Sexual health in Inner North West London

Sexual health in Inner North West London

Dr Paul Crook - Regional Epidemiologist – Health Protection Agency London

James Hebblethwaite - Senior Public Health Intelligence Manager, INWL PCTs

HPA London Regional Epidemiology Unit

Overview

Focussing on young people (15 to 24 yrs)Triborough demographicsSTIs – including HIVReproductive health (teenage conception, abortion)Sexual assaultService access

How do we design health promotion, testing and treatment services effectively?


Young people’s sexual health: population types

Post-school influx of residents

– students and workers

Secondary school population – 40-50% live

‘out of borough’

Daytime/night time population – visitors to

pubs/clubs/nightlife

Sexual health riskWhich groups do local services

target?

Young residents – mid to late teens

Slides from INWL PH team


Age structure of the tri-borough area

• Many families move from the area• Largely deprived population remains• Influx of students and workers post-school age

15-19 20-24 TOTAL

H&F 7,916 17,279 25,195

K&C 6,475 11,322 17,797

West 9,997 17,490 27,487

2011 Census resident population:



Ethnic and cultural profile

• Similar ethnic mix to London for 15-19 year olds (but fewer from Asian groups)• Influx of white population post school age

Main ethnic group in tri-borough area(aged 15-19 and 20-24)

Common nationalities, where 15-24 year olds

live

15-19Around 6 out of 10 from UK. Other common nationalities include: -Iraq, Somalia, Bangladesh, Philippines, Caribbean countries-- USA, Australia, European countries

20-24Around 5 out of 10 from UK. Other common nationalities include: -USA, France, China, Italy, India



Age 15-19

Age 20-24

Deprived areas: H&F: East Acton, West Kensington K&C: Latimer Road, St Charles, GolborneWestminster: Queen’s Park, Westbourne, Church Street

Student areas/ barracks:Imperial, UCL, halls of residence (South Kensington)Wellington/Hyde Park Barracks

Young people areas:H&F: White City, Shepherds Bush, Hammersmith, West Kensington K&C: South KensingtonWestminster: Soho/West End, Paddington

Student areas/ barracks:Imperial, UCL, halls of residence (South Kensington)Wellington/Hyde Park Barracks

Areas with a higher proportion of resident young people GP-registered residents



Poverty and NEETs

Purple = 20% highest in London

Child poverty

Out of work benefits

16-19 year olds NEET

• Strong geographical focus to poverty among young people locally

• Some significant areas of disadvantage


Local differencesSignificantly higher in College Park & Old Oak, Wormholt & White City, Queen’s Park, Harrow Road and Church Street

Rate, 2010 •High rate in H&F• Westminster similar to England• K&C far below

Two thirds of <18 conceptions end in abortion


Under 18 conception rate, 2010 Rate per 1,000 women aged 15-17 . Source TPU

Hammersmith and Fulham Kensington and

Chelsea

Westminster

Number of under 18 year old conceptions

2006 2007 2008 2009 2010

H&F 95 105 89 103 89

K&C 65 57 48 41 30

Westminster 83 70 81 87 81

Tri-borough 243 232 218 231 200

• Huge improvements in Kensington and Chelsea in particular


Under 18 conceptions over time Rate per 1,000 women aged 15-17 . Source TPU

Abortion rate in London(per 1,000 15-44 yr olds)

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Rate

per

1,0

00

Rate per 1,000 women aged 15-44 years London (25.7) England (17.6)

ONS data

W

HF

KC


STI epidemiology. How do we control STIs?

Epidemiology Intervention

Number of people susceptible

Vaccinate HPV vaccination and genital warts

Probability of transmission of infection per partnership

Consistent condom use

Change behaviour & access to condoms

Rate of partner acquisition

Decrease overlapping & multiple partners

Change behaviour

Duration of infectiousness

Routine and early testing to reduce undiagnosed

Change behaviour:- test seeking & accepting Change services-test offer-identify & treat partners

Treat successfully Change services- pathways


What makes someone at risk of an STI?

Unprotected sexOverlapping sexual partnersMultiple sexual partners

Picture from Jackie Cassell


Which population groups are at higher risk of STIs?

MSMYoung peopleBlack ethnic groupsPeople who live in areas of deprivation 0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

1600.0

IMD 5 (Most deprived)

IMD 4 IMD 3 IMD 2 IMD 1 (Least deprived)

Ra

te p

er

10

0,0

00

po

p.

