Sexual health

Sexual health is an integral part of physical and mental health. Good sexual health depends on safe and equitable relationships and ready access to high quality information and sexual health services. Relationships and sexual behaviour are influenced by a number of different factors which include: personal attitudes and beliefs, social norms, peer pressure, religion, culture, confidence and self-esteem, drug and alcohol misuse, abuse and coercion as well as access to information, prevention and services. Deprivation and social exclusion also impact on sexual health, with a higher burden of disease in the population living in more deprived areas.

Sexual health services offer services in relation to contraception, relationships and STIs (Sexually transmitted Infections) including HIV and abortion.  A wide range of providers including community sexual health services, outreach services, acute hospitals, general practice, pharmacies and the voluntary, charitable and independent sector is involved in delivering sexual health services.

The commissioning of sexual health services has changed since April 2013. The main responsibility to provide open access services for the local populations lies with local authorities. CCGs (Clinical Commissioning Groups) and NHS England are commissioning distinct aspects of sexual health as detailed in the table below.

Last updated: 2015-12-14 10:42:49
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1. What are the key issues?

  • Sexually transmitted infection rates are generally low except for a continuous increase in gonorrhoea infections.
  • The decrease of diagnosed chlamydia infections demonstrates a need for increased, targeted chlamydia testing.
  • Middlesbrough had the second highest rate of new HIV diagnoses in the North East but still below national average. The proportion of late diagnoses was over 50% and the highest in the North East.
  • Teenage pregnancy rates in Middlesbrough are among the highest in England although teenage pregnancy rates have declined by 22% between 1998 and 2012.
  • Long acting reversible contraceptives (LARC) account for a comparatively low proportion of contraceptives prescribed in sexual health clinics and GP practices.
  • Repeat abortions particularly in women aged over 25 years were high. 
  • Service utilisation in Middlesbrough clinics is good but lower for residents living in the South of Middlesbrough, where currently no clinics are located.
  • Awareness and information of availability, location and opening hours of sexual health services is limited.
  • There are gaps in sexual health education and awareness in Middlesbrough. 
  • Leadership and provision of sexual health promotion and prevention is limited.
  • There are inequalities in sexual health prevention and access to services for vulnerable and at risk groups caused by discrimination, stigmatisation and other barriers. Current provision may not be aligned with need.
Last updated: 09/06/16

2. What commissioning priorities are recommended?


Reduce under-18 conceptions by maintaining the efforts to reduce teenage pregnancies through universal and targeted interventions to reach young people particularly in areas with high levels of teenage pregnancy.


Improve access to LARC to prevent unplanned pregnancies and repeat abortions. Ensure the workforce is trained to offer and provide LARC.


Increase chlamydia screening by raising awareness in at risk groups and provision of tests though different routes including sexual health clinics, outreach, youth services, GPs and community pharmacies.


Improve access to services by reviewing the opening times and locations of sexual health service clinics (hub and spoke) with a view to increase access in the South of Middlesbrough.


Increase the awareness of sexual services by ensuring that people know where and when sexual health services are provided nearby. This information should be available through local services and partners, the internet and social media.


Improve sexual health promotion by providing clear local leadership including coordination of campaigns and provision of resources.


Improve the quality and reach of sexual health advice and sex and relationship education by providing a programme of workforce development for those working with young people. This should ensure that young people receive consistent education, information and advice in relation to sexual health, risk taking behaviour and resillience.

