Sexual health

Sexual and reproductive health is a fundamental part of health and wellbeing, affecting both individuals and wider society. Good sexual health is fostered by healthy relationships, access to high quality information and easy access to sexual health services. A number of different factors influence sexual health needs and behaviour including age, gender, sexuality and ethnicity, social norms and cultural influences. 

Sexual health is a key public health priority as poor sexual health can be a consequence of and associated with other risk taking behaviour (e.g. drug and alcohol use), coercion, exploitation and abuse, leading to poor short and long term outcomes. Deprivation and social exclusion also impact on sexual health, with a higher burden of disease in populations who live in more deprived areas.

Poor sexual health holds costs for both individuals and society, sexually transmitted infections are the main cause of preventable infertility, teenage pregnancy is associated with poverty, low aspirations, and not being in education, employment or training (Department of Health 2013). Unintended pregnancy can affect woman across all areas of society of fertile age, and it has been estimated that the annual cost to the NHS in England of unintended pregnancy stands at £817 million (2020health 2013).

A whole systems approach is required to meet the different needs that individuals and populations will have throughout the life course. Education around health relationships and sexual health is delivered through schools, colleges & voluntary settings; specialist sexual health services offer contraception, advice & guidance, STI testing & treatment and a range of providers including primary care, acute hospitals, pharmacies, community & voluntary sector deliver sexual health services.

Evidence demonstrates that spending on sexual health interventions and services is cost effective, for example:

• For every £1 spent on contraception, £11 is saved in other healthcare costs.

• National Institute for Health and Clinical Excellence (NICE) Clinical Guideline CG30

demonstrated that (LARC) is more cost effective than condoms and the pill, and if more

women chose to use these methods there would be cost savings

• Early testing and diagnosis of HIV reduces treatment costs – £12,600 per annum per

patient, compared with £23,442 with a later diagnosis

Commissioning responsibilities for sexual health sit across local authorities, CCGs (clinical commissioning groups) and NHS England 

Under 18 conceptions

In 2015, the under 18 conception rate for Stockton –on-Tees 15-17 year olds was significantly higher than the England average rate. Since 1998, overall conception rates for under 18’s have fallen by 55% nationally (ONS 2015). This success is not reflected on a local level, although rates have fallen over the last 3 years the Stockton the gap between the national and local rate has not decreased significantly within the same period. This is a similar trend to the region

Across the borough, pooled rates for the time period 2012-2014 indicate that 13 wards have under 18 conception rates higher than the local average rate.

In 2015 the under 18 birth rate for 15-17 year olds within Stockton on Tees was significantly higher than the national average. but the same as the regional average.

STIs

The 5 most common STIs are chlamydia, genital warts, genital herpes, gonorrhoea and syphilis. The most common infection in Stockton-on-Tees is chlamydia, which reflects the infection rate across the North East. Diagnostic rates for the other major STIs have remained similar over the last few years, where they are similar to or lower than the national average, apart from gonorrhoea which has increased in the last year and the diagnostic rate is now similar to the national average.

In 2015, 57% of diagnoses of new STIs made in specialist sexual health services were in young people aged 15-24 years. The burden of STIs is highest in young women aged 15-19, with men aged over 25 having higher rates of new STI diagnosis during 2015 than women.

Proportion of new STIs by age group and gender in Stockton-on-Tees 2015 (graph reproduced from Stockton-on-Tees Local Authority HIV, sexual and reproductive health epidemiology report ((LASER)) 2015)

STI’s and deprivation have a strong correlation; this is reflected in the diagnosis rates for 2015 where rates of STI’s were higher in areas of high deprivation.

Rates per 100,000 population of new STIs by deprivation category in Stockton-on-Tees (specialist SHC diagnoses only): 2015 (graph taken from Stockton on Tees LASER report 2015)

Chlamydia often does not display any symptoms, therefore identification and treatment is crucial to preventing serious reproductive health problems. The chlamydia detection rate reflects both the coverage of testing and the proportion of positive cases of chlamydia identified through testing. Stockton-on-Tees has a significantly lower detection rate than both the national average and regional average. (please note a reporting error means that data for 2012 and 2013 are not accurate due to double counting)

The proportion of new attendees accepting a HIV test in specialist sexual health services (coverage of HIV) in 2016 was 65.5% which was lower than the national average of 67.7% and better than the regional average of 62.1%. The HIV testing coverage for the borough has been decreasing since 2012.

