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Background: Sexually transmitted infections (STIs) are a serious public health issue in many countries. Online postal self-sampling (OPSS) is increasingly used to test for STIs, a trend accelerated by the COVID-19 pandemic. There remains limited understanding of how service users experience OPSS and what leads them to access it over clinic-based services, or vice versa. This research seeks to address these gaps, by undertaking a large qualitative study which sits within the ASSIST study, a mixed-methods, realist evaluation of OPSS., Methods: Participants were recruited via clinic-based and online sexual health services in three case study areas in England. Purposive sampling was used to over-represent populations disproportionately affected by poor sexual health: young people; people of colour; men who have sex with men; and trans and non-binary people. Semi-structured interviews were analysed using Levesque's conceptual framework of access to healthcare., Results: We interviewed 100 service users. Participants typically became aware of OPSS from sexual health services, the internet or word of mouth. Acceptability of OPSS was facilitated by the perceived privacy it offered over clinic-based services, which some participants found embarrassing to access. OPSS also enabled participants to overcome barriers to reaching clinic-based services, such as a lack of appointment availability, although difficulty obtaining OPSS kits in some areas undermined this. As all services in our case study areas were free to use, affordability did not significantly shape access, although OPSS enabled some participants to avoid costs associated with travelling to clinic-based services. Participants were usually able to engage with OPSS, finding it easy to use and reliable, although blood self-sampling was challenging for most. Participants valued the support offered by clinic-based services beyond STI testing, including the opportunity to access contraception or ask staff questions, and felt this was more appropriate when they had specific concerns about their sexual health, such as STI symptoms., Conclusions: Our findings constitute one of the largest qualitative studies to have explored OPSS and offer valuable insights to providers. OPSS shapes access to STI testing in a number of ways, including facilitating access in many circumstances, but users also want to retain access to clinic-based services, particularly for when they believe they need support beyond STI testing., (© 2024. The Author(s).)

Objectives: We provide a guide to conducting a crowdsourcing activity at an international sexually transmitted infection (STI) conference to design public messaging about STI testing and disseminating that messaging via social media., Methods: A speaker gave a presentation at a conference plenary session on the concepts of cocreation, crowdsourcing and designathons, and the application of these participatory approaches in public health research. To illustrate one of these approaches (crowdsourcing), attendees in the audience were asked to take part in a voluntary participatory activity, in which they would pair up with a fellow attendee sitting nearby and write down an idea on a blank notecard. Dyads were given 10 min to create an entry responding to the prompt, 'Write something that inspires gonorrhoea and/or chlamydia testing (eg, picture, jingle, rhyme)'. Each entry was judged by at least four independent judges on a scale of 0 (lowest quality) to 10 (highest quality) based on their innovation and potential to promote chlamydia/gonorrhoea testing. Scores were averaged to determine the finalist entries., Results: We received 32 entries. The average score was 6.41 and scores ranged from 4.5 to 8 (median 6.63, IQR 5.75, 7.06). Half of entries (n=16) were slogans, 15.6% (n=5) were poems/rhymes, 12.5% (n=4) were memes/images, 9.4% (n=3) were programme implementation ideas, 3.1% (n=1) was a song verse, and 3.1% (n=1) was a video idea. One finalist entry was a meme and received 720 impressions, 120 engagements, 27 detail expands, 19 likes, 6 reposts and 1 response on Twitter. The second finalist entry was a slogan and received 242 impressions, 16 engagements, 6 detail expands, 4 likes and 2 reposts., Conclusions: Conducting crowdsourcing activities at future conferences may be an innovative, feasible way to develop and disseminate engaging and important STI and other health messaging to the public in a short period of time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Following increased rates of domestic abuse/violence (DAV) reporting during the pandemic, London's online sexually transmitted infection (STI) testing service (Sexual Health London, SHL) introduced routine DAV enquiry and directed survivors to supportive online information. SHL evaluated this adaptation., Method: SHL's database identified the first individuals that ordered a test-kit between 17.8.21-28.2.22 and triggered questions disclosing DAV. SHL clinicians only contacted these individuals if positive/abnormal STI results required communicating. Within these interactions DAV was opportunistically discussed and further counselling/support offered., Results: 3846/231460 (1.7%) service users triggered DAV question(s). The first 202 individuals were: median age 28 yrs (18-73 yrs); 66% (134/202) female; 72% (145/202) heterosexual; 75% (152/202) UK born. 27% (55/202) reported physical/emotional abuse, 81% (164/202) coercive control, and 22% (45/202) sexual abuse. 26% (52/202) had never visited a clinic. Telephonic discussion occurred with 10% (20/202) individuals: 10/20 accepted counselling/signposting; 2/20 referred to independent DAV advocate, 6/20 stated historic abuse, 2/20 mistakenly triggered, 2/10 declined support or disengaged. Of 29% (58/202) individuals that ordered another e-kit, 38% disclosed ongoing DAV and 9% sexual assault., Conclusion: 1.7% e-service users reported DAV. Telephonic DAV discussion was accepted by 80% individuals contacted. Despite providing online support 38% experienced ongoing/escalating abuse. Further engagement and support for DAV survivors using e-services is required.

