SPLASH York 2024-07-10

Summary profile of
local authority sexual health

York

Field Service, Regions Directorate, Health Protection Operations

STI team, Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Clinical Public Health

10 July 2024

 

Interim Update

  • This report is a mid-year update to include the latest sexually transmitted infection (STI) statistics published in June 2024. This means that figures for STIs relate to 2023, while other figures are from 2022 or the most recent year for which data are available.
  • Due to Upper Tier Local Authority (UTLA) boundary changes in Cumberland, Westmorland & Furness, North Northamptonshire, West Northamptonshire, North Yorkshire UA and Somerset UA historic data may not be complete for all indicators. On publication, this report included data available on the sexual health profiles for the updated UTLA.
  • Abortion data for 2022 were not available for this report and therefore the most recent published data are presented.
  • Four indicators for HIV testing coverage have been removed from this report as they no longer provide an accurate picture of HIV testing in a locality. New indicators for HIV testing uptake are in development and will be published on the SRH profiles later in the year. They will be included in future SPLASH reports. The HIV coverage indicators will remain available on the SRH profiles until they are replaced.

Key findings

  • This report summarises the latest available sexual and reproductive health data for York.
  • Overall, the number of new sexually transmitted infections (STIs) diagnosed among residents of York in 2023 was 1,204. The rate was 589 per 100,000 residents, lower than the rate of 704 per 100,000 in England, and higher than the average of 546 per 100,000 among its nearest neighbours.
  • York ranked 96th highest out of 151 upper tier local authorities (UTLAs) and unitary authorities (UAs) for new STI diagnoses excluding chlamydia in those aged under 25 in 2023, with a rate of 352 per 100,000 residents, better than the rate of 520 per 100,000 for England.
  • The chlamydia detection rate per 100,000 females aged 15 to 24 years in York was 1,530 in 2023, worse than the rate of 1,962 for England.
  • The rank for gonorrhoea diagnoses (which can be used as an indicator of local burden of STIs in general) in York was 95th highest (out of 151 UTLAs/UAs) in 2023. The rate per 100,000 was 90.9, better than the rate of 149 in England.
  • The number of new HIV diagnoses in York was 8 in 2022. The prevalence of diagnosed HIV per 1,000 people aged 15 to 59 years in 2022 was 0.8, better than the rate of 2.3 in England. The rank for HIV prevalence in York was 145th highest (out of 151 UTLAs/UAs).
  • In York, in the three year period between 2020 - 22, the percentage of HIV diagnoses made at a late stage of infection amongst those first diagnosed in the UK (all individuals with CD4 count ≤350 cells/mm3 within 3 months of diagnosis) was 100%, similar to 43.3% in England.
  • The total rate of Long Acting Reversible Contraception (LARC) (excluding injections) prescribed in primary care, specialist and non-specialist Sexual Health Services (SHS) per 1,000 women aged 15 to 44 years living in York was 66.2 in 2022, higher than the rate of 44.1 per 1,000 women in England. The rate prescribed in primary care was 41.7 in York, higher than the rate of 26.5 in England. The rate prescribed in the other settings was 24.4 in York, higher than the rate of 17.7 in England.
  • The total abortion rate per 1,000 women aged 15 to 44 years in 2021 was 11.3 in York , lower than the England rate of 19.2 per 1,000. Of those women under 25 years who had an abortion in 2021 the proportion who had previously had an abortion was 22.2% lower than 29.7 % in England.
  • In 2022/23, the percentage of births to mothers under 18 years was 1.0%, similar to 0.6% in England overall.

Figure 1. Chart showing key sexual and reproductive health indicators in York compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars

Introduction

Aim

This report describes sexual and reproductive health in a local area in an integrated way, including sexually transmitted infections (STIs), HIV, under-18 conceptions, abortion and Long Acting Reversible Contraception rates for women aged 15 to 44.

This is produced alongside other local HIV, sexual and reproductive health intelligence tools provided by the UK Health Security Agency (UKHSA) to help inform local Joint Strategic Needs Assessments (JSNAs) so that commissioners can effectively target service provision.

This report has been produced by the UKHSA, with support from the Office for Health Improvement and Disparities (OHID).

Information used in this report

Unless otherwise indicated this report is compiled from publicly available data on the online Sexual and Reproductive Health Profiles. Please access this tool for further data analysis and more information about the data included in this report which is described in the ‘definitions’ tab for each indicator.

Please note that City of London and Isles of Scilly are not included in the rankings in this document. Where comparisons are made to Hackney or Cornwall, please note that the data for these areas may have been combined with City of London and Isles of Scilly respectively. Please check the online Profiles.

For an introductory guide on sexual health data sources, please access https://www.gov.uk/government/publications/sexual-and-reproductive-health-in-england-local-and-national-data.

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STIs

As STIs are often asymptomatic, frequent STI screening of groups with greater sexual health needs is important and should be conducted in line with national guidelines.1 Early detection and treatment can reduce long-term consequences, such as infertility and ectopic pregnancy. Vaccination is an intervention that can be used to control genital warts, hepatitis A and hepatitis B, however, control of other STIs relies on consistent and correct condom use, behaviour change to decrease overlapping and multiple partners, ensuring prompt access to testing and treatment, and ensuring partners of cases are notified and tested.

There was an increasing trend in diagnoses of chlamydia, gonorrhoea and syphilis in England from 2010 until 2019, while diagnoses of genital warts have decreased since 2013 due to the protective effect of HPV vaccination.2 During 2020 and 2021, the response to the COVID-19 pandemic disrupted sexual health services leading to a decline in testing and diagnoses of STIs. Larger decreases in diagnoses were observed for STIs that are usually diagnosed clinically at a face to face consultation, such as genital warts or genital herpes, when compared to those that could be diagnosed using remote self-sampling kits such as chlamydia and gonorrhoea.3 STIs continue to disproportionately affect gay, bisexual and other men who have sex with men (GBMSM), young people (aged 15 to 24) and some minority ethnicities. Please see the official statistics report for more details and data.

This report has been compiled using data from sexual health services (SHS) reported to UKHSA via the GUMCAD STI Surveillance System and data on chlamydia testing and diagnoses from all settings reported to UKHSA via the CTAD Chlamydia Surveillance System.

‘Sexual health services’ refer to services offering specialist STI related care (e.g. services offering Level 3 care including integrated sexual and reproductive health services) and non-specialist sexual health services (e.g. services offering Level 2 care including online services and contraception and sexual health services for young people). Data on chlamydia testing and diagnoses are collected from sexual health services via GUMCAD and from other settings including general practice, pharmacies, abortion services, and other services via CTAD.

Burden and trend of new STIs

A total of 1,204 new STIs were diagnosed in residents of York in 2023. It should be noted that if high rates of gonorrhoea and syphilis are observed in a population, this suggests ongoing transmission of infections is occurring.

