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Who's at risk and why?

Background papers: Lifestyle and wider determinants :: Sexual health [Update in progress] :: Who's at risk and why?

All people who engage in sexual activity are at risk of sexual ill-health or unplanned pregnancy; however risk is not distributed evenly.

People from some Black and Ethnic Minority Communities

In the UK 34% of those receiving treatment for HIV are black African [1], due, in part, to the higher incidence of HIV infection in sub-Saharan Africa. Efforts to tackle HIV among high risk groups should be supported with work to reduce stigma.

Undiagnosed HIV, and therefore late diagnosis, is of concern among black Africans and in particular black African women [2]. People living with HIV who live outside London are at a higher risk of being undiagnosed than those living inside London. The ethnic groups black and black British are at higher risk of being diagnosed with an STI than the general population [3].

Men who have sex with men

Men-who-have-sex-with-men (MSM) face a range of health inequalities, including HIV and issues related to mental health and wellbeing, alcohol, drugs and tobacco [4].

It is estimated that 7% of the population are lesbian, gay or bisexual, but in England MSM accounts for 11% of all new STI diagnoses (81% of syphilis and 55% of new HIV diagnoses) [5].

While not relevent to all MSM, lifestyle factors including HIV sero-sorting, condomless sex, multi-partnering, chemsex, public sex environments all contribute to the risks of STI and HIV transmission. Increased extra-genital testing alongside improved laboratory testing are likely to have contributed to the increase in STI detection among MSM.

Given that MSM are disproportionately affected by STIs, the emergence of antibacterial resistant gonnorhoea is likely to have greatest impact on this group.

Young people

The National Survey of Sexual Attitudes and Lifestyles (NATSAL) survey (2013) indicates that just under a third of young people aged 16-24 at the time of the survey had had sex before age 16. Young people aged 16-24 are experimenting with a range of sexual practices, 71% have given or received oral sex, 19% males and 17% females have had anal sex. Anal sex among this group is higher than any other age range and unless participants observe safer sex messages this can increase health risks.

Young people are more likely to use contraception effectively if they are aware of the alternatives and are able to make their own choices. This group should be included in universal sexual health services, while acknowledging that those who are socially disadvantaged may require tailored support. Schools and other educational establishments have proved to be good sites to base contraceptive services. Due to the high prevalence of STIs condoms should be offered in addition to other forms of contraception [6].

Looked-after children

Looked-after children are at a high risk of teenage pregnancy and while there is much policy and guidance to reduce teenage pregnancy, little of the guidance is directly focused on this group's needs. The limitations of school-based programmes with this group are well recognised.

Consultations with this group are key if targeted interventions are going to be effective [7].

Sex workers

A literature review conducted by Balfour and Allen (2014) indicates that there are several factors that can adversely affect the health of sex workers [8]. The different types of sex work carry varying risk; for example, low risk activities such as stripping, web-casting and other forms of non-contact sex have significantly different impacts on health to on- or off-street sex work.

Even though some sex workers still engage in risky behaviour, research indicates that condom use among sex workers has increased over the last 30 years and incidence of HIV has decreased [8]. It should be noted that although potential for transmission is very high the actual rate of STI infection remains low. This may, in part, be due to the focus of support for sex workers being around sexual ill-health; prevention and support work should continue with this group.

People subjected to sexual violence, abuse and exploitation

A needs assessment for the Sexual Assault Referral Centre (SARC) for Kent & Medway has been carried out. Details of the SARC are available online on the Beech House webpage

NATSAL, one of the largest scientific studies of sexual behaviour, indicated that 1 in 71 males and 1 in 10 females have had non-volitional sex (2013). The median age for this in males was 16 and for females 18 years.

Sexual violence is often linked to domestic violence. The long-term health effects of sexual violence are associated with depression, anxiety, post-traumatic stress disorder, psychosis, substance misuse, self-harm and suicide.

Violence in all its forms are common for many sex workers but reporting of violent crimes to authorities by commercial sex workers is low.

Although the effects of sexual abuse on people are well documented, detection and prevention of Child Sexual Exploitation is a developing field. Victims are likely to be at increased risk of HIV, STIs and pregnancy.

It is widely acknowledged that reliable information on the volume of sexual offences is difficult to obtain as a significant proportion of offences are not reported to the police, although the number of reported incidents is increasing.


References

[1]   NAT. HIV and Black African Communities in the UK 2014; http://www.nat.org.uk/media/Files/Publications/NAT-African-Communities-Report-June-2014-FINAL.pdfhttp://www.nat.org.uk/media/Files/Publications/NAT-African-Communities-Report-June-2014-FINAL.pdf .
[2]   PHE. HIV in the UK - Situation Report 2015 2015; https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477702/HIV_in_the_UK_2015_report.pdf .
[3]   PHE. Table 3 (a): Number of new STI diagnoses in England by ethnic group, 2010 - 2014 2015;
[4]   PHE. Promoting the health and wellbeing of gay, bixeual and other men who have sex with men (initial findings)
[5]   PHE. Table 4 (a) Number of all STI diagnoses & services in England by gender & sexual risk 2010 - 2014 2015;
[6]   NICE. Cost report: Contraceptive services with a focus on young people up to the age of 25 2014;
[7]   SCIE. SCIE Research Briefing 9: Preventing teenage pregnancy in looked after children 2005; http://www.scie.org.uk/publications/briefings/briefing09/index.asp .
[8]   Balfour J. A review of the literature on sex worwork and social exclusion 2014; UCL Institute of Health Equity for Inclusion Health.