Although HIV self-testing (HIVST) has expanded in many regions, a few HIVST services have been tailored for and organized by youth. Innovative HIVST models are needed to differentiate testing services and generate local demand for HIVST among youth. The current pilot study aimed at examining the feasibility and efficacy of crowdsourced youth-led strategies to enhance HIVST as well as sexually transmitted infection (STI) testing. Teams of youth iteratively developed HIVST interventions using crowdsourcing approaches and apprenticeship training. Five interventions were selected and then evaluated among youth (ages 14-24) from September 2019 to March 2020. Given the similar outcomes and approaches, we present cumulative data from the completed interventions. We assessed HIVST uptake (self-report), STI uptake (facility reports for gonorrhea, syphilis, hepatitis B, and chlamydia testing), and quality of youth participation. Mixed-effect logistic regression models estimated intervention effects at baseline and 6 months. Of the 388 youths enrolled, 25.3% were aged 14-19, 58.0% were male, and 54.1% had completed secondary education. We observed a significant increase in HIVST from 3 months compared with 6 months (20% vs. 90%; p  < 0.001). Among those who received an HIVST at 3 months, 324 out of 388 were re-tested at 6 months. We also observed significant increases in testing for all four STIs: syphilis (5-48%), gonorrhea (5-43%), chlamydia (1-45%), and hepatitis B testing (14-55%) from baseline to the 6-month follow-up. Youth participation in the intervention was robust. Youth-led HIVST intervention approaches were feasible and resulted in increased HIV/STI test uptake. Further research on the effectiveness of these HIVST services is needed.

Maximising opportunities and removing barriers to HIV testing can help reduce the undiagnosed HIV population. Digital STI/HIV screening services have increased in availability and can improve access and testing coverage. We identified the characteristics of individuals who tested HIV positive using a regional, integrated, self-sampling STI service. The e-notes of service users with reactive HIV screening results were reviewed. Between 8 January 2018 and 31 December 2019, 0.097% (144/148,257) users received a reactive HIV result, 30/144 (20.8%) of whom had previously diagnosed HIV infection. All of the remaining 114 users were notified of their screening result, an estimated 109/114 (95.6%) received confirmatory testing (CT) at a sexual health clinic (SHC) and the confirmatory outcome was documented in 102/114 (89.5%) of cases: 34/114 (29.8%)were HIV positive, 68/114 (59.6%) HIV were negative and the result was unknown in 12/114 (10.5%). All new diagnoses transitioned to HIV outpatient care. These individuals were median age 28 years; 94.1% (32/34) male; 88.2% (30/34) men who have sex with men and 11.8% (4/34) heterosexual; 58.8% (20/34) of white/'white other' ethnicity and 42.2% of Black, Asian and minority ethnic group; 50%(17/34) had a concurrent STI; 9% and 21% had never tested for HIV or attended a SHC before. n HIV test reactivity rate of 0.1%(95% CI) was observed. Confirmed new HIV diagnoses comprised 0.023% of all HIV tests performed. All individuals where CT confirmed a new HIV diagnosis transitioned to HIV specialist care.

