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Sexual Health   Download this section

The Yorkshire and Humber regional office of the Health Protection Agency produced a sexual health needs assessment for the region in 2010 (Health Protection Agency). The needs assessment identified that young people, Black Minority Ethnic communities, and men who have sex with men are key target groups for any work on sexually transmitted infection prevention.

Sexual health matters to both individuals and communities. The Government wants to improve sexual health, and its ambition is to improve the sexual health and wellbeing of the whole population. In order to achieve this, the government’s report – A Framework for Sexual Health Improvement in England aims to:

  • Reduce inequalities and improve sexual health outcomes
  • Build an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex
  • Recognise that sexual ill health can affect all parts of society – often when it is least expected.

The same report also highlights that:

  • Up to 50% of pregnancies are unplanned; these have a major impact on individuals, families and wider society
  • In England during 2011, there was one diagnosis of HIV every 90 minutes
  • Almost half of adults newly diagnosed with HIV were diagnosed after the point at which they should have started treatment
  • Rates of infectious syphilis are at their highest since the 1950’s
  • Gonorrhoea is becoming more difficult to treat, as it can quickly develop resistance to antibiotics
  • In 2011, 36% of women overall (rising to 49% in black and black British women) having an abortion, had had one before
  • In 2011, just over half of women having an abortion had previously had a live or stillbirth, indicating that better support is needed to access contraception following childbirth
  • Estimates from the Crime Survey for England and Wales indicate that there are around 400,000 female victims of sexual offences each year and, of these, around 85,000 are victims of rape (Department of Health, 2013).

The Framework for Sexual Health Improvement in England document also identifies that:

  • For every £1 spent on contraception, £11 is saved in other healthcare costs
  • The provision of contraception saved the NHS £5.7 billion in healthcare costs that would have had to be paid if no contraception at all was provided
  • National Institute for Health and Clinical Excellence (NICE) Clinical Guideline CG30 demonstrated that long acting reversible contraception (LARC) is more cost effective than condoms and the pill, and if more women chose to use these methods there would be cost savings
  • Early testing and diagnosis of HIV reduces treatment costs – £12,600 per annum per patient, compared with £23,442 with a later diagnosis
  • Early access to HIV treatment significantly reduces the risk of HIV transmission to an uninfected person

Work from the South West of England demonstrated that improvements in the rates of partner notification resulted in a reduced cost per chlamydia infection detected.

Most adults in England are sexually active. The 2010 Health Survey for England found the following:

  • Of those aged 16 to 69, 92% of men and 94% of women reported that they had ever had sexual intercourse with someone of the opposite sex.
  • Of those aged 16 to 69, 80% of men and 79% of women reported that they had had sexual intercourse with someone of the opposite sex in the past year.
  • Men reported an average of 9.3 female sexual partners in their lives so far, while women reported an average of 4.7 male sexual partners.
  • Overall, 80% of men and 86% of women reported that they had not had sex with someone of the opposite sex before the age of 16.
  • The median age at first sex with someone of the opposite sex was 17 for both men and women.
  • Of those aged 16 to 69, 1.6% of men and 1.8% of women reported that they had had sex with someone of the same sex in the past five years (Health & Social Care Information Centre, 2011).

The latest data show new Sexually Transmitted Infections (STI) diagnoses rose by five per cent in 2012 (up to 448,422 from 428,255 in 2011).

However, the continuing high Sexually Transmitted Infection rates in England suggest too many people are still putting themselves at risk through unsafe sex, especially men who have sex with men (MSM) and the young adult population.

Chlamydia remained the most commonly diagnosed Sexually Transmitted Infections (206,912; 46% of all STI’s), but considerable numbers of genital warts (73,893; 16%) and genital herpes (32,021; 7%) cases were also reported last year. New gonorrhoea diagnoses rose 21% overall (from 21,024 in 2011 to 25,525 in 2012), and by 37% in the men who have sex with men population (from 7,851 in 2011 to 10,754 in 2012).

High gonorrhoea transmission rates are concerning as the global threat of antibiotic resistance grows. Ensuring treatment resistant strains of gonorrhoea do not persist and spread remains a public health priority, and the Gonorrhoea Resistance Action Plan for England and Wales was launched by Public Health England (PHE) to help tackle this threat in early 2013 (Public Health England, 2012).

Those aged under 25 experienced the highest Sexually Transmitted Infection rates, contributing to 64% of chlamydia and to 54% of genital warts diagnoses in heterosexuals in 2012.

