I welcome the new State of the Nation report from Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) because an investigation into sexual health across England is long overdue. 

The report makes for sobering reading. It presents some uncomfortable truths and throws down challenges to the Government, NHS, sexual health sector, and voluntary and community organisations. 

The State of the Nation report confirms once again that England has some of the poorest sexual health outcomes in Europe and that we need action. More alarmingly, it confirms the burden of poor sexual health is not evenly distributed and that marginalised communities continue to be disproportionally impacted by higher rates of sexually transmitted infections (STIs). 

The overrepresentation of Black communities, gay and bisexual men (GBM), trans people and people impacted by deprivation and poverty in poor sexual health should come as no surprise. 

If you take a quick look across any area of health, such as reproductive, mental health, coronary heart disease and some cancers, it’s clear that people from marginalised communities have consistently poorer health outcomes. 

The report, justifiably, calls for more research and evidence into the impact of structural, systemic and individual racism, homophobia and transphobia on sexual health. 

It highlights the need for all providers to recognise multiple marginalised identities, the intersectionality of communities and the people that make them up. 

The report also recognises that for any response to succeed at improving the poor sexual health of those most affected and those left behind, we must have members of those communities meaningfully involved in that research, design, delivery and evaluation. 

The State of the Nation report makes a strong case for representation, inclusion, the appropriate use of language and challenging heteronormative and racial norms. 

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We in the HIV and sexual health sector need to step out of our safe bubble


As a health promoter and activist I welcome all of these recommendations and am ready with colleagues to take up the challenges. 

But here comes the rub – none of this is new! 

We’ve known about the higher rates of STIs in GBM, particularly those living with HIV, since the early 2000s. The higher rates of gonorrhoea in African-Caribbean communities made headlines in the 1980s. Exclusion, violence and poor access to services have long been reported by trans people.

People from the most affected communities have been challenging the mainstream sexual health sector to do better for as long as I can remember. 

And so, while we need more research and more evidence, we don’t need to wait for new evidence to take action: we already have library shelves teeming with research that sits dusty with inaction. Let’s take it off the shelves and put it into action

All of that evidence provides us with a plan of what we can act upon now: it’s up to all of us to make this happen. 

And to do that, we need leadership and innovative ways to reach into communities not currently engaging with us.  

Individuals and communities at risk of poor sexual health do not sit in a vacuum. Our lives are complex and multilayered, with a range of factors impacting our access, choice and behaviors. The response cannot sit in a silo. 

We in the HIV and sexual health sector need to step out of our safe bubble and build relationships with mental health providers, those delivering reproductive health services to women from Black, Asian and other minority communities and work directly with grassroots trans activists and organisations.

Attempting to ‘fix’ the poor sexual health of those most in need, those most vulnerable and at risk will take investment, resources and action. 

The State of the Nation report makes many recommendations to begin to address this. Question is, are we collectively ready to act? 

Read the State of the Nation report