Sexual health data on transgender and non-binary (TNB) people in the United Kingdom are limited. TNB individuals experience significant socioeconomic and stigma-related disadvantages. Sexual health morbidity and unmet need is likely to be significant. We compared the sexual health outcomes of TNB and cisgender users of London's online sexual health service. Of 119329 users that registered with the e-service between 30.4.19 and 31.12.19, 504 (0.42%) identified as TNB: 302 TNB users requested 463 kits. 78.4% (363/463) of kits were returned. 99.4% of dispatched kits included throat and rectal swabs for gonorrhoea and chlamydia testing. STI/HIV test positivity was: 5.5% syphilis, 4.8% chlamydia, 3.4% gonorrhoea and 0.7% HIV positive. HIV prevalence amongst TNB individuals was: 4.3%. 19.9% of TNB individuals engaged in chemsex, group sex, or fisting and were more likely to engage in sex work. 97.7% gave the service 4/5 or 5/5 star rating. We observed high positivity rates of HIV/STIs amongst TNB individuals and significant levels of high-risk sexual activity. Service users rated the service highly. Given TNB often have complex healthcare needs, some of which cannot be met entirely online, physical clinics must work collaboratively with e-services to support and protect this marginalised population.

Despite the benefits of modern contraceptives, its usage is low among adolescents in sub-Saharan Africa. Based on the theory of gender and power, this study explored adolescents' (non-)use of contraceptives in the context of their sexual and reproductive health. Data were collected from adolescents (15-19 years) through focus group discussions as well as through interviews with five key informants. The collected data were investigated through thematic analysis. The study revealed that gender and power influenced adolescents sexual behavior. Both young men and young women engaged in risky sexual behavior, which exposed them to unintended pregnancy. Whereas some young women engaged in risky sexual behaviors due to financial reasons, young men engaged in such behaviors for pleasure. Lack of knowledge about the correct use of modern contraceptives, type of sexual relationship, and cultural norms of adolescent girls' appropriate sexual behavior influenced the use of contraceptives by adolescent girls. Avoiding pregnancy could be easier for adolescent girls if only they could have easy access to more long-term and reliable contraceptive methods. Education on the need to use condoms during sexual intercourse should be intensified to create awareness about using condoms to avoid sexually transmitted infections in addition to unwanted pregnancy., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world's largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.

Sexual transmission of hepatitis C (HCV) between HIV positive men who have sex with men (MSM) is increasingly being reported. There is limited and conflicting data as to whether HIV negative MSM are at increased risk of infection. Local directorate guidelines recommended HCV testing only in MSM having a sexual transmitted infection (STI) screen who disclosed risk factors. In 2007 we introduced unselected screening into routine practice within our sexual health clinics. This report reviews the results of this change in our practice. Over 6 months, 3365 MSM attended for STI screening. Of 2309 MSM who agreed to be screened for HCV (69%) the prevalence of HCV was 0.65% (95% CI 0.36-1.1). This is similar to the prevalence of HCV in the general population within England. We conclude that unselected screening of MSM for HCV within our sexual health services is not currently justified., (2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background/objectives: Sex work has been seen as both a health and a social problem. However, there is a paucity of evidence on the longer term impact on health. We explored the health and career paths over a period of 15 years among women who have worked in the sex industry., Design: A longitudinal study of sex workers recruited between 1986 and 1993 and followed for 15 years. Outcome data were obtained through interview, clinic records, or third parties., Setting: Clinic and community settings in London., Participants: We obtained outcome data on 130 (37%) of the original cohort of 354 women, with a combined follow up of 1247 years., Main Outcome Measures: Vital status, most recent occupation, duration of sex work, sexually transmitted infections (STI), major health problems., Results: The majority (73/124, 59%) were still in the sex industry and had sold sex for a mean of 13.6 years. There were six deaths, a mortality of 4.8 per 1000 person years. Surviving women had a high cumulative risk (110 of 118, 93%) of STI. Past gonorrhoea was associated with pelvic inflammatory disease (RR 2.28, 95% CI 1.12 to 4.66) and infertility (RR 10.9, 95% CI 1.5 to 77.3). Other outcomes included mental health problems (38 of 97, 40%) and addiction (46 of 72, 64%). There were no significant differences in health outcomes between women who were still in the sex industry and those who had stopped. There was a high level of occupational mobility, and 31 women (of 84, 37%) had completed vocational or higher education, including eight to postgraduate level., Conclusions: Sex work is associated with excess mortality and morbidity including the sequelae of STI, mental health problems, and substance misuse. The relation between these health problems and sex work is complex.

