New Terrence Higgins Trust resources developed for and by trans, non-binary and gender diverse people

Trans and non-binary sexual health information from Terrence Higgins Trust

Little is known about the sexual health needs and knowledge of trans and non-binary people making it challenging to design effective health promotion and clinical services for them. In November 2019, Terrence Higgins Trust conducted a survey in sexual health and HIV knowledge, attitudes and experience which aimed to address this.

Survey demographics

The survey was disseminated online via target advertising and through the charity’s social media channels. The survey captured experiences through quantitative and qualitative data. A total of 223 responses were collected, of which 208 were suitable for analysis.

Respondents could select multiple answers to how they described their gender. Most used more than one term or described it in multiple ways:

  • 45% identified as non-binary
  • 31% trans man
  • 15% trans woman
  • 56% genderqueer/fluid/non-conforming
  • 16% other: trans masculine/masc, demigirl/boy, trans, neutrois, androgyne.

Nine individuals identified themselves as intersex. The age range of participants was 16 to 72. The majority of respondents described their ethnicity as White British (174).

Survey results

The survey identified a clear need to provide trans and non-binary people with sexual health information and raise awareness of the importance of testing for HIV and sexually transmitted infections (STIs):

  • Almost half of respondents (96) had anal/vaginal/frontal sex without a condom in the last six months; 35 had never tested for HIV and 13 had tested over two years ago.
  • Nearly half of all respondents (101) never tested for HIV.
  • 33 respondents had had an STI other than HIV (16%).

Findings and recommendations for creating sexual health resources for trans and non-binary people

The survey results produced clear themes and actions to address and inform a sexual health resource for the community.

Language
  • Should reflect thr range of gender identities and sexualities.
  • Must use representative non-gendered language.
Terminology
  • Must avoid gendered anatomical/medical vocabulary and phrases for body parts.
HIV transmission and treatment

A lack of knowledge was identified regarding routes (bodily fluids that might contain HIV), testing and HIV treatment.

  • Promotion of regular testing, even if people consider their sexual practices are safe, using a ‘best to know your status’ approach.
  • Ensure the community are aware of home testing options (self-sampling and self-testing kits) so that individuals know where to access test kits, their ease of use and reliability.
  • A need to promote the effectiveness of HIV treatment, and Treatment as Prevention (TasP).
HIV Prevention: PrEP/PEP

There was an overall lack of awareness of these prevention technologies. Resources need to:

  • Raise awareness of the difference between PrEP and PEP.
  • Provide information on where to obtain PrEP and PEP.
  • Provide the correct dosing requirements and methods of PrEP for trans individuals and individuals who have a vagina/front hole.
STIs

STI information should cover common STIs, how they are transmitted, their symptoms, and testing and treatment options.

Additional concerns identified in the research

Additional areas for consideration should include:

  • Sex, drugs and alcohol.
  • Consent, including sex and the law, and information and support for people to understand what appropriate sexual boundaries are and when a crime may have been committed against them so that they know how and where to report it.
  • Signposting to relevant agencies, including trans-specific clinical and therapeutic services.
Improving access to sexual health services

Respondents gave a number of recommendations to improve access to sexual health services (SHS). Practical measures include ensuring that diverse gender options are available on forms and systems; displaying LGBT+ posters and materials in clinics so people are aware they are in a safe space; and creating gender-neutral waiting rooms.

The other key recommendations focused on training for SHS colleagues. Areas of focus identified included:

  • Up-to-date and inclusive information regarding trans issues and LGBTI people.
  • Address the impact of assumptions of patients being heterosexual, cisgender and/or non-intersex.
  • Online training on trans issues available at gires.org.uk with modules for GPs etc.
  • Respectful use of pronouns.
Key topics for inclusion in sexual health resources

As well as standard sexual health information tailored towards trans people, respondents wanted to see information on key subjects including: trans-specific clinics; raising awareness of consent; sex drive, sexuality and transition; body image and feeling good about yourself; transition and relationships; hormone treatments; contraception, fertility and pregnancy; safer sex; and upper and lower surgery.

Other areas suggested included: mental health and sex; sex and dysphoria; prevention with trans genitalia; HIV treatment interactions with hormones; cervical screening; sexual health information for women who have sex with women.

New resources

Trans and non-binary people co-produced and feature in the new online resource and information leaflet. Ensuring the resource is trusted and represents the diversity within the trans community is key to its success.

Celebrating and reflecting the diversity within the trans community, it features eight trans and non-binary people from different cultural backgrounds with different body types and identities.
The new health information is directed to the needs of trans, non-binary and gender-diverse people and provides up-to-date HIV, sexual health and contraception information and advice. This includes the impact of hormones and surgery, considerations when taking HIV prevention pill PrEP and how to navigate happy, healthy sex.

