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. HPA London Regional Epidemiology Unit 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. HPA London Regional Epidemiology Unit 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 risk Which groups do local services target? Young residents – mid to late teens Slides from INWL PH team

4. HPA London Regional Epidemiology Unit 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 15-1920-24TOTAL H&F7,91617,27925,195 K&C6,47511,32217,797 West9,99717,49027,487 2011 Census resident population: Slides from INWL PH team

5. HPA London Regional Epidemiology Unit 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 15-19 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 Slides from INWL PH team

6. HPA London Regional Epidemiology Unit Age 15-19 Age 20-24 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 Areas with a higher proportion of resident young people GP-registered residents Slides from INWL PH team

7. HPA London Regional Epidemiology Unit 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 Slides from INWL PH team

8. Local differences Significantly 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 Slides from INWL PH team Under 18 conception rate, 2010 Rate per 1,000 women aged 15-17. Source TPU

9. Hammersmith and Fulham Kensington and Chelsea Westminster Number of under 18 year old conceptions 20062007200820092010 H&F951058910389 K&C6557484130 Westminster8370818781 Tri-borough243232218231200 Huge improvements in Kensington and Chelsea in particular Slides from INWL PH team Under 18 conceptions over time Rate per 1,000 women aged 15-17. Source TPU

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

11. HPA London Regional Epidemiology Unit STI epidemiology. How do we control STIs? EpidemiologyIntervention Number of people susceptible VaccinateHPV vaccination and genital warts Probability of transmission of infection per partnership Consistent condom useChange 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 successfullyChange services - pathways

12. HPA London Regional Epidemiology Unit What makes someone at risk of an STI? Unprotected sex Overlapping sexual partners Multiple sexual partners Picture from Jackie Cassell

13. HPA London Regional Epidemiology Unit 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 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

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) HF KC W

18. 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 People living with HIV (SOPHID)

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

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

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

22. HPA London Regional Epidemiology Unit Rates of acute STI diagnoses (GUM) by gender and age group: 2010

23. HPA London Regional Epidemiology Unit 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. HPA London Regional Epidemiology Unit Ethnicity of Triborough young people with acute STIs diagnosed at GUM clinics (15 to 24 yrs, GUMCAD)

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

26. HPA London Regional Epidemiology Unit Rate of acute STIs per 100,000 resident, 2011: GUMCAD W HF KC

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

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

29. HPA London Regional Epidemiology Unit 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) W HF KC

30. HPA London Regional Epidemiology Unit 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.