Factors associated with bacterial sexually transmitted infections amongst people of South Asian ethnicity in England

Objectives Despite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services and sexually transmitted infection (STI) diagnoses, though recent data suggests this may be changing. This study aimed to investigate factors associated with a bacterial STI diagnosis amongst South Asians attending SHS in England. Methods Using data from the GUMCAD STI Surveillance system, a descriptive analysis of South Asians attending sexual health services in England in 2019 was carried out. Factors associated with a bacterial STI diagnosis were examined using univariate and multivariable logistic regression models adjusted for age, Asian ethnic subgroup, HIV status, patient region of residence and Index of Multiple Deprivation quintile. Analyses were stratified by gender and sexual orientation (heterosexual male vs. gay, bisexual, and other men who have sex with men [GBMSM] vs. women of any sexual orientation). Crude and adjusted associations were derived using binary logistic regression. Results There were 121,842 attendances by South Asians to SHS in England in 2019. Compared to heterosexual South Asian men, GBMSM had a higher odds of being diagnosed with a bacterial STI (aOR 2.32, 95% CI 2.19-2.44) and South Asian women had a lower odds (aOR 0.83, 95% CI 0.78-0.87). For women and heterosexual South Asian men, a diagnosis was associated with younger age, being of any other Asian background other than Bangladeshi, Indian or Pakistani and not being HIV positive. For heterosexual South Asian men, there was an association with increasing socioeconomic deprivation. For GBMSM, a bacterial STI diagnosis was associated with known HIV positive status and living in London. Conclusions People of South Asian ethnicity in England are heterogenous with regards to their sexual health needs, which should be explored further through focused research and policy. ### Competing Interest Statement None of the authors have received any direct fundng for this study. RD has received educational grants from the British HIV Association and speaking honoraria from Gilead Sciences and ViiV Healthcare. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Research and Public Health Practice Ethics and Governance Group of the UK Health Security Agency gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript