Sexual Health

Sexual and reproductive health refers to a broad range of services that cover access to contraception, fertility and infertility care, maternal and perinatal health, prevention and treatment of sexually transmitted infections (STIs), protection from sexual and gender-based violence, and education on safe and healthy relationships.

Experiencing sexual and reproductive health means that a person has complete physical, mental and social well-being in all matters relating to their reproductive system and its functions. In everyday life, this means that people are able to have satisfying and safe sex lives, to have healthy pregnancies and births, and decide if, when and how often to have children (WHO).

Access to sexual and reproductive health services is a human right and should be available to all people throughout their lives, as part of ensuring universal health coverage. Responsibility for commissioning sexual and reproductive health services is shared across local authorities, integrated care boards (ICBs) and NHS England.

The key policy context documents, National and Local:

• The Health and Social Care Act 2012 (HM Government)
• Integrated Sexual Health Service Specification (OHID and UKHSA, 2023),
• Service specification: adult specialised services for people living with HIV (NHS 2024)
• A guide to whole system commissioning for sexual health, reproductive health and HIV (PHE, 2015)
• Towards Zero: the HIV Action Plan for England – 2022 to 2025 (DHSC, 2021)
• National Chlamydia Screening Programme (NCSP) (UKHSA)
• Women‘s Health Strategy for England (DHSC 2022)
• Abortion commissioning guidance (NHSE, 2025)
• Cervical cancer elimination by 2040 – plan for England (NHSE, 2025)

STIs

Higher STI diagnoses rates are seen among young people aged 15-24, gay, bisexual and other men who have sex with men (GBMSM) and people of Black and Mixed ethnicity.  Ethnic disparities in STI diagnosis rates are influenced by underlying socio-economic factors and the role they play in the structural determinants of health of the population with the most deprived areas seeing the highest rates of STIs (UKHSA, 2025).

Rising trends in STI diagnosis seen nationally can be attributed to increased testing, both online and in clinics, improved diagnostics, a decrease in condom use driven by the success of interventions such as HIV pre-exposure prophylaxis (PrEP) and long-acting reversible contraception (LARC). Additionally, changes to social norms such as increased diversity of sexual practices, increases in gender and sexual fluidity and an increase in use of geosocial networking applications to meet sexual partners have contributed to this rise (STI Prioritisation Framework, UKHSA).

As STIs are often asymptomatic, frequent STI screening of groups with greater sexual health needs is required as early detection and treatment can reduce long-term consequences, such as infertility and ectopic pregnancy. Controlling the spread of STIs relies on consistent and correct condom use; behaviour change to decrease overlapping or multiple partners; prompt access to testing and treatment; ensuring partners of positive cases are notified and tested; and in some cases, vaccination.

Lincolnshire has consistently had lower rates of new STI diagnoses, compared with national rates (OHID). Lincolnshire’s all new STI rate is higher than regional and statistical neighbours because the local national chlamydia screening programme (NCSP) is one of the highest performing in the country (OHID).

The city of Lincoln has the highest all new STI rate of any lower tier local authority (LTLA) outside of London (OHID). This is in part due to the high performance of the NCSP in Lincoln. However, even when excluding these diagnoses, Lincoln’s new STI diagnoses rate is the highest in the East Midlands and the 22^nd highest out of all districts in England. Possible reasons for this are because Lincoln has a higher proportion of people with greater sexual health needs in its population, such as a high proportion of young people, higher levels of deprivation, and a more diverse population in in terms of ethnicity and sexuality.

Chlamydia accounts for approximately 70% of all new STIs in Lincolnshire. Rates of chlamydia diagnoses in the over 25s in Lincolnshire have increased by approximately 70% since 2019, due to the increase in over 25s chlamydia diagnoses in Lincoln, and by the increase in testing and online testing in the over 25s since 2021 (OHID).

Gonorrhoea diagnoses and STI reinfection rates are useful markers for understanding rates of unsafe sexual activity and STIs in the population. Lincolnshire’s gonorrhoea diagnoses rate is lower than the national, regional, and statistical neighbour rate. Following a significant increase in gonorrhoea diagnoses in Lincolnshire in 2022 and 2023, the 2024 diagnoses rate has now decreased back to 2019 (pre-COVID-19) levels (OHID). This follows the national trend. The spike seen in gonorrhoea diagnoses was likely due to a return to social mixing and increased access to sexual health services among heterosexual young people following national lockdowns. Lincolnshire has a lower rate of reinfections than nationally, particularly among men (source: SPLASH Supplementary report, UKHSA).

