Sexual health in Inner North West London

1. 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

2. Overview • Focussing on young people (15 to 24 yrs) • Triborough demographics • STIs – including HIV • Reproductive health (teenage conception, abortion) • Sexual assault • Service access How do we design health promotion, testing and treatment services effectively?

3. Young people’s sexual health: population types Young residents – mid to late teens Secondary school population – 40-50% live ‘out of borough’ Post-school influx of residents – students and workers Daytime/night time population – visitors to pubs/clubs/nightlife Sexual health risk Which groups do local services target? Slides from INWL PH team

4. Age structure of the tri-borough area 2011 Census resident population: • Many families move from the area • Largely deprived population remains • Influx of students and workers post-school age Slides from INWL PH team

5. Ethnic and cultural profile Common nationalities, where 15-24 year olds live • Similar ethnic mix to London for 15-19 year olds (but fewer from Asian groups) • Influx of white population post school age • 15-19 • Around 6 out of 10 from UK. Other common nationalities include: • Iraq, Somalia, Bangladesh, Philippines, Caribbean countries • - USA, Australia, European countries • 20-24 • Around 5 out of 10 from UK. Other common nationalities include: • USA, France, China, Italy, India Main ethnic group in tri-borough area (aged 15-19 and 20-24) Slides from INWL PH team

6. Areas with a higher proportion of resident young people GP-registered residents Age 15-19 Deprived areas: H&F: East Acton, West Kensington K&C: Latimer Road, St Charles, Golborne Westminster: 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 Kensington Westminster: Soho/West End, Paddington Student areas/ barracks: Imperial, UCL, halls of residence (South Kensington) Wellington/Hyde Park Barracks Age 20-24 Slides from INWL PH team

7. Poverty and NEETs 16-19 year olds NEET • Strong geographical focus to poverty among young people locally • Some significant areas of disadvantage Child poverty Out of work benefits Purple = 20% highest in London Slides from INWL PH team

8. Under 18 conception rate, 2010 Rate per 1,000 women aged 15-17 . Source TPU • Rate, 2010 • High rate in H&F • Westminster similar to England • K&C far below • Two thirds of <18 conceptions end in abortion Local differences Significantly higher in College Park & Old Oak, Wormholt & White City, Queen’s Park, Harrow Road and Church Street Slides from INWL PH team

9. Under 18 conceptions over time Rate per 1,000 women aged 15-17 . Source TPU Hammersmith and Fulham Kensington and Chelsea • Huge improvements in Kensington and Chelsea in particular Westminster Number of under 18 year old conceptions Slides from INWL PH team

10. Abortion rate in London(per 1,000 15-44 yr olds) HF KC W ONS data

11. STI epidemiology. How do we control STIs?

12. What makes someone at risk of an STI? • Unprotected sex • Overlapping sexual partners • Multiple sexual partners Picture from Jackie Cassell

13. Which population groups are at higher risk of STIs? • MSM • Young people • Black ethnic groups • People who live in areas of deprivation Acute STIs in London by deprivation level

14. HIV in London 26% diagnosed very late Around 2,600 new HIV diagnoses are made in London clinics each year ½ of all people living with HIV in England live in London 1/5of Londoners with HIV remain undiagnosed( Over 31,000 Londoners with diagnosed HIV access care(

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

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

17. Rate of people living with HIV per 1,000 adults (2010) KC HF W

18. People living with HIV (SOPHID) • Greatest concentration in Soho/ West End area of Westminster • High numbers in Earl’s Court/ West Kensington and Notting Hill/ Bayswater Slides from INWL PH team

19. People living with HIV over time (SOPHID) • Since 2006, • 23% increase in Westminster • 14% increase in H&F • 11% increase in K&C 74% MSM 64% MSM 71% MSM Slides from INWL PH team

20. Rates of acute STIs: London vs other regionsGUM + NCSP + Non-GUM Non-NCSP data, 2011 Source: HPA, GUMCAD, Non-GUM Non-NCSP, NCSP

21. Diagnoses of acute STIs: London GUM clinic attendees, 2001-2011 Source: HPA, GUMCAD & KC60

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

23. 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

24. Ethnicity of Triborough young people with acute STIs diagnosed at GUM clinics (15 to 24 yrs, GUMCAD)

25. Country of birth of Triborough young people with acute STIs diagnosed at GUM clinics (15 to 24 yrs, GUMCAD)

26. Rate of acute STIs per 100,000 resident, 2011: GUMCAD W HF KC

27. STI diagnosis rate per 100,000 aged 15-59, 2010: GUMCAD North Kensington Paddington Some parts of the ‘tri-borough’ area have among the highest rates in London White City and Shepherd’s Bush Soho and West End Hammersmith & West Kensington Earl’s Court Slides from INWL PH team

28. Chlamydia diagnoses in London residents aged 15-24 yrs by local authority (2011/2) HF KC W

29. Sexual assault in the capital • Westminster – location of highest number of serious sexual assaults reported to the Police • Referral rates of residents to Haven’s for medical assessment lower than the London average (figure below 2011/12) HF KC W

30. Sexual health services • Open access and quick access • Confidential • 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.

31. 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

32. 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.