Friday 16 August 2013

All good things have a price

What is the role of the condom IF a sexual network does not have a sexually transmitted infection (STI)?  In heterosexual couples it is to reduce the risk of unwanted pregnancy; however, with a typical failure rate of 15 per 100 per year these couples would be better off finding something more effective (  

Unfortunately, unless a couple is exclusively monogamous, it is a good idea to continue to use a condom just in case an STI is brought into the relationship.  Once an infection enters a sexual network, its transmission depends on how infectious the organism is, the number & frequency of sexual acts, any concurrency (two plus partners at the same time) and the duration of the infection. 

Since many infections do not have symptoms it is important that everyone who starts a new relationship is tested for the four infections recommended by the British Association of Sexual Health and HIV (BASHH) which are HIV, Syphilis, Chlamydia & Gonorrhoea.  

Unfortunately all good things have a price and even non-penetrative acts such as oral sex can transmit infections.  The risk of catching an infection depends upon the sexual act. SXT has developed a simple risk estimator to help its clients know the facts. 

Finally, SXT has developed a way to support individuals to let their partners know about infections (  The new share function can be anonymous if the user wishes; although, SXT recommends that the clinic name and the patient number is added to the message to help the health advisors support the treatment of the whole network.  “What goes around comes around” and SXT is keen to support all providers of sexual health services to break the chain of transmission.

Monday 5 August 2013

Digital public health marketing

Where do you go when you need to look something up?  

Rarely do people carry around health leaflets, flyers, business cards just in case they may one day use this information.  Similarly, few remember the adverts on buses and trains when they realize that a specific service is required.   Google is the most common answer you hear to this question and this is where public health marketing needs to be to make a difference.

SXT Health CIC ( was set up with a grant from UnLtd ( Guy's & St Thomas' Charity ( to increase access to information and services and over two years it has proven itself to be a flexible digital platform to support health education and a range of providers.   SXT is free to use and the providers control their web profile, times, services and have access to a powerful analytics page. This year, SXT has run a number of digital public health marketing campaigns using Google Adwords in London to sign post clients to services on both sides of the Thames.

The latest round of Ads have focused on four areas and keywords used have been informed by the experience of working in sexual health, discussion with colleagues in Guy's & St Thomas' (GSTT) Sexual Health Department and Brook as well as advice from the Google Adwords software.  The latest Ads have been running since 24th June and the adverts have been displayed on 235,022 occasions to Londoners during this time with 864 clicking on an advert [344 Emergency contraception, 296 STI testing, 123 Post Exposure Prophylaxis (PEP) & 101 on Contraception].  The average cost per click has been £0.47 and this SXT June 4:1 campaign has cost so far £409.43.

These adverts have been paid from the marketing budget of the sexual health department at GSTT to prove the concept for digital public health marketing and determine a return on investment.  SXT is charging a 10% fee per advert clicked during this proof of principle trial [Total cost £500].  Of the 246 SXT users of the site during this campaign, two thirds (163) chose a specific clinic and 32 of these clients (20%) selected a GSTT clinic [Burrell Street or Lloyd clinic].   The median (range) distance between the SXT client and the GSTT clinic they chose was 2.2km (0.58 - 12.71km).  The other 131 providers chosen were sexual health clinics, community services, GPs and pharmacies.

SXT is keen to support commissioners to pool their financial risk and expand public health marketing strategy across other digital platforms such as Facebook & Twitter as well as run banner adverts on Gaydar, Grindr, Manhunt etc. to optimize the access of men of sex with men to HIV testing and PEP.  In addition, SXT is partnering with Connecthings ( to facilitate the creation of SXT clients by the use of NFC tags and QR codes in venues to support access to information on sexual health, drugs and find high quality services across the capital. 

Sunday 4 August 2013

The clinic was closed or busy! (The turn away tragedy)

We have a problem with matching capacity with demand for sexual & reproductive health care services.  If a clinic becomes popular then it can be difficult to be seen.  Some clinics use an appointment system for their consultations, others only walk-in whilst a large majority use a combination of the two.  

A walk-in service is crucial to meet the needs of service users who need urgent care and these patients include those requiring post exposure prophylaxis following sexual exposure to HIV or emergency contraception.  The earlier these services are delivered the better and the walk-in service is the only way to provide this.  Similarly the walk-in service is really important for those patients who are symptomatic (for example the first episode of anogenital herpes) or they have complications that affect the Fallopian tube or testicles.  If you make the whole service walk-in then it is possible that clients will arrive when the clinic opens and all the time slots over the day can be used up within the first hour.  The impact of this for those who are in work or school is that they can turn up later in the day only to find that the service is now closed for the day.

The use of an appointment system is attractive to clinics because they can spread out the work load across the service and it supports users who are unable to attend at the time when the clinic opens.  However, some of the problems with an appointment system are that it can be oversubscribed and the waiting time to access the service can become weeks, there are unused slots from non-attendance or the service is put under significant pressure because the appointments have been made but there are not enough staff because of sickness, compassionate leave etc. 

Getting the balance right is challenge to all services but this does not always have to be the case.  In many areas there are range of providers that are not been fully realized such as general practitioners with a special interest, pharmacies and online providers.  In big cities where there are more than one provider of sexual & reproductive health services it is possible that one is busy and the other one quiet that this imbalance can only be resolved by real-time information about where is the next service open that can serve this individual.

In SXT there are a number of verified clinics who have been partners since its inception in 2012.  The range of providers include condom providers to university teaching hospitals and this includes GPs & pharmacy services within its database.  The third iteration of SXT (launch 6th August 2013) will have all the sexual health providers in the UK, all the UK emergency departments for out of hours post exposure prophylaxis and a range of free emergency contraception providers in London.  The mission of SXT is to improve access to sexual & reproductive health services and these changes will be a significant step towards this goal. 