Overall, the HIV prevalence rate for the borough in 2016 was lower than the UK and regional average prevalence rate. Rates have displayed a similar trend over the last 6 years. It should be noted that there is variation in rates across MSOA (middle super output area) prevalence rates, with higher rates recorded within MSOAs within areas of higher deprivation

Reproductive Health

LARC (Long Action Reversible Contraceptives) are the most effective method of contraception at preventing pregnancy (NICE 2005).  The prescribing rate for LARC by both GPs and Sexual Health Services in 2015 for Stockton-on-Tees was lower than both the England and regional average.

In 2015 16.5% of under 25s chose LARC as their main method of contraception at Sexual Health Services, this is lower than the national average of 20.2% and the regional average of 22.9%.

The proportion of abortions in the first 10 weeks of pregnancy in 2016 was 79.2%, this is similar to the national average of 80.8%; however this means that there are still a sizeable proportion of abortions taking place past 10 weeks within the borough, and this increases the risks of complications for the female. 29% of abortions in under 25s are repeat abortions, this is above the regional (23.6%) and national (26.7%).

The percentage of women having an abortion after a birth, aged under 25 years for the borough has increased over the last few years and the gap between the local and national average is increasing. In 2016, 41.9% of women under 25 who had an abortion had previously had a birth.

Primary Care

GP practices provide sexual health advice and support to their registered patients and offer hormonal contraception and STI testing if indicated as part of their general service.

13 GP practices offer more specialised sexual health services as a subcontract of the Integrated Sexual Health Service for the area including Long active reversible contraceptives (LARC) and chlamydia screening

Community Pharmacies

As a subcontract of the Integrated Sexual Health Service 39 community pharmacies deliver Emergency Hormonal Contraception (EHC) and chlamydia screening. The 39 community pharmacies also offer a C-Card scheme where 13-24 year olds can access free condoms, advice & support.

Sexual Health Teesside

Sexual Health Teesside is commissioned by the 4 Tees local authorities, NHS England, Hartlepool & Stockton on Tees Clinical Commissioning Group and South Tees Clinical Commissioning Group. The service is provided by Virgincare and delivers a fully integrated community based sexual health service offering contraception, STI testing & treatment, counselling & advice, vasectomy, cervical screening and outreach support to the community to help them maintain good sexual health.

The service is delivered through a hub and spoke model, the main service hub is delivered from Lawson Street, with spoke clinics delivered in Thornaby and Billingham health centres. The service also provides a virtual hub where people can access online information & advice, and book appointments.

HIV Home Sampling Service

Stockton-on-Tees are part of the nationally commissioned framework offering free HIV home screening tests for high risk users.

Secondary Care

James Cook University Hospital infectious disease department provides treatment and support to patients with HIV and AIDS

North Tees Pregnancy Advice Clinic offer termination services up to 18 weeks of pregnancy.

Schools & Colleges

Sex & Relationship education is statutory for all maintained secondary schools to provide, and in 2019 it will be statutory for both primary and secondary schools to teach Relationship & Sex Education as part of the curriculum. Currently, the majority of schools across the borough offer sex and relationship education to their students. Colleges within the borough offer a variety of education and services such as condom distribution to their students, but this is not consistent across all college settings.

Youth Direction

Stockton on Tees Youth Direction services offer group  SRE delivered within group work and 1-1 advice & support through individual case work.

Voluntary Sector

A Way Out provide one to one support, group work and outreach support vulnerable women across the borough

Brook are subcontracted by Sexual Health Teesside to deliver education and outreach service to children and young people

BPAS provide medical terminations for pregnancies over 18 weeks.

Helen Britton House is the Sexual Assault Referral Centre (SARC) for victims of sexual assault & rape across Teesside.

Marie Stopes is subcontracted by Sexual Health Teesside to provide vasectomy services.

The Terence Higgins Trust is a subcontractor of Sexual Health Teesside and provides advice, support and HIV testing to vulnerable groups within the borough.

A sexual health needs assessment was carried out in 2013 and identified the need for more focused needs assessment including the needs of young people in or leaving care, people with learning difficulties.  These groups remain priority groups which would benefit from an assessment of need.

TBC

Name: Gemma Mann

Job title: Health Improvement Specialist

Organisation: Public Health

Phone number: 01642 524293

Contributor/s: Nicola Childs, NHS Hartlepool and Stockton-on-Tees CCG