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Summary

Background papers: Lifestyle and wider determinants :: Sexual health :: Summary

Introduction

The health and economic wellbeing of any population and the wellbeing of individuals can be critically influenced by sexual health. The financial case for sexual health services has been made repeatedly; effective sexual health services and the prevention of sexually transmitted infections (STI) and unplanned conceptions are cost-saving.

Total new STI diagnosis rates have fallen in England since 2012. Chlamydia infection is the most common followed by genital warts, non-specific genital infection (NSGI), gonorrhoea, herpes and syphilis (PHE, 2017). Chlamydia detection among 15-24 year olds had increased in Medway as screening in GPs and pharmacies was extensively promoted but has recently seen a slight downward trend. Late diagnosis of HIV is above the England average and remains a priority area.

This chapter does not include teenage pregnancy specifically as this is addressed in the teenage pregnancy chapter.

Key issues and gaps


• Sexual ill health is not equally distributed among the population with the highest levels seen in men-who-have-sex-with-men (MSM), teenagers, young adults and some black and minority ethnic groups. It is therefore a necessary to promote sexual health in a multifaceted manner as it is influenced by a number of issues including socio-economic and cultural issues.
• There is some correlation between deprivation and STI rates, with Chatham town centre having the highest concentration of GUM diagnoses per 100,000 population. The National Chlamydia Screening Programme (NCSP) has identified the highest rates of positivity in Strood North, Luton and Wayfield, and the Rochester wards; it should be noted that the Young Offenders Institution and the Secure Training Unit skew the data for Rochester West.
• The highest HIV prevalence rates are shown in Chatham with lower prevalence in rural areas.
• The Pelvic Inflammatory Disease rate is significantly higher in Medway than the England average.
• Although reducing, the total abortion rate in Medway is significantly above England average.

Recommendations for Commissioning


• A needs assessment should be conducted to identify existing or new gaps in service provision.
• HIV is of particular concern with late diagnosis of HIV posing serious problems at individual and community level. This increases the risk of onward transmission and ultimately treatment costs. There is a need to improve HIV awareness training amongst secondary care medical disciplines to improve early diagnosis.
• As a large proportion of those affected by HIV in Medway are of black-African origin, it is important to review services to ensure that they are accessible to this population.
• Improve sexual health services delivered by GPs, in particular access to Long Acting Reversible Contraception ( LARC), Chlamydia screening and referral for full STI screening.
• Improve chlamydia screening rates through core services to achieve the 2400/100,000 diagnosis rate.
• Reduce the number of women who have repeat abortions to the south East England average rate of 25.2%.
• Increase the uptake of LARC to achieve the South East average of 54/1,000.