Devon County Council is the commissioner of most sexual health services in Devon, with the exception of HIV services, Sexual Assault Referral Centres and primary care contraception services which are the responsibility of NHS England and terminations of pregnancy which are commissioned by Clinical Commissioning Groups. The complexity of these commissioning arrangements is addressed through the Sexual Health Alliance which works to ensure sexual health outcomes improve, especially as they are an area where considerable health inequalities exist. Rates of sexual transmitted infections are highest for young adults.
Figure 8.20 below shows rates of acute sexually transmitted infections in Devon were lower than both the South West and England rates. There are large variations between the local authorities with Exeter having a statistically significantly higher rate of infections than nationally. Rates in all local authorities apart from North Devon and Exeter were significantly lower than the regional rate. The main genitourinary medicine clinics are in Exeter, North Devon and Torbay and access and accessibility may have an impact on those diagnosed. Services have been redesigned to enable integrated contraception and sexual health clinics to be offered in many of the towns across Devon at times convenient to the needs of both the young and young adult populations which will make accessibility easier. There are signs these clinics are being well used and so, although an increase in rates may be seen initially, this will have a positive impact on inequalities across Devon.
Figure 8.20, Rates of acute sexually transmitted infections diagnoses per 100,000 population (excluding Chlamydia in under 25s), by local authority, 2015
Source: Public Health England, 2016
HIV (Human Immunodeficiency Virus) remains one of the most serious communicable diseases in the United Kingdom, associated with morbidity, mortality and high numbers of years of life lost. There are high costs associated with both treatment and care. In the United Kingdom, health protection data showed an increase in HIV cases, peaking in 2005 and has since decreased. The numbers vary across the United Kingdom and Devon has a lower rate than the South West and England average. Table 8.10 shows outcome measures for people with HIV from the Public Health England Sexual and Reproductive Health Profiles. This highlights that around 330 adults aged 16 to 59 are living with HIV in Devon, a rate that is significantly lower than the England average. There are around 20 new diagnoses of HIV per year in Devon, a rate that is around a quarter of the England level. Whilst rates of new diagnosis are falling, the number living with the condition (prevalence) is slowly increasing due to improved treatment and increasing life expectancy for those with HIV. Levels of late diagnosis fell in 2013 and 2014. Both the availability and uptake of HIV testing in Genitourinary medicine clinics in Devon is above the England average, and has improved over recent years as rates nationally have declined. The coverage and uptake of testing for men who have sex with men is higher than the national average, with a testing coverage rate of 90.8% (versus 88.0% for England) and an uptake rate of 96.0% (versus 93.4% for England).
Table 8.10, HIV health outcomes, Devon and England, 2011 to 2015
| Measure | Area | 2011 | 2012 | 2013 | 2014 | 2015 |
| HIV prevalence rate per 1,000 (aged 16-59) | Devon n | 280 | 280 | 307 | 330 | |
| Devon | 0.69 | 0.69 | 0.75 | 0.80 | ||
| England | 1.97 | 2.06 | 2.13 | 2.22 | ||
| New HIV diagnoses per 100,000 (aged 15 and over) | Devon n | 29 | 29 | 19 | 21 | |
| Devon | 4.6 | 4.5 | 3.0 | 3.2 | ||
| England | 12.7 | 12.9 | 12.3 | 12.3 | ||
| HIV late diagnosis (%) | Devon n | 10 | 10 | 6 | 7 | |
| Devon | 44.8% | 47.5% | 34.0% | 37.0% | ||
| England | 49.8% | 47.9% | 45.0% | 42.2% | ||
| HIV testing coverage in Genitourinary medicine (%) | Devon | 73.6% | 75.4% | 77.4% | 78.2% | 81.6% |
| England | 70.5% | 70.5% | 69.8% | 68.3% | 67.3% | |
| Uptake of HIV testing in Genitourinary medicine (%) | Devon | 83.5% | 85.5% | 86.7% | 87.4% | 86.6% |
| England | 80.4% | 80.5% | 79.4% | 77.2% | 76.2% |
Source: Public Health England, 2016
There were 209 conceptions in Devon between April 2014 and March 2015 for females aged under 18, with around half leading to a birth. The latest rate (17.1 per 1,000 females) was below South West (18.3), local authority comparator group (19.4) and England (22.3) rates. Rates have fallen significantly over recent years. The teenage conception rate in West Devon (6.5) is significantly below the Devon rate. There is a strong association between deprivation and teenage conceptions, with rates four times higher in the most deprived areas compared with the least deprived areas of England. A similar pattern is seen locally, with the highest rates seen in parts of Exeter, and other deprived wards across the county. However, rates have fallen more rapidly in the most deprived wards in recent years compared to the Devon average. Most teenage conceptions occur at the age of 17, and there are only a small proportion under the age of 16 (around 50 to 60 per annum), with less than 10 under 16 births per year. Figure 8.21 shows teenage conception rates by District Council for Devon, highlighting that although the highest rates are seen in Exeter, the rates have shown considerable decrease. Year-on-year fluctuations are seen, which are mainly due to the low number of conceptions involved at a district level, but overall rates are showing a strong downward trend, a pattern that is also seen nationally.
Figure 8.21, Under-18 conception rates per 1,000 15 to 17 year-old females for District Councils in Devon, 2000 to 2014
Source: Office for National Statistics, 2015