When interpreting trends, please note:

  • The decrease in STI testing and diagnoses in 2020 due to the disruption of sexual health services during the COVID-19 pandemic response, with testing rates largely recovering during 2021.Diagnoses levels, for some infections, returned to and exceeded pre-pandemic levels by the end of 2022. Others, such as genital herpes have increased more slowly and remain lower than before the pandemic.
  • Recent decreases in genital warts diagnoses are due to the protective effect of HPV vaccination, and are particularly evident in the younger age groups (25 and younger) who have been offered the vaccine since the national programme began.

Figure 2. Chart showing STI indicators in York compared to the rest of England, 2023

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars

Table 1. Rates per 100,000 population of new STIs in York and England: 2022 to 2023

Diagnoses 2022 2023 % change 2022 to 2023* Rank among 16 similar UTLAs/UAs† Rank within England: 2023‡ Value for England: 2023
New STIs 589.6 588.6 -0.2% 5 70 703.6
New STIs (exc chlamydia aged <25) 342.2 352.5 3.0% 7 96 519.9
Chlamydia 343.7 327.5 -4.7% 6 62 341.4
Gonorrhoea 107.1 90.9 -15.1% 9 95 149.2
Syphilis 5.9 8.3 41.7% 12 90 16.7
Genital warts 46.4 48.9 5.3% 5 42 45.8
Genital herpes 35.7 42.0 17.8% 6 76 47.6
Mycoplasma genitalium1 1.0 4.9 400.0% 10 123 15.6
Trichomoniasis1 2.4 4.4 80.0% 14 125 16.0
Sexually transmitted Shigella spp. 1.0 1.0 0.0% 10 123 9.0
* Percent change not provided where the value in 2022 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.
1 Data for Mycoplasma genitalium and trichomoniasis were included for the first time in 2022. Testing for these infections is not included as part of a standard sexual health screen, but is advised for those with symptoms and the partners of those diagnosed (see BASHH guidelines for Mycoplasma genitalium and trichomoniasis).

Table 2. Number of new STIs by year, York

Diagnoses 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
New STIs 1,190 1,546 1,628 1,534 1,632 1,828 1,718 1,590 939 931 1,206 1,204
New STIs (exc chlamydia aged <25) 823 928 1,008 998 953 1,093 1,084 943 514 501 700 721
Chlamydia 528 793 805 683 853 978 877 873 544 576 703 670
Gonorrhoea 28 60 76 96 88 136 138 152 61 53 219 186
Syphilis 3 11 11 6 15 12 17 8 8 14 12 17
Genital warts 252 283 290 381 290 294 270 264 155 130 95 100
Genital herpes 138 156 148 115 128 153 170 127 74 76 73 86
Mycoplasma genitalium1 - - - - - - - 2 4 2 2 10
Trichomoniasis1 7 4 7 2 5 4 11 4 10 2 5 9
Sexually transmitted Shigella spp. - - - - 2 2 1 0 0 0 1 1
- Data Suppressed (due to small numbers or missing data)
Disruption to sexual health services during the response to the COVID-19 pandemic led to reduced STI testing and diagnoses in 2020 and 2021.
1 Data for Mycoplasma genitalium and trichomoniasis were included for the first time in 2022. Testing for these infections is not included as part of a standard sexual health screen, but is advised for those with symptoms and the partners of those diagnosed (see BASHH guidelines for Mycoplasma genitalium and trichomoniasis).

Figure 3. Map of new STI diagnoses (excluding chlamydia in under 25-year olds) per 100,000 population in York by Middle Super Output Area: 2023

Please note that this data is not available on the online Sexual and Reproductive Health Profiles. Data is sourced from routine specialist and non-specialist sexual health services’ returns to the UKHSA GUMCAD STI Surveillance System and from routine non-specialist sexual health services’ returns to the CTAD Chlamydia Surveillance System.


 

New STI diagnoses in York by MSOA
New STI diagnoses in York by MSOA

Contains Ordnance Survey data © Crown copyright and database right 2021
Contains National Statistics data © Crown copyright and database right 2021

Figure 4. Rates per 100,000 population of new STIs (excluding chlamydia in under 25-year olds) in 16 similar local authorities compared to England: 2023

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model


  Value suppressed for 1 local authority.


 

Figure 5. Rates per 100,000 population by diagnosis by year in York compared to rates in England: 2012 to 2023

Please note the charts have different y axis scales.


 
 

Figure 6. Rates per 100,000 population of gonorrhoea in 16 similar local authorities compared to England: 2023

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Figure 7 shows rates of syphilis per 100,000 population for York, compared to national, regional, and neighbouring rates. The UKHSA has published analyses of the epidemiology of syphilis,4 in alignment with the Syphilis Action Plan (2019).5

Figure 7. Rates per 100,000 population of syphilis in 16 similar local authorities compared to England: 2023.

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Chlamydia detection

Increasing diagnosis rates for chlamydia among people aged 15 to 24 years are largely driven by changes in testing activity through the National Chlamydia Screening Programme (NCSP), although ongoing high levels of condomless sex will have played a role. In June 2021, the primary aim of NCSP changed, focusing on reducing the harms from untreated chlamydia infection, which occur predominantly in young women and other people with a womb or ovaries.6 Therefore, opportunistic screening should be offered to these groups, combined with reducing time to test results and treatment, strengthening partner notification and re-testing after treatment. The NCSP data tables provide additional data on chlamydia testing coverage, positivity, and diagnostic rates (for those aged 15 to 24 years).7

Since chlamydia is most often asymptomatic, a high detection rate reflects success at identifying infections that, if left untreated, may lead to serious reproductive health consequences.

The chlamydia detection rate in 15 to 24 year old females in 2023 in York was 1,530 per 100,000 population (305 positives out of 3,559 screened), lower than the 3,250 target. 17.9% of 15 to 24 year old females were tested for chlamydia, compared to 20.4% nationally. The detection rate per 100,000 and its rank among CIPFA nearest neighbours and England are shown in Table 3.

Table 3. Chlamydia detection rate per 100,000 population and percentage screened in 15 to 24 year olds in York and England: 2023

2022 2023 % change 2022 to 2023* Rank among 16 similar UTLAs/UAs† Rank within England: 2023‡ Value for England: 2023
Detection rate
Female 1,650.7 1,530.3 -7.3% 11 116 1,961.7
Male 903.7 1,010.0 11.8% 6 64 1,041.6
Total 1,650.7 1,530.3 -7.3% 11 116 1,961.7
Proportion screened
Females aged 15-24 20.7 17.9 -13.5% 9 87 20.4
* Percent change proportional to the value in 2022, not a change in percentage points. Percent change not provided where the value in 2022 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Variation in rates of chlamydia detection (Figure 8) may represent differences in prevalence, but are influenced by screening coverage and whether most at risk populations are being reached (i.e. the proportion testing positive).

Figure 8. Map of chlamydia detection rate per 100,000 females aged 15 to 24 in York by Middle Super Output Area: 2023

Please note that this data is not available on the online Sexual and Reproductive Health Profiles. Data is sourced from the CTAD Chlamydia Surveillance System (CTAD).

