Resources – Page 5 – HIV Prevention England

PHE and HPE launch shigella campaign

29 June 202124 June 2021 by HPE

Public Health England (PHE) and HIV Prevention England (HPE) are launching a campaign which will focus on raising awareness of shigella amongst gay and bisexual men (GBM). Activities for the campaign will start on Monday 28 June 2021.

Shigella transmitted by sexual contact in GBM has been on the increase in England since the start of 2018. The impact of the COVID-19 pandemic in 2020 saw a reduction in diagnoses, but as England emerges from lockdown we are seeing increases in the North West and Manchester, South East and London. We’re seeking to promote the campaign in areas where we can access the GBM population and similar past scenarios have indicated are at risk of an increase, for example Brighton.

Due to the symptoms of shigella (severe diarrhoea, fever etc.), it is often diagnosed in primary care or emergency departments, rather than sexual health services (SHS).

Shigella transmitted by sexual contact in GBM is now more dominant than the travel-associated variant. It is important that health professionals look out for the signs of shigella in GBM who present symptoms, rather than relying on a recent history of travel abroad.

What is shigella?

Shigella is a bacterial pathogen which causes infection and can lead to severe diarrhoea and hospitalisation. In England infections are increasing in Brighton, London and Manchester and has been linked to transmission through sexual contact among GBM.
Shigella is an overlooked pathogen as a sexually transmitted infection and health professionals’ knowledge about it and the current situation is very low.

The campaign

This digitally based campaign aims to raise awareness of the signs, symptoms and causes of sexually transmitted shigella, and provide information to GBM who think they may have it.

The campaign is targeted to GBM in the most affected areas of England, but resources are available for all local authorities and stakeholders who are concerned about shigella in their local population.

Key messages

Have you experienced a bad case of diarrhoea after sex? It could be shigella. It is often mistaken for food poisoning and is caught from bacteria in poo getting into your mouth during sex.

Find out about shigella and what are the causes, signs and symptoms. Learn how to protect yourself and what to do if you think you have caught it after sex.

Campaign promotion and resources

From Wednesday 23 June 2021:

Download the campaign social media pack [ZIP]

Download campaign posts and links [DOC]

Share our social media assets and key campaign messages through your communications channels.
Sign-post people to http://www.sexwise.org.uk/shigella
Download and print your physical resources

Available assets

‘Maybe It’s… Shigella’ poster (size A4)
‘Maybe It’s Shigella’ leaflet (size A6, six pages)

Please email [email protected] for more information or support.

New Terrence Higgins Trust resources developed for and by trans, non-binary and gender diverse people

13 January 2021 by Kian Scott-Loach

Little is known about the sexual health needs and knowledge of trans and non-binary people making it challenging to design effective health promotion and clinical services for them. In November 2019, Terrence Higgins Trust conducted a survey in sexual health and HIV knowledge, attitudes and experience which aimed to address this.

Survey demographics

The survey was disseminated online via target advertising and through the charity’s social media channels. The survey captured experiences through quantitative and qualitative data. A total of 223 responses were collected, of which 208 were suitable for analysis.

Respondents could select multiple answers to how they described their gender. Most used more than one term or described it in multiple ways:

45% identified as non-binary
31% trans man
15% trans woman
56% genderqueer/fluid/non-conforming
16% other: trans masculine/masc, demigirl/boy, trans, neutrois, androgyne.

Nine individuals identified themselves as intersex. The age range of participants was 16 to 72. The majority of respondents described their ethnicity as White British (174).

Survey results

The survey identified a clear need to provide trans and non-binary people with sexual health information and raise awareness of the importance of testing for HIV and sexually transmitted infections (STIs):

Almost half of respondents (96) had anal/vaginal/frontal sex without a condom in the last six months; 35 had never tested for HIV and 13 had tested over two years ago.
Nearly half of all respondents (101) never tested for HIV.
33 respondents had had an STI other than HIV (16%).

Findings and recommendations for creating sexual health resources for trans and non-binary people

The survey results produced clear themes and actions to address and inform a sexual health resource for the community.

Language

Should reflect thr range of gender identities and sexualities.
Must use representative non-gendered language.

Terminology

Must avoid gendered anatomical/medical vocabulary and phrases for body parts.

HIV transmission and treatment

A lack of knowledge was identified regarding routes (bodily fluids that might contain HIV), testing and HIV treatment.

Promotion of regular testing, even if people consider their sexual practices are safe, using a ‘best to know your status’ approach.
Ensure the community are aware of home testing options (self-sampling and self-testing kits) so that individuals know where to access test kits, their ease of use and reliability.
A need to promote the effectiveness of HIV treatment, and Treatment as Prevention (TasP).

HIV Prevention: PrEP/PEP

There was an overall lack of awareness of these prevention technologies. Resources need to:

Raise awareness of the difference between PrEP and PEP.
Provide information on where to obtain PrEP and PEP.
Provide the correct dosing requirements and methods of PrEP for trans individuals and individuals who have a vagina/front hole.

STIs

STI information should cover common STIs, how they are transmitted, their symptoms, and testing and treatment options.

Additional concerns identified in the research

Additional areas for consideration should include:

Sex, drugs and alcohol.
Consent, including sex and the law, and information and support for people to understand what appropriate sexual boundaries are and when a crime may have been committed against them so that they know how and where to report it.
Signposting to relevant agencies, including trans-specific clinical and therapeutic services.

