually transmitted infection and, though mostly asymptomatic can cause significant harm such as pelvic inflammatory disease and fertility problems if left untreated. The national chlamydia screening programme aims to control chlaymdia through offering testing to sexually active young people aged 15 to 24.

Public Health England recommends that local authorities should be working towards achieving a chlamydia detection rate of at least 2,300 per 100,000 population. In 2014 in Slough our detection rate was similar to the national average but fell below the target rate (Figure 2).

Figure 2. Chlamydia detection rate in those aged 15-24 per 100,000

Graph shows estimated prevalence* of LARC and EHC issued by general practice per 1000 registered 15-44y females.

The rate of new diagnoses of HIV in Slough in 2014 (18.2 per 100,000 people aged over 15) remains higher than the national average (12.2 per 100,000) however has reduced by almost a third between 2011 and 2014. Though rate of new diagnoses is reducing, due to improvements in treatment the prevalence of HIV in Slough remains fairly stable (Figure 3).

HIV late diagnosis is an important indicator (part of the Public Health Outcomes Framework) measures the percent of adults newly diagnosed with HIV in whom the disease has already progressed (CD4 count <350). In Slough the rate of late diagnoses is steadily decreasing and now stands at 44.2% (2012/14) which is still significantly away from the goal of <25%.

The proportion of new visits to GUM services in which an HIV test offer is accepted has also improved, standing at 55.8% in 2014 an over 10% increase since 2010 when rate was <50%.

Figure 3. Prevalence of diagnosed HIV per 1,000 people aged 15-59

Graph shows rates of common sexually transmitted infections per 100,000 of the population.
 

National & Local Strategies (Current best practices)

National

The National Framework for Sexual Health Improvement in England (2013) sets out priorities for sexual health improvement, including increasing testing and primary prevention of sexually transmitted infections, increasing uptake of LARC and reducing unwanted pregnancies, rate of teenage pregnancies and reducing abortion rates.

In addition to this Best Practice Guidance on Commissioning Sexual Health Services is available for Local Authorities which sets out key principles including:

  • open access services (i.e. being able to receive sexual health services in any area)
  • rapid access to STI testing and treatment services
  • provision of Long-Acting-Reversible-Contraception (LARC)

Guidelines and standards for the diagnosis and management of HIV are available via:

NICE Clinical and Public Health Guidelines are available on a range of topics including:

While child sexual exploitation is covered in greater detail in another section, it is imortant to note that BASHH and Brook have launched a new child sexual exploitation (CSE) proforma, Spotting the Signs, to help health professionals across the UK identify young people attending sexual health services who may be at risk of or experiencing sexual exploitation.

Local

Berkshire sexual health website has recently been developed and online ordering for self-test kits for both chlamydia and HIV has been trialled.

What is this telling us?

There remains need for increased provision of LARC through general practice as well as a need to increase uptake of testing for sexually transmitted infections particularly HIV and chlamydia. Plans are in development for internet-based screening.

A previous unmet need was a single comprehensive website for young people, families and professionals to use which makes clear the range of integrated services available and ensures pathways are clear in future. This service is now available from the Berkshire Healthcare website.

What are the key inequalities?

Poor sexual health is more common in groups that already experience inequality associated with their age, gender, ethnicity, sexuality, or economic status. This inequality may be compounded by the stigma which is still attached to HIV and poor sexual health. (Source: British HIV Association - (BHIVA))

What are the unmet needs/ service gaps?

  • Low rates of contraception provision through primary care.
  • Complex diversity of cultures, religions and beliefs.
  • Access issues among hard to reach communities especially among some BME groups, asylum seekers, those who are sexually exploited, looked after children, leavers of care and those with learning disabilities.

Recommendations for consideration by other key organisations:

  • To signpost young people to the new Berkshire sexual health website.
  • Ensure that universal services such as schools and school nursing services have capacity to deliver comprehensive personal, social and health education support

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