New Chlamydia diagnoses in York by MSOA
New Chlamydia diagnoses in York by MSOA

Contains Ordnance Survey data © Crown copyright and database right 2021
Contains National Statistics data © Crown copyright and database right 2021

Figure 9. Chlamydia detection rate per 100,000 females aged 15 to 24 in 16 similar local authorities compared to England: 2023

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

In the five years from 2018 to 2023 there was a 31% decrease in the chlamydia detection rate among 15 to 24 year olds in York. From 2022 the decrease was 7%.

Figure 10. Chlamydia detection rate per 100,000 population in 15 to 24 year olds females in York and England, 2012 to 2023

Shigella

Shigellosis, or bacillary dysentery, spread through sexual contact has become endemic in England and in many other countries worldwide. Due to its presentation as an enteric illness, most symptomatic cases present to primary care (GPs, A&E) rather than SHS. Although most cases resolve without treatment, cases of shigellosis can be severe and require admission to hospital for treatment of complications.8 The management of sexually transmitted enteric infections should be conducted in line with national guidelines.9

The prevalence is highest in larger cities and towns in England, although the infection is becoming more widespread. Over the last decade, the number of cases of sexually transmitted Shigella among GBMSM in England has increased,10 with concerning increases in antimicrobial resistance. Only a minority of GBMSM are thought to be aware of Shigella and how to avoid it,11 however, surveillance shows transmission of these infections is commonly associated with high risk behaviours such as sexualised drug use (including ‘chemsex’) and multiple casual sex partners.

A new indicator showing trends in sexually transmitted shigellosis in the adult male population was added to the Sexual and Reproductive Health Profiles in June 2023.

STI testing in sexual health services (SHS)

In 2023 the rate of STI testing (excluding chlamydia in under 25 year individuals) in SHS in York was 3,737 per 100,000, a 2% decrease compared to 2022. This is lower than the rate of 4,111 per 100,000 in England in 2023. The positivity rate in York was 4.8% in 2023, lower than 7.3% in England. Positivity rates depend both on the number of diagnoses and the offer of testing: higher positivity rates compared with previous years can represent increased burden of infection, decreases in the number of tests, or both.

The methodology to calculate the STI positivity changed in September 2021 to better reflect testing within the population accessing SHS by area. More details are available on the Sexual and Reproductive Health Profiles.12

Figure 11. STI testing rate and positivity rate (excluding chlamydia in under 25 year olds) per 100,000 population by year in York and England: 2012 to 2023


 

Other infections transmitted sexually

Some bloodborne viruses can be spread through sex as well as by other routes, e.g. hepatitis B, hepatitis C. Some gastro-intestinal infections, typically linked to contaminated food or water can also be spread faecal-orally during sexual activity: these are called sexually transmissible enteric infections (STEIs) e.g. hepatitis A and Shigella.

Lymphogranuloma venereum (LGV), an invasive form of chlamydia, is a sexually transmitted infection which disproportionately affects MSM. In the past decade, the number of LGV diagnoses has increased substantially in England. Historically, LGV was mainly concentrated among MSM living with HIV. However, in recent years, a greater proportion of cases have been among MSM who are HIV negative.13

Hepatitis A vaccination is available for GBMSM in SHS. In 2016 an outbreak of hepatitis A was identified among GBMSM in England and across Europe. Between July 2016 and April 2017 266 cases associated with the outbreak had been identified in England, 74% of these among GBMSM.14 This resulted in work to raise awareness of how to prevent infection through hygiene measures (e.g. washing hands after sex)15 and recommendations around hepatitis A vaccination of MSM attending SHS. This outbreak highlights how quickly and widely an infection can become established in key populations if prevention measures such as vaccination are not undertaken.

Most Hepatitis B infections in England are acquired overseas in high prevalence countries; where infection is acquired in England it is most often acquired sexually. Where information on risk exposures was recorded on acute and probable acute cases of hepatitis B, the most commonly reported risk was heterosexual exposure (50%), followed by sex between men (17%).16 Vaccination can prevent infection and is recommended for GBMSM, for individuals with multiple sexual partners and for individuals engaging in sexual activity when travelling to high prevalence countries.

Most people in England acquire hepatitis C through injecting drug use.17 However, GBMSM are also a risk group for hepatitis C transmission. GBMSM living with diagnosed HIV, especially those reporting high risk sexual practices, are disproportionately affected by hepatitis C compared to HIV-negative GBMSM; therefore guidance for hepatitis C testing in SHS has been targeted towards this group.

In May 2022, an international outbreak of mpox (monkeypox) was detected with cases reported concurrently from many countries where the disease is not endemic. To date, most reported cases in the outbreak have involved mainly, but not exclusively, men who have sex with men. Over 3,500 individuals have been diagnosed in England. Vaccines developed to protect against smallpox have been approved and used for prevention of mpox and were used as part of the response. Preventative vaccination continues, with numbers of new cases falling to lower levels but continuing throughout 2023.18

HIV

England has set an ambition to end HIV transmission, AIDS and HIV-related deaths by 2030. The England HIV Action Plan 2022-2025 set out intermediate commitments for the next 4 years to achieve the 2030 ambition, including how HIV transmission will be reduced by 80% by 2025.19 The monitoring and evaluation framework published in December 2022 sets out the indicators that will be used to monitor the progress towards this goal.20

Free and effective antiretroviral therapy (ART) in the UK has transformed HIV from a fatal infection into a chronic but manageable condition. People living with HIV in the UK can now expect to have a near normal life expectancy if diagnosed promptly and they adhere to treatment. In addition, those on treatment are unable to pass on HIV, even if having unprotected sex (undetectable=untransmissible [U=U]).

In 2022, 3,805 people were newly diagnosed with HIV in England, of whom 1,361 were previously diagnosed abroad. The remaining 2,444 new diagnoses that were first made in England represent a 6% rise from 2,313 (in 2021) and a 8% rise from 2,271 (in 2020).21 Among these, men exposed through sex between men accounted for 30% (724), women exposed by heterosexual contact for 23% (564), men exposed by heterosexual contact for 17% (411), injecting drug use for 2% (41). High risk sexual practices such as chemsex can also increase the risk of HIV transmission.

More than half those first diagnosed in England in 2022 were diagnosed at a late stage (with a CD4 count below 350 cells per mm³). People diagnosed late have a fivefold risk of death within a year of their diagnosis compared to those who were diagnosed promptly.

Of the estimated 99,000 (credible interval (CrI) 97,700 to 100,900) people living with HIV in 2022, an estimated 4,500 (95% CrI 3,500 to 6,200) were undiagnosed. In 2022, England again achieved the UNAIDS 95-95-95 target nationally, with 95% of people living with HIV being diagnosed, 98% of those diagnosed being on treatment and 98% of those on treatment having an undetectable viral load. For 2022, HIV surveillance data includes two new indicators on HIV Pre-exposure prophylaxis (PrEP):

  • Determining PrEP need Proportion of all HIV negative individuals with estimated PrEP need who had this need identified (%)
  • Initiation or continuation of PrEP among those with PrEP need: Proportion of all HIV negative individuals with estimated PrEP need who started or continued PrEP (%)

In 2022, 9.7% (121,547 of 1,249,511) of HIV-negative people accessing specialist SHSs in England were defined as having PrEP need. Among these, 71% (86,324 out of 121,547) initiated or continued PrEP.