Improving access to sexual health services

Respondents gave a number of recommendations to improve access to sexual health services (SHS). Practical measures include ensuring that diverse gender options are available on forms and systems; displaying LGBT+ posters and materials in clinics so people are aware they are in a safe space; and creating gender-neutral waiting rooms.

The other key recommendations focused on training for SHS colleagues. Areas of focus identified included:

Up-to-date and inclusive information regarding trans issues and LGBTI people.
Address the impact of assumptions of patients being heterosexual, cisgender and/or non-intersex.
Online training on trans issues available at gires.org.uk with modules for GPs etc.
Respectful use of pronouns.

Key topics for inclusion in sexual health resources

As well as standard sexual health information tailored towards trans people, respondents wanted to see information on key subjects including: trans-specific clinics; raising awareness of consent; sex drive, sexuality and transition; body image and feeling good about yourself; transition and relationships; hormone treatments; contraception, fertility and pregnancy; safer sex; and upper and lower surgery.

Other areas suggested included: mental health and sex; sex and dysphoria; prevention with trans genitalia; HIV treatment interactions with hormones; cervical screening; sexual health information for women who have sex with women.

New resources

Trans and non-binary people co-produced and feature in the new online resource and information leaflet. Ensuring the resource is trusted and represents the diversity within the trans community is key to its success.

Celebrating and reflecting the diversity within the trans community, it features eight trans and non-binary people from different cultural backgrounds with different body types and identities.
The new health information is directed to the needs of trans, non-binary and gender-diverse people and provides up-to-date HIV, sexual health and contraception information and advice. This includes the impact of hormones and surgery, considerations when taking HIV prevention pill PrEP and how to navigate happy, healthy sex.

Visit Terrence Higgins Trust’s new trans-specific sexual health pages.

Sexually transmitted infections in 2019

3 September 2020 by HPE

Public Health England (PHE) has released the latest sexually transmitted infection (STI) surveillance data for 2019. Following the upward trend since 2015, STIs diagnoses have risen again and 468,342 diagnoses were made in England in 2019, a 5% increase from 2018.

Key findings

Diagnoses

468,342 diagnoses of STIs in England in 2019.
- 249,690 recorded gender ‘male’.
- 216,058 recorded gender ‘female’.
26% increase in gonorrhoea since 2018, the highest since records began in 1918.
10% increase in syphilis since 2018. In women the increase is 36%, but 81% of infections were recorded in men who have sex with men (MSM), of which almost a third (31%) were MSM living with diagnosed HIV.
7% increase in number of consultations at sexual health services.
- This is largely driven by a 84% increase in consultations reported by internet services (from 260,708 to 480,112).
11% decrease in genital warts.

Testing and screening

The National Chlamydia Screening Programme (NCSP) conducted 2% more tests in 2019 compared to 2018; however, there has been a 13% decline since 2015 (from 1,546,180 in 2015 to 1,339,913 in 2019).
181 sexual health services reported testing for Mycoplasma genitalium (M.Gen) in 2019, compared to 107 in 2018.
- This increase in testing capabilities has largely influenced the 196% increase in M.Gen diagnoses in 2019, up to 5,311.

Disproportionately impacted populations

Young heterosexuals 15 to 24 years; black ethnic minorities; and gay, bisexual and other MSM continue to report the highest rates of STIs in England.

Young heterosexuals

The majority of chlamydia diagnoses (62%) and gonorrhoea diagnoses (54%) in sexual health services were made in young heterosexuals. This group was also attributed to 41% of genital herpes diagnoses and 40% of genital warts.

MSM

Bacterial STIs are more likely to be diagnosed in MSM than other men. 81% of syphilis diagnoses were in MSM as well as 66% of gonorrhoea. The most common STIs have seen substantial increases in this population, with gonorrhoea diagnoses increasing by 26% and chlamydia diagnoses by 21%.

Of all MSM diagnosed with an STI in sexual health services in 2019, 18% were living with diagnosed HIV. A breakdown of STIs diagnosed in MSM by HIV status is provided in the graph below.

STI diagnoses among MSM by HIV status, 2010-2019

Black minority ethnic and other impacted populations

Black minority ethnic (BME) populations continue to be disproportionately impacted by STIs. In particular, the rate of gonorrhoea in BME people is 3.5x that of the general population and the rate of trichomoniasis is 9x that of the general population.
The largest proportional increase in all new STI diagnoses was in people of Asian ethnicity (16%; from 15,168 to 17,522), this was largely due to large increases in new gonorrhoea (36%) and chlamydia (27%) diagnoses.
The disparities between different ethnic groups are best seen in these images below, looking at rates of STIs for both men and women.

Rates of STI diagnoses by ethnic group among males, England 2019

Rates of STI diagnoses by ethnic group among females, England 2019

PHE has provided data based on World regions of birth, these have shown high overall increases of STI diagnoses in England with:

9% of people born in the EU,
11% of people born in North America,
12% of people born in South Asia,
16% of people born in South America,
21% of people born in Central America.

Impact of COVID-19

The latest data release does not cover the period since the COVID-19 pandemic began. However, PHE has advised that they are already analysing the surveillance data and how the impact of the COVID-19 response in England has affected HIV and STI service provision and epidemiology. Provisional findings are due in the coming months.

The latest report outlines how the national programme with PHE, Terrence Higgins Trust and 56 Dean Street delivered 10,000 free self-sampling HIV (and opt-in syphilis test) kits as part of the summer ‘Break the chain’ campaign.

PHE has also published a new national framework for e-sexual and reproductive healthcare. This provides information on how e-sexual and reproductive services can complement specialist, clinic-based facilities in local areas, providing other methods of accessing healthcare.