Young adults are advised to test for chlamydia annually, or on change of sexual partner, as part of the National Chlamydia Screening Programme to control the infection and its complications. In 2012, over 1.7 million chlamydia tests were undertaken and over 136,000 diagnoses made (Public Health England, 2013).

Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in the UK, affecting both men and women. Most people who have it will have no symptoms and would therefore probably not know anything is wrong. If you or your sexual partner are left untreated it can cause infertility (not being able to have children) and long term pelvic pain.

If you are sexually active and under 25 you should be tested for chlamydia annually. The test for chlamydia is simple – just one quick and painless test that you do yourself. You do NOT need to be examined!

The National Chlamydia Screening Programme offers access to free Chlamydia tests and is specifically aimed towards under 25 year old people who are sexually active. It is recommended that sexually active under 25 year olds are tested annually.

The full Sexual and Reproductive Health Profile data is available for York through Public Health England and is summarised below: 

These measures show that when compared to national performance figures, York has lower levels of:

  • Syphilis diagnoses per 100,000 population
  • Gonorrhoea diagnoses per 100,000 population
  • Chlamydia diagnoses per 100,000 young people aged 15 – 24
  • Proportion of population aged 15 – 24 screened for Chlamydia
  • Uptake of HIV testing among women measured in sexual health clinics (GUM clinics)
  • Uptake of HIV testing among men measured in sexual health clinics (GUM clinics)
  • Population vaccination coverage for Human Papillomavirus (HPV)

These measures also show that when compared to national data, York has similar levels of:

  • Rate of genital wart diagnoses per 100,000 population
  • Uptake of HIV testing among men who have sex with men
  • Percentage of adults newly diagnosed with a CD4 count less than 350 cells cubit millimetre (this is an indication of 'later' diagnosis where early diagnosis is preferable)
  • Cervical cancer registrations
  • Under 18’s conception rate
  • Under 18’s conception rate leading to abortion

When compared to national figures, York has worse data for:

  • Pelvic inflammatory disease admissions
  • Ectopic pregnancy admissions

When compared to national levels, York has higher rates of:

  • General practice prescribed long acting reversible contraception (LARC)

There are two measures where York is not compared against national indicators, these are:

  • Prevalence of diagnosed HIV infection per 1,000 people amongst 15 – 59 year olds
  • Sexual offences

 Sexual and Reproductive Health Profiles

Health Profile data shows that York has better than average rates of acute sexually transmitted infections – that is, York has lower rates of sexually transmitted infections than the England averages (Public Health England, 2013).

Rates for York in 2013 were 599 per 100,000 population compared to an England average of 804. The highest rate in England was 3,210 and the lowest rate was 162.

A North Yorkshire and York Sexual Health Needs Assessment was completed in July 2014 and is summarised below. The full report can be found here.

  • Rates of herpes in York are higher than the England average. Nationally genital herpes is on an upward trend although York is not as yet following this trend
  • Chlamydia is the most commonly diagnosed STI in the local population followed by genital warts, although the Chlamydia diagnostic rate across the County falls well below the recommended national target.
  • Gonorrhoea, although low numbers in North Yorkshire, is predominantly diagnosed in the male population. Gonorrhoea is over represented in Harrogate and York when compared to other districts across North Yorkshire.
  • Whilst numbers of people diagnosed with HIV in North Yorkshire and York are lower than the national average, HIV diagnosis rates in Harrogate shows an increasing trend and given the area also has high levels of gonorrhoea; it is possible that there is a risk taking population concentrated in the district. It should be noted that most women with HIV were infected through heterosexual sex whilst most men were infected through homosexual sex. 

Numbers of attendances at genito-urinary clinics is increasing by North Yorkshire residents both locally and nationally. Between 2010-11 to 2011-12, attendances by our local residents to North Yorkshire clinics increased by 8% and attendances to clinics by our local residents to clinics outside of North Yorkshire by 5%.

The table below shows the number of men who have had a sexual experience with another man projected rates from a national survey for each district by age group. There are significant health inequalities faced by this group for diseases such as Gonorrhoea and HIV. Therefore there is value in knowing where concentrations of this population are, in order to target interventions. Harrogate has the biggest number followed by Scarborough.

