Sexual Health

The national framework for sexual health improvement (2013) focuses on prioritising the prevention of poor sexual health, addressing its wider determinants and meeting the needs of more vulnerable groups.

The Sexual and Reproductive Health Profiles have been developed by Public Health England to support local authorities and public health leads to monitor the sexual and reproductive health of their population and the performance of local public health related systems. The profiles provide a snapshot of sexual and reproductive health across a range of topics including teenage pregnancy, abortions, contraception, HIV and sexually transmitted infections (STIs). Wider influences on sexual health such as alcohol use, and other topics relating to teenage pregnancy such as education and deprivation level are also included. In addition, interactive maps and charts enable comparisons to be made regionally and nationally across a range of indicators relating to teenage pregnancy, abortions, contraception, sexually transmitted infections and other relevant issues.

Key findings from the national profiles were last updated on 25/07/2019 and include:

HIV and STI

Sexually transmitted infections are the main preventable cause of infertility. When left untreated, they facilitate HIV transmission by increasing both HIV infectiousness and HIV susceptibility.

Derby performs comparably with the national average across the following HIV and STI indicators:

• Rate of chlamydia diagnoses – 426 per 100,000 population
• Rate of first episode genital warts diagnoses – 97.7 per 100,000 population
• Late diagnosis of HIV – 41.7% of adults aged 15 years or more that are newly diagnosed with a HIV infection
• Rate of new HIV diagnoses – 11.2 per 100,000 population aged 15 or above
• Rate of gonorrhoea diagnoses – 93.0 per 100,000 population
• STI testing rate (excluding Chlamydia in under 25 year olds) - 18,201 per 100,000 population aged 25-64
• % of girls aged 12-13 who have received one dose of the HPV vaccine – 81.2%
• Chlamydia detection rate amongst young people aged 15-24 – 2,226 per 100,000 population aged 15-24
• HIV testing coverage amongst MSM – 87.5%
• Proportion of TB cases offered an HIV test – 100%

Derby performs significantly better than the national average across the following indicators:

• Rate of syphilis diagnoses – 4.7 per 100,000 population
• HIV testing coverage amongst men – 85.2% amongst eligible new male genitourinary medicine (GUM) attendees
• All new sexually transmitted infection (STI) diagnoses (excluding Chlamydia in under 25 year olds) – 790 per 100,000 population aged 15-64
• Overall HIV testing coverage – 71.0%
• HIV testing coverage amongst women – 62.0%

Derby performs significantly worse than the national average across the following HIV and STI indicators:

• Rate of first episode genital herpes diagnoses – 69.6 per 100,000 population
• Proportion of population aged 15-24 screened for chlamydia – 15.9%
• STI testing positivity rate (excluding chlamydia in under 25 year-olds) – 1.9%

Reproductive Health

Abortions highlight a lack of access to good quality contraception and advice, as well as problems with individual use of contraceptive methods. In Derby, the rate of abortions amongst females aged 15-44 is significantly lower than the national average (16.6 per 1,000 compared with 17.2), but higher than the regional average (14.7). However, Derby performs significantly worse than the national average for the proportion of women under 25 having an abortion after a birth (39.3%). Derby also has a high rate of ectopic pregnancy admissions – 121.4 per 100,000 amongst females aged 15-44

Derby performs comparably with the national average across the following reproductive health indicators:

• Repeat abortions in women under 25 years – 22.3%
• Rate of abortions in women aged 25 and over – 14.0%
• Rate of Pelvic inflammatory disease (PID) admissions – 246.7 per 100,000 amongst females aged 15-44
• Rate of cervical cancer registrations – 11.5 per 100,000 female population
• The percentage of abortions under 10 weeks – 76.8%

Teenage Pregnancy

Previous research suggests that teenage pregnancy is associated with poorer outcomes for both young parents and their children. Teenage mothers have a higher risk of poor mental health than older mothers, and are more likely to bring up their child in poverty. In addition, babies born to women under 20 are at a 30% greater risk of neonatal mortality and stillbirth, and a 44% higher risk of infant mortality.

Derby performs comparably with the national average across the following indicators:

• Rate of conceptions amongst females aged 13-15 – 3.3 per 1,000
• Rate of abortions amongst females aged 15-17 – 7.4 per 1,000

Derby performs significantly worse than the national average across the following Teenage pregnancy indicators:

• Rate of conceptions amongst females aged 15-17 – 22.3 per 1,000.
• Percentage of conceptions to those under 18 that led to an (41.5% compared with 52%).

Wider Determinants of Health

The wider determinants of sexual health include factors such as poverty, crime and alcohol.

Derby performs significantly worse than the national average across the following:

• Percentage of people living in the 20% most deprived areas in England – 34.6%
• Children under 16 in low income families – 21.0%
• Pupils achieving an average attainment 8 score – 42.7 Score
• Percentage of half days missed by pupils due to overall absence – 4.97%
• Rate of first-time entrants to the youth justice system – 424.6 per 100,000

Key findings for Derby from a Sexual Health Needs Assessment undertaken in Derbyshire during 2018 include:

• Derby has high rates of diagnosis for all STIs, with a slightly higher proportion of reinfection in females
• An increasing trend persists in the diagnoses of gonorrhoea
• Derby City is lower than the England average for the proportion of the target population tested for chlamydia outside of genitourinary medicine (GUM) clinics, and below the England average for diagnosis rate in all settings (15.5% of the target population tested; 11.56% of tests were positive during 2017/18).
• The prevalence of HIV in Derby has exceeded 2 per 1,000 population, (2.46 per 1,000) the number at which an area is considered to have high HIV prevalence.

Services

Sexual health is a key part of our identity and is essential to our physical and psychological wellbeing. The fundamental aspects of good sexual health are aided by access to services and information. Adequate and accessible provision contributes to equitable, positive and safe relationships and sexual fulfilment.

The Derby City Integrated Sexual Health Service is based at London Road Community Hospital. Services include: STI testing and treatment; contraception; pregnancy support; health promotion. Specific sexual health services are also provided by primary care and pharmacies, such as, the provision of Long Acting Reversible Contraception and emergency contraception.