Sexual health

Sexual health outcomes, such as sexually transmitted infections (STI) and abortion rates, are not equally distributed across the population, with a high correlation between deprivation and poor outcomes. There are other groups that are at higher risk of poor outcomes, such as young people and gay, bisexual and men who have sex with men (GBMSM). Sexual health is therefore an important aspect of public health to reduce health inequalities in Stockton-on-Tees.  

Local authorities have a statutory responsibility and are required to commission comprehensive open access sexual health services, including: 

• free STI and genitourinary medicine (GUM) testing and treatment 
• notification of sexual partners of infected persons 
• advice and access to a broad range of contraception 
• advice on preventing unplanned pregnancy 

Sexual heath is about more than the absence of disease and or dysfunction. It is about choice, positivity and respect, requiring: "a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled". (World Health Organisation, 2002)  

Numerous strategies and tools help shape sexual health priorities including: 

• Women's Health Strategy (2022) 
• HIV Action Plan (2022 to 2025 and 2025 to 2030) 
• STI Prioritisation Framework (UK Health Security Agency, 2024) 
• Teenage Pregnancy Framework (2018) 
• Teesside Sexual Health Needs assessment (2022) 

There is a priority to improve access and take up of Long-Acting Reversible Contraception (LARC) across Stockton-on-Tees, reflected in the new service model design which will provide this service in the community across our area. There are various options of LARC to suit women's needs and choices and can last up to 10 years. LARC also removes the need of daily management and is highly effective in preventing unplanned pregnancy. LARC does not prevent against sexually transmitted infections. 

Emergency Hormonal Contraception (EHC) is provided free of charge from the sexual health clinic and subcontracted pharmacies in Stockton-on-Tees. The vast majority of EHC in Teesside is issued from pharmacies. 

STI diagnosis rates in Stockton-on-Tees have been similar to the north east average in recent years. Syphilis diagnoses before 2019 were highest in the men who have sex with men (MSM) group. This has changed with much higher numbers of syphilis diagnoses in women and heterosexual males since 2019. A syphilis outbreak was declared across Teesside in September 2021. 

In Stockton-on-Tees, like all other areas across the UK we are working towards the national and regional HIV Action Plan (2022 to 2025) targets of no new transmissions of HIV and ending AIDS related deaths by 2030. Nationally, new HIV infections in England have decreased steadily since 2014. Testing and treatments for HIV are free regardless of economic or immigration status and people living with HIV on effective treatment (usually for 6 months) cannot pass the HIV virus on to others.  

There are a range of factors that determine a person's sexual health, including education and geographical access to services. National research conducted by the Department for Education (DfE) found that young people who did not receive any Relationship and Sex Education (RSE) in schools were more likely to take more sexual risks.  

Examples of the sexual risks are: 

• including having sex before the legal age of consent
• unprotected sex
• contraction of a sexually transmitted infection

Lower educational attendance and specifically RSE access could link to poorer sexual health outcomes for young people. 

Stigma

There is also the impact that stigma has on sexual health, as Sexually Transmitted Infections (STIs) are often stigmatised, which can deter individuals from seeking testing and treatment. This stigma can worsen health disparities, particularly among marginalised populations, including young people, men who have sex with men (MSM), and individuals in lower socioeconomic groups.  

STIs

STIs can lead to serious health consequences if left untreated, including: 

• infertility 
• pelvic inflammatory disease  
• pregnancy complications  
• neonatal infections

If some STIs, including Syphilis and Gonorrhoea, are left untreated, it can cause more severe outcomes, such as cardiovascular and neurological damage, blindness in newborns and even life-threatening conditions.  

Teenage pregnancy 

Teenage pregnancy can also have poor physical and mental health impacts, alongside educational and economic consequences. Research has shown that teenage pregnancy is associated with poorer outcomes for both young parents and their children. Teenage mothers are less likely to finish their education, are more likely to bring up their child alone and in poverty and have a higher risk of mental health problems than older mothers. Infant mortality rates are 60% higher for babies born to teenage mothers. As children, they have an increased risk of living in poverty and are more likely to have accidents and behavioural problems. 