2012 Commissioning Priorities

Reduce under 18 conceptions by maintaining efforts to reduce teenage pregnancy in the context of work to reduce child poverty and health inequalities and focusing targeted interventions in specific areas where there are high levels of teenage pregnancy. (Update 2015 There has been a decrease in teenage pregnancy rates since 2012 (highest teenage pregnancy rates in England) but the rate is still the 7th highest in England

Ensure young people have access to sexual health services by making certain that services are delivered in accordance with service standards and are appropriate and accessible to all, including provision and access for young people.  Improve the quality and opportunities for sex and relationship and risk-taking behaviour education in schools and other settings. (Update 2015 All hub and spoke clinics in Middlesbrough have achieved You're welcome accreditation, there is limited sexual health outreach provision across schools in Middlesbrough, the improvement of sex and relationship an risk taking behaviour education remains a priority)

Increase uptake of HIV testing and reduce late HIV diagnosis by exploring the merits, acceptability and cost-effectiveness of setting up specific community-based HIV testing sites targeted at the Black African population and men who have sex with men. (Update 2015 Rapid HIV testing has been introduced in community clinics mainly targeted at MSM. Events for Black African population to improve HIV awareness and testing have taken place. HIV home sampling targeted at MSM and Black African population has been introduced in November 2015)

Reduce sexually transmitted infections by increasing testing in high risk groups and maximising service contacts. (Update 2015 Service utilisation and STI testing has increased since 2012, chlamydia testing has decreased,  new STI diagnoses have decreased  in 2014 but gonorrhoea infections are increasing)

Make sure that service provision is in line with need by combating discrimination and stigmatisation and reducing barriers to access sexual health information. (Update 2015 This remains a priority)

Increase long-acting reversible contraception (LARC) provision and ensure the workforce is trained to offer and provide LARC. (Update 2015. Uptake of LARC is comparatively low. This remains a priority)

Last updated: 09/06/16

3. Who is at risk and why?


Young people between 15-24 years, experience the greatest burden of sexual ill health. 78% of diagnoses of new STIs in the North East in 2014 were in this age group. A lack of knowledge about risks and prevention as well as risk taking behaviours including drug and alcohol misuse all contribute to the higher risk of contracting STIs.

Socioeconomic status

There is a clear relationship between poverty, social exclusion and poor sexual health. A number of vulnerable, at risk or hard to reach groups that are experiencing particular risks have been identified. Some individuals from these groups experience difficulties in accessing appropriate sexual health services while others are more exposed to the risk of unwanted pregnancies, sexual exploitation and STIs or engage in risk taking behaviours.

Deprivation is highly associated with sexual ill health. People living in poorer, more deprived areas which are characterised through lower educational attainment, higher unemployment and lower income are experiencing a higher rate of STIs and teenage pregnancies.

Young people who are in or leaving care, who have low educational attainment and who are from disadvantaged backgrounds are particularly vulnerable to poor sexual health including infections, sexual exploitation and teenage pregnancies.

Homeless people are at a higher risk of poor sexual health in particular in terms of access to services and sexual exploitation.

Black and minority ethnic (BME)

People from BME groups may be at higher risk of HIV, mostly because of higher prevalence of the disease in their country of origin. Black African migrants have the highest risk. Women with African background are also more likely being a victim of female genital mutilation and suffering from the associated consequences and complications.

Learning difficulties

People with learning difficulties often do not have appropriate access to sex and relationship education and information and consequently are more vulnerable to sexual exploitation, unwanted pregnancies and STIs.

Lesbian, gay, bisexual and transsexual people

Lesbian, gay, bisexual and transsexual people (LGBT) have particular risks of STIs. MSM (Men having sex with men) are at higher risk of contracting STIs, and therefore have a significantly higher incidence and prevalence of most STIs including HIV. Growing evidence on the impact of club drugs on risk taking sexual behaviour and the associated risk of HIV and other STIs in the gay community causes further concerns. 

Sex workers

Sex workers are at higher risk of poor sexual health because of more frequent exposure to sexual violence, homelessness and drug and alcohol misuse. In addition access to mainstream services, particularly for those who are being trafficked or coerced is difficult.

Behaviour and lifestyle

Alcohol and substance misuse is strongly associated with poor sexual health as a result of risk taking behaviour.  Alcohol consumption influences judgements and risk taking behaviours and is associated with an increased likelihood of sex at a younger age, a greater number of partners, more regretted or coerced sex, risk of sexual aggression and violence and teenage pregnancy.


