We’re in an STI crisis. Once again, Black women are being left behind

The gonorrhoea vaccine should be a major breakthrough, but young Black women are being left out of sexual health policy – with devastating effects.

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Oct 18, 2025

a person holding a needle — Pic: *Unsplash*

In May last year, Bailey*, a 28-year-old postgraduate student who moved to the UK from Kenya, walked into a new sexual health clinic after noticing unusual symptoms. Her regular clinic had shut down indefinitely.

She was hoping for answers and reassurance, instead, she was met with dismissive questions and racialised assumptions. She was already worried her symptoms had escalated into something more serious, and the condescending tone of the nurses didn’t ease her anxiety. One nurse kept cutting her off to press her about whether she had contracted a sexually transmitted infection [STI] in the past. The second nurse, after confirming Bailey was of African origin, suggested she must have multiple sexual partners.

“I’ve only ever had one boyfriend,” Bailey explains. “We broke up after I found out he was involved with someone else, and that was when my symptoms showed up. The nurses refused to believe me. It felt like they already had a picture of me and my ‘deviant’ sexual behaviours in their minds.”

Two weeks later, Bailey finally learned she had gonorrhoea. While she has now fully recovered, the demeaning encounter at the clinic has left her uncertain about interacting with sexual health services in future. She says she would rather seek advice online than try to see someone in person.

More and more women like Bailey are finding themselves in a similar position. Across the UK, sexual health services are buckling under pressure due to years of budget cuts at the very moment infections are climbing, and Black women are bearing the brunt of the impact.

For years, Black women have been disproportionately affected by STIs. Contrary to harmful stereotypes, it’s not because of ‘riskier’ sexual behaviour: data shows Black African and Caribbean women in the UK are less likely to report condomless sex or multiple new partners than white women. Yet they remain more likely to be diagnosed with an STI, suggesting these disparities are driven by structural, demographic, and cultural causes.

One explanation is that Black communities in the UK are much younger overall: the median age is 30 compared to 43 for white people. With 16.1 per cent of Black people aged 15-24 (versus 10.8 per cent of white people), a greater share fall into the age group most affected by STIs.

And, of course, Black women still face deep-rooted biases in healthcare. Around 65 per cent of Black patients (rising to 75 per cent among 18–34-year-olds) have experienced prejudice from staff. Those encounters discourage routine testing and treatment, pushing infections to spread unchecked. At the same time, cultural silence around sex in Black and immigrant households has left many young, Black women less informed about STIs and hesitant to seek testing.

Angela Vossen, a sexual health expert, tells The Lead about Aisha*, a 25-year-old Black woman with Caribbean heritage who contracted chlamydia from her partner despite using condoms. “She only sought testing after symptoms appeared,” Angela says. “She had never been tested before because she didn’t know STIs could be asymptomatic.”

That gap in sexual health education widens when campaigns fail to adequately reach Black women. Bailey remembers being the only Black woman at a sexual health event she attended some months ago at her university. Even when free HIV testing was offered, she didn’t get the impression it was meant for her.

“Most of the posters I saw were aimed at gay men, none of them looked like me,” she says.

And even when Black women actively seek these services, access is increasingly difficult due to cuts in sexual health spending, particularly in deprived areas and cities with large Black populations.

Between 2015 and 2021, sexual health spending in England fell by 17 per cent. In London, the city with both the UK’s largest Black population and the highest STI prevalence overall, ten publicly funded clinics closed between 2015 and 2022. Some sexual health clinics in Suffolk, Cambridgeshire, Nottingham, Brighton and Hove, Doncaster and Norfolk also faced closure or had to reduce their opening hours in 2018.

A reprieve – but not for everyone

If Black women already struggle to access routine services, it is clearly unrealistic to expect that they will benefit from the gonorrhoea vaccine rollout.

Gonorrhoea admission rates have almost tripled since 2013, so the roll-out of the world’s first gonorrhoea vaccine across England, Wales, and Scotland should provide a welcome reprieve. New data from the UK Health Security Agency [UKHSA] shows that although gonorrhoea infection rates fell slightly in 2024 compared to 2023 – where we saw the highest number since records began at 85,000 cases – a new strain has emerged that is antibiotic-resistant.

Even though the vaccine is only around 32-42 per cent effective, it could help to reduce the rising rates of antibiotic-resistant cases, and the NHS has estimated it could prevent more than 100,000 cases of gonorrhoea.

Gonorrhoea is characterised by painful urination, unusual discharge, abdominal or pelvic pain, and vaginal bleeding between periods in women. If left untreated, it could lead to pelvic inflammatory disease [PID], an infection of the reproductive organs that can cause infertility. Black women are 2.2 times more likely to get PID compared to white women due to the higher rates of undiagnosed gonorrhoea. Untreated gonorrhea also increases the risk of contracting and transmitting HIV.

While experts hail the gonorrhea vaccine as another arrow in the quiver against the second-most-commonly-diagnosed STI in England, past experiences show marginalised communities are at risk of not benefiting from this breakthrough.