Men who have had a sexual experience with another man

Males - Any sexual experience or contact with another man
Area 16-24 25-34 35-44 45-54 55-64 65-74 All
Craven 175 181 237 377 408 201 1559
Hambleton 321 360 381 643 619 326 2630
Harrogate 570 651 757 1113 989 493 4541
Richmondshire 389 338 246 324 317 164 1808
Ryedale 179 171 213 362 392 204 1505
Scarborough 411 399 424 711 753 414 3101
Selby 294 344 421 618 555 253 2456
               
York 1118 1080 942 1191 1059 510 5956
North Yorkshire 2339 2443 2678 4148 4032 2054 17600
Yorkshire & Humber 23794 26464 25738 33788 30704 14393 154981
England 223191 282641 267035 339280 298604 142201 1554053

 

Women who have had a sexual experience with another woman

Females - Any sexual experience or contact with another woman

Area

16-24

25-34

35-44

45-54

55-64

65-74

All

Craven

457

422

395

391

280

95

2358

Hambleton

721

710

646

628

420

150

3754

Harrogate

1312

1460

1240

1110

674

233

6622

Richmondshire

418

511

376

317

216

72

2064

Ryedale

420

390

366

351

264

93

2197

Scarborough

1041

933

710

715

530

193

4647

Selby

789

832

689

608

370

112

3631

 

 

 

 

 

 

 

 

York

3111

2424

1482

1163

737

250

8827

North Yorkshire

5158

5256

4422

4119

2753

948

25272

Yorkshire & Humber

62020

61509

40223

32599

20567

6655

224912

England

580985

659417

420611

330642

203315

65347

2268470

 

Chlamydia

Compared to other areas in the region, North Yorkshire and York has the third lowest diagnosis rate per 100,000 population.

Chlamydia is caused by the bacterium Chlamydia trachomatis and is the most common bacterial sexually transmitted infection in England. It is most prevalent among sexually active young people. Infection is mostly asymptomatic. If untreated, Chlamydia can lead to complications including pelvic inflammatory disease, ectopic pregnancy and infertility. The national programme to control Chlamydia offers opportunistic screening to sexually active under-25s.

The NCSP commenced in 2003 with the objective of controlling Chlamydia, through the early detection and treatment of asymptomatic infection, targeting young people in the 15-24 years age group. Screening uptake has increased over the last few years in North Yorkshire, and the latest figures (2012) show that 32.7% of the highest risk population were screened. These figures are based on tests at NCSP registered sites, non-NCSP sites and GUM clinics. During 2011/12, 7.4% of those aged 15-24 screened in North Yorkshire and York tested positive for Chlamydia, similar to the national average of 7.3% yet below the Yorkshire and Humber average of 8.6%.

Gonorrhoea

Neisseria gonorrhoea is the second most common bacterial STI in the United Kingdom.it can lead to serious complications including pelvic inflammatory disease, ectopic pregnancy and infertility. Gonorrhoea can usually be effectively treated with antibiotics but this is threatened by emerging resistance to currently recommended drugs (specifically ceftriaxone and cefixime).

Young people are most commonly infected, with current rates highest in males aged 20-24 years and females aged 16-19 years. The highest rates are found in London and predominantly urban areas. Gonococcal infection tends to be concentrated in core prevention groups. In the UK these include homosexual/bisexual men and black ethnic minority populations.

In Yorkshire and the Humber region, 24% of diagnoses seen in men during 2010 were among men who have sex with men. North Yorkshire and York also share these patterns with 77% of diagnoses during 2010 being amongst the male population (of which 33% were men who have sex with men). Nationally Gonorrhoea is concentrated in urban areas and those at greatest risk include young adults, certain black ethnic minorities and men who have sex with men (MSM). However, in North Yorkshire and York, 47% of diagnoses during 2010 were amongst the 15-24 age groups and the rate of Gonorrhoea diagnoses was highest amongst the black or black British ethnic group.

Genital Herpes

Genital herpes simplex virus (HSV) infection is the most common ulcerative sexually transmitted disease in the UK. Symptoms can start with mild soreness and groups of small painful blisters appearing on the genitals and surrounding areas. Further episodes of these symptoms can occur from time to time as recurrent episodes. The virus can cause severe systemic disease in neonates (new-born infants) and the immunosuppressed and it may facilitate HIV transmission.  

Genital herpes is a major viral cause of poor sexual health. It can be effectively treated by antiviral drugs, though it can recur frequently post treatment. In rare cases, the virus can be transmitted from mother to new-born, resulting in serious infant morbidity or death.

