Sexual and Reproductive Health

The impact of COVID-19

The COVID-19 pandemic had a significant effect on the delivery of sexual health services and on the sexual behaviours of the population. Partners across the sector have worked hard to recover and respond to the impacts that COVID-19 had on sexual health.

The impact of the COVID-19 pandemic was seen in many of the figures relating to sexual health in the year 2020 including a drop in STI diagnostic rates and reduction in long acting reversible contraception prescribing rates. The figures for 2022 for many of the data points are seeing recovery. We know that the pandemic necessitated and accelerated the use of phone and video consultations and the increase in postal kits for sexually transmitted infection (STI) testing. We also recognise how important face to face services are in order to facilitate identification of issues such as reinforcing behavioural messages and reducing health inequalities for people who do not have access to digital service. The sexual health service has returned to offering face to face appointments and drop in clinics.

Local data relating to sexual health in Cheshire West and Chester

• In 2019 58.4 women per 1000 were using Long Acting Reversable Contraception (LARC), trending above the North West and England average. However, the impact of COVID-19 meant that in 2020 this had dropped to 36.1 per 1000. In 2021 the rate had improved to 52.7 per 1000 and this remained similar in 2022 with a rate of 50.0 per 1000. This is above the England rate of 44.1 per 1000 (3).
• The rate of new Sexually Transmitted Infection (STIs) diagnoses (excluding chlamydia in 15- to 24-year-olds, for which there is a national screening programme) has fluctuated, reaching a peak in 2018. There was a significant reduction in 2020, most likely caused by the impact of the pandemic. However, the rate of STIs rose to 288 per 100,000 in Cheshire West and Chester in 2021 and rose further in 2022 up to 386 per 100,000. This is higher than the pre-pandemic rate of 335 per 100,000 in 2019 but not as high as the peak rate of 415 per 100,000 in 2018. The rate of STIs has risen each year between 2020 and 2022 across the whole of England and the rates in Cheshire West and Chester are lower than both the North West and England averages. The England average rate in 2022 was 496 per 100,000 (3).
• The most common sexually transmitted infections diagnosed in Cheshire West and Chester are chlamydia and gonorrhoea. Gonorrhoea and Syphilis diagnostic rates are seeing a significant rise in 2022 both in England as a whole and in Cheshire West and Chester although the rates in Cheshire West and Chester are below both the England and North West average. In 2019, before the pandemic the gonorrhoea diagnostic rate was 46 per 100,000 in Cheshire West and Chester. This dropped to 38 per 100,000 in 2020 and remained stable into 2021 with a rate of 40 per 100,000. However, in 2022 Gonorrhoea rates have reached a record high of 98 per 100,000 which compares with a rate of 146 per 100,000 as the England average. Syphilis diagnostic rates have similarly roughly doubled from a rate of 5.9 per 100,000 in 2021 to a rate of 11.2 per 100,000 in 2022 which compares to an England average rate of 15.4 per 100,000 (3).
• The chlamydia diagnostic rate in Cheshire West and Chester has seen an increase from 2020 into 2021 to 282 per 100,000. This has increased further in 2022 to 358 per 100,000 which is similar to the North West rate of 355 per 100,000 and the England average rate of 352 per 100,000 (3).
• The proportion of females aged 15-24 screened for chlamydia in 2022 is 21.6 percent, which is similar to the England average of 21.2 percent (3).

• The prevalence of HIV (Human Immunodeficiency Virus) in Cheshire West is lower than the prevalence for England as a whole. The most recent diagnosed prevalence rate was 1.36 per 1,000 aged 15-59 years in 2022. This meets the national target of less than two per 1,000 (3).
• Of those who do receive a diagnosis of HIV in Cheshire West and Chester (2020-2022) 57.1 percent are diagnosed at a late stage of infection which is higher than England (43.3 percent) (3).

• Since 1998, national and local conception rates in females aged under 18 have reduced. In recent years the rate has remained stable. The latest data (2021) records a rate of 13.2 conceptions per 1,000 females under the age of 18 in Cheshire West and Chester (3).

Emergency Hormonal Contraception is available free of charge to all women from accredited Pharmacists in Cheshire West and Chester. Between April 2016 and March 2017 2,995 consultations were carried out, of which 53 per cent were with women aged under 25. The abortion rate in Cheshire West and Chester in 2021 was 18.8 per 1000 which is similar to the England average rate of 19.2 per 1000.  The abortion rate is increasing.  In 2019 the abortion rate in Cheshire West and Chester was 16.9 per 1000 (3).

References

3. Education, Department for. Relationships and Sex Education (RSE) and Health Education. s.l. : Department for Education, 2020.