Sexual health data in South West London

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Sexual health data in South West London
Dr Paul Crook Consultant in Communicable Disease
Control South West London Health Protection Unit
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• Explore the uses of sexual health data
• Identify current trends and groups at risk

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Uses for sexual health services data

• Raising political profile for extra resources for
  management and control
• Targeting health promotion and health services
• Identify emerging problems or outbreaks
• Monitor patient pathways
• Monitor performance

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Raising political profile for extra resourcefor
management and control
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SWL GUM clinic diagnoses 1995 to 2004
KC60 data
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HIV in SWL cases by year of occurrence 1995 to
2004
HIV/AIDS reports HPA data
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STIs in SWL

• Changes since 2000
• Up
• HIV up 34
• Chlamydia up by 64
• Genital herpes up by 34
• Genital warts up by 13
• Syphilis cases increased from 6 cases in 2000 to
  88 in 2004
• Down
• Gonorrhoea down by 18

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Raising political profile

• National Sexual Health and HIV Strategy
• London Sexual Health Framework targets
• Choosing Health White Paper
• Sexual Health as one of 3 main priorities
• Chlamydia screening
• Funding
• Local Delivery Plan targets for PCTs
• Decrease in Gonorrhoea Improve waiting time
  (100 within 48hrs)
• PCTs must produce plans detailing how they will
  do this
• Operating Framework for 2006/7
• Sexual health and access to GUM waiting times one
  of 6 priorities for NHS

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Targeting health promotion andhealth services
who?
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Gonorrhoea rates in SWL by age and sex 2000-2004
KC60 data
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Chlamydia positivity by ethnic group among young
people (under 25), 2004/05
Data source National Chlamydia Surveillance
Programme, England
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SGH disaggregated data
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Sex distribution of STIs in SWL - including MSM
(men who have sex with men)
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Exposure category of HIV infected people by year
of diagnosis in SWL, 1995 to 2003
HIV/AIDS reports, HPA
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How infection was probably acquired in presumed
heterosexually acquired new HIV cases in SWL in
2004
HIV/AIDS reports, HPA
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Likely geographical location of infection for new
heterosexual HIV infections that were probably
acquired abroad 1995 to 2004
HIV/AIDS reports, HPA
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SWL HIV patients seeking care- by PCT, sex and
ethnicity
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HIV infections in SWL in 2004

• SWL has 5 of all new HIV diagnoses in UK
• Since 1995 the number of new HIV infections in
  SWL has increased by 160
• New HIV infections are most likely to be
  heterosexually acquired (75)
• The majority are acquired abroad (62 of all new
  HIV cases)
• 54 of all new HIV cases acquired in Africa
• Of those acquiring HIV in the UK, the most common
  probable exposure is due to sex between men

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Undiagnosed HIV infections in London in 2003

• with previously undiagnosed HIV
• 4.7 of MSM attending GUM clinics
• 0.8 of GUM heterosexual attendees
• 2.7 of GUM heterosexual attendees from
  sub-Saharan Africa

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Groups requiring targeted prevention

• MSM
• HIV, Syphilis, LGV, Hepatitis A, Shigella
• Black and minority ethnic populations
• HIV acquired in Africa
• High levels undiagnosed HIV
• Black-Caribbean populations Gonorrhoea
  Chlamydia
• Young people
• STIs are major public health problem in people
  aged 16-24
• Injecting drug users
• HIV

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Targeting health promotion andhealth services
where?
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HIV prevalence rates
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HIV patients seeking care place of residence in
2004
Total for 2004 2,367
SOPHID
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Rates of gonorrhoea1 diagnoses by sex across the
UK, 2004
1Uncomplicated Data source KC60 and
STISS/ISD(D)5 returns from GUM clinics
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Rates of gonorrhoea diagnoses by London SHA
Data source KC60 returns from GUM clinics
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SWL GUM Gonorrhoea data
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SWL GUM chlamydia data
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Ward under 18 conception rates in London, 2000-02
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St Georges Disaggregated Data
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Emerging problems
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Distribution of ciprofloxacin resistant1
gonorrhoea by area
1Ciprofloxacin Resistant Definition
MIC1mg/l Data sources The Gonococcal Resistance
to Antimicrobials Surveillance Programme (GRASP)
and the Gonococcal Antibiotic Surveillance
Scotland (GASS), United Kingdom
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Syphilis in South West London

• Dramatic rise in syphilis cases in all groups in
  SWL
• Also rise in heterosexual cases of syphilis
  across South London noted since 2002 associated
  with-
• sex workers and their clients
• greater than expected proportion in
  Black-Caribbean men
• high rates of unprotected intercourse

KC 60 data
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Laboratory confirmed cases of Lymphogranuloma
venereum (LGV)

• 275 cases since 2003
• 99 MSM
• 75 known to have HIV at diagnosis
• 95 white, 80 acquired in UK
• 69 in London 6 in SWL

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Monitoring patient flows
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HIV-infected individuals accessing treatment and
care services by SHA of residence and treatment,
London 2004
Data source SOPHID, London
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Performance management
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GUM clinic waiting times by provider in SWL
Data source GUM Waiting Times Audit
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GUM 48 hour waiting time data for residents of
PCTs in SWL
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Way forward

• What missing?
• residence based ethnicity data for STIs
• primary care data
• Joint work between BASHH and HPA to develop
  simpler extracts of disaggregated data including
  residence information
• Sexual health common dataset
• Local chlamydia data from screening programme
• GP data
• Laboratory data

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National picture

• Epidemiological info found on HPA website
• www.hpa.org.uk

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Thank you