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Introduction
Sexually transmitted infections (STIs) are a major global health issue, with the World Health Organization estimating that one million new infections occur each day worldwide.1 Although age-standardised rates of STI incidence have decreased in most countries from 1990 to 2019, the actual number of new cases has increased.2 This highlights the ongoing challenge that STIs pose to public health, particularly in regions such as sub-Saharan Africa and Latin America. Although STIs potentially affect all people, there are significant ethnic disparities reported in some Western countries, such as the United States and the United Kingdom.3,4 STIs disproportionately affect people from minoritised ethnic groups (MEGs), with people of black heritage or mixed race being significantly more likely to be diagnosed with STIs such as chlamydia, gonorrhoea, and syphilis compared to their white counterparts.5 Addressing the disparities in STI prevalence and advancing sexual health equity requires an understanding of the complex relationships between ethnic groups, disease prevalence, and social structures.
Poorer STI outcomes for ethnic minorities are commonly caused by systemic issues such as limited access to quality health care, social stigma, and economic inequalities rather than differences in behaviour.6 Unfortunately, cultural stereotypes and biases in health care, including assumptions about sexual promiscuity and racism, can discourage MEGs from seeking care. Moreover, economic disparities, unemployment, insecure work and migration status may further exacerbate these issues, making it difficult for people to access sexual health services.7 Additionally, these disparities are not only health-related but are also evident in research and policy.
People from MEGs are notably under-represented in sexual health research. For instance, in the IMPACT trial, which explored the feasibility of HIV pre-exposure prophylaxis (PrEP), only 1.5% of participants identified as black African.8 Therefore, addressing the epidemiology of STIs requires an understanding of the complex interplay of social determinants of health, such as socio-economic deprivation, and social stigma, as well as access and utilisation of quality sexual health services, especially in the era of digitalisation and automation.9,10
Digital sexual health services are becoming increasingly important in addressing ethnic disparities in STIs. These services offer remote consultations, online testing kits, and digital resources for education and support, which can overcome barriers to access, such as location and stigma associated with...