Figure 12. Chart showing key HIV indicators in York compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars

HIV treatment and care

In 2022, there were 99 York residents aged 15 to 59 years and 128 residents aged 15 years and over who were seen at HIV services (the prevalence of diagnosed HIV). People who are accessing health-care in extremely high HIV prevalence areas (greater than 5 per 1,000 residents aged 15 to 59 years old) should be offered an HIV test. 22 The diagnosed prevalence per 1,000 residents aged 15 to 59 years was 0.8, better than 2.3 per 1,000 in England. The rank of York was 145th highest (out of 151 UTLAs/UAs). Since 2021, the change in York was 0%; in the 5 years since 2017, the decrease was 9%.

In 2022, 12.7% (460 out of 3,624) of HIV-negative people accessing specialist SHSs in York were defined as having PrEP need. Among these, 45.0% (207 out of 460) initiated or continued PrEP.

Figure 13. Diagnosed HIV prevalence per 1,000 population aged 15 to 59 years by year in York compared to rates in the Yorkshire and the Humber region (statistical) and England: 2011 to 2022.

Figure 14. Diagnosed HIV prevalence per 1,000 population aged 15 to 59 years in 16 similar local authorities and the Yorkshire and the Humber region (statistical), compared to England: 2022

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

The percentage of people (aged 15 years and over) in York accessing HIV care who were prescribed ART in 2022 was 100%, similar to 98.1% in England. The percentage of people in York newly diagnosed with HIV in the three-year period between 2020 - 22 who started antiretroviral therapy (ART) promptly (within 91 days of their diagnosis) was 66.7%, similar to 85.4% in England.

The percentage of adults in York accessing HIV care in 2022 who were virally suppressed (undetectable viral load) was 97.6%, similar to 97.7% in England.

The Sexual and Reproductive Health Profiles also provides these data at lower tier local authority geographies.

Figure 15. Map of diagnosed HIV prevalence among people of all ages in York by Middle Super Output Area: 2022

Please note that this data is not available on the online Sexual and Reproductive Health Profiles. Data is sourced from the UKHSA HIV and AIDS Reporting System (HARS). As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.

HIV prevalence in York by MSOA
HIV prevalence in York by MSOA

Contains Ordnance Survey data © Crown copyright and database right 2021
Contains National Statistics data © Crown copyright and database right 2021

New HIV diagnoses among persons first diagnosed in the UK

To measure HIV transmission in the UK more accurately, diagnoses where the first HIV positive test occurred in the UK are considered in this section. All reports of new HIV diagnoses, regardless of country of first HIV positive test, are presented in Figure 12.

In 2022, the number of York residents aged 15 years and older who were newly diagnosed with HIV in the UK was 2. The rate of new diagnoses per 100,000 residents was 1.0, better than the rate of 4.3 per 100,000 in England. This represented a incalculable increase since 2021 and a 59% decrease in the 5 years since 2017. The rank of York for the rate of new HIV diagnoses was 133rd highest (out of 151 UTLAs/UAs).

Figure 16. Rate of new HIV diagnoses per 100,000 population among people aged 15 years or above first diagnosed in the UK by year in York compared to rates in the Yorkshire and the Humber region (statistical) and England: 2011 to 2022.

Figure 17. New HIV diagnoses among persons first diagnosed in the UK rate per 100,000 population aged 15 years and above in 16 similar local authorities and the Yorkshire and the Humber region (statistical), compared to England: 2022

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Value suppressed for 2 local authorities.

Late HIV diagnosis

Late diagnosis is the most important predictor of HIV-related morbidity and short-term mortality. It is a PHOF indicator, and monitoring is essential to evaluate the success of local HIV testing efforts. Late diagnosis is defined here as having a CD4 count <350 cells/mm3 within 91 days of first HIV diagnosis in the UK. An updated definition of late HIV diagnosis which incorporates evidence of recent seroconversion has also been published in other outputs.

In York, the percentage of HIV diagnoses made at a late stage of infection in the three-year period between 2020 - 22 was 100%, similar to 43.3% in England.

Figure 18. Percentage of late HIV diagnoses (all CD4<350) in 16 similar local authorities and Yorkshire and the Humber region (statistical), compared to England: 2020 - 22

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Value suppressed for 1 local authority.

Figure 19. Percentage of late HIV diagnoses (all CD4<350) in York compared to the Yorkshire and the Humber region (statistical) and England: 2009-11 to 2020-22

For York residents, the percentage of HIV diagnoses made at a late stage of infection for different risk groups in the three-year period between 2020 - 22 was as follows: MSM - 100% not compared to 34.2 % in England; heterosexual men - 100% similar to 58.9 % in England; heterosexual women - 0.0% not compared to 49.9 % in England.

Reproductive health

The COVID-19 pandemic and reproductive health

During 2020, the UK government responded to the COVID-19 pandemic with national lockdowns which directly impacted SRH service provision in England.

Access to Long Acting Reversible Contraception (LARC) fittings and removals have been particularly impacted by the pandemic due to the requirements for face-to-face interactions.

Abortion

The total abortion rate, under 25 years repeat abortion rate, under 25 years abortions after a birth, and over 25 years abortion rates may be indicators of lack of access to good quality contraception services and advice, as well as problems with individual use of contraceptive method.

In York the total number of abortions in 2021 was 518 . The total abortion rate per 1,000 female population aged 15 to 44 years was 11.3 lower than the rate in England of 19.2 per 1,000. The rank (out of 149 UTLAs/UAs) within England for the total abortion rate was 148th highest .

Figure 20. Chart showing key abortion indicators in York UTLAs/UAs compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars


 

Table 4. Abortion figures in York and England: 2021


 

2020 2021 % change 2020 to 2021* Rank among 16 similar UTLAs/UAs† Rank within England: 2021‡ Value for England: 2021
Rates
Total abortion rate / 1,000 11.4 11.3 -0.9% 16 148 19.2
Under 18s abortions rate / 1,000 6.5 6.2 -4.6% 8 79 6.5
Over 25s abortion rate / 1,000 12.2 10.2 -16.4% 16 147 17.9
Percentages
Under 25s repeat abortions (%) 19.1 22.2 16.2% 15 144 29.7
Under 25s abortion after a birth (%) - 23.4 - 5 93 26.0
- Data suppressed (due to small numbers or missing data)
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.
* Percent change proportional to the value in 2020, not a change in percentage points. Percent change not provided where the value in 2020 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Figure 21. Abortion rates per 1,000 women by age in York compared to the Yorkshire and the Humber region (statistical) and England: 2012 to 2021

Figure 22. Characteristics of abortions over time in York compared to the Yorkshire and the Humber region (statistical) and England: 2012 to 2021

Figure 23. Abortion rate per 1,000 women in 16 similar local authorities and Yorkshire and the Humber region (statistical), compared to England: 2021

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model


 

The earlier abortions are performed the lower the risk of complications. Prompt access to abortion, enabling provision earlier in pregnancy, is also cost-effective and an indicator of service quality.