Herpes rates nationally have been on the increase in recent years. York still remains above the national rate.

Syphilis

Syphilis is caused by a bacteria-like spirochete Treponema pallidum subspecies pallidum. Syphilis can be transmitted between partners during sexual intercourse and from an infected pregnant woman across the placenta to a developing baby.

In England, diagnoses of Syphilis have increased substantially since 1997, driven in part by outbreaks in cities such as Manchester and London. Symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis (not able to move certain parts of the body), numbness, blindness, and dementia (mental disorder). In the late stages of Syphilis, the disease damages internal organs and can result in death.

The diagnostic rate for Syphilis is predominantly low in the nation (5 people in every 100,000) For local authority areas the trend can change annually due to the small numbers involved. York demonstrated this in 2011 when rate of diagnosis rose to 6 people in every 100,000. The current rate in York is lower than national figures at just under 2 people in every 100,000.

Genital Warts

There are more than 100 types of HPV (human papillomavirus), including 40 which can infect the genital tract and are sexually acquired. Genital HPV infections are frequently asymptomatic and resolved without causing disease. However, certain HPV infections can cause cervical cancer, other cancers and genital warts. Warts are the most common viral STI diagnosed in the UK, with highest rates of new cases in 20-24 year old men and 16-19 year old women. Warts are found on or around the penis, anus or vagina. Low risk HPV types 6 and 11 cause the majority of genital warts. The number of genital warts diagnosed in the UK population has continuously risen since records began in 1971.

Genital warts nationally have shown little change over the recent years. North Yorkshire and York have followed a similar pattern to each other and the national picture over the same time period. York has been similar to the national level across this time frame and North Yorkshire always significantly below the national picture. The biggest change is that in 2012 York appeared to dip below the national level for the first time.  

HIV

The human immunodeficiency virus (HIV) is a lentivirus (slowly replicating retrovirus) that causes the acquired immunodeficiency syndrome (AIDS) a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.

HIV testing is predominantly offered through genitourinary medicine (GUM) clinics and a HIV prevention service. In 2010, 64% of women who attended genitourinary medicine clinics in York accepted the offer of a HIV test, with 68% of heterosexual men and 94% of men who have sex with men taking up the offer of HIV testing(Health Protection Agency, 2010). 

Regional data suggests that new diagnoses of HIV remain relatively low and that 48% of new cases were in the black African community, with the infection being acquired heterosexually. In spite of this, 25% of new cases were in men who have sex with men. In 2008, 35% of those diagnosed in the region presented as late diagnoses, in York this was more than 50% of new diagnoses for the period 2008-2010 and therefore more works needs to be done to diagnose HIV infections earlier.

Over the period 2002 to 2010 there has been a significant rise in the prevalence of HIV in York (Health Protection Agency, 2010). This is in line with national trends. Improvements in the management of HIV have dramatically improved peoples chances of survival and therefore the number of individuals with HIV/AIDS has increased. Currently there are 133 patients accessing treatment and care from the York service.

Cervical Cancer

Numbers of cases of cervical cancer are low. The incidence rates for 2008-10 in York was statistically significantly lower than the national average.

On the whole, the trend in incidence of cervical cancer for North Yorkshire and York has been downwards from 1993 to 2010.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (or disorder) (PID) is a term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This can lead to infertility. PID is a vague term and can refer to viral, fungal, parasitic, though most often bacterial infections.

The rate of hospital admission for pelvic inflammatory disease is increasing nationally. York has seen a decreased rate in the same time frame.

Sexual Health services are currently provided by York Hospitals Foundation Trust on a contract which expires on the 31st March 2015. 

Sexual Health Services are currently being re-procured in a joint commissioning arrangement with North Yorkshire County Council in line with Department of Health best practice guidance for Commissioning Sexual Health Services and Interventions.

SERVICE PROVISION AND ACTIVITY

Due to historical commissioning arrangements there are a large number of sexual health providers across North Yorkshire and York delivering different levels of service to different target groups. These services include:

  • Genito-urinary services
  • Contraceptive advice and support services
  • School sexual health drop-ins
  • Yorscreen – Chlamydia screening programme
  • Freetestme – web based Chlamydia testing site
  • Condom Distribution Scheme
  • HIV prevention services
  • HIV and AIDS support service
  • Level 2 enhanced sexual health services – specifically in the Craven and Scarborough area
  • Services delivered in GPs – Long Acting Reversible Contraception and Chlamydia tests
  • Services delivered in Pharmacies – Emergency Hormonal Contraception.