Objectives: To describe major changes in the London sex industry between 1985 and 2002 and assess the implications for sexually transmitted infection (STI) risk., Method: A descriptive study comparing women who first attended a sex work clinic between 1996 and 2002 and those first attending from 1985 to 1992; a nested case-control study. 1050 female sex workers took part. The setting was a specialist clinical service for sex workers based in a London genitourinary medicine (GUM) clinic, and fieldwork in west London. The main outcome measures were reported condom use and prevalent STI., Results: Over the period of the study there was a significant increase in the proportion of sex workers not born in the United Kingdom (from 25% to 63%, p < 0.001), and women entered sex work at an older age (median 24 years compared with 20 years, p < 0.001). Condom use increased (with the exception of oral sex). There was a significant decline in the proportion of participants reporting a previous STI (32% compared with 80%, p < 0.001) and the prevalence of acute STI declined from 25% to 8% (p < 0.001). Acute STI was associated with younger age, younger age at first sex work, being new to sex work, and inconsistent condom use. In a multivariate analysis unprotected sex with clients was the only significant risk., Conclusion: Major restructuring of the sex industry, including the shift to a primarily migrant workforce, has been associated with a steep decline in acute STI, undermining popular assumptions that migrant sex workers are central to the ongoing STI epidemic. We attribute the decline in acute STI to an increase in safer sex.

Up to 70% of GU clinic attendees with a sexually transmitted infection (STI) and undiagnosed HIV, remain HIV undiagnosed after their visit. STIs have been shown to facilitate HIV transmission. Therefore, patients with an STI should test for HIV. Our objective was to compare the uptake of HIV testing in GU clinic attendees with an STI (study group) with those receiving a negative GU screen (control group). This re-audit was performed after introduction of the following clinic changes: nurse-performed asymptomatic GU screening; 'opt-out' HIV testing policy; discontinuing routine pre-HIV test counselling; access to HIV results by post. The uptake of HIV testing overall, and in the study and control groups respectively was 53% (n = 573), 41% (n = 285) and 65%, showing significant improvement compared to the first audit in 1999 (18%, 14% and 33% respectively) (P < 0.01). The clinic interventions increased HIV testing rates which were in keeping with National Sexual Health strategy targets.

Objectives: To assess whether a previously established low sexually transmitted infection/HIV risk in prostitutes in London has been sustained, and to measure other occupational risks, including mortality., Design: 9 year prospective study in west London., Subjects: 402 prostitutes recruited from 1985 to 1991, 320 were followed up for 675 person years to 1994., Main Outcome Measures: Condom use in commercial and non-commercial sex; viral and bacterial sexually transmitted infection at initial and follow up visits; death., Results: Condom use increased significantly from 1986 to 1993 and protected the majority of commercial sexual contacts. Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Viral infections were associated with injecting drug use and non-British nationality; bacterial infections were associated with numbers of non-commercial partners but not with sexual contacts at work. Four women died during the course of the study; two had AIDS, two were murdered. This mortality of 5.93 per 1000 person years was 12 times the expected rate for women of a similar age., Conclusions: This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently: there has been a sustained increase in condom use in the sex industry. None the less, prostitutes are at increased risk of sexually transmitted infections, primarily through non-commercial sexual partnerships. Infectious diseases are only one of the risks facing prostitutes, as illustrated by the mortality from violence as well as from HIV infection.

