Sexual health strategy reports progress but warns of screening gaps and rising sexual offences
- Syphilis diagnostic rates dropped from 12 to 3 per 100,000 population in 2025, the lowest since 2019, whilst gonorrhoea rates fell from 30.1 to 7.5 per 100,000.
- Chlamydia detection rates in females aged 15-24 fell to 580 per 100,000—well below national benchmarks—with screening coverage dropping to 14.1%, suggesting significant under-detection.
- Sexual offences reported in 2025 rose 9% to 258 cases, including 69 rapes, equating to 3.88 per 1,000 population compared to England's 3.1 per 1,000.
- The Domestic Abuse and Related Provisions Law came into force in June 2025, introducing offences including threatening to disclose private sexual images and recognising coercive control.
- A critical sexual health outreach nurse post remains vacant despite multiple recruitment attempts, representing the strategy's only red performance indicator.
Guernsey and Alderney's sexual health services have achieved improvements in service delivery and disease prevention, but face persistent challenges with screening coverage and staffing, according to the first annual report on the islands' Sexual and Reproductive Health Strategy.
The report, covering 2025 and published in July 2026, shows 39 green performance indicators against just one red, with notable successes in reducing sexually transmitted infections and expanding access to services.
Syphilis diagnostic rates dropped from 12 to three per 100,000 population in 2025—the lowest since 2019. Gonorrhoea diagnostic rates decreased from 30.1 to 7.5 per 100,000, also the lowest since 2019 and consistently below rates for England and Surrey.
The Orchard Centre sexual health clinic underwent significant restructuring in 2025, with two nurse consultants now providing non-medical prescribing services for HIV and sexually transmitted infections. A new service lead qualified as a non-medical prescriber in August 2025, and a genitourinary medicine consultant was substantively employed through HSC.
Of 72 service users surveyed, 99% rated overall care as excellent. For Choices, the commissioned contraception provider, 98% of 100 respondents stated they were likely or extremely likely to recommend the service.
Choices delivered 3,335 consultations to 1,476 individual patients in 2025, including 459 new patients. The provider supplies approximately 83% of free contraception requirements on-island and saw a 21% increase in cervical screening compared to 2023. Choices became a quality-assured partner of Bailiwick Social Prescribing and signed up to the Liberate Rainbow Mark for LGBTQ+ inclusion.
The number of people living with HIV in the Bailiwick increased from 63 in 2024 to 72 in 2025, with nine new clients attending the Orchard Centre. Late diagnosis of HIV remains rare, with fewer than five cases diagnosed late over the past five years—far below the England target of less than 25%.
The nurse-led HIV Pre-Exposure Prophylaxis service, operational since June 2024, has shown significant demand increase and is now more secure with two non-medical prescribers in place. In December 2025, the Orchard Centre introduced Meningococcal B vaccination for high-risk groups in accordance with JCVI guidelines, protecting against gonorrhoea.
The proportion of at-home terminations increased from 8% in 2023 to 43% in 2024, enhancing choice for women. During 2022-2024, 97% of abortions had no complications. There were 350 abortions during 2022-2024, averaging 117 per year. In 2024, 127 abortions were recorded—the highest in 10 years. The age-standardised rate was 10.1 per 1,000 women aged 15-44, consistently below England and Wales rates.
The Domestic Abuse and Related Provisions (Bailiwick of Guernsey) Law, 2024, approved unanimously in October 2024, came into force in June 2025. This represents the most significant overhaul in decades, introducing threatening to disclose private sexual images as an offence, recognising coercive control as criminal behaviour, and expanding child cruelty offences.
Additional reforms approved for 2026 implementation include offences for stalking, strangulation and suffocation, drink-spiking, sexual harassment in public places, and female genital mutilation.
In the 2024-2025 academic year, the SHARE team delivered 663 hours of relationships and sex education across 30 educational settings. Safer delivered 242 hours on domestic and sexual abuse across 28 settings, whilst the Digital Safety Lead delivered 263 hours across 30 settings. The Youth Commission delivered 36 hours on child sexual exploitation across eight settings.
A new lesson on harmful content for Year 10 students introduced in 2025 addresses online harms including harmful sexual content, pornography, child sexual abuse material, deepfakes, and non-fatal strangulation in pornography.
The NSPCC Harmful Sexual Behaviour Framework was updated in August 2024, with multi-agency safeguarding procedures developed. All States schools received training, with refresher courses planned for June 2026.
