Despite high sexual health service engagement, one-in-eight men and gender-diverse individuals having sex with men in England reported unmet need for in-person sexual health services, with disparities by geography, financial status, and health condition.
A substantial proportion of participants had accessed in-person sexual health services, both historically and in the past year.
12% of those who tried to access in-person care in the past year experienced unmet need.
Unmet need was substantially higher outside London compared to within London.
The most common barriers to accessing in-person SHS were appointment unavailability and inconvenient appointment times.
Financial comfort was associated with lower odds of unmet need for in-person SHS.
Participants with markers of higher sexual risk were substantially less likely to report unmet need.
Having a limiting long-term physical health condition was associated with higher odds of unmet need.
Prior use of online postal self-sampling (OPSS) services for STI testing was associated with higher odds of unmet need for in-person SHS.
Sexual health service delivery in England shifted substantially during the COVID-19 pandemic, with rapid expansion of online services, prompting concern about unmet in-person need.
The authors recommend local service delivery guided by joint strategic needs assessments to address unmet need.
This research suggests that while most gay, bisexual, and gender-diverse men in England regularly use sexual health services, a meaningful gap exists in accessing in-person care. Using an online survey of over 2,400 people conducted in late 2024, researchers found that one in eight individuals who tried to get an in-person sexual health appointment in the past year were unable to do so. The most common reasons were that appointments simply weren't available or were offered at inconvenient times. People living outside London were nearly twice as likely to face this unmet need compared to those in London, highlighting a significant geographic inequality in service access. The study also found that people with long-term physical health conditions and those who had previously used online postal STI testing kits were more likely to have unmet in-person needs, suggesting these groups may face particular barriers to clinic-based care. Interestingly, people with higher sexual risk profiles — such as those using HIV-prevention medication (PrEP) or who had a recent STI diagnosis — were far less likely to report unmet need, possibly because they are more actively engaged with and prioritized by specialist services. Financial comfort was also linked to lower unmet need, pointing to socioeconomic inequalities in healthcare access. This research suggests that the rapid shift toward online and postal sexual health services during the COVID-19 pandemic, while expanding reach in some ways, has not fully replaced the need for in-person care — particularly outside major cities and for people with health conditions. The findings point to the importance of local planning and needs assessments to ensure that clinic-based services are available and accessible to those who need them most.
Ogaz D, Mullen D, Baldry G, Jayes D, Phillips D, Lowndes C, et al.. (2026). The waiting room: Unmet sexual health service needs among men and gender-diverse individuals having sex with men in England, findings from an online, cross-sectional community survey in 2024.. International journal of STD & AIDS. https://doi.org/10.1177/09564624251413004