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 below. 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-to-skin 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 behaviour (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 tell us what you think about these opposing points of view. And you may like to share your thoughts on how this topic might be handled in school or in the family. If at all
I think that the profit side of the equation never should go out of sight. We are speaking here at the level of a hundreds of millions of dollars worth industry. Abstinence has fewer defenders than “safe-sex” partly because the poor monetary immediate return it sports…
On the other hand, there is a curious epistemological dimension in all this, for it seems clear to me that expensive, high-tech lab testing will never mirror real-life intercourse between people that, when having sex, are willingly attempting to escape the cold rationality of the lab, so as to “get crazy” and “have fun.” If my line of thought is correct, one should say that it is not only condoms that are letting the world down but too self-confident scientific knowledge as well.
Those who emphasize the use of condoms in the prevention of AIDS tend to ignore the inevitability of the frequent failure of those who would claim they practice “safe sex” to always use condoms, and the risk of the passage of other STDs which condoms do not protect against. Equally those who advocate abstinence, or fewer sexual partners and the avoidance of sex workers, must accept that human frailty will never permit us to reach that happy nirvana where sex is practised only in marriage.
It would seem, then, that education remains the key to changing behaviour and solving the problems that encourage it in the beginning. As Stephen Genius rightly proposes, early sexual activity is often the result of other external factors rather than teenage Romeos and Juliets embarking on their first relationships.
It is self-evident that the government’s approach of value-free sexual instruction is not the right answer – indeed it may provoke children into earlier experimentation, particularly in a society with an uncritical view of promiscuity and a relativist revulsion against making moral judgments. As long as the government is determined to consider all kinds of relationships equally morally valid teachers will find it difficult to transmit any moral vision to their charges.
Sex and relationship education does not need to be the exclusive province of schools. While parents may be more willing to discuss such matters with their children today than in the past, there is still insufficient interaction between curious children and embarassed parents who, perhaps, postpone too long any kind of discussions on these important issues.
Instead, perhaps, the approach should be to include parents in the relationship classes along with their children. These classes, however, while compulsory need not be taught by a school teacher. Instead, parents should be able to choose whether the course they attend with their children – perhaps once a month – should be given by a teacher or by a qualified minister of religion (priest, minister, rabbi or imman). The latter would be required to take an instructional course but would not be expected to dish out a politically correct line that conforms to the moral relativism advocated by so many polticians. Parents then could choose the non-judgemental government route, or for this delicate subject to be addressed by someone with whose moral vision they are completely comfortable. Those parents who find the subject a difficult one to address with their children will likely find the door opened to a much more productive and positive relationship in the future.
The twinned articles in the BMJ referred to by Quentin are competent reviews of published evidence concerning the value of condoms in preventing non-HIV sexually transmitted infections. They were presumably commissioned to inform debate following the ill-advised Lancet editorial commenting on the Pope’s remarks on HIV prevention in sub-Saharan countries.
They both agree that condoms afford significant protection – in particular against transmission of HIV/AIDS infection despite the fact that this is outside their official remit.
The position is more complicated in the case of other STDs in which the infection may be more widespread, but condoms are still of use. It is of interest to note that condoms specifically adapted for prophylaxis and female prophylactic condoms, a development of the occlusive pessary, are not mentioned.
The arguments in the first paper may be summarised by the paragraph:-
“Other than abstinence, which is difficult to achieve, condoms are the most effective means of stopping the spread of sexually transmitted infections.”
Similarly the arguments in the second paper may be summarised by the paragraph:-
“The main problem with condoms is that average people, particularly aroused youth, do not use them consistently, regardless of knowledge or education.”
Steiner and Gates (the authors of the first paper) basically agree with the latter point (in the rebuttal by Stephen Genius) but do not consider it to be of overriding importance.
With regard to the question of the education of children, surely it does not need a degree in Child Psychology to appreciate the fact that the more we interest children in the idea of having sex, the more likely they are to try it for themselves, especially if opportunities readily arise and seem to be tacitly approved.
Just a couple of thoughts which may be of interest.
I was Deputy Head of a Catholic secondary school when the AIDS crisis broke in the mid-1980s. At a borough-wide meeting of Deputy Heads (Catholic and non-Catholic) we had a talk on AIDS from a school nurse.
I asked the question as to how “safe was safe”? I pointed out that condoms have a failure rate as contraceptives (6 – 15% depending on usage?) and this when a woman is fertile for only 24 hours or so each cycle, whereas a person with HIV or another STD has it all the time. It follows that the failure rate of condoms as protection against STDs should be higher than when used as a contraceptive. The school nurse accepted this logic and ventured a “conservative failure rate” of about 20%.
Another Deputy Head – a female deputy from an all-girls school – told us of one of her pupils who asked the question:”What do you do when you want to have a baby?” The obvious answer is to stop using a condom – but then you run the risk, according to the Government-led argument, of contracting HIV.
The lesson is that unless you confine yourself to a partner you can trust – who is disease-free and trustworthy – you could never have babies!
I also remembering writing at the time in protest to the Department of Health about the “safe sex” campaign – along the lines that condoms can fail. I received a reply saying that what I said may be correct but it all depends on how condoms are used – and they gave the example of prostitutes in Western Australia who, apparently, have it down to a fine art – with little failure. What wonderful role models to present to our children!
I like Stair Sainty’s idea of parents being able to choose the provider of sex/relationships instruction for their children, and attend the classes along with them.
One thing that puzzles me is the link (or lack of same) between the legal situation (illegal to have sex with a minor, since minors are considered to be below the age of consent) and the push to make contraception and contraceptive advice freely available to minors. Why isn’t the latter seen as encouragement to break the law? Indeed, is that law currently implemented at all?