Despite a decrease in gonorrhoea diagnoses, nationally cases of antimicrobial resistant gonorrhoea are increasing (UKHSA).

Lincolnshire has not seen the increase in syphilis diagnoses that have been seen nationally, and rates are lower than nationally and among regional and statistical neighbours (OHID). In Lincolnshire in 2024, there were more cases of trichomoniasis and mycoplasma genitalium than syphilis (OHID).

HIV

The HIV Action Plan (2021) sets out a commitment to achieving zero new HIV infections, AIDS and HIV-related deaths in England by 2030, and an 80% reduction in new HIV infections in England by 2025. An updated action plan is due in December 2025.

In 2024, Lincolnshire’s HIV diagnosed prevalence rate was 1.17 per 1,000 15 to 59 year olds (OHID). This makes Lincolnshire by definition, an area of low HIV prevalence. It is likely that the Boston district, with a HIV diagnosed prevalence rate of 1.82, will show as a high prevalence area (exceeding 2 in 1,000 population aged 15 to 59 years) in 2025 data when published (OHID), if rates continue to rise across Boston.

2024 data show there to be 651 people living with HIV (PLWH) in Lincolnshire, a 95% increase since 2015 (OHID).  Since 2021, Lincolnshire and England have seen an increase in HIV diagnoses among persons first diagnosed abroad, coinciding with the introduction of the Health and Care Worker visa. In 2024, 43% of new HIV diagnoses in Lincolnshire were among those previously diagnosed abroad (OHID). The impact in Lincolnshire has been greatest in areas that have bigger migrant populations. Between 2022 and 2024, 68% of new HIV diagnosis in Lincoln and Boston were first diagnosed abroad (OHID).

Local ethnicity data is not available. However, nationally, 71% of people diagnosed with HIV before continuing care in England in 2024 were born in Africa (specifically, 45% were born in East Africa, 17% in Western Africa), 9% were born in Asia and 8% were born in Latin America (UKHSA). In 2023, 13% of people living with diagnosed HIV in Lincolnshire were of Black African ethnicity despite Black people comprising only 0.6% of the population (source: SPLASH Supplementary report, UKHSA).

Those over 60 years of age now account for a 24% of PLWH in Lincolnshire, up from 13% ten years ago. East Lindsey and West Lindsey have a higher proportion of older PLWH with around two-thirds over 60. Older PLWH are at an increased risk of comorbidities, including mental health morbidities. Nationally, over half (52%) of the population living with HIV are aged 50 years and over (UKHSA).

Pre-exposure prophylaxis (PrEP) is a drug taken by HIV-negative individuals before they have sex to stop them acquiring HIV and is an important component of HIV prevention strategies. Lincolnshire has a lower proportion of residents assessed as having need, and a lower proportion of those identified with a need are started or continued with PrEP when compared with regional and statistical neighbours (OHID). This suggests unmet need for PrEP within the population.

2024 data show Lincolnshire’s HIV testing rate to have returned to pre-COVID-19 levels, though testing rates are lower than statistical neighbour, regional and England averages (OHID).

Late diagnosis is the most important predictor of HIV-related morbidity and short-term mortality. People diagnosed late in England in 2023 were 10 times more likely to die (deaths due to all-cause mortality) within a year of their diagnosis, compared to people diagnosed promptly (UKHSA). In Lincolnshire, over half of HIV diagnoses (56%) are made at a late stage of infection (OHID). This is higher than the national (43%) and regional averages (48%).

In 2024, the UK and England met the UNAIDS 95-95-95 targets; 95% of people with HIV were diagnosed; 99% of the diagnosed were on treatment; and 97% of those on treatment were virally suppressed (UKHSA). In Lincolnshire, people (aged 15 years and over) diagnosed and on treatment was 98.9%, with 97.3% of those on treatment virally supressed (OHID).

Reproductive health

The current model for abortion in Lincolnshire does not offer women and girls sufficient reproductive autonomy. Lincolnshire women are experiencing delays in either seeking or receiving abortion services in the first 9 weeks of pregnancy. Lincolnshire is an outlier here, with the 2^nd worst (highest) proportion out of 149 upper tier local authorities (OHID). A Lincolnshire Women’s Sexual and Reproductive Health Needs Profile (LCC, 2024) also identified a lack of choice in abortion method, with only 8.5% of abortions provided using methods, in comparison to 13.8% on average for England. In addition, women with a pregnancy gestation of over 12 weeks must go out of the county for abortion care. In 2022, compared to an average of 1.7% for England, 5.8% of patients in Lincolnshire privately funded abortion care, the third highest proportion in England.

