Sexual health clinic attendance and non-attendance in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Abstract

ObjectivesIn Britain, sexual health clinics (SHCs) are the most common location for STI diagnosis but many people with STI risk behaviours do not attend. We estimate prevalence of SHC attendance and how this varies by sociodemographic and behavioural factors (including unsafe sex) and describe hypothetical service preferences for those reporting unsafe sex.MethodsComplex survey analyses of data from Britain’s third National Survey of Sexual Attitudes and Lifestyles, a probability survey of 15 162 people aged 16–74 years, undertaken 2010–2012.ResultsOverall, recent attendance (past year) was highest among those aged 16–24 years (16.6% men, 22.4% women), decreasing with age (<1.5% among those 45–74 years). Approximately 15% of sexually-active 16–74 year olds (n=1002 men; n=1253 women) reported ‘unsafe sex’ (condomless first sex with a new partner and/or ≥2 partners and no condom use, past year); >75% of these had not attended a SHC (past year). However, of non-attenders aged 16–44 years, 18.7% of men and 39.0% of women reported chlamydia testing (past year) with testing highest in women aged <25 years. Of those aged 16–44 years reporting unsafe sex, the majority who reported previous SHC attendance would seek STI care there, whereas the majority who had not would use general practice.ConclusionWhile most reporting unsafe sex had not attended a SHC, many, particularly younger women, had tested for chlamydia suggesting engagement with sexual health services more broadly. Effective, diverse service provision is needed to engage those at-risk and ensure that they can attend services appropriate to their needs.

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

“…The fact that individuals rarely have complete information on these factors, combined with other influences on risk perception as described above may lead to an under- or over-estimation of individual STI risk, which in turn could influence sexual behaviour and healthcare-seeking. We have previously shown that in Britain, substantial proportions of those at risk had not accessed sexual health clinics or chlamydia testing despite these services being free at the point of care [8] , suggesting either a lack of risk perception or other barriers to accessing care. We have also previously shown a mismatch between HIV risk perception and indicators of HIV risk among the British population [9] , however these findings may not be generalisable to other STIs due to real and perceived differences in how prevalent the infections are, which population groups are affected, and the consequences of infection.…”

Navigating new sexual partnerships in midlife: a socioecological perspective on factors shaping STI risk perceptions and practices

“…In terms of services, participants’ accounts indicated virtual absence of GP-initiated discussion of sexual matters and a perception of specialist sexual health services as youth-focused. Previous research suggests preference for STI diagnosis and treatment in general practice among at-risk individuals not attending sexual health clinics 29. GP training may, therefore, be useful to challenge assumptions about the sex lives of midlife patients and equip them with confidence to raise discussions.…”

Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England

“…Our findings are somewhat more difficult to interpret than those of nationally representative surveys, 23 25 because ethnic and gender differences may be diluted among the high-risk population of SHC attendees. 25 26 However, we used a clinic-verified outcome, in conjunction with detailed patient-reported data.…”