HEALTH: by Dr Nicholas Tonti-Filippini, PhDNews Weekly
How 'safe sex' misinformation puts young lives at risk
, May 3, 2003
A GP was confronted by a very angry young man recently. He had sought advice about a groin rash and had been diagnosed with genital herpes. Genital herpes is a virus: the symptoms can be treated but the condition cannot be cured and often recurs. The person remains possibly infectious and must warn sex partners of the risk, including all future sex partners. The latter is profoundly disturbing for a 21-year-old seeking companionship and a relationship.
This young man's anger was over the fact that he had never had sex without a condom. He was a victim of a great lie, the "safe sex" lie told by sex educators and reinforced by medical experts in the belief that multiple sexual relationships are inevitable for today's generation.Message
The "harm minimising" message denies young people the option of abstinence until they are ready to commit to a lasting, exclusive relationship. It denies them knowledge of the truth that might protect them.
Few young people are being told that condoms are not fail-safe. A recent Cochrane review of the medical literature concluded that condoms reduce the heterosexual transmission of HIV by 80% but that still leaves significant risk. More to the point, HIV is comparatively not very infectious.
Sexually transmissible viral infections like genital herpes and the human papilloma virus that causes genital warts (and is associated with cervical cancer in women) are spread not only by bodily fluids (as with HIV) but are shed from the whole genital region. Condoms are estimated to only reduce their rate of transmission by around 50%.The Age
editorial (April 10) reports a recent survey that 20.2 per cent of men and 16.9 per cent of women in Australia had been diagnosed with a sexually transmissible infection. What was not mentioned is that most of these infections are in people between the ages of 15 and 39 and that the rate of infection for genital herpes and the genital warts virus is increasing at an extraordinary rate with estimates (they are not notifiable diseases) of prevalence being about 8% of the Australian population for each.
The rate of increase of the sexually transmitted bacterial infection, Chlamydia, in young people is astounding. Chlamydia is the most common notifiable disease.
The Australian Institute for Health and Welfare reports that 92% of reported cases of Chlamydia were in the 15-39 year age range and that, between 1998 and 1999, the number of reported cases increased by 22.6% and continued to increase at a similar rate in 2000 and 2001.
Chlamydia is the major cause of tubal infertility in Australia. In women, Chlamydia is virtually symptomless until after the internal harm to their reproductive organs has been done.
The incidence of Gonorrhoea, Hepatitis B and Hepatitis C shows the same type of age disparity in the community. Wise advice might be not to have sex with anyone under 40, particularly those between 15 and 29 whose rate of sexually transmitted infection is twice that of the 30-39 age group!
What is disturbing is that the emphasis on "safe sex" does nothing to halt the increasing proportion of young people who are becoming sexually active. The Australian Research Centre in Sex, Health and Society (La Trobe University) estimated from 1997 data that by the age of 19, more than two-thirds of both males and females had initiated sex.
Much has been made of the fact that AIDS has been significantly controlled in Australia. Often it is claimed that that is due to the "safe sex" message. From an early, very high peak in 1985 (when sensitive tests for HIV were first developed and there was a backlog of previously undiagnosed HIV) the number of HIV diagnosed then began to drop.
However, between 1993 and 2001 the number of cases of newly-acquired HIV remained constant. The major factor in controlling the incidence of AIDS was not control of the spread of infection - for the last four years there have been around 700 diagnoses of HIV each year in Australia. Rather the major factor in the control of AIDS would seem to have been the use of drugs to prevent or delay HIV resulting in AIDS.
In 1994 there were as many diagnoses of AIDS as there were diagnoses of HIV. In 2001, HIV diagnoses outnumbered AIDS diagnoses three to one. HIV is now much more treatable, though at considerable public cost for the chemotherapies.
There are also significant side-effects for those who are treated for HIV. By the end of 2001 there had been 8,810 AIDS cases and 6,174 deaths in Australia and 18,854 people had been diagnosed with HIV. In 2001, there were 12,730 people living with HIV.
In 2000, the US Congress voted $50 million to programs aimed at delaying sexual initiation. Much research has been directed toward assessing the effectiveness of such programs.
The picture emerging is that neither abstinence only messages nor "value free" information programs work. What does appear to work are programs that combine abstinence-oriented values about self, friendship, respect for the body and the significance of sexual relationships with the biological information.
This approach is vastly different from the contemporarily dominant approach of sex educators who presume a recreational attitude to sex and seek only to harm minimise by advocating measures to reduce harm.
The data now tell us that we have an increasing problem and that such measures are not working to reduce harm from infection and the emotional harm from sexual relationships in people who are too immature to be able to handle the power of a sexual relationship.The Age
editorial emphasised that parents are the best educators in this area. It is odd to see an Age
editorial supporting the Catholic Archbishop of Melbourne who recently issued a directive to Catholic schools insisting that they had a critical role in supporting parents to educate their children in this area. Archbishop Denis Hart asked them to use their teaching skills and resources to help parents in a partnership in which the parent is the primary educator.
It is worth noting that there are socio-demographic factors that appear to delay sexual initiation including: less than one in five early sexual initiates come from two parent households, higher socio-economic background, better school performance, greater participative religiosity, absence of suicidal thoughts, feeling that adults care, and parents with high expectations. Parents and support for parents obviously have a crucial role in delaying sexual initiation.
What we need most is for government policy and education policy-makers to recognise the harm being done by inadequate sex education and the failure to address a major issue - parenting. The "safe sex" message is a myth and a lie undermining the development of effective educational policy.
Recognise that, and we can, by supporting parents and devising programs that combine abstinence-oriented values and evidence-based information, try to turn around the health and relationship devastation being visited upon young people.
- Dr Nicholas Tonti-Filippini PhD, Consultant Ethicist