Lincolnshire’s abortion rate is significantly lower than the national rate ( per 1,000) and is the 7^th lowest out of 149 upper tier local authorities (OHID). The rate also shows no significant change over the last 10 years, while the national abortion rate has increased. The indicator could be interpreted as evidence of lower need and demand for abortion services in Lincolnshire. However, with evidence of delays in access, lack of choice and high use of private abortion care, Lincolnshire’s low abortion rate may be an indication that some women in Lincolnshire area are simply not able to access abortion services and have no choice but to carry an unwanted pregnancy to .

Women also have difficulty in accessing contraceptive services and advice at crucial times of their life, such as following an abortion or a birth. This is having a significant, detrimental impact on women’s health outcomes and health inequalities. Data shows that almost a third (31%) of women under 25 in Lincolnshire have had an abortion after a previous birth (compared to 26% nationally), indicating issues for women Source: OHID). Improving access to contraception in the immediate postpartum period, and up to 21 days following childbirth, has been identified as a priority locally and nationally.

Despite the declining number of teenage pregnancies, teenagers remain the group at highest risk of unplanned pregnancy. The most recent available published data (2022) shows a small increase in under 18 conception rates locally, regionally and nationally. Lincolnshire’s under 18 conception rate (14.3 per 1,000), is similar to the regional (14.4) and national rate (13.9) (OHID). Teenage pregnancy is more common in girls who have grown up in poverty, girls who are disengaged from education and girls who lack access to sex education and contraception (Wallace, 2023). Recent ONS data for October to December 2024 shows that more young people (age 16-24) in England were not in education, employment or training (NEET) than at any point in the last eleven years. The Teenage Pregnancy Prevention Framework notes that most conceptions to under-18s are among 16–17-year-olds with NEET as an associated risk factor.

Analysis of data and evidence on uptake and cervical screening found Lincolnshire to be off-track in progress towards elimination of cervical cancer by 2040. Analysis found disparities in vaccination and screening coverage within Lincolnshire. Lincoln, Boston and the coastal areas have the lowest HPV vaccination uptake and the lowest cervical screening coverage, putting women in these areas at higher risk of cancer, later diagnoses and worse outcomes. Coverage of both HPV vaccination and cervical screening are lower among ethnic minority groups and people living in areas of high deprivation. Data suggests that inequalities in cervical cancer incidence will widen, and incidence rates will likely increase among women in the most deprived areas of the county (Lincolnshire County Council (LCC), 2025).

A Health Needs Assessment (HNA) of Women’s Health in Lincolnshire is undertaken by the Public Health Division estimates there to be around 135,000 women aged 16 to 55 in Lincolnshire who have recently experienced a reproductive health problem, and around 51,000 women living with a serious reproductive health issue.

Lincolnshire County Council (LCC) commission Lincolnshire Community Health Services (LCHS) to provide the Greater Lincolnshire Integrated Sexual Health services (GLiSH). GLiSH provide open access to confidential, non-judgemental services including sexually transmitted infections (STIs) and blood borne viruses (BBV) testing (including HIV), treatment and management; HIV prevention including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP); the full range of contraceptive provision; health promotion and prevention including relevant vaccination.

In Lincolnshire, GLiSH also provide a sexual health and HIV treatment and care service. This means that GLiSH can support Lincolnshire resident service users across the whole care pathway for HIV, from prevention through to testing, diagnosis and treatment.

Lincolnshire County Council (LCC) commission a sexual health outreach, HIV prevention and support service, delivered by Positive Health, to provide support to people living with HIV (PLWH) and affected by HIV in Lincolnshire. The service offers practical and emotional advice and support, advocacy, peer support, and help with social care issues such as insecure housing, poverty, unemployment and social isolation which are common for PLWH. The service contributes to objectives in the government’s plan to end HIV transmission by improving quality of life for people living with HIV, addressing stigma, and helping people to stay in care and adhere to HIV treatment.

The service also provides outreach interventions such as health promotion and community STI and HIV testing to communities at higher risk of sexual ill-health who may not be accessing mainstream services.