In York the percentage of NHS-funded abortions that were under 10 weeks was 88.4% in 2021 similar to the percentage in England of 88.6 %. The rank within England for this indicator was 86th highest (out of 149 UTLAs/UAs).

Since the introduction of early medical abortion (EMA) methods, there has been an increase in the overall percentage of abortions performed at under 10 weeks gestation in England. Early medical abortion is less invasive than a surgical procedure and carries less risk as it does not involve instrumentation or the use of anaesthetics.

However, women may prefer a surgical abortion under local or general anaesthesia/conscious sedation for a variety of reasons, including wishing to avoid the experience of going through an induced pregnancy loss and having the procedure carried out during a single visit. Ensuring women have access to a method of contraception of their choice post-abortion is recommended practice. Provision of LARC methods post-abortion has been shown to lower subsequent unintended pregnancy rates.23

An indicator relating to the use of medical procedures will help to improve transparency at a local level on the extent of medical and surgical services available to women, and will thus be an indicator of patient choice. A very low or a very high percentage of medical abortions compared to other areas could be an issue for concern.

Among NHS-funded abortions in York the percentage of those under 10 weeks gestation that were performed using a medical procedure in 2021 was 96.9% , similar to the percentage in England of 95.5 %. The rank within England for this indicator was 48th highest (out of 149 UTLAs/UAs).

Table 5. Abortion figures for York and England: 2021


 

2020 2021 % change 2020 to 2021* Rank among 16 similar UTLAs/UAs† Rank within England: 2021‡ Value for England: 2021
Abortions under 10 weeks (%) 88.3 88.4 0.1% 7 86 88.6
Abortions under 10 weeks that are medical (%) 98.0 96.9 -1.1% 4 48 95.5
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.
* Percent change not provided where the value in 2020 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Figure 24. Early abortion over time in York compared to the Yorkshire and the Humber region (statistical) and England: 2012 to 2021

During the COVID-19 pandemic the UK government put in place a temporary approval in England, enabling women to take both pills for early medical abortion (EMA) up to 10 weeks (9 weeks and 6 days) gestation in their own homes, following a telephone or e-consultation with a clinician, without the need to first attend a hospital or clinic. This measure was put in place during the pandemic to reduce the risk of transmission of COVID-19 and ensure continued access to abortion services. It is time limited for 2 years, or until the pandemic is over ‒ whichever is earliest.

Under-18s Conception

Teenage pregnancy is a cause and consequence of education and health inequality for young parents and their children. Babies born to mothers under 20 years consistently have higher rates of stillbirth, infant mortality and low birthweight than average. Children born to teenage mothers have a 63% higher risk of living in poverty.24 Teenage mothers are more likely than other young people to not be in education, employment or training; and by the age of 30 years,25 are 22% more likely to be living in poverty than mothers giving birth aged 24 years or over.26 Young fathers are twice as likely to be unemployed aged 30 years, even after taking account of deprivation.27

Since the introduction of the Teenage Pregnancy Strategy in 1999, England has achieved a 66.3% reduction in the under-18 conception rate between 1998 and 2019. Further progress in both reducing the under-18s conception rate and improving the outcomes for young parents is central to improving young people’s sexual health and narrowing the health and educational inequalities experienced by young parents and their children.

Maintaining the downward trend is a priority in the Department of Health Framework for Sexual Health Improvement in England28 and addresses a number of key public health priorities including reducing health inequalities, ensuring every child gets the best start in life, and improving sexual and reproductive health. The Public Health Outcomes Framework (PHOF) includes the under-18 conception rate and a number of other indicators disproportionately affecting young parents and their children.

International evidence identifies the provision of high quality, comprehensive relationships and sex education (RSE) linked to improved use of contraception as the areas where the strongest empirical evidence exists on impact on teenage pregnancy rates.29, 30, 31 In September 2020, Statutory Guidance was introduced that requires all primary schools to provide relationships education, all secondary schools to provide relationships and sex education and both primary and secondary schools to provide health education, including puberty.32 This includes specific reference to ensuring all secondary school pupils know about local services providing confidential SRH advice and care.

Contraceptive services need to be accessible and youth friendly to encourage early uptake of advice, with consultations that recognise and address any knowledge gaps about fertility and concerns about side effects and support young people to choose and use their preferred method. Some young people will be at greater risk of early pregnancy and require more intensive RSE and contraceptive support, combined with programmes to build resilience and aspiration, providing the means and the motivation to prevent early pregnancy.

Reaching young people most in need involves looking at area and individual level associated risk factors. Child poverty and unemployment are the two area deprivation indicators with the strongest influence on under-18 conception rates.33 At an individual level, the strongest associated factors for pregnancy before 18 years are free school meal eligibility, persistent school absence by age 14 years, poorer than expected academic progress between ages 11-14 years, and being looked after or a care leaver.34, 35, 36

Teenagers are more likely to present late for abortion and to book late for antenatal care.37 The higher risk of unplanned pregnancy, late confirmation of pregnancy and fear of disclosure, all contribute to delays in accessing abortion and maternity services.38 Early pregnancy diagnosis, unbiased advice on pregnancy options and swift referral to maternity or abortion services are required to minimise delays.39 Young people who have experienced pregnancy are also at higher risk of subsequent unplanned conceptions.40

Figure 25. Chart showing under-18s conception indicators in York compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars

In 2021, the under-18s conception rate per 1,000 females aged 15 to 17 years in York was 10.2, similar to the rate of 13.1 per 1,000 in England. The decrease from 2020 was 18%. The rank within England for the under-18s conception rate was 108th highest (out of 151 UTLAs/UAs). Between 1998 and 2021, the decrease in the under-18s conception rate in York was 70%, compared to a 66% decrease in England.

Figure 26. Under-18s conception rate per 1,000 women in 16 similar local authorities and the Yorkshire and the Humber region (statistical), compared to England: 2021

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Figure 27. Rates of under-18s conception and births over time in York compared to the Yorkshire and the Humber region (statistical) and England

Among the under-18 conceptions in York, the percentage of those leading to abortion in 2021 was 36.7%, similar to the percentage in England of 53.4%. The rank for the percentage of conceptions leading to abortion in York was 142nd highest (out of 151 UTLAs/UAs). A lower than average percentage may indicate a higher proportion of young women choosing to continue the pregnancy, but can also reflect barriers to accessing abortion care.

