Recovery JSNA: Sexual Health, Early Parenthood and BBV
Introduction
In response to the COVID-19 pandemic, in March 2020 the UK Government took steps to reduce transmission of COVID-19 through the introduction of social and physical distancing measures. These measures and the redeployment of health staff to the pandemic response led to a reduction or reconfiguration of clinical services providing care for sexually transmitted infections (STI) and blood borne viruses (BBV). The Association of Directors of Public Health published recommendations on the prioritisation of sexual and reproductive health services in April. Analysis by Public Health England has shown that between March and May 2020, there was a reduction in:
- - consultations undertaken by sexual health services (SHSs) and specialised HIV services
- - testing for and diagnosis of viral hepatitis, HIV and STIs in SHSs
- - hepatitis C (HCV) treatment initiations
A resurgence in HIV, STIs and hepatitis tests and diagnoses, and an increase in hepatitis C virus (HCV) treatment initiations, were observed from June 2020, following the easing of national lockdown restrictions. This reflects a partial recovery in service provision and demand. Nevertheless, numbers of consultations, vaccinations, tests, diagnoses, and treatment initiations in the summer of 2020 were considerably lower than in corresponding months in 2019.
This Chapter includes the following:
Trends in Sexual Activity & Health
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Trends in Sexual Activity & Health
NHS sexual health services are free and available to everyone, regardless of sex, age, ethnic origin and sexual orientation. They provide a variety of services including advice about both sexually transmitted infections (STIs) and contraception. They are sometimes called family planning, GUM or sexual and reproductive health clinics. Their services are completely confidential. Individuals should be able to get the following:
- - testing and advice on STIs and how to protect yourself
- - information on different types of contraception
- - any type of contraception, including emergency contraception
National analysis by Public Health England shows that between January to June in 2019 and January and June 2020, there was a 13% reduction in consultations at SHSs in England (including face to face and internet delivered consultations) compared to the same period in 2019. There was a downward trend from January to April 2020, followed by a recovery in May and June, however, the number of consultations reported in June 2020 was 11% lower than in June 2019.
Trend in HPV Vaccine Cover (First Dose, Females age 12-13)
The Human papillomavirus vaccines (HPV) will protect women against cervical cancer and reduce the amount of cervical cancer screening they are likely to need in their lifetime.
In 2018-19 over 2,500 young women aged 12-13 received their first dose of the HPV vaccine, this represent over 90% of the population which is higher than the cover seen in England and the South West.
The vaccine is adolescents in school.
Source: https://fingertips.phe.org.uk on 12th April 2021

Trend in new STI Infections in people Age 15-64

During 2019 there were over 1,500 new sexually transmitted infections diagnosed in Wiltshire in the population aged 15-64 excluding Chlamydia in those aged under 25. This is a slight increase on previous years.
The rate in Wiltshire is lower than that seen in England and the South West. This may reflect different behaviours in the population or different approaches to screening and service provision.
Source: https://fingertips.phe.org.uk on 12th April 2021
Trend in new Chlamydia Diagnosis Rate

During 2019 there were over 1,300 new chlamydia infections diagnosed in Wiltshire in the population. This is a 10% (150 cases) increase on 2018 and represents a departure from the previous slowly decreasing trend.
The rate in Wiltshire is lower than that seen in England and the South West and may reflect different behaviours in the population or different approaches to screening and service provision.
Achieving a higher chlamydia detection rate reflects improved control of chlamydia infection. Identifying and treating more infections means individuals will have reduced risk of serious sequelae and will no longer be infectious to others.
Trend in new Gonorrhoea & Genital Wart Infections


These infections will be included within the overall new STI infections but these clearly show a different trajectory. There were 162 cases of Gonorrhoea in 2019 which is an increase of more than 50% from 2018. There were 350 cases of genital warts in 2019 which is a reduction of around 10% from 2018.
Source: https://fingertips.phe.org.uk on 12th April 2021
Trend in the Total Abortion Rate
In 2019 there were nearly 1,200 abortions in Wiltshire, this is an increase of around 6% on the number in 2018 and continues the upward trend from 2017.
The increase in Wiltshire is also seen in England and the South West and the rate in Wiltshire remains lower than the South West and significantly lower than the England rate.
Source: fingertips.phe.org.uk extracted on 12th April 2021

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Maternal & Perinatal Health
The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. Pregnant women and mothers were not necessarily at higher risk of COVID-19 infection than people who are not pregnant, however, pregnant women with symptomatic COVID-19 may have experienced more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles in pregnancy and early parenthood.
While rigorous studies have not yet been conducted, early evidence from scoping reviews shows that many of the social and economic consequences of the COVID-19 crisis may affect women more than men. The low risk of mother to child transmission in utero or via breast milk is well documented. An increased risk of distress and psychiatric problems during pregnancy and postnatally during the pandemic is likely, but evidence is lacking.
Further research is required on the health impact of infection with COVID-19 during pregnancy as well as the changes in health care service and accessibility and their impact on maternal health. There is evidence that mothers with children are more likely to suffer job and income losses during the pandemic than men and women without children. Single mothers in particular are likely to suffer from food insecurity. These socioeconomic consequences for women are similar across many high- and low-income countries.
Trend in General Fertility Rate
In 2019 there were around 4,750 births in Wiltshire. There has been a general decline in births in Wiltshire following a peak in 2012 following the 2008 financial crises.
In 2019 the General Fertility rate in Wiltshire was significantly higher than the England and South West averages. There is some variation in the Wiltshire rate but it does not seem to be falling as rapidly as it is in England or the South West.
Source: https://fingertips.phe.org.uk on 14th April 2021