Visit Terrence Higgins Trust’s new trans-specific sexual health pages.

Sexually transmitted infections in 2019

Public Health England (PHE) has released the latest sexually transmitted infection (STI) surveillance data for 2019. Following the upward trend since 2015, STIs diagnoses have risen again and 468,342 diagnoses were made in England in 2019, a 5% increase from 2018.

Total number of STI diagnoses, England 2010 to 2019
Key findings

Diagnoses

  • 468,342 diagnoses of STIs in England in 2019.
    • 249,690 recorded gender ‘male’.
    • 216,058 recorded gender ‘female’.
  • 26% increase in gonorrhoea since 2018, the highest since records began in 1918.
  • 10% increase in syphilis since 2018. In women the increase is 36%, but 81% of infections were recorded in men who have sex with men (MSM), of which almost a third (31%) were MSM living with diagnosed HIV.
  • 7% increase in number of consultations at sexual health services.
    • This is largely driven by a 84% increase in consultations reported by internet services (from 260,708 to 480,112).
  • 11% decrease in genital warts.

Testing and screening

  • The National Chlamydia Screening Programme (NCSP) conducted 2% more tests in 2019 compared to 2018; however, there has been a 13% decline since 2015 (from 1,546,180 in 2015 to 1,339,913 in 2019).
  • 181 sexual health services reported testing for Mycoplasma genitalium (M.Gen) in 2019, compared to 107 in 2018.
    • This increase in testing capabilities has largely influenced the 196% increase in M.Gen diagnoses in 2019, up to 5,311.

Disproportionately impacted populations

Young heterosexuals 15 to 24 years; black ethnic minorities; and gay, bisexual and other MSM continue to report the highest rates of STIs in England.

Young heterosexuals

The majority of chlamydia diagnoses (62%) and gonorrhoea diagnoses (54%) in sexual health services were made in young heterosexuals. This group was also attributed to 41% of genital herpes diagnoses and 40% of genital warts.

MSM

Bacterial STIs are more likely to be diagnosed in MSM than other men. 81% of syphilis diagnoses were in MSM as well as 66% of gonorrhoea. The most common STIs have seen substantial increases in this population, with gonorrhoea diagnoses increasing by 26% and chlamydia diagnoses by 21%.

Of all MSM diagnosed with an STI in sexual health services in 2019, 18% were living with diagnosed HIV. A breakdown of STIs diagnosed in MSM by HIV status is provided in the graph below.

STI diagnoses among MSM by HIV status, 2010-2019

Black minority ethnic and other impacted populations

Black minority ethnic (BME) populations continue to be disproportionately impacted by STIs. In particular, the rate of gonorrhoea in BME people is 3.5x that of the general population and the rate of trichomoniasis is 9x that of the general population.
The largest proportional increase in all new STI diagnoses was in people of Asian ethnicity (16%; from 15,168 to 17,522), this was largely due to large increases in new gonorrhoea (36%) and chlamydia (27%) diagnoses.
The disparities between different ethnic groups are best seen in these images below, looking at rates of STIs for both men and women.

Rates of STI diagnoses by ethnic group among males, England 2019

Rates of STI diagnoses by ethnic group among females, England 2019

PHE has provided data based on World regions of birth, these have shown high overall increases of STI diagnoses in England with:

  • 9% of people born in the EU,
  • 11% of people born in North America,
  • 12% of people born in South Asia,
  • 16% of people born in South America,
  • 21% of people born in Central America.

Impact of COVID-19

The latest data release does not cover the period since the COVID-19 pandemic began. However, PHE has advised that they are already analysing the surveillance data and how the impact of the COVID-19 response in England has affected HIV and STI service provision and epidemiology. Provisional findings are due in the coming months.

The latest report outlines how the national programme with PHE, Terrence Higgins Trust and 56 Dean Street delivered 10,000 free self-sampling HIV (and opt-in syphilis test) kits as part of the summer ‘Break the chain’ campaign.

PHE has also published a new national framework for e-sexual and reproductive healthcare. This provides information on how e-sexual and reproductive services can complement specialist, clinic-based facilities in local areas, providing other methods of accessing healthcare.

Resources from PHE

Sexually transmitted infections and chlamydia screening in England: 2019 [PDF].

Latest STI data tables, infographics and supplemental information.

National framework for e-sexual and reproductive healthcare: User guide [PDF]

Time to test campaign

Test now before lockdown endsThe Time to Test campaign, founded by 56 Dean Street (Chelsea and Westminster Hospitals NHS Foundation Trust), seeks to maximise the current social distancing situation to identify everyone who has undiagnosed HIV so that they can start treatment early, improve their health and prevent them from passing on HIV to anyone else.

