If you work in sexual health, you’ve probably heard the comments about Sexual Health Advisers…
Some are curious, some are confused, and some are… well, a little off the mark!
For example:
- “Aren’t Sexual Health Advisers kind of an endangered species?”
- “Don’t they make people cry?”
- “Or stop people crying?”
- “They’re the ones who tell partners they’ve got an STI, right?”
- “They sort out the upset/drunk/angry people so we can get on with the job.”
Underneath the humour and the misunderstandings is a simple truth: a lot of people — even inside Sexual Health Services — don’t fully understand what SHAs actually do.
And honestly? It’s not surprising. The role has changed hugely over the last few decades, and it continues to expand. Measuring its effectiveness is tough, partly because the work is so varied and so often invisible. Yet SHAs continue to be a core part of modern sexual health services, bringing something unique, human, and deeply supportive to patient care.
A Quick Look Back: How Things Used to Be
Once upon a time, SHAs had a much narrower job description:
- Mostly contact tracing
- HIV pre‑ and post‑test counselling
- Notes written in green pen (the classic SHA trademark!)
- HIV social workers handling emotional and social issues
- Very little routine safeguarding work
- No PEP
- No PrEP
- Limited HIV treatment options
Simple? Yes. Limited? Definitely.
And Now? The Role Has Exploded in Scope
Today’s Sexual Health Adviser is part counsellor, part educator, part public health practitioner, part safeguarding lead, part crisis‑manager, part motivator — and sometimes the calm, grounding presence a distressed patient desperately needs.
Here’s just a taste of the modern SHA toolkit:
- Partner Notification (for a huge range of STIs, not just HIV)
- Health promotion and risk‑reduction work
- Providing STI diagnoses sensitively and clearly
- Dispensing antibiotics under SOP to streamline care
- Supporting people with new HIV diagnoses
- Assessment and provision of PEP and PrEP
- Addressing drug and alcohol issues
- Support for sexual assault survivors
- Helping patients manage mental health difficulties
- Working with people with learning disabilities
- Child and adult safeguarding
- Domestic and intimate partner violence support
- Psychosexual concerns
- Specialist work with young people
- Managing health anxieties
- Education and training for colleagues and partners
- Referrals, follow‑up, case management
- Non–face‑to‑face work: calling people back, chasing results, supporting them remotely
The list goes on — because the work goes on. Every patient is different, every situation is different, and SHAs adapt constantly.
So, How Do We Show the Value of SHA Work?
In today’s NHS, everyone is being asked to demonstrate value — and SHAs are no exception. But measuring something so human and nuanced can be tricky.
Some possibilities include:
- Patient feedback (though timing matters — a distressed patient isn’t always ready for a survey)
- Local audits
- Involvement with SSHA, BASHH, and national standards
- Better coding so SHA complexity isn’t lost in GUMCAD data
- Using productivity tools to show good practice or highlight gaps
It’s not perfect — but it’s a start.
Meeting Demand: What Needs to Change?
Sexual health services everywhere are under pressure. So how do we keep up?
- More SHAs (always helpful!)
- Using existing SHAs more strategically
- Investing in specialist training, such as:
- Motivational interviewing
- Drugs and alcohol
- Safeguarding children and vulnerable adults
- Domestic violence
- Sexual assault
- Complex partner notification
The more skilled and confident the team, the better the care.
Why SHA Work Needs to Be Seen
One of the biggest challenges is that SHA work is mostly invisible:
- It doesn’t come with a tariff
- It is often behind closed doors
- MDT colleagues sometimes underestimate how complex the cases are
Managers may assume the work can be done by “anyone”
But the truth is this:
Most clinicians absolutely do not want to (and should not have to) manage the intense psychological, emotional, safeguarding, or trauma‑related issues SHAs handle every single day.
Having SHAs in the MDT frees doctors and nurses to do what they do best — whilst knowing their patients are supported professionally, holistically and safely.
Doing More With Less: Improving Quality Without Breaking the Bank
How can services strengthen SHA work while staying financially realistic? Some possibilities could be:
- Build on individual team strengths and interests
- Create SOPs that streamline care (e.g., SHAs issuing antibiotics, PEP, PrEP)
- Continue audit and research
- Make the most of in‑house/local training
- Recognise the complexity of SHA cases — don’t underestimate them
And let’s not forget:
Over the last 60 years, the SHA role has transformed beyond recognition. And during COVID, SHAs stepped far outside their usual remit:
- Helping with staff testing
- Supporting infected staff
- Running contact tracing in prisons and other challenging settings
- Working on COVID wards helping patients communicate with family
- Training local Public Health teams
If anyone still thinks SHAs “just do contact tracing” the pandemic proved otherwise.
In the End, It’s All About Symbiosis
Sexual Health Advisers and the wider MDT rely on each other. Each brings skills the other doesn’t. Together, they create something stronger, safer, and more supportive for patients.
Because sexual health isn’t only about treating infections.
It’s about people.
Their lives, their health, their worries, their safety, their relationships, their choices.
And Sexual Health Advisers are right there in the middle of all of it — quietly but powerfully making a difference.
Use us, don’t lose us!