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 10:42:00
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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.
  • The number of new HIV diagnoses is very low but the proportion of late diagnoses in HIV among those is high.
  • Teenage pregnancy rates in Redcar and Cleveland are higher than the England average although teenage pregnancy rates have declined by 39% since 1998.
  • Repeat abortions in Redcar and Cleveland are high.
  • Long acting reversible contraceptives (LARC) are comparatively well used. Encouraging their use is key to reducing teenage pregnancy and repeat abortion rates.
  • Service utilisation in Redcar and Cleveland clinics is low with many residents attending services in neighbouring local authority (Middlesbrough).
  • The rural nature of many areas in East Cleveland  means access to sexual health services for local residents is limited, especially for those relying on public transport.
  • Awareness and information of availability, location and opening hours of sexual health clinics is limited.
  • There are gaps in the provision of sexual health advice and sex and relationship education though schools, colleges and youth centres.
  • Leadership and provision of sexual health promotion and prevention is limited.
Last updated: 09/06/16

2. What commissioning priorities are recommended?

2015/01

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.

2015/02

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.

2015/03

Improve access to services by reviewing the opening times and locations of sexual health service clinics (hub and spoke) with relocation of these where required, to ensure improved access, particularly for people living in East Cleveland.

2015/04

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.

2015/05

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.

2015/06

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

2015/07

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

2012 COMMISSIONING PRIORITIES

2012/01

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 Under 18 conceptions have declined since 2012 but remain above the regional and national average)

 

2012/02
Reduce sexually transmitted infections and HIV by increasing testing in high risk groups, maximising service contacts and contribute to regional work to reduce the late diagnosis of HIV. (Update 2015 Work continues to reduce STIs and HIV as well as late diagnosis)

2012/03
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 sexual health service clinics have achieved ‘You are welcome’ status, there is good outreach provision across schools in Redcar and Cleveland, the improvement of sex and relationship and risk taking behaviour education remains a priority)

2012/04

Improve equity of service provision across Redcar & Cleveland.(Update 2015 Service locations have been reviewed, resulting in changes to clinic locations and implementation of further services in pharmacies, service provision in rural East Cleveland remains a priority)

2012/05

Improve the quality of sex and relationship education by providing a programme of workforce development for those working with young people.  This should ensure young people (aged 11 to 16, or up to age 25 if the young person has a disability or struggles to learn) receive education, advice and information in relation to their health and wellbeing especially in relation to risk-taking behaviours, including from services such as housing and employment. (Update 2015. This remains a priority).

2012/06
Increase long-acting reversible contraception (LARC) provision and ensure the workforce is trained to offer and provide LARC. (Update 2015. High utilisation of LARC, continuous and new training for LARC remains a priority)

Last updated: 09/06/16

3. Who is at risk and why?

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.

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 Redcar and Cleveland in 2014. Data source: GUMCAD

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

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 2013, Redcar and Cleveland achieved a diagnosis rate of 1,471.

 


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 Redcar and Cleveland 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

Gonorrhoea

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. Redcar and Cleveland had the lowest rate of gonorrhoea diagnoses in the North East with 24.5 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 Redcar and Cleveland has increased; however, this has been at a slower pace than in other areas in Tees Valley and the North East.

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

Syphilis

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 shows 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 Redcar and Cleveland are the lowest in Tees Valley. Rates declined between 2009 and 2012 and have increased slowly since 2012.

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

Genital warts and herpes

The rates of genital warts  and genital herpes have gradually increased since 2009. Nationally, there has been a drop of genital warts and a slight increase in genital herpes. Compared to other local authorities and national average, the rates of genital warts and herpes in Redcar and Cleveland are low.

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 2015

HIV

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. 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 Redcar and Cleveland was significantly lower than the North East and national 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 Redcar and Cleveland was 50%. However, this needs to be considered in relation to the very low incidence and prevalence rates.

 

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 Redcar and Cleveland is low. In 2014, the diagnosed HIV prevalence rate was 0.25 per 1,000 compared to 0.61 per 1,000 in the North East and 1.32 per 1,000 in England. 

Reproductive health

Conceptions

The number of conceptions in Redcar and Cleveland in 2013 was 1,783. Approximately 19% of these led to an abortion. The conception rate was 74.4 (per 1,000 population) compared to 78.8 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. Redcar and Cleveland achieved a similar (39.3%) reduction during the same time period. The teenage pregnancy rate in 2013 was 33.5 (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

Figure 14 Teenage conception rates 2000-2013. Data source. ONS conception and neighbourhood statistics. 2015

In Redcar and Cleveland, the proportion of teenage pregnancies leading to abortion (40.7%) in 2012 was lower than the national average (49.1%).

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 39.9% of women who visited the sexual health service for the first time for contraception. This was higher than the England  of 31% and similar to 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 Redcar and Cleveland was below the regional and above the 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, 1071 cases in Redcar and Cleveland received EHC.

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

Abortions

Many abortions could be prevented by better knowledge and access to contraception. Abortion rates for under 18-year-olds in Redcar and Cleveland in 2013 were similar to 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 Redcar and Cleveland (77.8%) is 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 (39.6%) and particularly those over 25 (50.3%) years are higher in Redcar and Cleveland, compared to national average of 37.6% for all age groups and 45.6% for over 25s.

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.

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 Redcar and Cleveland in 2014. Data source: GUMCAD

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

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 2013, Redcar and Cleveland achieved a diagnosis rate of 1,471.

