Almost 1 in 8 people with symptoms turned away from sexual health clinics in SE London: 40% are under 25 and 6% under 18 years old
Simon Collins, HIV i-Base
A pilot survey of people unable to access sexual health services in three London boroughs revealed the lack of capacity in these services. The majority of people had symptoms and a quarter reported previously being unable to access another service. 
This was a commissioner-initiated survey and the results were presented at the 4th BHIVA/BASHH conference by Aideen Dunne, on behalf of the Southwark Public Health Directorate.
This anonymous snapshot survey was run from 1 – 30 November 2017 to find out the numbers and characteristics of people being turned away from sexual health clinics in inner south east London and to see whether these people had already been turned away from other services.
Anyone who was turned away from one of eight clinics in Southwark, Lewisham and Greenwich was asked to complete either a paper or online survey.
Overall, there were 8859 attendances with 1094 people completing a survey about being turned away. An additional 1116 residents were turned away from online testing services.
Almost 75% of people were residents of the participating boroughs. An alarming proportion of surveys were completed by younger people: 40% were 24 or younger, including 19% aged 22–24, 15% aged 19–21 and 6% were 16–18.
The main reasons for the clinic visit was answered by 90% of respondents, of whom only 11% were asymptomatic and applying for a routine check up. More than half (54%) reported STI symptoms, 29% were for contraception services, including 4% needing emergency contraception, and 2% had partners who had recently been diagnosed with an STI.
More than 1 in 4 (26%) reported having been previously turned away from another service, of which 44% were from a GP and 42% from a sexual health service. Of the people previously turned away, one third (33%) were under 25, and 3% were under 18 years old. The survey did not collect information on how many times people had been turned away or whether this was for the same reasons.
The study concluded that in addition to showing the feasibility of running a turn-away survey. It also noted that while the results demonstrated unmet need, actual need was expected to be higher still.
Based on these pilot results, an updated survey has been rerun during the last two weeks of April.
This lack of capacity at sexual health clinics, especially for young people, is likely to be common in many regions and similar surveys to measure currently unmet needs should be initiated by other centres.
The findings also suggest that similar denial of service audits should be routinely included in the commissioning specifications.
These results are likely to underestimate the numbers of people unable to access sexual health care as it only presents results from those who completed the survey.
They are likely to be a direct outcome from the decision to make local authorities responsible for sexual health at a time when local authority budgets are increasingly being cut.
The alarming outlook for sexual health services is further threatened by the proposal for ring-fencing for local authority funding to be removed for these services in 2020. This was highlighted by BHIVA and BASHH earlier in the year, who jointly call for the ring-rencing to remain. [2, 3]
A useful article in the Lancet HIV this month also summarises other aspects of these threats to our services. 
- Dunne A et al. How many people do we turn away? Measuring unmet demand on sexual health services. 4th Joint BHIVA/BASHH Conference, 17–20 April 2018, Edinburgh. Oral abstract O8. HIV Medicine, 19 (Suppl. 2), s5–s20.
- THT/NAT/BHIVA and others. The big issue: sexual health services must be protected to prevent a crisis. Letter to the Guardian. (14 January 2018).
- BASSH/BHIVA online petition. (Currently at ~ 7300 out of 8000 needed signatures).
Kirby T. UK sexual health services struggle with public health cuts. Lancet HIV. (2018): 5(5):e207–e208. (May 2018).