A 1-month pilot for blood-borne viruses (BBV) opt-out testing, including testing for HIV, hepatitis B and C, began at Boston Pilgrim Hospital in September 2025, in response to the high number of hepatitis cases in the area.

LCC commission GP practices to provide, fit and remove Long-Acting Reversible Contraception (LARC), such as subdermal implants (SDI) and intrauterine contraception (IUC). GPs are also able to provide LARC devices for non-contraceptive or gynaecological purposes, which means women can have their needs met in primary rather than secondary care and can be seen quicker and closer to home.

Oral contraception – Combined Oral Contraceptive (COC) and Progestogen Only Pill (POP) – is now available at participating pharmacies via the NHS funded Pharmacy Contraception Service. Emergency hormonal contraception (EHC) was included in this service from October 2025.

Lincolnshire’s ICB conducted a women’s health survey and community & online conversations report in November 2024, detailing feedback and experiences from members of the public regarding women’s health services in Lincolnshire.

A 2024 report by Healthwatch on Menstrual and Menopausal Health was based on a survey of 450 service users and 18 professionals who shared their views on diagnosis, mental health and treatment and management.

In both reports local women share their poor experiences of the healthcare system. Women report feeling “ignored”, “dismissed” and a “lack of knowledge or interest” of symptoms and their impact among healthcare professionals (HCPS). Women also report long waits for diagnosis and specialist care. The reports conclude that a more inclusive, supportive and effective healthcare system is needed that addresses the specific needs of women.

• Further work is required to improve identification on those with a PrEP need and improve uptake of PrEP, particularly among groups under-represented among PrEP users (see BASHH, 2025).
• Collaboration with system partners is required to ensure the needs of older People Living with HIV (PLWH) are met. There are an increasing number of older people living for long periods with HIV, with co-morbidities and the health and care needs associated with ageing.
• Further work is needed to ensure that those moving to Lincolnshire to work in the health and care sector from countries of high HIV prevalence are offered timely testing and treatment support.
• Local systems should prepare to meet relevant HIV guidelines for high-prevalence HIV areas, in anticipation of Boston becoming a HIV prevalence area in 2025.
• To improve access to contraception and abortion, and address inequalities in access, experience and outcomes, local commissioners should adhere to the recently published NHSE abortion commissioning guidance bringing waiting times in line with NICE’s two-week standards, and increasing surgical capacity.
• Fragmentation of commissioning responsibilities for reproductive health services, including contraception, is exacerbating inequalities in access, experience and outcomes. Co-commissioning arrangements for GP LARC services shows how this can be overcome. A working group on contraception should be established, involving all contraception commissioners, to fund and commission contraception for women at key stages in their life and online contraception.
• A GP LARC improvement plan is in place to increase uptake of LARC in primary care and improve equity of access to LARC services.
• The Health Needs Assessment of Women’s Health recommends that local plans to improve healthy life expectancy should focus on the specific needs and experiences of women, and that reproductive autonomy (including access to abortion and contraception) is at the centre of plans to address health inequalities. The report also recommends that mental health support is integrated into provision of treatment for reproductive ill health and menopause.
• There is a need to ensure young people receive high quality, comprehensive, relationship and sex education (RSE), and, “All schools must have in place a written policy for Relationships Education and RSE” (DfE). Recent national findings show only half of pupils rate their RSE as Good or Very Good, and a shortage of teachers who are trained, knowledgeable or confident in RSE.

• Continue to develop commissioned services to meet the needs of the p The GliSH service is beginning to roll out new interventions for the prevention of STIs, including post-exposure prophylaxis to reduce the risk of acquiring syphilis or chlamydia (Doxy PEP), and vaccinations to protect against gonorrhoea and mpox. These interventions are targeted towards those at higher risk of acquiring these infections in the gay, bisexual and men who have sex with men (GBMSM) population.
• Develop a local HIV Action Plan that sets out how Lincolnshire will contribute to the national goal of ending HIV transmission in England. The plan will focus on the increasing prevalence of HIV in some areas of the county, supporting PLWH moving from abroad, supporting the ageing population of PLWH, re-engaging PLWH in care, improving access to preventative interventions, and supporting the delegation of responsibility for HIV treatment and care commissioning from NHSE to the ICB.
• Work with system partners to bring about improvements to women’s health outcomes and to women’s access to and experiences of care. New NHS priorities set out in the 10 Year Health Plan for England on moving care to communities, using technology and focusing on prevention should provide an impetus for transforming women’s healthcare.