Significant progress was made toward supporting children and young people who are victims of sexual assault through Willow House, the sexual assault referral centre. In 2025, the Committee for Home Affairs approved expansion to include victims of domestic assault and non-fatal strangulation. Forensic examiners now complete body mapping, photography and documentation.
For women aged 50-64 in Guernsey, 83.6% received adequate cervical screening within 5.5 years—above the 80% target. However, Alderney coverage was 54.4%, well below target. Over eight years (2018-2025), there were 10 cervical cancer diagnoses, equating to 1.88 per 100,000 population—below WHO's elimination target of four per 100,000.
Despite these achievements, the report highlights significant challenges. The sexual health outreach nurse post remains vacant despite multiple advertisements including off-island, earning the strategy's only red indicator. The role requires specialised expertise in sexual health, contraception, and outreach—skills in limited supply locally. This position, filled for only two years from January 2023-2025, provided valuable clinical and educational support to vulnerable young people.
Chlamydia detection rates raise particular concern. The detection rate in females aged 15-24 decreased from 691 per 100,000 in 2024 to 580 per 100,000 in 2025—consistently lower than England and Surrey since 2019. This is substantially below the PHOF benchmark of 2,300 overall or approximately 3,250 for females, suggesting low case finding and likely under-detection.
The proportion of 15-24-year-old females screened declined from 18.5% in 2024 to 14.1% in 2025—the lowest since 2019 and below the national expectation of approximately 20%. For males aged 15-24, the chlamydia detection rate was 628 per 100,000, with overall screening rate of only 6.9%. These metrics suggest insufficient chlamydia control activity with likely under-detection, particularly concerning given young women face highest morbidity risk.
HPV vaccination coverage remained around 86.2% for eligible children in Guernsey in the 2023/2024 academic year—below the WHO global elimination target of 90%. While higher than England's 76.7% for females only, coverage has lagged over recent years.
Only 68.4% of eligible women aged 25-49 in Guernsey had adequate cervical screening within 3.5 years—below the 80% target. Alderney's estimated coverage of 56.1% was significantly worse. Several recommendations were issued to improve data accuracy, monitoring, quality assurance, and investigate IT infrastructure to support programme administration.
HIV testing rates declined to 845.3 tests per 100,000 population in 2025, down from 1,081.4 in 2024. The 2024 England rate was 2,842.7 per 100,000 and Surrey's was 2,287.3 per 100,000. Opt-out HIV testing in the emergency department was considered but costs proved prohibitive. Testing strategy has pivoted to enhanced testing in primary care according to BHIVA/BASHH guidelines, though details are not yet finalised.
Data from Choices shows 159 long-acting reversible contraceptives fitted in 2025—69 IUDs and 90 implants—equating to 13.6 per 1,000 females aged 15-44 and 5.5 per 1,000 women over 15. This is significantly lower than England and Surrey rates of 40 per 1,000 in 2024, though primary care data is not included.
Access to affordable contraception, especially long-acting reversible contraceptives, is difficult for many islanders. Unlike the UK where all LARC methods are completely free through NHS, Guernsey only provides free contraception to under-21s or vulnerable individuals over 21. The availability of contraceptive services including emergency contraception through pharmacies is still being investigated.
Over 15 years, reduction in crude abortion rates for under-20s is notable, possibly related to free under-21 contraception introduced in December 2017. However, there is a recent increase in the 25-29 age group, which accounts for 50% of procedures in 2022-2024. The technical team is investigating reasons, including lack of eligibility for free contraception, LARC provision costs, and availability of immediate post-birth or post-abortion contraception.
While 79% of terminations occurred under 10 weeks, this is lower than England and Wales at 88% and Jersey at 93%. Guernsey performs higher proportion between 10-12 weeks—16% versus 5% for England and Wales. An audit is underway to investigate reasons.
There were 25 under-18 conceptions during 2022-24, averaging eight per year and equating to 8.9 per 1,000 women aged 15-17. While higher than the lowest rate in 2019-2021 of 4.3 per 1,000, it is still lower than levels before free under-21 contraception introduction. The under-16s conception rate was 2.4 per 1,000 women aged 13-15 during 2022-2024—the highest since 2012-2014.
There were 258 sexual offences reported in 2025, including 69 rapes and 67 sexual assaults—up 9% from 2024. This represents 11.65% of all reported crimes, equating to 3.88 sexual offences per 1,000 population. England's rate was 3.1 per 1,000 in 2024-2025, Surrey's 2.1 per 1,000.
