Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England

evidence from cross-sectional bio-behavioural surveys

Catherine Aicken, Sonali Wayal, Paula Blomquist, Stella Fabiane, Makeda Gerressu, Gwenda Hughes, Catherine Mercer

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background:
In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities.
Methods:
We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups.
Results:
BC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45–8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner’s symptoms or diagnosis (AOR 1.82, 95% CI 1.14–2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42–13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38–0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification.
Conclusions:
Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained – and indeed facilitated – for those at greatest risk of STI, regardless of ethnicity.
Original languageEnglish
Article number668
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 18 Sep 2019

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Reproductive Health
England
Delivery of Health Care
Sexually Transmitted Diseases
Ethnic Groups
Sexual Behavior
Surveys and Questionnaires
Contact Tracing
Women's Health
Health Services
Logistic Models
Odds Ratio

Bibliographical note

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keywords

  • Black Caribbean
  • Ethnicity
  • Health behaviour
  • Health inequalities
  • Healthcare behaviour
  • Sexual health clinics
  • Sexually transmitted infections

Cite this

Aicken, Catherine ; Wayal, Sonali ; Blomquist, Paula ; Fabiane, Stella ; Gerressu, Makeda ; Hughes, Gwenda ; Mercer, Catherine. / Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England : evidence from cross-sectional bio-behavioural surveys. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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title = "Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys",
abstract = "Background: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities.Methods: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups.Results: BC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s attendances (adjusted odds ratio, AOR 3.54, 95{\%} CI 1.45–8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner’s symptoms or diagnosis (AOR 1.82, 95{\%} CI 1.14–2.90; AOR BC men compared with BC women: 4.36, 95{\%} CI 1.42–13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95{\%} CI 0.38–0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification.Conclusions: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained – and indeed facilitated – for those at greatest risk of STI, regardless of ethnicity.",
keywords = "Black Caribbean, Ethnicity, Health behaviour, Health inequalities, Healthcare behaviour, Sexual health clinics, Sexually transmitted infections",
author = "Catherine Aicken and Sonali Wayal and Paula Blomquist and Stella Fabiane and Makeda Gerressu and Gwenda Hughes and Catherine Mercer",
note = "This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.",
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Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England : evidence from cross-sectional bio-behavioural surveys. / Aicken, Catherine; Wayal, Sonali; Blomquist, Paula; Fabiane, Stella; Gerressu, Makeda; Hughes, Gwenda; Mercer, Catherine.

In: BMC Health Services Research, Vol. 19, No. 1, 668, 18.09.2019.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England

T2 - evidence from cross-sectional bio-behavioural surveys

AU - Aicken, Catherine

AU - Wayal, Sonali

AU - Blomquist, Paula

AU - Fabiane, Stella

AU - Gerressu, Makeda

AU - Hughes, Gwenda

AU - Mercer, Catherine

N1 - This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2019/9/18

Y1 - 2019/9/18

N2 - Background: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities.Methods: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups.Results: BC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45–8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner’s symptoms or diagnosis (AOR 1.82, 95% CI 1.14–2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42–13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38–0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification.Conclusions: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained – and indeed facilitated – for those at greatest risk of STI, regardless of ethnicity.

AB - Background: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities.Methods: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups.Results: BC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45–8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner’s symptoms or diagnosis (AOR 1.82, 95% CI 1.14–2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42–13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38–0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification.Conclusions: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained – and indeed facilitated – for those at greatest risk of STI, regardless of ethnicity.

KW - Black Caribbean

KW - Ethnicity

KW - Health behaviour

KW - Health inequalities

KW - Healthcare behaviour

KW - Sexual health clinics

KW - Sexually transmitted infections

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U2 - 10.1186/s12913-019-4396-3

DO - 10.1186/s12913-019-4396-3

M3 - Review article

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

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