# 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

## TL;DR

Many men and gender-diverse individuals in England who have sex with men face unmet needs for in-person sexual health services, especially outside London and among those with health conditions or using online testing.

## Contribution

This study identifies unmet in-person sexual health service needs among key populations in England using a large community survey.

## Key findings

- 12% of participants who tried to access in-person sexual health services experienced unmet need in the past year.
- Unmet need was higher outside London and among those with physical health conditions or using online postal self-sampling services.
- Financial comfort and sexual risk markers were associated with lower unmet need for in-person services.

## Abstract

Sexual health service (SHS) delivery in England shifted substantially with rapid expansion of online services during the COVID-19 pandemic. While digital services may improve reach, limited data exist on unmet need for in-person SHS in England, especially among men and gender-diverse individuals who have sex with men, key populations disproportionately affected by sexual health inequalities.

We analysed data from “Reducing inequalities in Sexual Health” (RiiSH) 2024 (Nov/Dec 2024), an online survey of UK-resident men and gender-diverse individuals having sex with men. We assessed in-person SHS access and unmet need (tried but failed to access a SHS in-person) over the past year. Bivariate and multivariable logistic regression was used to examine associations with unmet need.

Among 2404 participants living in England (median age 45 years, 88% White, 95% cisgender), 86% had ever accessed in-person SHS 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]).

Despite high SHS engagement, one-in-eight reported unmet need for in-person SHS. Local service delivery guided by joint strategic needs assessments could help address unmet need for SHS.