Figure 28. Percentage of under-18 conceptions leading to abortion, over time in York compared to the Yorkshire and the Humber region (statistical) and England: 1998 to 2021

Figure 29. Percentage of births where the mother is aged under 18 years, over time in York compared to the Yorkshire and the Humber region (statistical) and England: 2010/11 to 2022/23

Table 6. Under-18s conception and birth figures in York and England: 2020

2020 2021 % change 2020 to 2021* Rank among 16 similar UTLAs/UAs† Rank within England: 2021‡ Value for England: 2021
Under 18s conception rate / 1,000 12.5 10.2 -18.3% 9 108 13.1
Under 16s conception rate / 1,000 2.4 1.7 -30.0% 9 94 2.1
Under 18s conceptions leading to abortion (%) 50.0 36.7 -26.7% 16 142 53.4
* Percent change not provided where the value in 2020 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Contraception

The government and the Faculty of Sexual and Reproductive Healthcare (FSRH) both highlight the importance of knowledge, access and choice for all women and men to all methods of contraception to help reduce unplanned pregnancies. Good contraception services have been shown to lower rates of teenage conceptions.

Contraception is available free of charge for people of all ages from a wide range of services in England. Contraceptive pills can be obtained from specialist sexual and reproductive health services, non-specialist sexual and reproductive health services including services for young people, some online services, pharmacies delivering the NHS Pharmacy Contraception Service, and general practice. Long-Acting Reversible Contraception (LARC) can be obtained from some general practices as well as all specialist and non-specialist sexual and reproductive health services. Other services that offer contraception include abortion services. Contraceptive pills can be purchased over-the-counter from most pharmacies and from online services.

Emergency hormonal contraception (levonorgestrel and/or ulipristal acetate) can be obtained free of charge from pharmacies participating in local schemes, general practices, and from some online services. Specialist and non-specialist sexual and reproductive health services can fit intrauterine devices (IUDs) for use as emergency contraception in addition to emergency hormonal contraception. Emergency hormonal contraception can be purchased over-the-counter from most pharmacies and from online services.

Condoms can be obtained free of charge from sexual health services and from local condom distribution schemes, where available. Condoms can be purchased from pharmacies, supermarkets and other retailers.

Currently, data on contraception provision are only centrally collected from specialist SHS, level 2 SRH services and some young person’s clinics through the Sexual and Reproductive Health Activity Dataset (SRHAD) and from NHS prescription forms within primary care. Data sources used in this report are SRHAD and Prescribing Analysis Cost Tabulation (ePACT2). ePACT2 data is available by number of prescriptions and is therefore a more useful indicator of use for LARC than short acting methods that require repeated prescription. However, there is no way of measuring method continuation, so the LARC data reflects method initiation only. The way in which this report presents total amount of contraception used in England should therefore be interpreted with care.

Attendance indicators provide a measure of young people’s access to specialist contraceptive services. The indicators are split by sex and unique attendances because there are different patterns of service access and recording relating to each sex. Females access services more than males and make more repeated visits in a year.

Attendance and service provision at SRH services is likely to be reflective of local service models and local geography e.g. more urban areas may have greater attendance at specialist SRH services as they may be easier to access, whereas in more rural areas it may be easier to attend general practice than travel to a specialist clinic.

Figure 30. Chart showing key contraception indicators in York compared to the rest of England

The local result for each indicator is shown as a circle, against the range of results for England shown as a grey bar. The line at the centre of the chart shows the England average, the diamond shows the average for the Yorkshire and the Humber region (statistical).

Compared to England:

  • Better Better
  • Similar Similar
  • Worse Worse
  • or
  • Lower Lower
  • Similar Similar
  • Higher Higher
  • or
  • Not compared Not compared
Key for spine bars
Key for spine bars

Attendance and service provision at sexual and reproductive health (SRH) clinics

Table 7. Attendance at specialist contraceptive services per 1,000 residents under 25 by gender, in York and England: 2021 to 2022

2021 2022 % change 2021 to 2022* Rank among 16 similar UTLAs/UAs† Rank within England: 2022‡ Value for England: 2022
Under 25s individuals attend specialist contraceptive services rate / 1,000 - Females 116.0 107.4 -7.5% 4 44 84.3
Under 25s individuals attend specialist contraceptive services rate / 1,000 - Males 30.4 34.8 14.4% 2 10 12.6
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.
* Percent change not provided where the value in 2021 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Figure 31. Attendance at specialist contraceptive services among under 25s by gender, in York compared to the Yorkshire and the Humber region (statistical) and England: 2014 to 2022

Contraceptive care

Table 8. Women’s choice of contraception at SRH services in York and England: 2020


 

2019 2020 % change 2019 to 2020* Rank among 16 similar UTLAs/UAs† Rank within England: 2020‡ Value for England: 2020
Women choose injections at SRH Services (%) 7.6 4.3 -42.8% 14 126 8.1
Women choose user-dependent methods at SRH Services (%) 56.2 49.6 -11.6% 13 107 54.9
Women choose hormonal short-acting contraceptives at SRH Services (%) 43.6 32.4 -25.7% 13 118 41.7
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.
* Percent change proportional to the value in 2019, not a change in percentage points. Percent change not provided where the value in 2019 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Table 9. Usage of LARC (excluding injections) at SRH services in York and England: 2022

2021 2022 % change 2021 to 2022* Rank among 16 similar UTLAs/UAs† Rank within England: 2022‡ Value for England: 2022
Under 25s choose LARC excluding injections at SRH Services (%) 47.9 46.0 -3.9% 3 20 36.2
Over 25s choose LARC excluding injections at SRH Services (%) 59.1 63.9 8.2% 3 28 53.2
As a response to the COVID-19 pandemic, in March 2020 the Government implemented national and regional lockdowns and social and physical distancing measures. These measures affected sexual behaviour and health service provision, which is reflected in sexual and reproductive health indicator data. Interpreting data from 2020 onwards should consider these factors, especially when comparing with data from pre-pandemic years.
* Percent change proportional to the value in 2021, not a change in percentage points. Percent change not provided where the value in 2021 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Focus on Long Acting Reversible Contraceptives (LARCs)

National GP and SRH Long Acting Reversible Contraception prescribing data41 shows that there was a significant drop in prescribing of IUD, IUS and implants from April 2020 with significant national recovery in prescribing by December 2020. However, no month during 2020 was prescribing above 2019 baseline rates, so significant backlogs in provision likely remain. National recovery masks significant regional and local variation.

The total rate of Long Acting Reversible Contraception (LARC) (excluding injections) prescribed in York primary care, specialist and non-specialist SHS was 66.2 per 1,000 women aged 15 to 44 years in 2022, higher than the rate of 44.1 per 1,000 women in England.

LARC provision is likely to reflect local geography and service models e.g. there may be more provision in primary care in more rural and semi-rural areas. In York, the rate prescribed in primary care was 41.7 in 2022, higher than the rate of 26.5 in England. The rate prescribed in the other settings was 24.4 in 2022, higher than the rate of 17.7 in England.

