Sexual health is integral to the health and well-being of the nation. While the UK is making progress towards meeting the 2030 goal of ending new HIV transmissions, sexually transmitted infections (STIs) such as gonorrhoea, chlamydia, and syphilis are on the rise.
Sexual health services in England are struggling to meet the increasing demand as a result of a decade of under-investment.
This is having a greater impact on some communities and clear inequalities have emerged on who is at higher risk of sexual ill-health, and who is missing out on accessing essential sexual healthcare.
We're working with our friends at British Association for Sexual Health and HIV (BASHH) and other partner organisations, to highlight and tackle these inequalities.
Sexually Transmitted Infections in England: The State of the Nation was a project in partnership with BASHH. It used existing evidence, carrying out a review of the data available in the public domain.
Published in 2020, the report provided a comprehensive overview of the trends in STIs, who was affected, why we were seeing these trends, the inequality in the burden of STIs, and where the gaps are in our understanding.
We called for a timely, fully funded national sexual and reproductive health strategy that takes a holistic approach, including a focus on the wider determinants of STIs. In line with this, we highlighted the need to fill the gaps in the research which we identified, particularly in relation to inequalities, access to services, STI awareness and risk behaviours.
In 2023 we launched a report on the state of sexual health services called Over-stretched and under strain: A Mystery Shopper Approach to Access to Sexual Health Services in England, Scotland and Wales. Using a 'mystery shopper' methodology, we surveyed the availability of face-to-face appointments, online booking systems, postal STI testing, and drop-in services across England, Scotland and Wales.
Our findings indicate that resource constraints for sexual health services across Great Britain are resulting in an emerging trend of ‘gatekeeping’ face-to-face appointments, with too few alternatives provided. Face-to-face appointments were offered by only half of clinics (51%) contacted by telephone, and waiting times for face-to-face appointments available to book via telephone averaged 13 days, rising to 19 days in rural parts of England.
Our recommendations included free, nation-wide postal STI testing in England and Scotland, making sexual health appointments bookable via relevant NHS apps, and the implementation and monitoring of a 48-hour waiting time target for access to sexual health appointments.
Unmet need in sexual health
While the poor state of sexual health in the UK affects everyone, some groups bear a greater burden of STI diagnoses or face additional barriers to accessing sexual health services.
Over the past year we have been undertaking research to examine unmet needs in sexual health, highlighting in particular the experiences of communities whose sexual health needs are currently not met. The findings of this research will be published in early 2024.