We know STIs significantly impact certain groups of people: young people aged 15-24; gay, bisexual and other men-who-have-sex-with-men [GBMSM]; and some minority ethnic groups. Understandably, the initial vaccine roll-out is prioritising GBMSM who account for approximately half of all gonorrhoea diagnoses in England. However, without deliberate inclusion of other high-risk groups – particularly young Black women, who sit at the intersection of two of the most affected populations (young people and Black women) – there’s a real danger this intervention could repeat the exclusion patterns seen with Pre-Exposure Prophylaxis [PrEP].

And yet, the stakes are clear. Gonorrhoea rates are highest in women from deprived areas and among Black women.

This has happened before

To ensure young Black women aren’t once again left behind in this vaccine roll-out, it is worth looking back at how PrEP was introduced and where it fell short.

“With any public health roll-out, it’s always a balancing act of trying to make the biggest impact you can with the smallest amount of intervention,” says Benjamin Weil, head of research at The Love Tank CIC.

When PrEP was first introduced, GBMSM were identified as the highest-risk group. Focusing on them maximized both the immediate impact and the cost-effectiveness of the intervention. From 2017-2020, PrEP was distributed through the NHS’s Impact Trial, during which HIV diagnoses among GBMSM began to fall sharply. Today, PrEP is available free of charge in NHS sexual health clinics.

Despite current wider accessibility, many Black women still don’t know that PrEP exists, despite rising HIV rates. As PrEP was being rolled out, the proportion of Black, African women diagnosed with HIV increased between 2017 and 2021 in England.

Making a sexual health intervention available is not enough if the rollout strategy doesn’t actively account for the specific needs of different groups. There are a number of reasons why PrEP failed to reach so many Black women in the UK. Negative perceptions of the drug within Black communities played a part.

The National Aids Trust conducted a study to assess why more Black African and Caribbean women weren’t on PrEP. They found many Black women recognised its value and even recommended it for other women they knew, but struggled to see themselves as at risk.

Some doubted its effectiveness, while others preferred hearing about it from peers rather than general practitioners. The drawback of this peer-to-peer approach was that many found it difficult to discuss HIV and PrEP because it could be read as an admission of HIV. Even among HIV-positive women who were eligible to get PrEP, discussing it still raised fears related to disclosure. The authors concluded that for Black African and Caribbean women to actually benefit from PrEP, campaigns must work across multiple levels of influence: helping women see how PrEP fits into their safer sex practices, tackling stigma around HIV and sexual health, and ensuring services are welcoming to them.

“It’s best if the information provided in these settings is provided by Black women, for Black women.”

Battling shame

For many Black women like Bailey, walking into a sexual health clinic feels stigmatising from the outset.

“No matter how friendly you make a clinic, some people will never set foot in one because it means identifying as sexually active. Not everyone is comfortable doing so,” Weil says. “Instead, we need to be engaging with communities and asking: if you want to access this vaccine, where would you be most comfortable accessing it?”

That means taking vaccines to more discreet settings where Black women are, such as community centres, youth centres, church halls, hubs, and cultural festivals. During this year’s UK Black Pride, Weil and his team successfully dispatched every gonorrhoea vaccine they had.

Susan Cole-Haley, a HIV activist, was recently part of a Do It London initiative that set up a community pop-up offering free HIV testing alongside services like nail care. “Lots of Black women aren’t comfortable going to sexual health clinics, that’s why this was a great initiative and we need more of this,” she tells The Lead.

“Most of these initiatives are funded by community-based organisations which are facing unprecedented cuts, so we need more funding. It’s also best if the information provided in these settings is provided by Black women, for Black women.”

Weil stresses the need to build what he calls an “ecosystem of care.” That means offering multiple pathways, including home testing such as shl.uk, community spaces, and clinics, but ensuring they reinforce, rather than replace, one another.

“There should be routes of repair for historical distrust,” he says. “Whether that’s through culturally competent training, diversity among clinic staff, or small encounters that build trust step by step.

Health authorities also need to give flexible access to these vaccines outside of work or school hours. Most vaccination programmes end up prioritising people with movable schedules – often older or better-off groups – leaving many Black and immigrant communities behind.

Sexual health campaigns and interventions should be co-designed with Black women, not simply delivered to them. “There needs to be meaningful involvement and leadership from Black women in designing the services, and being involved at every stage, from program design, to rollout, to monitoring and evaluations, to social media,” Cole-Haley says.

What next?

Dr. Hamish Mohammed, consultant epidemiologist at UKHSA, tells The Lead that in addition to the gonorrhoea vaccine, UHKSA is working with community-based organisations to better understand the barriers and facilitators to preventative interventions for STIs with the aim of improving access.

“We also continue to use health datasets to understand the epidemiology of gonorrhoea and identify communities with greater need for preventative interventions,” he adds. “We share this evidence with local stakeholders involved in the design and delivery of sexual health services.”

Public Health and Prevention Minister, Ashley Dalton, has called the gonorrhoea vaccine rollout a “major breakthrough in preventing an infection that has reached record levels,” emphasising the urgent need to confront rising cases and antibiotic resistance. She encouraged everyone eligible to get vaccinated to protect themselves and their partners.

The gonorrhoea vaccine rollout is being framed as part of the NHS’s 10-Year Health Plan, which pledges to prioritise prevention and address health inequalities by shifting care into communities. On paper, it’s a welcome shift. Over the next decade, it could save the NHS an estimated £7.9m, but policy pledges mean little if they don’t translate into services that Black women can realistically benefit from.■