The prison population with a high proportion of people with alcohol and drug misuse problems, people with poor educational attainment and from deprived backgrounds, care leavers and from BME groups has a higher prevalence of STIs.

Last updated: 14/12/15

4. What is the level of need in the population?

Sexually transmitted infections  

Sexual transmitted infections (STIs) are preventable and disproportionately affect vulnerable groups. It is well acknowledged that early diagnosis and management of STIs can break the chain of transmission and therefore prevent the further spread of the disease. Delayed diagnosis and treatment can lead to serious complications and adverse outcomes.

Public Health England leads on the surveillance of STIs including chlamydia, gonorrhoea, syphilis, HIV, genital warts and genital herpes and publishes STI reports on a regional and national level.

In 2014, the North East had one of highest rates of new STI diagnoses (712 per 100,000 population) following London, the North West and Yorkshire and Humber. Hartlepool had the highest rate in Teesside. Stockton and Redcar and Cleveland had the lowest rates in the North East. Middlesbrough ranked 8 out of 12 and was both below the regional and England average.


Figure 1 Rate of new STI diagnoses (excluding chlamydia diagnosis in persons aged 15-24 years) per 100,000 population aged 15-64 years among North East residents by local authority of residence: 2014. PHE North East

The number of new STIs diagnosed in North East residents fell by 12% between 2013 and 2014. Numbers of three of the five major STIs rose: syphilis increased by 13%, gonorrhoea by 11% and genital herpes by 1%. Numbers of chlamydia infections decreased by 21% and of genital warts by 5%.

The five main STIs are chlamydia, genital warts, genital herpes, gonorrhoea and syphilis. The most common infection is chlamydia. In 2014, in the North East, there were 9,470 chlamydia infections (rate of 362.8) compared to 3,677 cases of genital warts (rate 140.9), 1,413 cases of genital herpes (rate 54.1), 1,413 gonorrhoea (rate 54.1) and 150 syphilis infections (rate 5.7).

Figure 2  Diagnoses rates of the five main STIs: North East, 20010-2014. PHE North East. Data source: GUMCAD, CTAD, NCSP and laboratory Chlamydia data

Since 2013, there has been a decrease in genital wart and herpes infections and a slight increase in gonorrhoea infections.  

Figure 3 Diagnoses of selected STIs in Middlesbrough in 2014. Data source: GUMCAD

[h1] In the North East in 2014, about 23% of all gonorrhoea infections and 67% of all syphilis infections were in MSM. The number of gonorrhoea infections in MSM rose considerably between 2010 and 2014 from 88 to 329 cases. During the same time period, the ratio between male and female cases fell from 1.5 to 1.3 indicating more heterosexual transmission.

78% of diagnoses of new STIs in the North East were in young people aged 15-24 years.

Rates of new STIs were generally more common in the more deprived groups of the population. The highest rate was in the most deprived quintile and the lowest rate in the least deprived quintile of the population.


Chlamydia is the most common STI, with higher rates in more deprived areas and is equally common in males and in females. Chlamydia infection rates are highest in young people aged 16-24 years. The NCSP (National Chlamydia Screening Programme) promotes chlamydia testing in young people aged 15-24 years. A diagnosis rate of 2,300 or above is recommended (Public Health Outcomes Framework). In 2014, Middlesbrough achieved a diagnosis rate of 1,650.

Figure 4 Rate of chlamydia diagnoses per 100,000 population aged 15-24 years in North East by local authority of residence: 2014. PHE North East Data sources: GUMCAD and CTAD

The diagnosis rate for chlamydia testing in Middlesbrough has declined between 2012 and 2014.

Figure 5 Diagnosis rate of Chlamydia testing in young people aged 15-24 for Tees Valley, 2012- 2014. Source. PHE 2015


The number of gonorrhoea infections in the North East increased sharply between 2010 and 2014 from 590 to 1413. The increase has been observed across England and the North East but has been higher in the North of the region. Middlesbrough had the fifth highest rate of gonorrhoea diagnoses in the North East with 61.9 per 100,000. Gonorrhoea infection rates are higher in more deprived areas and more common in men.  Gonorrhoea rates are highest in young people aged 20-24 years.

