PLYMOUTH SEXUAL HEALTH NEEDS ASSESSMENT 2015 Author: Public Health, Office of the Director of Public Health, Plymouth City Council Date: March 2016 (v1.0) This document is produced as part of Plymouth’s Joint Strategic Needs Assessment. Document information Document status Draft / Final draft / Final Author Public Health Document version v1.0 Original document date 08 March 2016 Amendment record Version Date Reason(s) for change Pages affected Public Health Office of the Director of Public Health Plymouth City Council Windsor House Plymouth PL6 5UF Tel: 01752 307346 [email protected] Date: March 2016 (v1.0) Prepared by: Laura Juett and Sarah Macleod For queries relating to this document please contact: [email protected] or [email protected] © Public Health 2016 Page 2 of 92 Contents 1. Introduction ............................................................................................................ 5 1.1 Purpose of the Sexual Health Needs Assessment............................................................ 6 1.2 Methodology ............................................................................................................................. 6 2. Background ............................................................................................................. 7 2.1 Policy framework ..................................................................................................................... 7 2.2 Clinical and best practice guidance ...................................................................................... 8 2.3 Integrated sexual health services .......................................................................................... 9 2.4 Local policy framework ....................................................................................................... 11 2.5 Commissioning arrangements ............................................................................................ 11 3. Demography and population .............................................................................. 14 3.1 Population ............................................................................................................................... 14 3.2 Ethnicity ................................................................................................................................... 16 3.3 Deprivation ............................................................................................................................. 17 3.4 Plymouth comparators ........................................................................................................ 18 3.5 At risk groups ........................................................................................................................ 18 4. Plymouth’s sexual health profile ........................................................................ 23 4.1 Chlamydia ............................................................................................................................... 30 4.2 Gonorrhoea ........................................................................................................................... 33 4.3 Syphilis ..................................................................................................................................... 34 4.4 Herpes ..................................................................................................................................... 35 4.5 Ano-genital warts .................................................................................................................. 36 4.6 HIV ........................................................................................................................................... 37 4.6.1 HIV late diagnosis .................................................................................................... 39 5. Conceptions, contraception and abortions ....................................................... 43 5.1 All-age conceptions .............................................................................................................. 43 5.2 Teenage pregnancy (under-18 conceptions) .................................................................. 43 5.3 Contraception ....................................................................................................................... 47 5.4 Long acting reversible contraception ............................................................................... 49 5.5 Emergency contraception ................................................................................................... 49 5.6 Abortion.................................................................................................................................. 50 6. Sexual violence ..................................................................................................... 52 7. Sexual health service mapping (supply) ............................................................ 56 7.1 Contraception services ........................................................................................................ 56 7.2 Genitourinary medicine (GUM) services ......................................................................... 59 7.3 Psychosexual services .......................................................................................................... 59 7.4 Specialist HIV services ......................................................................................................... 60 7.5 Abortion services .................................................................................................................. 62 7.6 Chlamydia screening service .............................................................................................. 62 7.7 Sexual Assault Referral Centre (SARC) .......................................................................... 64 7.8 Young people’s sexual health services ............................................................................. 64 7.9 Sexual health communication and information .............................................................. 66 Page 3 of 92 8. Sexual health service activity and uptake (demand) ....................................... 68 8.1 Contraception ....................................................................................................................... 68 8.1.1 Emergency contraception ...................................................................................... 69 8.2 GUM services ........................................................................................................................ 69 8.3 Out of area service provision ............................................................................................ 70 8.4 Abortion.................................................................................................................................. 71 8.5 The Zone ................................................................................................................................ 72 8.6 Chlamydia Screening Programme...................................................................................... 74 8.7 HIV-related care .................................................................................................................... 78 8.8 The Eddystone Trust............................................................................................................ 79 8.9 Sexual Assault Referral Centre (SARC) .......................................................................... 81 9. Service user and stakeholder views ................................................................... 84 9.1 Service users .......................................................................................................................... 84 9.2 Service providers .................................................................................................................. 84 9.3 Schools Health Related Behaviour Survey 2014 ............................................................ 85 10. Commissioning framework ................................................................................ 86 11. Existing service provision .................................................................................... 89 Glossary ....................................................................................................................... 91 Page 4 of 92 1. Introduction Sexual health is an important public health priority. Good sexual and reproductive health is an essential component of positive health and wellbeing. The World Health Organisation’s working definition of sexual health is; “…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.1” The consequences of poor sexual health, including sexually transmitted infections (STIs) and unplanned pregnancies can have a lasting impact on people’s lives. STIs are communicable diseases and as such require effective clinical services and public health interventions to prevent onward transmission. The most recent figures2 suggest that new diagnoses of STIs in England might be beginning to slow. There was an overall 0.3% decrease in new