Sexual health: England’s STI services funds slashed by a third in five years - what types of STIs are there?

Sexual health services have seen their budgets slashed by almost a third over the last five years, leading campaigners to warn that specialist clinics for young people and in deprived areas are closing down.

Annual spending by councils on services across England has seen a real-terms cut of £221 million, or 29%, in the five years to March 2021, analysis of government figures by NationalWorld shows. This includes £153 million, in today’s prices, slashed from work to prevent, test and treat sexually transmitted infections (STIs) and advice services and £68 million cut from contraception services.

Sexual health charity Brook said the cost to individuals and to society because of untreated STIs, late identification of HIV status and unintended pregnancies is “extremely high” and that significant government investment was required to stop more services from closing.

The analysis comes after sexual health clinics across the country struggled to cope with demand for monkeypox vaccinations earlier this year after a surge of infections were reported over the summer months. Rates of STIs increased slightly last year across England, according to the latest figures from the UK Health Security Agency (UKHSA) with syphilis, gonorrhoea, genital herpes and warts all on the rise.

The government said it was giving English councils £3.4 billion for public health work this year and that it was up to individual authorities how much they allocated to sexual health services.

‘The right to good sexual and reproductive health’

Brook’s head of policy and public affairs, Lisa Hallgarten, said the charity had “consistently voiced concern about the level of cuts to sexual health services since 2015”.

She said: “Investing in sexual and reproductive health is good prevention, vital health promotion and is good value for money. It’s baffling why successive governments have failed to invest in this vital aspect of healthcare. Year on year cuts to public health budgets have resulted in cuts and closures of sexual health services, including specialist young people’s services and services in some of the most deprived areas of England.”

Data published by the Department for Housing, Levelling Up and Communities shows councils spent £373 million on STI testing and treatment and for advice, prevention and promotion of sexual health services in 2020/21, the latest available year. However, this is a drop of almost a third (29.1%) since 2015/16, when the real-terms equivalent was £527 million – a loss of £153 million from sexual health budgets.

Sexual health services for contraceptive work have faced similar cuts. Between 2015/16 and 2020/21, spending on this area fell by £68 million – a 29.7% cut. In total, when spending on STI treatment, sexual health advice and contraception work is combined, sexual health services have had a real-terms cut of 29.3%, or £221.3 million a year.

Of the money spent in 2020/21, 95% was funded by the public purse, with a further 5% paid for through income such as sales or fees.

Ms Hallgarten said: “High rates of STIs, long waits for the most effective Long Acting Reversible Contraceptives, high levels of unintended pregnancy leading to abortion or higher risk unplanned pregnancies can only be tackled with significant investment in our public health budgets and investment in the sexual health workforce.

“Everyone has the right to good sexual and reproductive health and it is vital for our general health and wellbeing. Compared to most health interventions, the price of funding it properly is modest and the returns on investment are significant. By contrast the cost to individuals and to society when people suffer from untreated STIs, late identification of HIV status, and unintended pregnancy are extremely high.”

Separate analysis by Brook in 2018 found 74 councils - nearly half of those which responded - had reduced or were planning to reduce the number of sites delivering contraceptive services.

The Local Government Association, which represents over 350 councils in England and Wales, said: “Unfortunately, sexual health services, and the public health budget as a whole, have had to deal with repeated cuts by central government as well as new burdens and this strain on their resources is taking its toll.”

Which STIs are on the rise across England?

Cases of syphilis, gonorrhoea and genital warts have all increased over the last year and latest figures from the UKHSA show STI rates remain high across England. The number of new STI diagnoses increased by 1% between 2020 and 2021 with the rate marginally increasing from 548 cases per 100,000 people in 2020 to 551 in 2021.

However, this remains well below pre-pandemic levels, when nearly half a million (445,000) infections were being identified on average each year with rates averaging at 809.6 new infections per 100,000 people. During the pandemic sexual health services, staff and laboratory facilities were repurposed to deal with the Covid-19 outbreak. This affected diagnosis rates, so the true number of infections is likely higher.

Mycoplasma genitalium (known as MG or Mgen) infections have surged by 21% in the last year, more than any other STI. This is followed by syphilis with an 8% increase and genital herpes with a 6% increase. Genital warts and gonorrhoea have also seen marginal increases of 2% and 1%. Additional analysis shows chlamydia is the most common STI in England, making up more than half (51%) of all recorded cases and equating to a rate of 282 cases per 100,000 people.

‘£3.4 billion of ring-fenced funding’

A spokesperson for the Department of Health and Social Care said billions of pounds worth of funding has been ring-fenced by the Government.

“This year we are providing more than £3.4 billion of ring-fenced funding to local authorities in England through the Public Health Grant to fund public health services, including sexual and reproductive health. Local authorities are required to fund open-access sexual and reproductive health services, including free and confidential HIV and STI testing, condoms, provision of the HIV prevention drug PrEP, vaccination, and contraception advice.”