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Theme A: Overview - Understanding risk and risk reduction for sexually transmitted infections and blood borne viruses

Aim - The overarching aim of this research theme is to improve understanding and the knowledge-base of the behaviours, attitudes, and factors that influence the risk of STI and BBV acquisition and transmission in key population groups to inform the development of novel interventions and support the targeting and delivery of timely interventions to maximise patient and public health benefit. 

Initially, the research will focus on key priority groups identified by Public Health England (PHE) i.e., people of Black Caribbean ethnicity, and those from ‘Black other’ ethnic background; and men who have sex with men (MSM). These groups experience poor STI and BBV outcomes and are known to access sexual health services, especially genitourinary medicine (GUM) clinics. Black Caribbean populations in England are between 12 and 20-fold more likely to acquire gonorrhoea than the general population.

The reasons for the magnitude of this disparity remain unclear, and detailed and contextual information about partnership types, attitudes to risk and partner notification is urgently needed. Likewise, MSM are at considerably greater risk of acquiring HIV and other STIs and BBVs. The increasing role of HIV sero-adaptive behaviours in dense sexual networks in facilitating recent STI and other STI epidemics, including Syphilis, HCV, LGV, Shigella flexneri, and gonococcal strains with reduced antimicrobial sensitivities, has been highlighted. Of particular concern currently is the association between recreational (club) drug use and needle sharing and sexual behaviours in MSM.

This HPRU research theme will generate urgently-needed evidence on how social, behavioural, and contextual factors shape risk and risk reduction capacity, with which to develop relevant and timely interventions, and health protection messaging specifically tailored to key populations, subcultures of risk, and social conditions, in addition to more generalised approaches. 

In order to do so in the 1st two years of this project we will establish a bio-behavioural Rapid Risk Assessment System which entails conducting a rapid systematic review and qualitative research to understand contextual factors and subsequently conducting a survey in sexual health clinics to collect data on risk behaviours and factors influencing them. These survey data will be linked to existing PHE’s Genitourinary medicine clinic activity dataset (GUMCAD) which routinely collects STI surveillance data. These data will guide the subsequent development of interventions for risk reduction in key populations. 

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Lead researchers

Dr Catherine Mercer

Senior Lecturer

University College London

Gwenda Hughes

Head of STI Section

Public Health England