Figure 6 Rate of gonorrhoea diagnoses per 100,000 population in the North East by local authority of residence: 2014.PHE North East. Data source: GUMCAD

The rate of gonorrhoea infections in Middlesbrough has increased in the past years and is now just below the national average.

Figure 7  Rate of gonorrhoea infections. 2012- 2014. Tees Valley.  Source. PHE 2015


In 2014, a total of 24 new cases of syphilis have been diagnosed in Teesside. The numbers within each local authority are very small. National and regional data show a higher rate of syphilis infections in more deprived areas and among young people aged 20-34 years. Syphilis infections were about six times more common in men than women. It is important to note that 67% of new syphilis diagnoses were in MSM.

Syphilis infection rates in Middlesbrough are below the national average. Rates declined significantly between 2009 and 2013 and have increased slowly since then.

Figure 8 Rate of syphilis infections. 2012- 2014. Tees Valley.  Source. PHE 2015

Genital warts and herpes

The rates of genital warts in Middlesbrough were similar to the national average in 2014 which has decreased gradually. The rates of genital herpes have gradually increased over the past five years but decreased in 2013-2014 following the national trend. 

Figure 9 Rate of genital wart infections. 2012- 2014. Tees Valley.  Source. PHE 2015

Figure 10 Rate of genital herpes infections. 2012- 2014. Tees Valley.  Source. PHE North East 2015


New HIV infections in the UK have decreased steadily since 2005. At the same time the number of people living with HIV has increased, this is because less people infected with HIV are developing AIDS and those with AIDS are living longer. London has a significantly higher incidence and prevalence than other areas in the UK and around half of all new HIV diagnoses are in MSM. The proportion of late diagnoses of HIV remains high.

The total number of people living with HIV has also increased in the North East and Teesside. In 2014, there were 1,602 people living with diagnosed HIV in the North East and of those 336 in Teesside.

There were 133 new HIV cases diagnosed in the North East in 2014, a similar number than in previous years. The number of new diagnoses depends on accessibility of testing as well as infection transmission. Approximately 75% of all new diagnoses in North East residents were in males. Black Africans represented 12% of all newly diagnosed North East residents in 2014 (compared to 18% in 2012 and 46% in 2004).

The incidence of HIV in Middlesbrough was significantly higher than the North East average. In 2014, the incidence rate was 5.08 per 100,000 population in the North East and 9.5 per 100,000 in England.

Figure 11 New HIV diagnoses (incidence) per 100,000 population by local authority, 2014 Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD).

The proportion of late HIV diagnoses in Middlesbrough was over 50% and highest in the North East.


Figure 12 Percentage of new HIV diagnoses that were diagnosed late by local authority, 2012-2014. Source: PHE, HIV and AIDS New Diagnosis Database, CD4 Surveillance, Survey of Prevalent HIV Infections Diagnosed (SOPHID).

The prevalence of HIV in Middlesbrough was above regional but below national average. In 2014, the diagnosed HIV prevalence rate was 0.92 per 1,000 compared to 0.61 per 1,000 in the North East and 1.32 per 1,000 in England.  

Reproductive health


The number of conceptions in Middlesbrough in 2013 was 2,473. Approximately 20% of these led to an abortion. The conception rate was 88.5(per 1,000 population) compared to 78.3 in England.

Table 3 Conceptions number and rate per 1000 women aged 15-44. Source: ONS Conception statistics 2013

Teenage pregnancies

The number and rate of teenage pregnancies in England has decreased significantly (40.5%) between 1998 and 2012. Middlesbrough achieved a significant but lower (21.8%) reduction during the same time period. The teenage pregnancy rate in 2013 was 40.1 (per 1,000 population) which is above the national average of 24.5.