Table 10. Rate of LARCs (excluding injections) prescribed per 1,000 women aged 15-44 years by setting, York and England: 2022

2021 2022 % change 2021 to 2022* Rank among 16 similar UTLAs/UAs† Rank within England: 2022‡ Value for England: 2022
Total prescribed LARC excluding injections rate / 1,000 67.4 66.2 -1.8% 1 9 44.1
GP prescribed LARC excluding injections rate / 1,000 43.4 41.7 -3.7% 6 21 26.5
SRH Services prescribed LARC excluding injections rate / 1,000 24.0 24.4 1.7% 3 38 17.7
* Percent change not provided where the value in 2021 was 0.
† These are York and its 15 statistical nearest neighbours, excluding those where values were suppressed due to small numbers. First rank has the highest value. Nearest neighbours are derived from CIPFA’s Nearest Neighbours Model.
‡ Out of 151 UTLAs/UAs in England, excluding those where values were suppressed due to small numbers. City of London and Isles of Scilly are always excluded. First rank has the highest value. Where the value was 0, ranks are based on order of local authority names.

Figure 32. Total rate of LARC (excluding injections) prescribed in primary care and in SRH services per 1,000 women aged 15 to 44 years in 16 similar local authorities and the Yorkshire and the Humber region (statistical), compared to England: 2022

Benchmarking refers to statistical nearest neighbours (comparison of local authorities with the most similar characteristics in England), derived from CIPFA’s Nearest Neighbours Model

Data sources

  • Abortions under 10 weeks (%). Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Abortions under 10 weeks that are medical (%). Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • All new STI diagnoses rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Antiretroviral therapy (ART) coverage in people accessing HIV care. Data source: UK Health Security Agency (UKHSA)

  • Chlamydia detection rate per 100,000 aged 15 to 24. Data source: UK Health Security Agency (UKHSA)

  • Chlamydia detection rate per 100,000 aged 15 to 24. Data source: UK Health Security Agency (UKHSA)

  • Chlamydia diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Chlamydia diagnostic rate per 100,000 aged 25 years and older. Data source: UK Health Security Agency (UKHSA)

  • Chlamydia proportion of females aged 15 to 24 screened. Data source: UK Health Security Agency (UKHSA)

  • Determining PrEP need. Data source: UK Health Security Agency (UKHSA)

  • GP prescribed LARC excluding injections rate / 1,000. Data source: OHID based on NHS Business Services Authority ePACT2 prescribing data and Office for National Statistics mid-year population estimates

  • Genital herpes diagnosis rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Genital warts diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Gonorrhoea diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • HIV diagnosed prevalence rate per 1,000. Data source: UK Health Security Agency (UKHSA)

  • HIV diagnosed prevalence rate per 1,000 aged 15 to 59. Data source: UK Health Security Agency (UKHSA)

  • HIV late diagnosis in gay, bisexual and other men who have sex with men first diagnosed with HIV in the UK. Data source: UK Health Security Agency (UKHSA)

  • HIV late diagnosis in heterosexual and bisexual women first diagnosed with HIV in the UK. Data source: UK Health Security Agency (UKHSA)

  • HIV late diagnosis in heterosexual men first diagnosed with HIV in the UK. Data source: UK Health Security Agency (UKHSA)

  • HIV late diagnosis in people first diagnosed with HIV in the UK. Data source: UK Health Security Agency (UKHSA)

  • Initiation or continuation of PrEP among those with PrEP need. Data source: UK Health Security Agency (UKHSA)

  • Mycoplasma genitalium diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • New HIV diagnoses among persons first diagnosed in the UK rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • New HIV diagnosis rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • New STI diagnoses (excluding chlamydia aged under 25) per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Over 25s choose LARC excluding injections at SRH Services (%). Data source: OHID based on NHS Digital SRHAD data

  • Over 25s abortion rate / 1000. Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Prompt antiretroviral therapy (ART) initiation in people newly diagnosed with HIV. Data source: UK Health Security Agency (UKHSA)

  • Repeat HIV testing in gay, bisexual and other men who have sex with men. Data source: UK Health Security Agency (UKHSA)

  • SRH Services prescribed LARC excluding injections rate / 1,000. Data source: OHID based on NHS Digital SRHAD data and Office for National Statistics mid-year population estimates

  • STI testing positivity (excluding chlamydia aged under 25). Data source: UK Health Security Agency (UKHSA)

  • STI testing rate (exclude chlamydia aged under 25) per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Sexually transmitted Shigella spp. per 100,000 adult male population. Data source: UK Health Security Agency

  • Syphilis diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Teenage mothers. Data source: OHID, based on NHS England data

  • Total abortion rate / 1000. Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Total prescribed LARC excluding injections rate / 1,000. Data source: OHID based on NHS Digital SRHAD data, NHS Business Services Authority ePACT2 prescribing data and Office for National Statistics mid-year population estimates

  • Trichomoniasis diagnostic rate per 100,000. Data source: UK Health Security Agency (UKHSA)

  • Under 16s conception rate / 1,000. Data source: OHID, based on Office for National Statistics data

  • Under 18s abortions rate / 1,000. Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Under 18s births rate / 1,000. Data source: OHID, based on Office for National Statistics data

  • Under 18s conception rate / 1,000. Data source: OHID, based on Office for National Statistics data

  • Under 18s conceptions leading to abortion (%). Data source: Office for National Statistics (ONS)

  • Under 25s abortion after a birth (%). Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Under 25s choose LARC excluding injections at SRH Services (%). Data source: OHID based on NHS Digital SRHAD data

  • Under 25s individuals attend specialist contraceptive services rate / 1000 - Females. Data source: OHID based on NHS Digital SRHAD data and Office for National Statistics mid-year population estimates

  • Under 25s individuals attend specialist contraceptive services rate / 1000 - Males. Data source: OHID based on NHS Digital SRHAD data and Office for National Statistics mid-year population estimates

  • Under 25s repeat abortions (%). Data source: Office for Health Improvement and Disparities, Department of Health and Social Care based on data from abortion clinics

  • Violent crime - sexual offences per 1,000 population. Data source: OHID, based on Home Office and Office for National Statistics data

  • Virological success in adults accessing HIV care. Data source: UK Health Security Agency (UKHSA)

  • Women choose hormonal short-acting contraceptives at SRH Services (%). Data source: OHID based on NHS Digital SRHAD data

  • Women choose injections at SRH Services (%). Data source: OHID based on NHS Digital SRHAD data and Office for National Statistics mid-year population estimates

  • Women choose user-dependent methods at SRH Services (%). Data source: OHID based on NHS Digital SRHAD data

References

  1. BASHH Summary Guidance on Testing for Sexually Transmitted Infections, 2023 https://www.bashhguidelines.org/media/1334/bashh-summary-guidance-on-testing-for-stis-2023.pdf↩︎