 


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 Redcar and Cleveland 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

Gonorrhoea

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. Redcar and Cleveland had the lowest rate of gonorrhoea diagnoses in the North East with 24.5 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 Redcar and Cleveland has increased; however, this has been at a slower pace than in other areas in Tees Valley and the North East.

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

Syphilis

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 Redcar and Cleveland are the lowest in Tees Valley. Rates declined between 2009 and 2012 and have increased slowly since 2012.

w just below the national average.

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

Genital warts and herpes

The rates of genital warts  and genital herpes have gradually increased since 2009. Nationally, there has been a drop of genital warts and a slight increase in genital herpes. Compared to other local authorities and national average, the rates of genital warts and herpes in Redcar and Cleveland are low.

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 2015

HIV

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 Redcar and Cleveland was significantly lower than the North East and national 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 Redcar and Cleveland was 50%. However, this needs to be considered in relation to the very low incidence and prevalence rates.

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 Redcar and Cleveland was low. In 2014, the diagnosed HIV prevalence rate was 0.25 per 1,000 compared to 0.61 per 1,000 in the North East and 1.32 per 1,000 in England. 

Reproductive health

Conceptions

The number of conceptions in Redcar and Cleveland in 2013 was 1,783. Approximately 19% of these led to an abortion. The conception rate was 74.4 (per 1,000 population) compared to 78.8 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. Redcar and Cleveland achieved a similar (39.3%) reduction during the same time period. The teenage pregnancy rate in 2013 was 33.5 (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 Redcar and Cleveland, the proportion of teenage pregnancies leading to abortion (40.7%) in 2012 was lower than the national average (49.1%).

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

In Redcar & Cleveland, 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 39.9% of women who visited the sexual health service for the first time for contraception. This was higher than the England  of 31% and similar to 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 Redcar and Cleveland was below the regional and above the 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, 1071 cases in Redcar and Cleveland received EHC.

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

Abortions

Many abortions could be prevented by better knowledge and access to contraception. Abortion rates for under 18-year-olds in Redcar and Cleveland in 2013 were similar to 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 Redcar and Cleveland (77.8%) is 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 (39.6%) and particularly those over 25 (50.3%) years are higher in Redcar and Cleveland, 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 increased 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 

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 (as of Jaunary 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.  As of January 2016, spoke or satellite clinics in Redcar and Cleveland are located in Eston, Guisborough and Saltburn and altogether offer 12 hours of clinic time per week. 

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

Outreach in Redcar & Cleveland is currently provided in five schools and colleges:

  • Laurence Jackson School in Guisbrough;
  • Prior Pursglove College in Guisborough;
  • Freeborough Academy in Brotton;
  • Hillsview Academy in Eston; and
  • Redcar College.

Other outreach clinics are located at:

  • ‘Tuned In’ in Redcar;
  •  Saltburn Children’s Centre;
  •  Greystones/EOTAS; and
  • Marske Clinic.

A sexual health information and vending machine for distribution of free condoms and chlamydia kits to registered users has been installed in Redcar College.

16 general practices in Redcar and Cleveland are subcontracted by Sexual Health Teesside. All subcontracted practices offer chlamydia testing and fitting of IUD & IUS, but only 56% offer LARC implants.

27 community pharmacies in Redcar and Cleveland 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

Utilisation of sexual health services by the population of Redcar and Cleveland is comparatively low. Possible explanations are the lower STI rates, lack of awareness of local services and/or barriers to access of existing services e.g. in rural communities.  

 

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

The service hub at the Redcar Primary Care Hospital is less popular than other service hubs. A significant proportion of Redcar and Cleveland residents seek treatment at the Middlesbrough Hub and a smaller proportion at the hub in Stockton-On-Tees.

The service hub at Redcar Primary Care hospital is predominately used by Redcar and Cleveland residents and to a lesser extent by Middlesbrough, Stockton-On-Tees and Hartlepool residents.

A more detailed analysis shows that the sexual health service hub at Redcar and Cleveland Primary Care Hospital is use more by those living in relative proximity. It also shows that Eston residents are among those least likely to use the hub in Redcar.

Last updated: 09/06/16

6. What is the projected level of need?

Over 70% 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 lower than in other local authorities in the North East and across England. Redcar and Cleveland ranks in lowest third of local authorities for all STIs.

Teenage pregnancies in Redcar and Cleveland have decreased by a third between 1998 and 2012, but remain above the national average.  

Utilisation of sexual health services for people living in Redcar and Cleveland is comparatively low. Many Redcar and Cleveland residents access services in Middlesbrough, whilst services based in Redcar and Cleveland are not used to full capacity.

Last updated: 14/12/15

7. What needs might be unmet?

Access to services based in Redcar and Cleveland is lower than expected, with a significant proportion of patients visiting services in Middlesbrough. The current location of hub and spokes as well as a lack of services in rural areas are possible causes for this utilisation pattern.

Access to services for young people and vulnerable groups is not equitable across the area, particularly for people living in rural areas where services are less easy to access e.g. because of transport.

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

HIV

  • 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

Other

  • 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 http://www.teespublichealth.nhs.uk/document.aspx?id=10393&siteID=1012 (display only www. teespublichealth.nhs.uk 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. The needs assessment has also highlighted particular needs in the rural parts of Redcar and Cleveland.

Last updated: 14/12/15

Key contract

Name: Dr Tanja Baun

Job title: Consultant in Public Health

Email: tbraun@nhs.net

Phone number: 01642 745286    

Contributor: James O’Donnell/ Katrina Jackson/ Jacky Booth

References

Data

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