Figure 13 Change in teenage pregnancy rate 1998 -2012 Source: Teenage pregnancy support lead, Public Health England 2014

Table 5 Teenage conceptions rate and rate change 1998-2012 Source: Teenage pregnancy support lead, Public Health England 2014

In Middlesbrough, the proportion of teenage pregnancies leading to abortion (36.9%) in 2013 was lower than the national average (50.7%).

Figure 14 Teenage conception rates 1998-2014. Data source. Child Health Profiles, Public Health England 2016

In Middlesbrough, The rate of teenage conceptions has reduced slightly since 1998, but is consistently statistically worse than the England average.

Long acting reversible contraceptives (LARC)  

Long acting reversible contraceptives are offered routinely to women and girls attending contraception clinics as an option to prevent unwanted pregnancies. LARCs include depots, implants and coils (IUD/IUS). LARCs are also offered by GPs. 

In 2013/14, the sexual health service issued LARC to 34.8% of women who visited the sexual health service for the first time for contraception. This was higher than the England average of 31% but below the regional average.

Figure 15 Proportion of LARC at first contact for contraception in sexual health service 2013/14. HSCIC 2014

LARC prescribed in GP practices in Middlesbrough was below the regional and national average. The comparatively low rate can be explained. LARC fittings in GP practices working closely with the sexual health service are reported through the sexual health service and not as GP prescribed LARC.

Figure 16 GP prescribed LARC per 1000 women aged 15-44. PHE 2014  Source. PHE Sexual and Reproductive Health Profiles.

Emergency Contraception (EHC)

Emergency contraception (morning after pill) is offered free of charge through pharmacies and sexual health clinics. Over a 12 month period in 2014/15, 1980 cases in Middlesbrough received EHC.

Figure 17 Number of EHC per local authority. Data source  Sexual Health Teesside


Many abortions could be prevented by better knowledge and access to contraception. Abortion rates for under 18-year-olds in Middlesbrough in 2013 were similar to the national average, whilst abortion rates in those 25-34 exceeded the national average.

The risk of complications increases the later an abortion is carried out. The proportion of abortions in the first 10 weeks of pregnancy in Middlesbrough (77.4%) was lower than the national average (80.5%).

Repeat abortions could be prevented through early and effective advice and use of contraceptives following an abortion. Repeat abortions for all age groups (44.8%) and particularly those over 25 (55.8%) years were higher in Middlesbrough, compared to national average of 37.6% for all age groups and 45.6% for over 25s.


Last updated: 17/11/16

5. What services are currently provided?

Primary care

General practices provide sexual health advice and support to their registered patients and offer hormonal contraception and test for STI’s if indicated as part of their general service.  GPs refer or signpost patients to the sexual health service if required. The majority of general practices also provide more specialised sexual health services as part of the sexual health service.

Sexual Health Teesside

Sexual health services are open access and free of charge. Patients can self-refer and use the service at a location of their choice. The service offers appointments and walk-in clinics.

Sexual Health Teesside provides a fully integrated community based sexual health service since 2011. The integrated service includes formerly hospital based GUM (Genito-Urinary Medicine) and community based CASH (contraception/family planning) services. The service is predominately commissioned by local authorities and currently provided by VirginCare. Smaller aspects of the service are commissioned by local CCGs and NHS England. The service is provided through four hubs, a number of spoke clinics, outreach and subcontracted services based in the four local authorities in Teesside.

The sexual health service offers full sexual health and contraception services including STI testing & treatment, chlamydia screening, HIV testing, post exposure prophylaxis for HIV, contraception, long acting contraception (LARC), sterilisation, vasectomy, cervical screening and psychosexual counselling. The service also delivers outreach services in schools, colleges and other settings to provide low threshold access to sexual health services for young people and other at risk groups.

Outreach work is an essential part of the Tees Sexual Health service; ensuring services are accessible to those who might not access regular sexual health clinics for a variety of reasons. Outreach clinics provide information and advice on contraception, STIs, emergency hormonal contraception, condoms and chlamydia tests.

General practice and community pharmacy

General practices and community pharmacies are subcontracted by Sexual Health Teesside to provide more specialised sexual health services. Services such as long acting reversible contraceptives (LARC) as well as chlamydia testing are provided.   

