England consistently has some of the poorest sexual health outcomes in Europe – we are a nation riddled with STIs. New diagnoses increased by 5% in 2018 from 2017, syphilis and gonorrhoea have increased by 165% and 249% respectively in the past decade. And, worryingly, it is marginalised communities and ethnic minorities who are disproportionately impacted by higher rates of sexually transmitted infections. It is no surprise that Black and minority communities fare worse when it comes to sexual health as these groups tend to have poorer health outcomes generally – with experts pointing to systemic inequalities in healthcare and poor accessibility as a root cause.
Another key cause of the unequal sexual health outcomes may be failings in sex education. Experts and campaigners believe that what we are taught in schools is a ‘whitewashed’ version of sexual health education that inherently excludes children of colour. ‘The images used to teach sex education so often only depict white bodies,’ Portia Brown, sex educator and ambassador for Kandid says: ‘I would love to see a Black person depicted in sex-ed literature. The people teaching us about our sexuality are often white and it’s not necessarily because there are no Black or POC sex educators, there certainly are, they just don’t often get the same opportunities are white sex educators.’
Portia believes that representation is vitally important for effective sexual education. She says that when the literature, educators, and sex brands fail to include non-white people, these groups are less likely to integrate those lessons into their lives, which puts them at risk. ‘If you hop on Instagram and search for a sex educator, or a sex therapist or coach, you’re going to be flooded with images of blond-haired, blue-eyed, attractive, able-bodied white women,’ says Portia. ‘As a sexuality professional, it’s discouraging. Doesn’t my perspective mean anything? Aren’t my thoughts important? ‘Sex toy companies, sex education workshops, and even condom companies do a poor job of hiring sexuality professionals that aren’t white. That representation is important. ‘When we whitewash sex education it impacts Black people and POC’s ability to feel fully included, to feel like this is something relevant to us and our experiences.’ It’s important to note that Black people and minorities aren’t any more prone to STIs or sexual health problems than white people. This isn’t a problem that relates to biology, it is about the systemic inequalities that ignore and exclude marginalised groups from adequate education and protection. Portia says that beyond the lack of representation, there is also a serious problem with accessibility.
Black and minority children just aren’t being exposed to the relevant knowledge and education about sexual health in schools. ‘Black and brown students aren’t learning comprehensive sex-ed as often as white and wealthy students,’ she explains. ‘Black people and other people of colour disproportionately learn abstinence-only sex education – in schools we deserve comprehensive sex education. I think key things these groups should be learning include topics of gender inclusivity, prioritising pleasure, consent, and communication skills. ‘We also have to consider cultural aspects when we talk about sex. The way specific groups of people are sexualised (such as Black and indigenous women) is different from the way the white and white-passing people are viewed sexually. ‘That element is important! It informs how we interact with our sexuality, it influences who has access to “sexual liberation”, and so much more.’
A 2020 report into sexual health in the UK calls for more research and evidence into the impact of structural, systemic and individual racism on sexual health. The State of the Nation report highlights the need for all providers to recognise multiple marginalised identities, the intersectionality of communities and the people that make them up. The authors add that we must have members of minority communities meaningfully involved in any research to improve sexual health outcomes. Not knowing that sexual health services are free and confidential can stop people seeking advice.
The inequalities in sexual health go far beyond the UK education system and the implications are long-lasting and impact every generation. Parminder Sekhon, LSL Sexual Health Partnership and CEO of NAZ says communities are in desperate need of culturally sensitive sexual health services and education. ‘In a city as diverse as London for example, more support is needed for non-native speakers and a need for basic awareness of the languages spoken in the boroughs and translation services,’ says Parminder. ‘There can also be a combination of stigma and shame associated with sexual health, which acts as a barrier for first and second-generation immigrants accessing support, whether it’s from sexual health providers themselves or community members, friends, and family.’ Parminder says that more support is needed for minority women living with HIV, as more than 70% of women accessing HIV care are BAME, and many face multiple challenges to health and wellbeing, including stigma, living in temporary accommodation, and risk of intimate-partner violence. ‘Lack of knowledge about the availability of the support might make it difficult for people to access,’ explains Parminder. ‘Not knowing that sexual health services are free and confidential can stop people seeking advice.
A lack of knowledge about STIs can build the fear of a diagnosis means a “death sentence”, which may cause people to not engage.’ This brings it right back to education. Effective sexual health education in schools could be what is needed to help tackle this level of fear and remove some of the stigma around STIs, which could lead to more people accessing protection and treatment. The LSL Sexual Health partnership is now calling for an inclusive and culturally specific approach to this issue. They want to see a collaborative effort that will require innovation and programs designed for, by and with the BAME community. ‘These projects must guarantee safe and accessible spaces,’ says Parminder. ‘While services informal settings need adapting, we also believe in being proactive in outreach and engagement. We know that it can be effective to engage people in non-healthcare settings, including in bars and nightclubs or probation services. ‘It is also essential to tap into informal networks of communication that many migrant communities are more likely to see and read messaging, such as Whatsapp broadcast lists, which we’ve seen community organisations enabling their service users to connect and provide mutual support to each other during the lockdown.’
Parminder adds that we also need dedicated resources to counter existing cultural and religious stigmas. ‘Culturally-specific resources are also important to promote awareness and education, Shine Aloud has recently put out a great video on intimate partner violence from the perspective of a young Black woman, Ava,’ she explains. ‘Where cultural and religious stigma act as a deterrent to being seen at the clinic, more discrete options are also needed. ‘We must also tackle stigmas and taboos and work on preventing intimate violence, it is also crucial to involve BAME men in these discussions.’ Crucially, Parminder says we need specific education for cultural sensitivity in sexual health services. ‘To tackle these issues, awareness and education materials mustn’t solely rely on being seen at the clinic or on a provider website – service should be making use of emerging media and digital platforms to reach younger people who are disengaged about their sexual health. ‘We should also increase access to home-testing. Covid-19 has shown that people favour at-home testing and screening – therefore strengthening the capacity of at-home testing (i.e. through Sexual Health London) is a priority.’ She adds that intersectionality needs to be at the heart of this drive for change. ‘We need to see the joining up of sexual health services with domestic violence agencies and LGBTQI+ support services to better support the needs of Black women and particularly Black queer and trans women who may face additional risks to their sexual health and wellbeing,’ she adds.
Worryingly, nine out of 10 BAME voluntary sectors are at risk of closure. These organisations can be a vital connector between mainstream services and minority communities, so Parminder is calling for ring-fenced funding to keep these sectors alive. To have a lasting and wide-reaching effect on sexual health inequalities, we need better representation, inclusion, funding and awareness. Sex educator Portia Brown says it is something that brands and organisations in the sector can begin to implement with simple steps. ‘If you’re considering having a workshop, hire someone who isn’t white, cis and heterosexual to conduct it,’ she suggests. ‘Start putting a variety of bodies into your literature. Address stigmas and stereotypes about people of colour when they come up in workshops or other conversations. ‘It begins with the individual. What are you doing as a brand or as an individual to address the prejudices you have? How are you creating space for more voices? How are you actively combating these issues and not just leaving it to Black people and other POC to do it themselves?’