Index of Multiple Deprivation (IMD) group

Acute STIs in London by deprivation level

HIV in London

26% diagnosed very late

1/5 of Londoners with HIV remain undiagnosed(

½ of all people living with HIV in England live in London

Over 31,000 Londoners with diagnosed HIV access care(

Around 2,600 new HIV diagnoses are made in London clinics each year

No. of new HIV diagnoses in heterosexuals (04-09)

No. of new HIV diagnoses in MSM (04-09)

Rate of people living with HIV per 1,000 adults (2010)

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Rate

per

1,0

00

Rate per 1,000 London (5.4) England (1.9)

HFKC

W

• Greatest concentration in Soho/ West End area of Westminster

• High numbers in Earl’s Court/ West Kensington and Notting Hill/ Bayswater


People living with HIV (SOPHID)

Since 2006, • 23% increase in Westminster• 14% increase in H&F• 11% increase in K&C

64% MSM 74% MSM 71% MSM


People living with HIV over time (SOPHID)


Rates of acute STIs: London vs other regions

GUM + NCSP + Non-GUM Non-NCSP data, 2011

Source: HPA, GUMCAD, Non-GUM Non-NCSP, NCSP

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

Ra

te p

er

10

0,0

00

po

pu

lati

on


Diagnoses of acute STIs: London GUM clinic attendees, 2001-2011

Source: HPA, GUMCAD & KC60

70,000

75,000

80,000

85,000

90,000

95,000

100,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber

of d

iagn

ose

s


Rates of acute STI diagnoses (GUM) by gender and age group: 2010

5000.0 3000.0 1000.0 1000.0 3000.0 5000.0

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

Rate per 100,000 population

Ag

e g

rou

p a

t d

iag

no

sis

Male Female


Focus on young people

Acute STIs– 15 to 24 year olds account for 38% of acute STIs

but only 12% of the population in London

Gonorrhoea– Accounting for other risk factors people aged 16 to

29 had twice the rate of gonorrhoea as those aged 30 to 44 years old

Triborough area– 15 to 24 yr olds account for just under a third of all

acute STIs diagnosed in GUM clinics (29 to 32%)– This is a relatively low proportion for London


Ethnicity of Triborough young people with acute STIs diagnosed at GUM

clinics (15 to 24 yrs, GUMCAD)

54%

13% 12%

8%5% 4%

2% 1%

0%

10%

20%

30%

40%

50%

60%

White Black Caribbean

Mixed Black African Other Asian excl. Chinese

Black other Chinese


Country of birth of Triborough young people with acute STIs diagnosed at

GUM clinics (15 to 24 yrs, GUMCAD)

61%

16%

7% 6% 5% 4%

0%

10%

20%

30%

40%

50%

60%

70%

UK Rest of Europe Asia Africa North America / Oceania

Latin America/Caribbean


Rate of acute STIs per 100,000 resident, 2011: GUMCAD

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

0.0

500.0

1000.0

1500.0

2000.0

2500.0

Rate

per

100

,000

Rate per 100,000 pop. London (1,245) England (792)

WHF

KC

Soho and West End

Paddington

Earl’s Court

Hammersmith & West

Kensington

White City and Shepherd’s

Bush

North KensingtonSome parts of

the ‘tri-borough’ area

have among the highest rates in

London


STI diagnosis rate per 100,000 aged 15-59, 2010: GUMCAD

Chlamydia diagnoses in London residents aged 15-24 yrs by local authority (2011/2)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

0

1,000

2,000

3,000

4,000

5,000

6,000

Rate

per

100

,000

Rate per 100,000 pop. (aged 15-24 years) London (2,366) England (2,090) Public Health Outcome Framework Indicator

W

HF

KC


Sexual assault in the capital

Westminster – location of highest number of serious sexual assaults reported to the PoliceReferral rates of residents to Haven’s for medical assessment lower than the London average (figure below 2011/12)

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Rate

per

100

,000

London (16.9)

W

HF

KC


Sexual health services

Open access and quick accessConfidential

London travel patterns to GUM services– Young people more likely to access local services– MSM, Black Caribbeans, Black Africans more likely to

travel– People were more likely to attend local services if clinics

• were open for longer hours, • were open at the weekend, • provided walk-in services • provided young people’s clinics.

Key messages

• Prevention efforts focus on groups at highest risk for STIs

Young people, MSM, Black ethnic groups

•Encourage safer sexual behaviour

Consistent condom use

Reducing the number of sexual partners

Avoidance of overlapping sexual relationships

Improved testing

Normalise testing, especially HIV in general medical services

Open access, private, confidential services, longer opening times

Focus on embedding chlamydia screening in primary care and sexual health services

Emphasise the need for repeat chlamydia screening annually and on change of sexual partner

MSM having unprotected sex with casual or new partners should have an HIV-STI screen at least annually, and every 3 months if changing partners regularly.

Documents

Sexual health in Inner North West London