Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with sexual health, 2016.
Who’s at risk and why?
All sexually active individuals of all ages are at risk of sexually transmitted infections (STIs), including HIV, and unplanned pregnancies (in the fertile years). The risks are not equally distributed among the population, with certain groups being at greater risk.
Poor sexual health may also be associated with other poor health outcomes. Those at highest risk of poor sexual health are often from specific population groups with varying needs which include:
- Men who have sex with men (MSM)
- Young people who are more likely to become re-infected with STIs
- Some black and ethnic minority groups
- Sex workers
- Victims of sexual and domestic abuse
- Other marginalised or vulnerable groups including prisoners
The Index of Multiple Deprivation is strongly correlated with distribution of STIs across England. This correlation is weaker in Leicester and there is a strong association with the distribution of the 15-24 year old population.
The level of need in the population
Figures published by Public Health England show that in 2014, Leicester has a statistically significantly similar rate of STIs (806 per 100,000 population), to the national average (797 per 100,000 population).
In 2014, there were 1,048 diagnoses of chlamydia in people aged 15-24 years in Leicester. This gives a diagnosis rate of 1,757 per 100,000 of the 15-24 population, which is significantly lower than the national rate of 2,012 per 100,000 population. 19.5% of 15-24 year-olds tested for chlamydia in Leicester in 2014, which is statistically significantly lower than the England rate of 24.3%.
In 2014, there were 312 acute diagnoses of genital warts in Leicester. This equates to a rate of 93.5 per 100,000 population, which is statistically significantly lower than the national average of 128.4 per 100,000 population.
The local genital herpes rate has seen a sharp decline, contrary to the national trend and there is recognition that this needs to be monitored and reasons for the decline ascertained. Both the Leicester gonorrhoea and syphilis rates are similar to the national rates, but the syphilis rate has risen significantly in recent years in the UK, while still being one of the least common STIs.
Leicester is considered a high HIV prevalent area, with a rate of 3.6 per 1,000 population aged 15-59 years in 2014. This rate is statistically significantly higher than the England average of 2.4 per 1,000 population.
In 2014, the total abortion rate for Leicester was 16.5 per 1,000 female population aged 15-44 years and this is similar to the England rate. Among women aged 25 and over who had an abortion in 2014, 43% had a previous abortion, compared to 46% for England.
Current services in relation to need
There are a variety of sexual health providers within Leicester, covering various levels of service provision. The community of sexual health providers across Leicester, Leicestershire and Rutland (LLR) is supported by the Sexual Health and HIV network, which meets twice a year in order to share developments and good practice.
The Integrated Sexual Health Services (ISHS) is commissioned by the local authorities (Leicester City Council, Leicestershire County Council and Rutland County Council) and is provided by Staffordshire and Stoke on Trent NHS Partnership Trust (SSOTP).
The aim of the ISHS is to provide a range of accessible, high-quality, responsive, cost-effective, confidential services across LLR. The service provides an open access hub and spoke model of sexual health provision, meeting all the sexual health needs of an individual in one visit. In addition to the ISHS, there are other services in Leicester which deliver elements of sexual health services, such as General Practices (GPs), Pharmacies, Termination of Pregnancy Services and Voluntary Care Organisations.
Projected services use and outcomes in 3-5 years and 5-10 years
There is a clear relationship between sexual ill health, poverty and social exclusion.
Indicators of sexual and reproductive health need have been deteriorating over the past decade, which has been linked to long-term changes in sexual behaviour and patterns of contraceptive usage within the population. This creates a complex picture of continual need for sexual health services.
Population sexual health is however, highly amenable to public health interventions, via high quality and age-appropriate relationships and sex education (RSE), accessibility to contraceptive, treatment and care services; as well as targeted interventions at specific groups with higher needs or risks. Therefore, addressing and reducing, or at least ameliorating, these trends is of importance.
Unmet needs and service gaps
There is a need to make improvements in the following areas of sexual health services in Leicester:
- HIV testing, diagnosis and care
- Chlamydia Screening
- Termination of pregnancy services
- Relationships and Sex Education
- Patient Pathways
- Behaviour change interventions
Recommendations for consideration by commissioners
There are recommendations around ensuring maximum cooperation between commissioners (as detailed in Table 2 of the downloadable section below) for effective commissioning of sexual health and related services and a seamless experience for patients; and considering the issues raised in this summary.
- Sexual Health Joint Specific Needs Assessment
- Sexual and reproductive health profiles
- Leicester Health and Wellbeing Survey 2015