Trend in Infant Mortality Rate

In 2017-19 there were 44 deaths of infants who did not reach their first birthday in Wiltshire. The vast majority of these happen within days of delivery.
In the last few years the infant mortality rate in Wiltshire has been consistently around 3 per 1,000 births following a substantial fall from 2012 to 2015. The rate in Wiltshire is now lower than the South West and significantly lower than the England average.
Source: https://fingertips.phe.org.uk on 14th April 2021
Trend in Stillbirth Rate

In 2017-19 there were 49 stillbirths to mothers in Wiltshire. This continues the reduction in the number of stillbirths which started in 2016.
The rate of stillbirths in Wiltshire is now around 4 per 1,000. This is lower than the South West and significantly lower than the England average.
Source: fingertips.phe.org.uk extracted on 14th April 2021
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Early Maternal Health & Wellbeing
The birth of a child is a critical and potentially stressful experience for women, entailing several changes both at the individual and interpersonal level. This event can lead to different forms of distress, ranging in intensity and duration. Many studies highlight medical, psychological, and social variables as risk factors potentially influencing the onset or aggravation of perinatal maternal conditions. The COVID-19 pandemic and the measures adopted by government to prevent the spread of infection may negatively affect mothers-to-be and new mothers a high frequency of maternal mental health problems have been reported potentially increasing the likelihood of anxiety, depressive or post-traumatic symptoms to develop with likely limitations on the access to professional services to support them.
Surveys have shown that some parents struggled enormously and described feeling abandoned or falling through the cracks, while others thrived. Some services were badly affected, others stepped up and did more than ever. Many families with lower incomes, from Black, Asian and minority ethnic communities and young parents have been hit harder by the COVID-19 pandemic. This is likely to impact inequalities in the early experiences and life chances of children. For those parents who have experienced overwhelming stress, with little social support/ support from family, friends and/or local services, the pandemic may cast a long shadow both in terms of their child’s early development and their own health and wellbeing. This, however, is not inevitable with the right support in place.
The first 2 years of a child’s life, from pregnancy to age two, lay the foundations for a happy and healthy life. The support and wellbeing of babies during this time is strongly linked to better outcomes later in life, including educational achievement, progress at work and physical and mental health. For generations, no other group of parents has had to navigate pregnancy, birth and beyond under such extraordinary circumstances.
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Blood Bourne Viruses (BBV)
Innovation in service delivery such as online or tele-consultations for HIV and hepatitis, STI and blood-borne virus (BBV) self-sampling kits, and expanded community outreach testing and linkage to care for HCV, has happened at pace during 2020. While this has enabled access to services during the COVID-19 response, there is a critical need to evaluate the impact of these changes on health inequalities, as HCV, HIV and many STIs predominantly affect socially disadvantaged and/or marginalised groups who already experience poor health outcomes, including people who inject drugs (PWID) and experience homelessness, and certain black and Asian ethnic minorities.
PHE national reporting suggests that HCV testing through traditional venues may not have reached those in greatest need. Between January and August 2020, there was a 30% reduction in treatment initiations reported compared to the same period in 2019. Between January and April 2020, reported treatment initiations declined by 68%. The number of reported monthly treatment initiations since April 2020 has remained lower compared to the same period in 2019. HCV and HEP B treatment data is not published nationally currently.
Though the data suggests HIV and STI testing was accessed by those with high likelihood of infection, some population groups were under-represented. HIV, across SHSs with complete reporting, the number of diagnoses between January and June 2020 was 21% lower than in the same period in 2019. There was slight increase in May and June 2020, however, the number of HIV diagnoses was 11% lower than in June 2019.
HEP B data is collected as part of screening in expectant mothers but this is reported regionally, and in the South West coverage for screening remains over 99%.
HIV Diagnosis
The only way to determine whether an individual has HIV is through testing as symptoms of HIV may not appear. There are different types of tests that individuals can take. It is very important that individuals with HIV symptoms get diagnosed as early as possible. Late diagnosis can lead to,
- poor quality of life
- decreased life expectancy
- high risk of onward transmissions
- reduced response to HIV treatment
Trend in new HIV Diagnoses
In 2019 there were 13 new HIV diagnoses in Wiltshire. This is broadly similar to the previous 2 years which represents a reduction on the numbers seen prior to 2017.
The rate of new diagnoses in Wiltshire is lower than the South West and significantly lower than the England average.
Source: fingertips.phe.org.uk extracted on 12th April 2021

Trend in new HIV Treatment

In 2017-19 around 84% (31 cases) of newly diagnosed HIV patients were promptly started on antiretroviral treatment (ART) within 91 days of diagnosis. This is broadly similar to the percentages seen in England and the South West.
Source: fingertips.phe.org.uk extracted on 12th April 2021
Trend in new Hepatitis C Detection Rate
The Government and NHS are committed to the elimination of Hepatitis C by 2030. To achieve this, patients are required to be identified and be provided with antiretroviral treatment. The latest available data shows a detection rate of around 10 per 100,000 population or around 50 cases.
The detection rate is around half of the rate in England, which may reflect differences in the demographics of the population or the approach to testing.
Source: fingertips.phe.org.uk extracted on 12th April 2021