Three GPs based in Redcar & Cleveland and Hartlepool are providing vasectomies for the sexual health service.

Secondary care

Treatment and support of patients with HIV and AIDS is provided through the infectious disease department at James Cook University Hospital. With the introduction of community based integrated sexual health services, there are currently no other GUM/STI services provided through secondary care.

North Tees and Hartlepool University Hospital and James Cook University Hospital are commissioned to offer female sterilisations and medical terminations of pregnancies up to 18 weeks. Patients need to be referred into the service through their GP or a sexual health clinic.

Other providers and organisations including voluntary and community sector

BPAS is commissioned to offer medical and surgical late terminations of pregnancies (> 18 weeks) to residents in Teesside. Patients can self-refer into this service. Early medical termination of pregnancy is also offered (but not commissioned) through the NHS.

Youth services are providing information and advice including free pregnancy testing, access to free condoms through the C-card scheme and chlamydia testing.

Most schools are offering Sex and Relationship Education (SRE) as part of their PSHE curriculum. Local authorities offer age appropriate information and resources to primary and secondary schools to deliver SRE.

Voluntary and community organisations offer wider sexual health services such as support for victims of domestic and sexual abuse as well as sexual exploitation. Others offer support to MSM and LGBT groups. Teesside Positive Action (TPA) is commissioned by Sexual Health Teesside to provide sexual health awareness, advice, support, testing to vulnerable groups in Teesside.  

Helen Britton House is the Sexual Assault Referral Centre (SARC) for victims of sexual assault and rape in Teesside. This was developed in 2007 in partnership with Cleveland Police, the health service and the voluntary sector. The centre offers advice and support to victims and is fully equipped to provide forensic examination, emergency contraception, STI testing and PEPSE if indicated.

HIV and STI testing

The sexual health service provides free and open access to HIV and STI testing in hub and spoke clinics. Teesside Positive Action offers rapid HIV testing in their Middlesbrough clinic and a range of satellite clinics.

STI and HIV testing has almost doubled between 2010 and 2014. The uptake and coverage of HIV testing was generally lower than average but average for MSM.

Chlamydia testing

Chlamydia testing as part of the National Chlamydia Screening Programme for young people aged 15-24 years is offered through a wide range of sexual health services including hub, spokes, outreach and subcontracted GP and Pharmacies. Youth services and teenage pregnancy services also provide chlamydia testing.


C-card schemes offer free condoms to young people aged 16-24 years to prevent STIs and unwanted pregnancies. A local authority run C-card scheme is co-ordinated through the teenage pregnancy prevention co-ordinator and offers the C-card scheme through youth services. Sexual Health Teesside has introduced a pharmacy based C-card scheme.

Long acting reversible contraceptives (LARC)  

LARC are offered through sexual health clinics and GP practices. A considerable number of GP practices deliver LARC on behalf of the sexual health service.

Emergency hormonal contraception (EHC)

Emergency hormonal contraception is offered free of charge from all sexual health clinics and through all subcontracted pharmacies in Teesside.

Location and utilisation of sexual health services

The four service hubs currently (January 2016) are located at:

  • Redcar Primary Care Hospital;
  • One Life Health Centre in Hartlepool;
  • Lawson Street Health Centre in Stockton-On-Tees; and
  • North Ormesby Health Village in Middlesbrough.

All hubs offer extended opening times (9am-8pm) on most days of the week. Service hubs offer the full range of community contraceptive and GUM services which are provided by nursing and medical staff. Current (January 2016) spoke or satellite clinics in Middlesbrough are located at the Cleveland Health Centre, Park Surgery and Endeavour practice offering 20h of clinic time per week 

Table 6 Opening times of hub and service spokes in 2015. Sexual Health Teesside 2015

Outreach in Middlesbrough is currently provided in five schools and colleges:

  • Ormesby Comprehensive
  • Unity City Academy
  • Middlesbrough College 

A sexual health information and vending machine for distribution of free condoms and chlamydia kits to registered users has been installed at Teesside University in Middlesbrough.