Public Health England (PHE) and HIV Prevention England (HPE) are supporting the campaign in the following ways:

  • PHE opened the National Home Sampling Service via https://freetesting.hiv on Friday, 5 June 2020 and residents in all local authorities in England can now order a free self-sampling kit.
  • PHE has committed to supplying 7,000 free HIV tests, including syphilis opt-out testing throughout the promotional period.
  • PHE will also provide co-ordination and leadership of the public health system through liaison with local authorities, professional bodies and ADPH to ensure that activity is as effective as possible.
  • HPE will promote the campaign via It Starts With Me using PR and targeted digital promotion across England.
  • Promotion will be targeted to black African people and gay and bisexual men across England, with 56 Dean Street fulfilling promotion to gay and bisexual men in London.

Campaign Information Briefing [PDF]

Download social media assets (Please contact [email protected] if you are unable to access Dropbox from your workplace)

 

Using online video conferencing platforms safely and securely

As we navigate new ways to deliver care and support through online services, it’s important to ensure the safety and security of people accessing these services, especially where their personal information is concerned.

The following information provides some guidance for people working in HIV and sexual health organisations who are currently delivering services through popular webinar, virtual meeting and video conferencing platforms.

Platforms and applications

Zoom has become the video conferencing platform of choice for most organisations and the majority of information herein will refer to this application. However, there are alternatives available:

Suitable for work with service users

  • Google Duo provides video conferencing for up to 12 people and is available via web and mobile devices. Video and audio calls are end-to-end encrypted.
  • Webex is a popular video conferencing and webinar platform already used by many businesses. Video calling supports end-to-end encryption.
  • GoToMeeting provides a similar service and includes end-to-end encryption as standard. There are no free plans.

Suitable for work with teams and colleagues

  • Microsoft Teams is a ‘full-package’ collaborating tool which is one of the most comprehensive options available; with good security features and streamlined synchronisation with other Microsoft Office applications. However, it can be complicated and clunky compared to Zoom, which is simple and straightforward to use, or other options.
  • Skype, Slack (paid plan only) and Facebook Messenger provide means to communicate by video but without full end-to-end encryption.

Using Zoom safely and securely

There has been noticeable media attention relating to ‘zoombombs’ in which uninvited trolls enter meetings and disrupt them by talking over meeting hosts or sharing undesirable content via video or screen share options.

There are some simple steps to avoid this practice:

  • Do not share Zoom meeting numbers publically, send the joining information in private emails to registered attendees.
  • Create a new meeting ID for each event or meeting rather than using your own personal meeting ID.
  • Create a password for your meeting, and never share this publicly.
  • Enable a waiting room (see advanced options), this will allow you to block anyone from joining who you were not expecting.
  • As a meeting host you can decide whether you want to give all meeting attendees the option of sharing their screens.
  • Once all of your attendees have arrived you can lock meetings to prevent anyone else from joining.

Recording meetings

Hosts can record audio and video from meetings and capture the chat function via meeting reports, including private 1-2-1 conversations between attendees.

  • Hosts should advise people in advance if they intend to record and share webinars and other educational meetings.
  • Avoid discussing confidential matters with other attendees if you do not want the information shared with the meeting organiser.

Zoom provides a comprehensive guide to security of their platform including information on:

  • Protecting your meetings
  • Protecting your data
  • Protecting your privacy

If you are concerned about the security and privacy in relation to providing services where personal information may be shared (for example online counselling), read more about Zoom’s security features and specific information regarding encryption for meetings.

Coronavirus (COVID-19) guidelines and resources for HIV and sexual health sector

Coronavirus (COVID-19) has created the biggest public health challenge in living memory. As the NHS continues to respond to the pandemic, the HIV and sexual health sector has adapted quickly to continue to support the populations it serves.

Our health systems and services delivered by the Voluntary, Community and Social Enterprise (VCSE) sector are finding new ways to deliver care and support by telephone, online and via their communication channels.

The following information provides sector guidelines for people working in HIV and sexual health, including resources for communities in response to the challenges coronavirus have presented.

Guidelines for health and sector professionals

British HIV Association (BHIVA)

British Association for Sexual Health and HIV (BASHH)

Faculty of Sexual and Reproductive Healthcare (FRSH)

FRSH, BASHH and BHIVA

The Association of Directors of Public Health (ADPH)

Community resources and information

Terrence Higgins Trust

NAT (National AIDS Trust)

NAM

i-base

Joint Council for the Welfare of Immigrants (JCWI), Migrants Organise, and Medact

Correlation Network, Europe

International

World Health Organisation (WHO)

UNAIDS

As new information arises we will update accordingly.