How NHS racism fears are risking fertility, with chlamydia blighting black Caribbean men and women

Doctors have accused the NHS of risking people’s sexual health and fertility through a misguided effort to avoid being accused of racism. New data reveals that black Caribbean men and women in England are at a disproportionately high risk of contracting and passing on chlamydia. But fears that talking about the problem will lead to claims of racism mean that people are not being warned about the disease – which can cause infertility – or treated for it, concerned doctors have told i.

They say the disparity should be tackled with a public health campaign targeted directly at black Caribbean communities, and particularly women, to let them know they are at higher risk and how to protect themselves.

Figures published by Public Health England in September, just before the quango was dissolved, showed that 1,100 black Caribbean men per 100,000 tested positive for chlamydia. The rate for white men is 200 in 100,000, and just 100 in 100,000 for Asian men. There is a similar disparity for women, with 800 per 100,000 Black Caribbean women carrying the sexually transmitted disease, compared with 80 for Asian women and 200 for white women.

A senior NHS microbiologist told i that the disparity had been well known among doctors for decades, but that nothing had been done to solve the problem, because “senior health leaders won’t share this information for fear of being told they’re racist”.

“Anything that touches on race makes NHS managers and commissioners, right up to government level, very nervous,” he said. “Nobody is willing to talk about it when young black men are the major group being diagnosed.”

The doctor, who has worked closely with Public Health England throughout his career, said 15 years ago similar data concerning sexually transmitted infections (STIs) was held back because the quango was too nervous to “set up a debate that may turn toxic”. Now the data is published but is still kept quiet, he claimed.

A second doctor, a north London GP, said: “Health leaders aren’t talking about this [chlamydia] to the public and the reason is there’s a fear of being told you’re racist if you point it out.”

“It’s racist not to talk about it,” she said. “If women know about this they can do something about it and be more likely to use condoms.

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“Otherwise these groups will have these increased rates of infertility and the NHS will be told it’s racist for not looking after certain groups properly. And if we don’t talk about it now and fully inform these women, we’ll have been racist.”

Another doctor – a consultant specialising in sexual health working in a London hospital – said that public health outreach on chlamydia and other STIs was being avoided over the fear of provoking anger, even though that fear was likely to be unfounded.

“What happens is people think they will be accused of racism, so they stop doing the things they’re supposed to do. They are backing away from this and a lot of issues over this sense of anxiety,” she said.

None of the doctors who spoke to i about the issue were prepared to make their identity public, because they feared that their jobs would be put at risk for admitting what was happening inside the NHS.

Public Health England did publish a document on promoting general sexual health among the black Caribbean community in September, just days before its dissolution. But it made no mention of the disproportionately high rate of chlamydia among the community.

If diagnosed, chlamydia can be treated with a simple course of antibiotics, but left untreated it can lead to serious health problems. The reluctance to discuss the issue means black pregnant women in particular could be at risk. Black women are already known to have worse obstetric outcomes than white women in Britain; untreated chlamydia increases the risk of stillbirth by 40 per cent and premature delivery by 17 per cent.

Wendy Olayiwola, the NHS England national maternity lead for equality, said that the disparity in infection rates for chlamydia was “not common knowledge” among midwives working with black Caribbean pregnant women.

“It’s not a routine test screening for pregnant women and it’s not known that it’s higher within the black community,” she told i. “If it’s high among those communities and they have carried it into their pregnancy, how do we pick that up? How do we treat it to prevent the risks to mother and baby?”

Olayiwola addded that having been made aware of the latest data she would now revisit NHS policy on whether chlamydia testing should be added to routine screenings in early pregnancy, alongside HIV and syphilis.

Zoch Nwaosu, a sexual health adviser and co-founder of a black outreach project for the British Association for Sexual Health and HIV (BASHH) said sexual health among Black Caribbean people was being “ignored and neglected”.

“When you compare levels of investment – I’m talking finance and effort – to try to tackle inequalities, we have got investment in young people and men who have sex with men, but hardly any investment in black ethnicity,” she said.

“I can say if this wasn’t people of black Caribbean ethnicity there would be much more investment. People of black ethnicity have been labelled hard to reach and it’s used as an excuse [by sexual health services] to prevent engagement with the black community.”

Any fears that talking openly about high STI transmission rates among black communities will provoke an angry reaction may be unfounded. There had been no such backlash against targeted public health messages for black African men in England around prevention, diagnosis and treatment of HIV, Nwaosu said. “If it’s done in a culturally sensitive manner people won’t be offended,” he added.

NHS midwife Leah Hazard, author of the book Hard Pushed, said she had heard “many times” that issues around sexual health and race weren’t being addressed because of how that might be perceived by the community.

“That anxiety stopping health bodies from reaching out shows how white they are,” she said. “I think that anxiety is a reason, but it’s not an excuse.”

A Department of Health spokesperson said: “Everyone should be given the appropriate public health advice to help prevent illness and infection by clinicians.

“We will publish a new Sexual and Reproductive Health Strategy and HIV Action Plan later this year that will set out our plans to improve sexual health outcomes including reducing transmission of STIs.”

Chlamydia facts: complications can be serious

Chlamydia is one of the UK’s most common sexually transmitted diseases, and is most prevalent among 16- to 25 year-olds. It cannot be passed by close contact such as kissing, but it can be passed by touching genitals, even if no penetration or ejaculation has taken place.

Most people with chlamydia do not know they have it, because it does not cause any symptoms, though some people may notice pain while passing urine or unusual discharge from the vagina or penis.

But if chlamydia goes undiagnosed it can cause serious complications, particularly for women, including pelvic inflammatory disease, infertility and ectopic pregnancy, and a higher risk of miscarriage, low birth weight or stillbirth in pregnancy.

The NHS recommends that all sexually active women under the age of 25 get a test for chlamydia every year, and that any man under 25 should get a yearly test if they’re not using condoms.

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