Genito-urinary (GU) services

York Hospitals NHS Foundation Trust currently provides GU sexual health clinics across North Yorkshire and York. Clinics are delivered in a range of settings, including:

  • Monkgate Health Centre, York
  • New Selby War Memorial Hospital
  • Heatherdene Centre for Sexual Health, Harrogate
  • Mowbray Square Medical Centre, Harrogate
  • The Mulberry Unit, Scarborough
  • Whitby Community Hospital
  • Castle Health Centre, Scarborough
  • Malton Hospital
  • Friarage Hospital, Northallerton

Clinic opening hours vary for each venue. There are a mix of drop in and appointments available. All clinic details can be accessed at www.yorsexualhealth.org.uk

Based on GUMCAD data for 2012/13 there were 10,604 new attendances and 6,441 follow-up attendances by North Yorkshire and York residents at sexual health clinics across North Yorkshire and York. There were 905 new attendances and 373 follow-up attendances by out-of-area patients at sexual health clinics across North Yorkshire and York.

Data from the service provider indicates that there is an average of 14,100 new attendances and 7,100 follow-up attendances across all patients per annum at North Yorkshire and York GU clinics.

Data from GUMCAD 2012/13 shows that there were 1591 new attendances and 514 follow up attendances at out of area clinics by North Yorkshire residents; and that there were 165 new attendances and 60 follow up attendances at out of area clinics by York residents (this does not include attendances by North Yorkshire residents at York clinics and vice versa).

 

GU Activity has been increasing locally and nationally by our residents. In area activity by NY residents increased from 2010-2011 to 2011-2012 by 8%. Out of area activity by NY residents increased from 2010-2011 to 2011-2012 by 5%.

Contraceptive Advice and Support (CASH) Services

York Hospitals NHS Foundation Trust currently provides CASH services across York and Selby. Harrogate NHS Foundation Trust currently provides CASH services for North Yorkshire (excluding Selby). Clinics are delivered in a range of settings, including:

  • Monkgate Health Centre, York
  • Acomb Health Centre, York
  • New Selby War Memorial Hospital
  • York College
  • Askham Bryan College, York
  • Selby College
  • Heatherdene Centre for Sexual Health, Harrogate
  • TRAX, Harrogate
  • Ripon Community Hospital
  • Skipton Contraception and Sexual Health Clinic
  • Bentham Contraception and Sexual Health Clinic
  • Settle Health Centre
  • Northway Contraception and Sexual Health Clinic, Scarborough
  • Yorkshire Coast College, Scarborough
  • Scarborough Sixth Form College
  • Castle Health Centre, Scarborough
  • Whitby Hospital
  • Whitby Community Centre
  • Filey School
  • Malton School
  • Norton College
  • Bedale Contraception and Sexual Health Clinic
  • Zetland House Contraception and Sexual Health Clinic, Northallerton
  • Catterick Garrison Contraception and Sexual Health Clinic
  • Richmond Contraception and Sexual Health Clinic
  • Stokesley Contraception and Sexual Health Clinic
  • Thirsk Contraception and Sexual Health Clinic

Clinic opening hours vary for each venue. There are a mix of drop in and appointments available. All clinic details can be accessed at www.yorsexualhealth.org.uk

Activity from 2012/13 shows that there were 12249 attendances at clinics provided by York Hospitals NHS Foundation Trust; and 4735 attendances at clinics provided by Harrogate NHS Foundation Trust.

Yorscreen – Chlamydia Screening Programme

York Hospitals NHS Foundation Trust currently provides the Yorscreen, Chlamydia Screening Service. The service is delivered to male and female service users under the age of 25 years (except for partner notification which will be delivered to clients of any age). The Chlamydia screening service is operated through a Central Screening Office (“CSO”) and works with a wide range of providers including GP practices, community pharmacists, contraceptive and sexual health (CASH) services, local authority youth services, termination of pregnancy services, voluntary services and any other relevant services working with the service user population. The Chlamydia screening service is delivered in a range of settings across North Yorkshire and York to reach service users who do not access core services.

Access to the Chlamydia screening service is offered in other locations such as youth services, gypsy / traveller populations, military bases (“non-core locations”) to reach those who do not use core services.

Free Chlamydia testing kits can also be ordered by texting a dedicated number followed by Test, name address, postcode and age.