Economic burden 

The economic burden of STIs is substantial. In the UK, the estimated treatment costs for STIs were around £620 million in 2011, excluding costs associated with HIV treatment. Investment into sexual health services can save future associated costs for the NHS. Every investment of £1 into contraception is estimated to return £9 of cost savings to the government. The financial implications extend beyond direct healthcare costs, with poor sexual health affecting productivity and quality of life for affected individuals. 

Positive sexual health is not equally distributed within the general population. There are strong links between deprivation and higher rates of Sexually Transmitted Infections (STIs), teenage conceptions and abortions, with the highest burden borne by people living in the most deprived areas. In Stockton-on-Tees, areas of high deprivation are linked to a higher under 18 conception rate and some STI diagnosis rates.  

Other higher risk groups include young people, gay, bisexual and men who have sex with men (GBMSM), and people from ethnically minoritised backgrounds. Women are also more affected by poor reproductive and sexual health than men. People who use substances are also at a higher risk of poor sexual health outcomes.  

There are specific areas within the Public Health Outcomes Framework that relate to sexual health, and which the new sexual health service has been designed to address, alongside the specific sexual health needs of Stockton-on-Tees residents and Teesside neighbours.  

Areas of focus include: 

• reduction in the under 18 conception rate 
• increase in prescribing of long-acting reversible contraception (LARC) excluding injections (females aged 15 to 44)    
• increase in chlamydia detection rate    
• reduction in new STIs diagnosis (excluding chlamydia in the under 25s)  
• reduction in people presenting with HIV at a late stage of infection  
• increase in cervical screening uptake 
• increase in condom use 

Within Stockton-on-Tees there is a range of population need in relation to achieving improved sexual health outcomes. Ultimately, there would be a significant improvement to sexual health outcomes across the population with improved use of condoms. This presents an opportunity to consider how to encourage condom use across the population, but also to evaluate the Condom Distribution Scheme, to ensure groups at higher risk of poor sexual health outcomes are being reached.  

Although there has been a reduction in the number of teenage pregnancies, there are disparities in the population between the most and least deprived. Furthermore, new data which suggests that we are at risk of increased rates and the high proportion of under 25 repeat abortions suggest that there is work that needs to be done to ensure that young people in Stockton-on-Tees can make informed decisions and practice safe sex.  

In Stockton-on-Tees, commissioners believe that all residents have the right and opportunity to live a healthy sexual and reproductive life, free from discrimination, regret, coercion, and violence. Collectively with Tees neighbours, Stockton-on-Tees seeks to improve the sexual and reproductive health of our residents through a sexual health system which supports people to make informed choices and when necessary, enables access to appropriate, timely and effective high-quality services that meet their needs.  

New sexual health service model 

A new sexual health service model in partnership with other Tees authorities, NHS England (NHSE) and North East and North Cumbria Integrated Care Board (NENC ICB), has been implemented on 1 August 2025 including access to sexual health support within local communities and a sexual health hub in each city or town centre. 

Condom use 

Across Stockton-on-Tees, we have low condom use across all ages and communities, reflected in high Sexually Transmitted Infection (STI) rates, high reliance on Emergency Hormonal Contraception (EHC), unplanned pregnancies including teenage conceptions and abortion, including repeat abortion. Teenage conceptions in Stockton-on-Tees remain an area of concern, and a Teenage Pregnancy Strategy and Working Group is being established. Stockton-on-Tees is working with stakeholders across the area to explore ways of promoting condom use and providing easier access to free condoms for the population, including young people. 

Syphilis  

There have been a higher number of syphilis diagnoses in women and heterosexual males since 2019. A syphilis outbreak was declared across Teesside in September 2021. In response to this, Stockton-on-Tees is part of a Tees Syphilis Action Plan; improving access to testing in the community and at home through a range of options and communications raising awareness of STI and use of condoms. Partner collaboration is important for effective and timely sexual health measures, this includes working with other Teesside authorities, the UK Health Security Agency (UKHSA) and sexual health services. 

1. Breaking point: Securing the future of sexual health services - Local Government Association
2. Department for Education (DfE) 2021, Experiences of Relationships and Sex Education, and Sexual Risk taking
3. Health matters: preventing STIs - Public Health England
4. Reducing sexually transmitted infections 2022 - National Institute for Health and Care Excellence