Saturday 3 August 2013


Despite the progress that have been made in sexual health services there is still significant

stigma associated with these type of services.  Like mental health, the providers of

sexually transmitted infection (STI) testing & contraception services have to support clients

who may come to a consultation with mixed emotions including fear, embarrassment,

shame, anger, sadness.......(the list is extensive).

Even the provision of emergency contraception or asking somebody to provide samples

for STI testing can carry these emotions and staff who serve these clients are aware of

these sensitivities.  The public health impact of stigma means that people are reluctant to

test for infections and they risk of carrying an infection to any new partner.  Also women

who don't access contraception services are more likely to experience an unwanted pregnancy.

When sexual health clients are asked about what they value the most in sexual health

services they report confidentiality, speed of service and rapid results (

14PX080).  Confidentiality is really important for young people and the young persons

charity Brook has clear guidance in every clinic about this important issue (


SXT recognizes the full privacy concerns of its clients and it has been designed to keep

everything anonymous.  No personal information is requested at any point during the SXT

service and when a mobile phone number is used it is deleted once the SXT service has

been provided.

The new features that go live next week in SXT are also influenced by these privacy

concerns.  Consequently if a client wishes to share a piece of information about an

infection / contraception or the clinic location it is possible to do this within the SXT site

without having to add their email address or mobile number.  The text box in the share

function allows a personal message to be included within the shared page and the SXT

client can decide how much personal information they would like to include.

Some clients may choose to use the share function to tell a partner about an infection

when they do this it is recommended that they use their clinic reference number

(pseudonym) to help clinics identify that partners have been effectively treated.  Other

clients may not be happy to add any details and they can keep their notification

anonymous.  Just in case this communication channel is used incorrectly, SXT has

created a feature that will allow a recipient of a shared message to report abuse and block

further messages from SXT.

Finally, SXT provides analytic pages to all the verified clinics that shows the location

of clients, the services they were looking for, the clinics that were displayed during that

search in if their clinic was chosen.  In order to maintain the IP address privacy of the

person using the locate me function on their computer or mobile, SXT has decided to

report this location with a random offset so that our client cannot be identified by their

geographical location.

Saturday 27 July 2013

Using SXT to teach sexual & reproductive health

Picture a Friday lunchtime after the food in warm canteen with the bench seats full of young people visiting their key workers and friends at

The projector is perched on a box, illuminating a screen perched on a fireplace, and the iPad is connect to this device as well as the internet via a hotspot on Jason Shonibare's [Kid's Company staff] iPhone.

Some of the young people don't want to commit to a presentation on sexual and reproductive health by a man with a tie and they strategically position themselves by the door the is open to let in some cool air.

The class outline has four parts and SXT is essential to the first three.

What is the most effective contraception?
Name the sexually transmitted infections that can give you lumps and bumps?
Where is the nearest local provider who offers these services and is open now?
How do you diagnose HIV in one minute?

Sexual health information is very easy to find in SXT and even though the internet connection was slow it was possible to use the website in real time for the Kid's company audience.
With two clicks we were on the page of the most effective contraception methods with the most effective method (the sub dermal implant) at the top of the list.  When the implant is selected then a short summary sentence is provided and a link to information from the Family Planing Association (

Once the SXT client has been given the information they require the next question is where can I get this service.  The picture below is of the local providers in the SW9 postcode area of London that could provide an implant service today.  The search was made at 11am on Saturday 27th July 2013.

The presentation ended with a demonstration of a one minute (INSTI) HIV test for HIV1/2 antibodies.  In the 30 minutes there were questions from a quarter of the audience and the numbers did not change over time.  Everybody was given an SXT card at the end of the lesson so that they can use the web, mobile and SMS service in their own time.

The launch of the SXT MedStartr campaign (crowd source funding for medically related projects)

SXT is a social enterprise whose mission is to facilitate access to sexual and reproductive health care services.  This is done by providing high quality sexual health information in under a minute and then real time identification of a local service.  Available on the web, mobile and SMS the information provided by SXT is not trapped by any digital divide.

The initial funding for this project came from UnLtd & 4iP (June 2009, £5000) and this money was used to scope the idea, choose the name, build the first prototype and identify the next steps to develop the service.  This data was then used to apply for funding from Guy's & St Thomas' Charity (February 2011, £66,000) and this award has enable SXT to develop a powerful digital platform to meet our mission.  Over the last couple of years SXT has had two major changes to its design and the data provided to clients and providers.  The MedStartr campaign has been developed to coincide with the third and final change to the SXT service that is funded from the charity.  MedStartr have successfully raised funds for medically related projects in the USA and they are now bringing their expertise to Europe. 

The changes in version three of SXT are as follows:-
  • A complete re-design to support the education of clients
  • Develop an application programming interface to support partners with high quality information
  • Build a simple sharing tool to allow partners to be informed of infections and then locate a local service
  • Upload all the key UK sexual & reproductive health care services
  • Capture effectively how many clients are turned away because of closure or demand and then support these individuals to find a local open service
  • Translate SXT into Spanish for the growing community in London
  • Support the provision of online appointments
In the MedStartr campaign we also are keen to support:-
  • The development of digital public health marketing campaigns
  • Enhance peer to peer education by the medical student organisation Sexpression
  • A project manager to introduce the changes and evaluate their introduction and impact

Thank you to Alex Fair & Ben Heubl for their support to set up the MedStartr campaign.  The marketing for this $90,000 fund raising campaign will fully commence with the launch of the SXT version 3.0 next week.