Freetest.me

Preventx provide the Freetest.me service which enables the eligible population to order testing kits online that are delivered through the post. Users get their results online through a secure site or via phone call. Treatment is provided via the Chlamydia screening service.

Activity from 2012/13 shows that 14,300 screens were provided through the YorScreen service (including those delivered via GP practices) and Freetest.me (of the 14,300, 860 were via Freetest.me). An additional 14,000 screens were provided through GU and Laboratory reports. This is a total of 28,300 screens. In order to achieve a diagnostic rate of 2,300 per 100,000 population as recommended in national guidance it is estimated (based on current positivity rates of 7%) that approximately 22,200 screens in North Yorkshire and 11,100 screens in York are required.

Condom Distribution Scheme (CDS)

The CDS targets young people 24 years and under. In addition other target groups include gay and bisexual men, known injecting drug users, GUM clinic attendees, sex workers, homeless people, people travelling abroad or holiday and any other group based on local need.

A wide range of organisations and professionals working with the target audience have signed up to the CDS to promote condom use. There are currently 45 organisations signed up in York.

HIV Prevention Services

Mesmac currently provides HIV prevention services across North Yorkshire and York.

The HIV prevention service is targeted at populations at high risk of HIV infection (black Africans, MSM, sex workers and LGBTQ adults and young people) in North Yorkshire and York. The service currently provides:

  • Advice, counselling and information about HIV and STIs, routes of transmission, treatment, post-exposure prophylaxis for HIV following sexual exposure (PEPSE), safer sex and locally accessible sexual health services.
  • Training on HIV and STIs, routes of transmission, safer sex, treatment and PEPSE. 
  • Testing for HIV, Hepatitis B and (in under 25s) Chlamydia (with pre and post-test discussion) in locally accessible settings with referrals to diagnostics and management/ treatment as appropriate.
  • Free condoms, lubricants and other safer sex resources (guidance for use).
  • Support to access Hepatitis B immunisation.
  • Awareness raising in key target groups and allied health professionals to prevent HIV transmission and promote early diagnosis.

In 2012/13 the service worked with 667 new service users (in receipt of structured services including training and online peer support); and 149 repeat service users (in receipt of structured services). They provided training for 318 service users; and 305 professionals/ front-line staff. The service delivered 157 HIV point of care tests; and distributed 12,286 condoms.

HIV and AIDS Support Service

North Yorkshire Aids Action (NYAA) currently provides a service across North Yorkshire and York that responds to requests for generic information on the prevention of sexually transmitted diseases and safer sex practice. NYAA signposts into specialist sexual health services where required.

NYAA is the expert local resource on HIV and responds to requests for specialist information on HIV (e.g. its transmission, treatment, LT problems and living with HIV).

One to one support and a package of care of health and social care support (following a full assessment of need) are provided. This is in line with service user needs, which is reflective of their stage of diagnoses and treatment.

An outreach and home visiting service is offered to service users who are socially isolated or require more high levels of support.

Over the course of a year NYAA provides support to an average of 158 people who are HIV positive or are carers of people who are HIV positive. Ninety eight of these people are North Yorkshire residents, and 60 are York residents. The levels of support provided are as follows:

  • Level 1 – high level service, all newly diagnosed and assessments carried out
  • Level 2 – regular contact (visits/ drop in/ groups) and allocated to support workers
  • Level 3 – maintenance, on books (birthday cards etc.)
  • Level 4 – registered with NYAA at some point, no regular contact needed at this point

At 30 September 2013, Level 1 support was provided to 43 people who were HIV positive, and 10 carers. Level 2 support was provided to 51 people who were HIV positive, and 28 carers. Level 3 support was provided to 31 people who were HIV positive and 6 carers. Level 4 support was provided to 40 people who were HIV positive and 7 carers.

Services Delivered in GP Practices

A proportion of GP practices have signed up to across North Yorkshire and York currently provide provision of Long Acting Reversible Contraceptives (LARC) and Chlamydia screening. This service is delivered outside of the General Medical Service (GMS) contract.

Seventy four GP practices are currently signed up to deliver LARC in North Yorkshire. Based on activity to date in 2013/14 it is estimated that in North Yorkshire there are 2,532 IUD/IUS insertions and 2,560 implants provided annually.

Seventy six GP practices are currently signed up to deliver Chlamydia screening in North Yorkshire. Based on activity to date in 2013/14 it is estimated that in North Yorkshire there are 1,836 screens and 132 treatments provided annually. The remaining activity is provided via Yorscreen.

