Amjad, diagnosed with autism, finds boundaries a challenge. This is especially the case around what is and isn't appropriate towards women. He has experienced sexual thoughts and feelings towards his female job coaches. With only limited knowledge of sexual health, this has been confusing and stressful for him.

"People with learning disabilities can be vulnerable to others trying to exploit them, especially as they're often conditioned to say 'yes' to people."

"The boundaries were complicated because nothing was set in stone in my perspective," he explains. "I felt frustrated because I didn't feel like accepting the rules."

The internet has provided unlimited access to relationships and sexual knowledge for young people. This includes those with learning disabilities like Amjad (not his real name) who would have been denied these possibilities in the past. However, the downside to all this information is they can end up at risk of abuse or misinformed.

Only a handful of programmes exist in the UK that address both learning disabilities and sexual health together.

Support and Advice on Sexual Health (SASH) runs one such project for people living in three London boroughs: the City of Westminster, the London Borough of Hammersmith & Fulham, and the Royal Borough of Kensington and Chelsea. SASH is managed by social care organisation Turning Point in partnership with sexual health charities and support services including NAZLondon FriendMETRO Charity, and Marie Stopes UK.

Psychologists, nurses and teachers are among those who can refer people, or they can self-refer to the service which is currently available in London.

Staff at SASH focus on several key areas including consent, and whether an individual has the capacity to make informed choices.

The programme provides advice and education for young people aged 15 and above on issues such as boundaries around intimate relationships.

It also deals with condom use and sexually transmitted infections (STIs).

Some people with learning disabilities have no concept of time so struggle with dates such as when their period is due. So the support team will therefore assess if they understand contraception, including the risk of pregnancy.

'Public and private'

Dolls are among props used by the team to help people express their knowledge and beliefs around intimacy, and help staff educate them about what is or isn't appropriate.

Stickers are given to them which they place on the doll's body to indicate which areas they regard as 'public' and 'private.' The breast for example would get a red sticker and the shoulder a green one. The team also uses images to improve understanding of different types of relationships such as same-sex, family, and romantic. 

Khushboo Gosai says young people often only see the 'glamorous side' of relationships and people with learning disabilities can be particularly vulnerable.

The well-being coach and care co-ordinator for SASH says: "Technology has increased access to relationships and to dialogue about sex, including for people with learning disabilities.

"But often they're only seeing the glamorous side. They're also vulnerable to others trying to exploit them, especially as they're often conditioned to say 'yes' to people.

"They can also end up confused. Sex should be enjoyable and people should be able to communicate their boundaries. That's why advice, support and education is vitally important."

For Amjad, the support he has gained knowledge that he hopes he can apply in everyday life so become 'less stressed and anxious'. He has been working since June with Lukasz, a SASH learning disabilities health and well-being coach who Amjad describes as 'fun' and someone he feels 'very open and comfortable with'.

"My autism affects my social skills with friends, family, teachers, job coaches and colleagues at work," adds Amjad.

"But Lukasz’s words of wisdom gave me a lot of support, empowerment, advice and we took things step by step. If a person with learning disabilities has relationship problems SASH would be the right place for them to learn."

His favourite experience was the ‘circle of friends’ exercise where participants draw a diagram of the people they know and the type of relationships they have with them. Good and bad touching, how he talks to colleagues and his boss, and how close he is with friends and family were all part of the learning process for Amjad.

Sex and relationships has been a subject that has been taboo for so long with people diagnosed with disabilities. With this pioneering support, Amjad and others like him can hopefully enjoy richer and more fulfilling lives. And understand why it's ok to say 'no'.