The waiting room: unmet sexual health service needs among men and gender-diverse individuals having sex with men in England, findings from an online, cross-sectional community survey in 2024
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Background
Sexual health service (SHS) delivery in England has shifted substantially following a rapid expansion of online services during the COVID-19 pandemic. While digital provision may improve reach, there are limited data on the extent of unmet need for in-person SHS in England. We sought to address this among men and gender-diverse individuals who have sex with men in England, a group disproportionately affected by sexual health inequalities.
Methods
We analysed data from “Reducing inequalities in Sexual Health” (RiiSH) 2024 (Nov/Dec 2024), an online cross-sectional survey of men and gender-diverse individuals who have sex with men residing in England. We assessed in-person SHS access and among those who tried to access a SHS in the last year - unmet need (i.e. participants who tried but were unable to access a SHS in-person) alongside reasons for inaccessibility. Using multivariable logistic regression, we examined sociodemographic and behavioural associations with unmet SHS need.
Results
Among 2,404 participants living in England (median age 45 years [interquartile range: 36-55], 88% White, 95% cisgender), 86% reported accessing in-person SHS ever, and 59% in the past year. Of those who tried to access in-person care in the past year, 12% (95% CI: 11%-14%) experienced unmet need, especially Outside London (15% vs. 8% in London). Common barriers included unavailable (50%) or inconvenient (41%) appointment times. In adjusted multivariable analysis, unmet need continued to be lower among participants living in London (aOR: 0.64 [95% CI: 0.44-0.92]), those financially comfortable (aOR: 0.69 [0.49-0.97]), and those reporting ≥1 marker(s) of sexual risk (e.g. HIV-PrEP use in the last year and/or in the last 3-4 months, the report of a bacterial STI diagnosis, engaging in chemsex, having had ≥10 male physical sex partners; aOR: 0.14 [0.10-0.20]). Unmet need was higher among participants with limiting long-term physical health conditions (aOR: 1.61 [1.12-2.30]) and those who reported ever using online postal self-sampling services for STI testing (OPSS) (aOR: 1.50 [1.07-2.09]).
Conclusions
Despite high SHS engagement, one in ten participants in this national community-based sample reported recent unmet need for in-person SHS. Equity-focused strategies are needed to meet evolving SHS demand. Local service delivery guided by joint strategic needs assessments could help address unmet need for SHS.
Ethical considerations
Ethical approval of this study was provided by the UKHSA Research and Ethics Governance Group (REGG; ref: R&D 524).
Consent to participate
Online informed consent was received from all participants and all methods were performed in accordance with guidelines and regulations set by the UKHSA REGG.
Declaration of conflicting interest
Authors have no conflicting interests to declare.
Funding statement
The RiiSH 2024 study and authors HM, JS, DR, CHM received partial funding support as part of The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the UK Health Security Agency ( https://bbsti.hpru.nihr.ac.uk ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors received no specific funding for this work.
Data availability
The data that support the findings of this study are not publicly available to protect participant privacy. However, some aggregate data are available upon reasonable request from the UK Health Security Agency (UKHSA). Requests can be directed to DataAccess@ukhsa.gov.uk .