20 general practices in Middlesbrough are working with Sexual Health Teesside to provide a range of sexual health services such as chlamydia testing and fitting of IUD & IUS.

37 community pharmacies in Middlesbrough are working with Sexual Health Teesside to provide sexual health services such as emergency contraception and chlamydia screening.  A pharmacy based C-card scheme has been introduced in community pharmacies in 2014/15.

Sexual health service utilisation

The utilisation of sexual health services by the population of Middlesbrough is comparatively high particularly for the population aged 15-44.


Figure 18 Proportion of population accessing sexual health services by local authority 2013-2015. TVPHSS 2015

The service hub at the North Ormesby Health centre is very popular with patients from across Teesside accessing this service. A more detailed analysis shows that the sexual health service hub at North Ormesby Health Centre is used mostly by those living in relative proximity including Middlesbrough residents but also Redcar residents living in Eston, Grangetown and Southbank.  

Table 9: Service utilisation at North Ormesby Health Village (hub) in Middlesbrough by Teesside residents. Source Sexual Health Teesside April 2013 – March 2015

Last updated: 09/06/16

6. What is the projected level of need?

Over 78% of the burden of disease in sexual health is in young people. The Office of National Statistics (ONS) projects a slight decrease in the number of young people aged 15-25 years by 2020, but an increase back to current numbers afterwards.

The burden of disease from STIs (except Chlamydia) is comparatively low and below the average in the North East and across England. Middlesbrough ranks 8 out of 12 local authorities for new STIs diagnoses.

Teenage pregnancies in Middlesbrough have decreased by a 22% between 1998 and 2012 and remain well above the national average.  

Utilisation of sexual health services for people living in Middlesbrough is comparatively high particularly for young people but also for the population aged 15-44.

Last updated: 14/12/15

7. What needs might be unmet?

Access to services based in Middlesbrough is very good in central and East Middlesbrough but less good in the South. The current location of hub and spoke clinics does not meet the need of residents in the South of Middlesbrough.

Access to services for young people and vulnerable groups is not equitable across the area, with limited outreach provision in schools, colleges and other settings or vulnerable/ at risk groups.

The utilisation of long acting reversible contraceptives could be higher particularly in young women and following termination of pregnancies.

Information and advice on clinics, opening hours and available services is not readily available or not always up to date.

Sexual health needs of vulnerable/at risk groups living in Middlesbrough including those with learning disabilities, homeless people and people with BME, traveller or Roma background  are not well understood und require further attention.

Last updated: 14/12/15

8. What evidence is there for effective intervention?

The following list gives an update on relevant guidance and clinical guidelines for the prevention, management and treatment of STIs and unwanted conceptions.

Prevention and health promotion

  • UK National Guideline on Safer Sex Advice (BASHH & BHIVA) 2012 
  • Prevention of Sexually Transmitted Infections and Under 18 Conceptions. (NICE PH3) 2007
  • C-card Distribution Scheme. (PHE and Brook) 2014

Contraception and abortion

Sexually transmitted infections


  • UK National Guidelines for HIV Testing. (BHIVA) 2008
  • UK Guideline for the Use of Post-Exposure Prophylaxis for HIV following Sexual Exposure. (BASHH) 2011
  • Position Statement on the Use of Antiretroviral Therapy to Reduce HIV Transmission. (BASHH and EAGA) 2014
  • Recommended Change of HIV Post Exposure Prophylaxis (EAGA) 2014
  • HIV Testing. (NICE LGB 21) 2014
  • Increasing the Uptake of HIV Testing Among Men who have Sex with Men. (NICE PH 34)  2011
  • Increasing the Uptake of HIV Testing Among Black Africans in England. (NICE PH 33) 2011


  • Research Governance Framework for Health and Social Care (DH) 2005
  • Domestic Violence and Abuse – how Services can Respond Effectively. (NICE PH50) 2014
Last updated: 14/12/15

9. What do people say?

A consultation with the general public, young people, service users, service providers and a wide range of other stakeholders, was undertaken across Teesside during the months of May and early June 2015. A total of 1063 people contributed views to the consultation through questionnaires, interviews and focus groups. 

