Amanda Jeffery

With what would have been National HIV Testing Week at the end of November, and World AIDS Day today, our Amanda Jeffery, Head of Sexual & Reproductive Health, takes a timely reflection on what we are doing to ensure that everyone in the UK has access to good sexual health advice, information, and services.

We are doing many things well, particularly when we look at advances in sexual health for young people. More young people are aware of Chlamydia & Gonorrhoea, and are getting tested and treated, which means that rates of infection amongst young people are decreasing. The Universal HPV Vaccination Programme has reduced risk of certain cancers and genital warts for many young people, and has now been expanded to include young men-who-have-sex-with-men (MSM), as well as young trans-men and young trans-women who are at risk. Relationships and sexual health education is now mandatory in all schools, including private schools and academies. There is an emerging body of research looking at the effects of pornography on young people, and an array of excellent resources coming out around consent and healthy relationships.

However, we are not doing nearly as well when it comes to supporting the sexual health of older people, particularly when they are already vulnerable or at risk due to their social or economic circumstances. Rates of new HIV infections are still highest amongst those aged 35-55, particularly MSM and black Africans. There is still a huge stigma around accessing sexual health services; we know that as sexual functioning and sexual satisfaction decrease with age, so does the likelihood of accessing clinical support. Some research (Natsal-3) suggests that those aged 45-65 are actually more at risk of non-volitional sex than young people are, and of the same level as those aged 16-25 in terms of taking new sexual risks.

On World Sexual Health Day last year, I wrote that sexual health does not exist in a silo, and shared my belief that engagement around sexual health is needed from a variety of stakeholders in order to reach our vulnerable older populations. I also shared that METRO had received EU funding for a project called SHIFT, on which METRO is working with partners in South East England, Belgium, and the Netherlands to improve sexual health outcomes amongst those Over 45. At its core, SHIFT wants to understand the diverse and varied sexual health needs of those Over 45, to help build responsive sexual health support into existing community resources.

Thus far, SHIFT has conducted over 1,000 surveys and held numerous 1:1 interviews with a broad range of people over the age of 45. We wanted to find out what kinds of relationships they were in, how they felt about their own sexual health and intimacy needs, what sexual health support is already offered, what key needs are, where any key gaps in knowledge or services might be, and what training and resources would be useful. METRO focused on those living with HIV, those identifying as LGBTQ, those with housing or homelessness issues, and/or those from black or minority ethnicities (BAME).

Though we are still analysing the many interviews we conducted, we have already learned that many Over 45s:

  • Do not feel listened to by healthcare practitioners
  • Believe that sexual health services and campaigns are not meant for them
  • Are embarrassed and frustrated over not being able to perform sexually
  • Have physical concerns that impede their sexual health and pleasure
  • Think that their sexual health and pleasure has taken a backseat to other things in life: money, stress, children, relationships, etc
  • Feel shame, embarrassment, and discomfort around sex
  • Do not talk to their friends or family about sex, relationships, or intimacy
  • Believe they are not at risk of poor sexual health outcomes
  • Do not know where to go for support when they need it
  • Are not comfortable disclosing their HIV status
  • Have not felt able to “come out” to family or friends
  • Do not feel comfortable with their sexual orientation or gender identity
  • Do not have a peer group that supports them to have good sexual health or positive intimate relationships
  • Have never had any sexual health or relationships education

When we are finished analysing the rich array of data we have collected, we will enter the next phase of the project, which is to develop a model to help key stakeholders better address sexual health so that we may start to improve overall outcomes amongst this age group, and respond to some of the issues we have identified above. This is hugely important work and we would welcome any feedback, contributions, or participation from relevant stakeholders.

For more information or to get involved, visit the SHIFT programme web page.