In 2025, 20 cases of child sexual exploitation, 96 cases of sexual abuse, and 72 cases of sexually harmful behaviour were referred to the Multi-Agency Support Hub. While the increase may reflect heightened awareness, better reporting, and better coordination through the sexual assault referral centre, it remains a concerning trend.
Key challenges for Willow House include raising wider public and professional awareness of the SARC service and the need for a dedicated database or digital system for recording client attendance and case information.
Deputy George Oswald, President of Health & Social Care Committee, said: "Sexual health and wellbeing are fundamental aspects of general health. The benefits of good sexual and reproductive health are far-reaching and all-encompassing and include the important elements of good physical, emotional, mental and social health and wellbeing relating to sexuality; sexual justice; sexual pleasure; and self confidence in creating healthy sexual relationships throughout the life course."
Antenatal screening results for 2025 showed 99.8% of women booked through maternity services offered and accepted testing for HIV, syphilis, and Hepatitis B. Routine chlamydia testing is performed by midwives, with all positive results referred to the Orchard Centre for treatment and partner notification.
More than 30 venues signed up for the Safe Place project in 2025. Police made 115 arrests for sexual offences and brought 72 charges or summons. Operation Soteria training was delivered by UK experts and Open University academics, with a new action plan for rape and serious sexual offence investigations. Intelligence-led deployments in the nighttime economy aimed to deter predatory behaviour.
Free condoms are distributed via the Orchard Centre to Choices, school nursing service, health visitors, SHARE, primary care in Guernsey and Alderney, the emergency department, Loveridge Ward, prison healthcare, outreach services, and local festivals and events.
Sexual health screening is offered to all new prison admissions, with the majority accepting. Hepatitis A and B vaccinations resumed for IV drug users after staff shortage resolution. A health fair was organised in 2023 with Choices and Orchard Centre attendance.
Public health services will map the cervical cancer elimination pathway in 2026. Efforts to recruit a Band 8 nurse with outreach responsibilities continue as the service seeks to fill the critical staffing gap.
Dr Jenny Rivers-Moore, associate specialist in public health and sexual and reproductive health strategic lead, said: "Good sexual and reproductive health is an important part of overall health and wellbeing. This report demonstrates the breadth of work taking place across the Bailiwick to support people throughout their lives, from education and prevention through to specialist healthcare services and safeguarding."
"The report provides an important baseline against which we can measure future progress and continue to ensure that services meet the needs of our community."
Laura Brouard, service lead for the Orchard Centre, said: "2025 was a significant year for the Orchard Centre. We have made important changes to strengthen and future-proof the service while continuing to provide confidential, accessible and high-quality care."
"As demand for services continues to grow, we remain committed to ensuring islanders can access the support they need. We are incredibly grateful for the positive feedback we receive from service users and for the strong partnerships that help us deliver the best possible care."
Fiona Hardy, service lead for Choices, said: "We are proud to contribute to the delivery of the Sexual and Reproductive Health Strategy and to work alongside our partners to improve outcomes for islanders. At Choices, we are committed to providing accessible, confidential and person centred sexual and reproductive healthcare, ensuring people have the information, support and services they need to make informed decisions."
"This first annual report highlights the value of partnership working and the positive impact that high-quality education, prevention and clinical services can have across the community."
The full annual report and the Guernsey and Alderney Sexual and Reproductive Health Strategy can be found at gov.gg/Sexual-and-Reproductive-Health-Strategy.
Q&A
Q: What were the key achievements in STI reduction in 2025?
A: Syphilis diagnostic rates dropped from 12 to 3 per 100,000 population—the lowest since 2019. Gonorrhoea diagnostic rates decreased from 30.1 to 7.5 per 100,000, also the lowest since 2019 and consistently below rates for England and Surrey.
Q: What is the main staffing challenge identified in the report?
A: The sexual health outreach nurse post remains vacant despite multiple advertisements including off-island. This position, which requires specialised expertise in sexual health, contraception, and outreach, was only filled for two years from January 2023-2025 and represents the strategy's only red performance indicator.
Q: What new domestic abuse legislation came into force in 2025?
A: The Domestic Abuse and Related Provisions (Bailiwick of Guernsey) Law, 2024, came into force in June 2025 after unanimous approval in October 2024. It introduced threatening to disclose private sexual images as an offence, recognised coercive control as criminal behaviour, and expanded child cruelty offences.
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