Leicestershire and Rutland Sexual Health Needs Assessment October 2015 Vivienne Robbins, Janet Hutchins, Katie Philips and Natalie Greasley Acknowledgements We would like to thank many people for their help with completing this sexual health needs assessment including all staff who provided data, distributed questionnaires, helped organise focus groups and participated in the visioning event in July 2015. We would also particularly like to thank Toni Burnett, Helen Tasker and Annette Wicks for proof reading the document and organising the visioning event and other meetings. Leicestershire and Rutland Sexual Health Needs Assessment October 2015 1 Contents 1. Introduction ............................................................................................ 5 1.1 National Context .......................................................................................... 6 1.1.1 Health and Social Care Act (2012) ...................................................................... 6 1.1.2 Healthy lives, healthy people – our strategy for public health in England (DH, 2010) .................................................................................................................... 7 1.1.3 A Framework for Sexual Health Improvement in England (DH, 2013) ................ 8 1.1.4 Making it Work: A Guide to whole system commissioning for sexual health, reproduction health and HIV (PHE, 2015) ........................................................... 9 1.1.5 All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (2015) ................................................................................................................. 10 1.2 Local Context ............................................................................................ 12 1.2.1 Leicestershire County Council Strategic Plan - 2014 to 2018 (LCC, 2014)17 .... 12 1.2.2 Rutland County Council – Strategic Aims and Objectives – 2012 to 2016 (Rutland CC, 2012) ............................................................................................ 12 1.2.3 Prevention Review ............................................................................................. 13 1.2.4 Implications on sexual health ............................................................................. 15 2 Methodology ......................................................................................... 16 2.1 Aim & objectives ....................................................................................... 16 3 Demography of Leicestershire and Rutland....................................... 19 3.1 Age ............................................................................................................. 19 3.2 Ethnicity ..................................................................................................... 20 3.3 Sexual Orientation .................................................................................... 21 3.4 Area Classification .................................................................................... 21 3.5 Migration .................................................................................................... 22 3.6 Deprivation ................................................................................................ 22 3.7 Education ................................................................................................... 24 3.8 Employment ............................................................................................... 24 3.9 Implications for sexual health .................................................................. 25 4 Groups at High Risk of Poor Sexual Health ....................................... 27 4.1 Drug users ................................................................................................. 27 4.2 Alcohol ....................................................................................................... 27 4.3 Sex workers ............................................................................................... 28 4.4 Mental Health Conditions and Wellbeing ................................................ 29 4.4.1 Stigma and embarrassment ............................................................................... 29 4.4.2 Victims of Sexual Assault ................................................................................... 30 4.4.3 Post abortion counselling and support needs .................................................... 30 4.5 Physical disabilities .................................................................................. 30 4.6 Learning Disabilities ................................................................................. 31 4.7 Homelessness ........................................................................................... 31 4.8 Looked After Children (LAC) .................................................................... 32 4.9 Children with a Protection Plan (CPP) .................................................... 32 4.10 Implications for Sexual health services .................................................. 33 5 Sexually Transmitted Infections (STIs) ............................................... 34 5.1 Burden and trend of new STIs ................................................................. 34 5.2 Reinfection of STIs .................................................................................... 38 5.3 STI prevention groups .............................................................................. 39 Leicestershire and Rutland Sexual Health Needs Assessment October 2015 2 5.3.1 Men who have sex with men (MSM) .................................................................. 39 5.3.2 Ethnic group and county of birth ........................................................................ 40 5.4 Chlamydia Screening Programme ........................................................... 41 5.4.1 Chlamydia Screening Programme by Age and Gender ..................................... 42 5.4.2 Chlamydia Screening Programme by Location of Tests .................................... 45 5.4.3 Opportunistic Chlamydia Screens in the Integrated Sexual Health Service (ISHS) 49 5.5 GUM clinic service use ............................................................................. 54 5.5.1 Residents of Leicestershire and Rutland ........................................................... 54 5.5.2 Clinics in Leicestershire, Leicester and Rutland ................................................ 56 5.6 Sexual Health Screens .............................................................................. 57 5.7 LLR Integrated Sexual Health Service (ISHS) .......................................... 60 5.8 Implications for sexual health .................................................................. 65 6 Human Immunodeficiency Virus (HIV) ................................................ 66 6.1 Diagnosed HIV prevalence ....................................................................... 66 6.2 People living with diagnosed HIV ............................................................ 67 6.3 New HIV diagnoses ................................................................................... 68 6.4 HIV late diagnoses .................................................................................... 69 6.5 Uptake of HIV testing at eligible attendances in GUM clinics ............... 70 6.6 Coverage of HIV testing among patients at GUM clinics ....................... 71 6.7 Treatment as Prevention .......................................................................... 73 6.8 Implications for sexual health .................................................................. 73 7 Sexual and Reproductive Health ......................................................... 74 7.1 Contraception ............................................................................................ 74 7.1.1 Specialist Sexual & reproductive health services .............................................. 74 7.1.2 General practice activity: Prescribing data on contraception provision ............. 78 7.1.3 Long acting reversible contraceptives (LARCs) ................................................. 79 7.1.3.1 GP LARC provision ............................................................................................ 80 7.1.4 Emergency contraception .................................................................................. 83 7.1.4.1 EHC provision in Pharmacy ............................................................................... 84 7.2 Pyschosexual/ sex addiction ................................................................... 89 7.3 HPV Vaccination ........................................................................................ 90 7.4 Teenage pregnancy .................................................................................. 91 7.4.1 District level data ................................................................................................ 92 7.4.2 Ward level data .................................................................................................. 94 7.4.3 Births .................................................................................................................. 95 7.4.4 Delivery episodes ............................................................................................... 97 7.4.5 Leicestershire’s Teenage Pregnancy Strategy .................................................. 97 7.4.5.1 Advice and access to contraception