Factors associated with bacterial sexually transmitted infections amongst people of South Asian ethnicity in England

Abstract

AbstractObjectivesDespite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services and sexually transmitted infection (STI) diagnoses, though recent data suggests this may be changing. This study aimed to investigate factors associated with a bacterial STI diagnosis amongst South Asians attending SHS in England.MethodsUsing data from the GUMCAD STI Surveillance system, a descriptive analysis of South Asians attending sexual health services in England in 2019 was carried out. Factors associated with a bacterial STI diagnosis were examined using univariate and multivariable logistic regression models adjusted for age, Asian ethnic subgroup, HIV status, patient region of residence and Index of Multiple Deprivation quintile. Analyses were stratified by gender and sexual orientation (heterosexual male vs. gay, bisexual, and other men who have sex with men [GBMSM] vs. women of any sexual orientation). Crude and adjusted associations were derived using binary logistic regression.ResultsThere were 121,842 attendances by South Asians to SHS in England in 2019. Compared to heterosexual South Asian men, GBMSM had a higher odds of being diagnosed with a bacterial STI (aOR 2.32, 95% CI 2.19-2.44) and South Asian women had a lower odds (aOR 0.83, 95% CI 0.78-0.87). For women and heterosexual South Asian men, a diagnosis was associated with younger age, being of any other Asian background other than Bangladeshi, Indian or Pakistani and not being HIV positive. For heterosexual South Asian men, there was an association with increasing socioeconomic deprivation. For GBMSM, a bacterial STI diagnosis was associated with known HIV positive status and living in London.ConclusionsPeople of South Asian ethnicity in England are heterogenous with regards to their sexual health needs, which should be explored further through focused research and policy.Key MessagesWhat is already known on this topic: Historically South Asians in England have had low rates of sexually transmitted infections and sexual health service utilisation. Despite South Asians being the largest ethnic minority group in England, there has been a paucity of research investigating their sexual health needs.What this study adds: To our knowledge, this is the first national epidemiological study focusing on people of South Asian ethnicity accessing sexual health services in England, finding variation in factors associated with bacterial STI diagnosis, particularly when stratified by gender and sexual orientation.How this study might affect research, practice or policy: Our results reflect the heterogeneity of South Asian communities in England with regards to sexual health need, and we suggest that policy makers and researchers should prioritise this under-served group to improve their sexual health outcomes.