The consultation focussed largely on perceptions relating to the successful elements of the current service, challenges facing the current service, opportunities to improve the current service and preferences and priorities for future services.

  • Main source of information about services was internet and though leaflets and posters in GP surgery
  • Main barrier to access services was ‘feeling embarrassed’ (32%), and not knowing where services were available (24%)
  • 90% rated the Sexual Health Service as good, 75% as ‘excellent’ or ‘very good’ 
  • 80% of users were completely satisfied  with service received
  • 90% were happy with appointment making process and location of clinics
  • Respondents preferred clinics close to home and showed a preference for services delived in GP practices and pharmacies followed by sexual health clinics
  • Respondents expressed a preference for walk in clinics and criticized long waiting times in some locations

Young people said that

  • 70% felt very well informed about how to avoid STIs
  • 73% felt very well informed how to avoid unwanted pregnancies
  • 54% felt very well informed where to get free condoms
  • 85% felt very well informed were to get a free sexual health checks
  • 48% felt very well informed where to get a free pregnancy test
  • Young people would like to find out about sexual health service in schools and colleges (41%), social media (29%) and apps (22%).
Last updated: 14/12/15

10. What additional needs assessment is required?

A sexual health needs assessment for Teesside has been conducted in 2013 and can be found at (display only www. and add hyperlink).

The sexual health needs assessment identified the need for a number of more focused needs assessments including needs of young people in or leaving care, people with learning difficulties, BME groups, sex workers and homeless people.

Last updated: 14/12/15

Key contract

Name: Dr Tanja Baun

Job title: Consultant in Public Health


Phone number: 01642 745286    

Contributor: James O’Donnell/ Joe Chidanyika/ Jacky Booth



North East Annual STI Report. 2015 Surveillance Report. Data for 2014. Field Epidemiology Services- Public Health England Centre North East. 2015

North East Quarterly Sexual Health Bulletin. Field Epidemiology Services- Public Health England Centre North East. Q1-4  2014, Q1 2015

Spotlight on STIs in North East Public Health England Centre. Field Epidemiology Services- Public Health England Centre North East. 2015

Local Authority sexual health epidemiology (LASER):2014. Public Health England. 2015

Sexual Health and Reproductive Profile. Public Health England. 2015

Tees Sexual Health Needs Assessment. Tees Valley Public Health Shared Service. 2014

HIV in the North East. 2014 data. Epidemiology Services- Public Health England Centre North East. 2015


Policy, Public health and clinical guidance

Health promotion for sexual and reproductive health and HIV. Strategic action plan, 2016 to 2019. PHE 2015

A Framework for Sexual Health Improvement in England. Department of Health. 2013

Making it work. Public Health England. 2014

C-card distribution scheme. Public Health England and Brook. 2014

Chlamydia screening . Public Health England. 2014

Long acting reversible contraception. CG 30. NICE 2014

Contraceptive services with a focus on young people up to 25. PH51. NICE 2014

Domestic abuse screening in health services. PH50. NICE 2014

Contraceptive services. LGB17. NICE 2014

HIV testing. LGB 21. NICE 2014

Standards for the management of sexually transmitted infections. BASHH. 2014

Guidance on testing MSM. BASHH. 2014

Guidance on treatment of molluscum contagiosum. BASHH. 2014

Position statement on the use of antiretroviral therapy to reduce HIV transmission. BASHH and EAGA. 2014

Recommended change of HIV post exposure prophylaxis. EAGA. 2014

Progesterone only implants.  FSRH. 2014

Male and female sterilisation.  FSRH. 2014

Contraceptive choices for women with cardiac disease. FSRH. 2014

Review of EHC containing Levonorgestrel or Ulipristal. European Medicines Agency. 2014