  2. https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables↩︎

  3. Stephanie J Migchelsen, Jessica Edney, Norah O’Brien, Celine El Hakim, Prarthana Narayanan, Ana Karina Harb, Lana Drisdale-Gordon, Stephen Duffell, Marta Checchi, Lucinda Slater, Hannah Charles, George Baldry, Hridhya, Vijayan, Giulia Habib Meriggi, Tika Ram, Kate Soldan, Kate Folkard, Katy Sinka, Hamish Mohammed and contributors. Sexually transmitted infections and screening for chlamydia in England, 2023. June 2024, UK Health Security Agency, London (https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables)↩︎

  4. Prochazka M, Evans J, Thorn L, Sinka K, and contributors. Tracking the syphilis epidemic in England: 2010 to 2019. January 2021, Public Health England, London (https://www.gov.uk/government/publications/tracking-the-syphilis-epidemic-in-england)↩︎

  5. Addressing the increase of syphilis in England: PHE Syphilis Action Plan. June 2019, Public Health England, London (https://www.gov.uk/government/publications/syphilis-public-health-england-action-plan)↩︎

  6. https://www.gov.uk/government/collections/national-chlamydia-screening-programme-ncsp↩︎

  7. https://www.gov.uk/government/statistics/national-chlamydia-screening-programme-ncsp-data-tables↩︎

  8. https://www.nhs.uk/conditions/dysentery/↩︎

  9. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023 https://www.bashh.org/resources/9/enteric_infections↩︎

  10. Charles H, Prochazka M, Godbole G, Jenkins C, Sinka K, and contributors. Sexually transmitted Shigella spp. in England: 2016 to 2020. Marchy 2021, Public Health England, London https://www.gov.uk/government/publications/health-protection-report-volume-15-2021/hpr-volume-15-issue-7-news-7-may-2021↩︎

  11. https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/stis/shigella↩︎

  12. https://fingertips.phe.org.uk/profile/sexualhealth↩︎

  13. Charles H, Prochazka M, Sinka K, and contributors. Trends of Lymphogranuloma venereum in England: 2019. December 2020, Public Health England, London (https://www.gov.uk/government/publications/lgv-infections-in-the-uk-trends-and-epidemiology)↩︎

  14. http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/613909/hpr1717_hepA.pdf↩︎

  15. http://www.gov.uk/government/publications/hepatitis-a-preventing-infection-in-men-who-have-sex-with-men ↩︎

  16. Acute hepatitis B (England): annual report for 2018 https://www.gov.uk/government/publications/hepatitis-b-annual-report-for-2013↩︎

  17. Hepatitis C in England 2022: Full report. https://www.gov.uk/government/publications/hepatitis-c-in-the-uk ↩︎

  18. https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview↩︎

  19. Department of Health and Social Care (2021). Towards Zero - An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England - 2022 to 2025 https://www.gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-england-2022-to-2025↩︎

  20. Martin V, Lester J, Adamson L, Shah A, Mackay N, Chau C, Sullivan A, Brown AE, and contributors. HIV Action Plan Monitoring and Evaluation Framework: Report summarising progress from 2019 to 2021. December 2022, UK Health Security Agency, London https://www.gov.uk/government/publications/hiv-monitoring-and-evaluation-framework/hiv-action-plan-monitoring-and-evaluation-framework↩︎

  21. Ammi Shah, Neil Mackay, Natasha Ratna, Cuong Chau, Kedeen Okumu-Camerra, Tobi Kolawole, Veronique Martin, Clare Humphreys, Alison Brown. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report. The annual official statistics data release (data to end of December 2022). October 2023, UK Health Security Agency, London https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2023-report↩︎

  22. British HIV Association British Association for Sexual Health and HIV/British Infection Association Adult HIV Testing Guidelines 2020 https://www.bhiva.org/HIV-testing-guidelines↩︎

  23. Aiken A, Lohr PA, Aiken CE, Forsyth T, Trussell J. Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service. BJOG. 2017 Apr;124(5):815-824. doi: 10.1111/1471-0528.14413. Epub 2016 Nov 14. PMID: 27862882; PMCID: PMC5506553↩︎

  24. Child Poverty Strategy: 2014-17. HM Government. 2014. Available from: http://www.gov.uk/government/publications/child-poverty-strategy-2014-to-2017↩︎

  25. National Client Caseload Information System (NCCIS). Department for Education. 2015↩︎

  26. Mothers, babies and the risks of poverty. Mayhew E and Bradshaw J (2005) Poverty No 121↩︎

  27. Fatherhood Institute Research Summary: Young Fathers. Fatherhood Institute 2013. Available from: https://www.fatherhoodinstitute.org/resources↩︎

  28. A Framework for Sexual Health Improvement in England. Department of Health. 2013. Available from: http://www.gov.uk/government/publications/a-framework-for-sexual-health-improvement-in-england↩︎

  29. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Kirby, D. National Campaign to Prevent Teen and Unplanned Pregnancy, 2007. Available from: https://powertodecide.org/what-we-do/information/resource-library/emerging-answers-2007new-research-findings-programs-reduce↩︎

  30. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Santelli, J. American Journal of Public Health. 2007. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716232/↩︎

  31. Understanding the Decline in Adolescent Fertility in the United States, 2007-2012. Lindbert, L., Santelli, J and Desai S (2016). Journal of Adolescent Health, 59.↩︎

  32. https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education↩︎

  33. Teenage conception rates highest in the most deprived areas. Short story published in Conceptions Deprivation Analysis Toolkit. ONS. 2014. Available from: https://webarchive.nationalarchives.gov.uk/20160107065209/http://www.ons.gov.uk/ons/rel/regionaltrends/area-based-analysis/conceptions-deprivation-analysis-toolkit/index.html↩︎

  34. Teenage Pregnancy in England. Crawford, C. Institute for Fiscal Studies. 2013. Available from: https://www.ifs.org.uk/publications/6702↩︎

  35. Births to looked after children. 2015. Public Health England. Unpublished data.↩︎

  36. Preventing unplanned pregnancy and improving preparation for parenthood for care-experienced young people. Fallon, D. & Broadhurst, K. 2015. Universities of Manchester and Lancaster, on behalf of Coram.↩︎

  37. Predictors and timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. Pregnancy and Childbirth 2013; 12:103.↩︎

  38. Pregnancy and Complex Social Factors: A model for service provision for pregnant women with complex social factors. Royal College of Obstetricians and Gynaecologists and Royal College of Midwives. 2010. National Collaborating Centre for Women’s and Children’s Health. Commissioned by NICE.↩︎

  39. Decision Making Support within the Integrated Care Pathway for Women Considering or Seeking Abortion. Guidance for commissioners for improving access and outcomes for women. 2014. Family Planning Association and Brook.↩︎

  40. Previous Pregnancies Among Young Women Having an Abortion in England and Wales. McDaid, L. A., Collier, J. & Platt, M.J. 2015. The Journal of Adolescent Health. 57 (4) 387-392.↩︎

  41. https://analytics.phe.gov.uk/apps/covid-19-indirect-effects/↩︎