Quentin de la Bédoyère Science and Faith
Much time and media space has been devoted to the Pope’s remarks on HIV prevention in sub-Saharan countries. I wrote about the factual background in my column of March 27.
But the topic is coming closer to home, as proposals for advertising condoms on television are in the news. It has indeed been smouldering away in discussions about the sexual education of children in schools for some time.
I bear in mind that those who are preparing educational programmes, perhaps for the summer term, need a substratum of impartial fact. And those of us who can influence opinion in other forums need this too.
So I have looked at twinned articles in the British Medical Journal from the issue of January 2008. They take opposing points of view and I will leave you to draw your own conclusions. You will find a link to the full articles at www.secondsightblog.com. And your library may have a copy.
The first article, by Markus Steiner and Willard Cates, argues that condoms are the answer to rising rates of non-HIV sexually transmitted diseases (STDs). It points out that good laboratory studies have shown that condoms offer a very high level of protection against a whole range of such infections. And that, where these studies have not been able to provide full empirical evidence, this has been owing to the technical difficulties of designing experiments.
Having read the major study in this area, I would certainly confirm that this conclusion is correct. The article goes on to say that the incidence of infections caused by skin contact alone is also reduced.
It quotes studies showing that condom promotion does promote sexual activity, but also quotes a meta analysis (an overall assessment of a number of studies) which concludes that such promotions do not increase unsafe sexual behaviour.
It concludes that condoms should be promoted within the context of other risk-prevention strategies but that condom use should have a “pivotal role” in this. Those who choose to be sexually active should be reassured that condoms reduce the risk of most infections provided that they are correctly and consistently used.
In the twin BMJ article Stephen Genuis takes a different view. The first point he makes is that skin-toskin contact, outside the specific area protected by the condom, allows infection by a whole range of STDs, including the most common pathogens. His description is a trifle graphic for this newspaper, but the article itself gives full details.
He tells us that average people, particularly aroused young people, do not use condoms consistently – whether they have the appropriate knowledge or not. In one study only 19 per cent of students used condoms consistently and nearly half never did. Only eight per cent of those with herpes use condoms, despite ongoing counselling, and just less than half of stable adult couples, one of whom is infected with HIV, do not consistently use condoms – again, notwithstanding counselling.
He points out that the unprecedented increase in education and promotion of condoms has been accompanied by a “relentless” rise in STDs – even in First World countries with advanced sexual relationship programmes. And he quotes Einstein: “The definition of insanity is doing the same thing over and over again and expecting different results.” He writes about the reduction in STDs in Thailand and Cambodia, where condom use is the major thrust of strategy. But he tells us that careful analysis of the data suggests that the beneficial changes in sexual behav iour (fewer partners, less casual sex, less use of sex workers) have played a larger part than widespread condom use.
Quoting the World Health Organisation’s worldwide estimates that two thirds of STDs occur in teenagers and young adults, he speaks of extensive studies which show that risky sexual activity is “often the expression of non-sexual need and associated with fundamental problems and difficulties”. To promote the use of condoms as the answer is to fail to tackle the real problems. He concludes by exhorting us to abandon ideological positions and to develop our remedial strategies according to the actual evidence.
An interesting study from America, published in the April Issue of the Journal of School Health, tells us that some 12 per cent of children have indulged in sexual intercourse by the age of 12. It comments: “These findings are alarming because youth who start having sex before age 14 are much more likely to have multiple lifetime sexual partners, use alcohol or drugs before sex and have unprotected sex, all of which puts them at greater risk for getting a sexually transmitted disease (STD) or becoming pregnant.” And Centers for Disease Control and Prevention reports that 80 per cent of the births to mothers aged 15 to 19 were the result of unintended pregnancies. We cannot directly transfer American experience to Britain, but I would be surprised if our statistics differed greatly.
It is not my province to tell you how to translate your own conclusions into an educational programme, because most of my experience has been with adult education.
But I recall, from some years back, asking engaged couples how they had received their first sexual education. About one in 10 had done so from their parents, and the largest single source reported by the others was from the playground. If that situation still pertains then it is folly to rely on the ideal of good parental education. The emphasis has to fall on the schools. The schools had better get it right although they start with the odds stacked against them.
So visit www.secondsightblog.com to look up references if you wish, but of course to make your own comments.