Objectives: To describe and assess measures to control sexually transmitted diseases (STDs) among sex workers and their partners., Methods: A review of medical, historical and social literature, focusing on selected cases., Results: Measures to control disease in sex workers today are often prompted by concerns about HIV transmission. However, the literature shows that prostitution varies from one place and time to another, together with the risk of sexually transmitted disease. A broad social definition of prostitution rather than a narrow reference to levels of sexual activity is important for effective disease control, as an understanding of the relation between social disadvantage and sexual activity enables the provision of occupational services that sex workers actually want and use. Social prejudice and legal sanctions cause some sex workers and their partners to avoid even the most appropriate and accessible specialist services. Therefore targeted programmes can only complement, and not replace, general measures to control STDs, which are developed for other social groups or the local population as a whole., Conclusions: Sex workers and sex work differ from one place to another and so a single model for STD control is inappropriate. None the less, occupational health risks suggest a general need for specialist services. Where these do not compound the disadvantages that sex workers already suffer, medical services are likely to offer significant benefits in prevention, early diagnosis, and treatment of STDs. As the stigma of prostitution leads many people to remain invisible to services, a general health infrastructure and anti-discriminatory measures will be equally important to effective disease control.

Presents methods for studying sexual networks which draw upon routine procedures in genitourinary medical clinics in Great Britain for tracing partners and identifying strains of infection. Microbiological data's assistance in the understanding of transmission; Social context's role in interpretation of microbiological data.

We aimed to describe and compare sexual links among people with gonorrhoea, by studying patients in 2 UK departments of genitourinary medicine. Interviews were completed for 510 and 235 cases in London and Sheffield respectively. There was a greater proportion of cases in men, homosexual men, non-white and non-British people and fewer female sex workers in London. Total networks of 1738 people in London and 570 people in Sheffield were described. Large linked heterosexual networks identified in Sheffield were associated with local contact, including men with higher numbers of sexual partners. Condom use for vaginal sex was reported for 11% of heterosexual partnerships in Sheffield, and 27% in London, with little difference between regular and casual partners. It was more difficult to define networks in London due to a high proportion of relatively anonymous contacts. These difficulties suggest that research and interventions may profitably focus upon venues for meeting partners as well as partner notification. [ABSTRACT FROM AUTHOR]

Background: We hypothesised that changes in the London sex industry will have weakened health and safety norms. Methods: Baseline data were collected on sex workers at St Mary's Hospital and grouped into four time periods: 1985-88; 1989-92; 1993-96; 1997-2000. Results: 1217 new patients were enrolled. The following changes were seen: women were older (median age increased from 25 to 27) less likely to have been born in the UK (declined from 80% to 39%), were older when they began sex work (median age increased from 21 to 24 years), and had been working for less time (median of 3 years declined to 1 year). The proportion working on the streets declined from 22% to 2%, while the proportion working in flats increased from 15% to 35%. Condom use at work rose from 80% to 99% for vaginal and from 50% to 81% for oral sex. Condom use with non-paying partners rose from 11% to 31%. There was a decline in the proportion reporting a past STI from 86% to 31%, and in the prevalence of most STI at first visit chlamydia declined from 8.2% to 3.9%, and gonorrhoea from 3% to 1%. The only increase was in hepatitis B core antibody from 6.6% to 10.1%. Discussion: We have documented significant changes in the London sex industry but these have not been associated with increased risk behaviour or risk of STI. This finding is all the more surprising given increasing migration from higher prevalence areas and increasing STI in the UK. [ABSTRACT FROM AUTHOR]