Of the eighteen GP practices in York, 17 are currently signed up to deliver LARC. Based on activity to date in 2013/14 it is estimated that in York there are 874 IUD/IUS insertions and 812 implants provided annually.

Eighteen GP practices are currently signed up to deliver Chlamydia screening in York. Based on activity to date in 2013/14 it is estimated that in York there are 662 screens and 24 treatments provided annually. The remaining activity is provided via Yorscreen.

Services Delivered in Pharmacies – Emergency Hormonal Contraception

A proportion of community pharmacies across North Yorkshire and York have signed up to supply the Emergency Oral Hormonal Contraception (EHC). This Service is delivered via a Patient Group Direction (PGD) free of charge to service users aged 14 years to 24 years inclusive.

Service users excluded from the PGD criteria are referred to another local service that is able to assist them, as soon as possible, e.g. GP, community contraception service,or are invited to purchase the pharmacy medicine product if the exclusion from supply via the PGD is only due to their age.

Fifty seven pharmacies are currently signed up to deliver EHC in North Yorkshire. Based on activity to date in 2013/14 it is estimated that in North Yorkshire there are 900 consultations for EHC annually with the target age group.

Of the forty-one pharmacies in York, 19 are currently signed up to deliver EHC. Based on activity to date in 2013/14 it is estimated that in York there are 1074 people within the target age group given EHC annually.

Source:  North Yorkshire & York Sexual Health Needs Assessment (2014)

A comprehensive engagement exercise to find out service provider, current service user, potential service user, and stakeholder views and thoughts on current and future sexual health service provision was run during the months of August–October 2013. The full engagement report can be found on www.nypartnerships.org.uk/sexualhealthservices.

This review highlighted the following:

  • Service users reported positive experiences of services they received, noting they were flexible, responsive and delivered by competent and friendly staff.
  • There is variation in both geographical service coverage and access to sexual health services particularly in rural areas. This means provision is fragmented and that the full range of sexual health services are not available in all localities. There are also issues around variation in opening times and different booking systems. All these issues create significant barriers to accessing services.
  • Residents do not always receive seamless care if the service they access cannot provide a full range of services. This means sometimes they have to make another appointment with a different service provider in another location.
  • There are variations in sexual health outcomes across localities and for high risk groups (young people and MSM).

The review also highlighted the areas that need to be addressed:

  • Improved integration between all levels of sexual health services and the sexual health workforce.
  • Better communication and a stronger interface between all sexual health services provided in each area.
  • Delivery of a co-ordinated and resourced training programme to professionals providing sexual health services.
  • Wider and better use of technology to improve access and increase awareness of services especially among young people and other most at risk groups.
  • Strengthened focus on prevention and early diagnoses with services utilising opportunities to also address wider lifestyle issues which may affect sexual health behaviours such as alcohol use and mental health issues.
  • Improved marketing and publicity of services.
  • More flexibility in service opening times and innovation in service delivery to ensure rapid and easy access in services, even in rural areas.

Despite efforts to control STIs, including the improved availability and update of sexual health screening, we are not seeing a significant impact on numbers of STIs diagnosed with some STI rates continuing to rise. Whilst some of the increase is associated with more testing e.g. Chlamydia and more diagnostic sensitivity, it is clear that high rates of infection persist in population groups such as men who have sex with men (MSM) and young people.

The percentage of late stage of diagnosis of new cases of HIV is concerning, and improved uptake of HIV is vital for early detection and treatment to reduce morbidity and mortality.

Existing prevention efforts, such as greater STI screening coverage and easier, more rapid access to sexual health services need to be sustained and improved in some localities to support earlier diagnosis and prevent onward transmission. These efforts need to be focussed on high risk groups in particular.

LARC is the most effective form of contraception. Provision of LARC services is good across North Yorkshire and maintaining and skilling up healthcare professional to support people to make informed choices about contraception and fit and remove LARC needs to be ensured.

Whilst good progress has been made on teenage pregnancy rates across North Yorkshire, more needs to be done in certain areas and work in other areas sustained to identify and support young people at risk of teenage pregnancy.

Control of STIs requires an integrated response from all relevant agencies. Given the responsibility that the Local Authority now has to protect its population from sexual health diseases, it needs to build on the existing good work that has previously occurred.




References

This page was last updated on 20 April 2015
This page will be reviewed by 20 April 2016