Sexual Health Needs Assessment Cheshire West and Chester • Jane Harris • Suzy C Hargreaves • Hannah CE Madden Simon Henning • Ann Lincoln • Gayle Whelan Rachel Lavin • Hannah Timpson ACKNOWLEDGEMENTS We would like to thank many people for their help with the project, including all staff who distributed questionnaires, helped organise interviews and focus groups and sent in data. We are especially grateful to those who took part in the research. We would particularly like to thank: Katie Whitehead, Jayne Fortune, the project steering group, Patricia Bowcock, Sharon Cotton-Smith, Heather Cantrill, Christopher Tomkinson, Debby Magee and Sheila Lister. 1 CONTENTS 1. INTRODUCTION ................................................................................................................... 4 National and regional perspective of sexual health ........................................................................................... 4 Profile of Cheshire West and Chester ................................................................................................................. 7 2. METHODOLOGY ................................................................................................................ 11 Aims and objectives .......................................................................................................................................... 11 Quantitative methods ....................................................................................................................................... 13 Qualitative methods ......................................................................................................................................... 15 3. EXISTING INFORMATION ON SEXUAL HEALTH IN CHESHIRE WEST AND CHESTER ........ 17 Sexually Transmitted Infections (STIs) including HIV ........................................................................................ 18 Teenage Pregnancy ........................................................................................................................................... 23 Termination of pregnancy ................................................................................................................................ 25 Fertility/infertility ............................................................................................................................................. 25 Sexual Assault ................................................................................................................................................... 26 Genitourinary Medicine (GUM) attendances ................................................................................................... 26 Integrated contraception and sexual health services (iCASH) .......................................................................... 29 General Practitioner Sexual Health Services .................................................................................................... 33 Contraception prescribing in Cheshire West and Chester ................................................................................ 40 Chlamydia screening ......................................................................................................................................... 42 4. SEXUAL HEALTH SERVICE USER SURVEY .......................................................................... 44 Demographics ................................................................................................................................................... 45 Making an appointment ................................................................................................................................... 45 Before making an appointment ........................................................................................................................ 47 Reason for visit ................................................................................................................................................. 49 Getting to the service ....................................................................................................................................... 50 Views on sexual health and sexual health services .......................................................................................... 51 5. GENERAL POPULATION SEXUAL HEALTH SURVEY ........................................................... 55 Demographics ................................................................................................................................................... 56 Knowledge of Sexual Health Services ............................................................................................................... 57 2 Service Use ....................................................................................................................................................... 59 Privacy and confidentiality ............................................................................................................................... 61 Staff Issues ........................................................................................................................................................ 62 Service issues .................................................................................................................................................... 62 General Health and Lifestyle............................................................................................................................. 64 Relationships, contraception, sexually transmitted infections (STIs) and HIV ................................................. 68 6. INSIGHTS INTO ‘SELDOM-HEARD’ GROUPS: MEN WHO HAVE SEX WITH MEN/LGBT ....73 Background ....................................................................................................................................................... 73 Findings ............................................................................................................................................................. 79 7. INSIGHTS INTO ‘SELDOM HEARD’ GROUPS: ADULTS WITH LEARNING DISABILITIES ..... 93 Background ....................................................................................................................................................... 93 Findings ............................................................................................................................................................. 98 8. INSIGHTS INTO ‘SELDOM-HEARD’ GROUPS: CARE LEAVERS ................................................ 101 Background ..................................................................................................................................................... 102 Findings ........................................................................................................................................................... 103 9. INSIGHTS INTO ‘SELDOM-HEARD’ GROUPS: GYPSY AND TRAVELLER POPULATION ..... 113 Background ..................................................................................................................................................... 113 Findings ........................................................................................................................................................... 115 10. SERVICE AUDIT ...................................................................................................................................... 119 11. RECOMMENDATIONS ......................................................................................................................... 125 General recommendations ............................................................................................................................. 131 Recommendations following consultation with ‘seldom heard’ groups ........................................................ 133 Key themes arising from the Sexual Health Needs Assessment ..................................................................... 137 References ................................................................................................................................................... 143 Appendices .................................................................................................................................................. 149 3 1. INTRODUCTION National and regional perspective of sexual health The sexual health of England has been a major concern to successive governments for over a decade, with escalating levels of sexually transmitted infections (STIs) including HIV, unplanned pregnancies leading to abortion and the highest teenage pregnancy rates in Europe. Additionally, excessive waiting times for genito-urinary medicine (GUM) services were a barrier to seeking care which also added to the spread of sexually transmitted infections. In response, a number of key documents were produced (see box 1.1) in order to improve access to services and reduce the burden of poor sexual health. Box 1.1 Summary of key sexual health documents In 2000, the Teenage Pregnancy Strategy was launched – a 10 year action plan to reduce teenage conceptions by 50% (DCFS, 2010); In 2001 the National Strategy for Sexual Health and HIV was published (DH, 2001a), the first national strategy to highlight the issues around the rising levels of STIs and HIV and poor access to services and how these issues could be reversed; In 2004, the Choosing