tag:theconversation.com,2011:/africa/topics/sti-5741/articlesSTI – The Conversation2016-06-02T20:23:31Ztag:theconversation.com,2011:article/600362016-06-02T20:23:31Z2016-06-02T20:23:31ZGood sex ed doesn’t lead to teen pregnancy, it prevents it<figure><img src="https://images.theconversation.com/files/124918/original/image-20160602-1943-a4xao3.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sex ed should be inclusive, empowering, and facilitate ethical sexual relationships.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/white_ribbons/4915419800/">lauren rushing/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em>CHANGING FAMILIES: In this <a href="https://theconversation.com/au/topics/changing-families">ten-part series</a>, we examine some major changes in family and relationships, and how that might in turn reshape law, policy and our idea of ourselves.</em></p>
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<p>Comprehensive, inclusive sexuality and relationships education (“sex ed”) teaches children and adolescents in age-appropriate ways that sexuality is a normal, healthy part of life. </p>
<p>Good sex ed covers diverse topics such as human development, relationships and interpersonal skills, sexual expression, sexual health, society and culture, as well as how to prevent unintended pregnancy, sexually transmitted infections (STIs) and HIV.</p>
<p>According to the United Nations, all young people have the right to information about sexuality. Without it, they’re <a href="http://www.unfpa.org/comprehensive-sexuality-education">vulnerable to coercion</a>, unintended pregnancy and STI transmission. </p>
<p>The <a href="http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/">World Health Organisation</a> agrees, arguing we all have a right to “a positive and respectful approach to sexual relationships [and] the possibility of having pleasurable and safe sexual experiences”.</p>
<p>Opponents of school-based sex ed argue that educating young people about sex and relationships can lead to promiscuity, teenage pregnancy, increased rates of STIs and can even influence sexual and gender orientation. But this isn’t supported by the research. </p>
<h2>Comparing sex ed programs</h2>
<p>Opposition to sex ed in schools has resulted in an approach in some states in the United States known as “abstinence-only”. Young people aren’t taught about prevention, they’re urged to pledge to delay any sexual contact until they are married.</p>
<p>To understand the effectiveness of different approaches to sex ed, a <a href="http://www.unsworks.unsw.edu.au/primo_library/libweb/action/dlDisplay.do?vid=UNSWORKS&docId=unsworks_7480&fromSitemap=1&afterPDS=true">2005 study compared sexual health outcomes</a> for young people in Australia and the Netherlands, where comprehensive sexuality education is taught, and the United States, where abstinence-only education was taught in some states. Researchers tracked rates of HIV and STI transmission, and unintended pregnancies. </p>
<p>The average age of first intercourse was similar in the Netherlands (17.7 years) and Australia (16 years). </p>
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<img alt="" src="https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124922/original/image-20160602-14821-k740m3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sexuality is a normal, healthy part of life.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/linahayes/4509274762/">Lina Hayes/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<p>But sexual health outcomes where abstinence-only programs were taught fell well behind. Teens in the US had an earlier age of first sexual intercourse (15.8), higher rates of pregnancy terminations and higher rates of teen births compared with the other countries in the study. Around 30.4 out of every 1,000 women aged 15 to 17 in the US will give birth.</p>
<p>The Netherlands stands out as having one of the lowest rates of teen pregnancy in the world (2.2 births per 1,000 women aged 15 to 17). </p>
<p>The Netherlands provides high-quality sexuality education for both primary and secondary school students. But rather than imposing a specific curriculum, Dutch schools incorporate sex ed into existing subject areas. Schools are <a href="http://www.unsworks.unsw.edu.au/primo_library/libweb/action/dlDisplay.do?vid=UNSWORKS&docId=unsworks_7480&fromSitemap=1&afterPDS=true">expected to include</a> discussions about pregnancy, STIs, sexual orientation and homophobia, values, respect for difference and skills for healthy relationships in their curriculum. </p>
<p>In Australia, age-appropriate, comprehensive sexuality education is included in the National <a href="http://www.australiancurriculum.edu.au/">Health and Physical Education Curriculum</a> for children and young people from the first year of school to year 10. </p>
<p>But despite the national curriculum, there is a lack of consistency in the delivery of programs across Australia. The decision about how to approach sex ed and how to engage parents is generally left to individual school principals.</p>
<p>The Dutch approach to sex ed – which embeds the content across curriculum areas – is considered best practice internationally and should be adopted in Australia. Rather than relegating sex ed to health and physical education, content should also be incorporated into topics such as English, science and pastoral care. </p>
<p>Adopting a “whole school” approach to sex ed is not easy, and would require additional training and support to transition to this model, but schools that have done it have achieved great results. </p>
<h2>Parents or teachers?</h2>
<p>Some of those who oppose school-based sex ed argue it is the responsibility of parents to educate their children about sex. They’re right. </p>
<p>A child’s first exposure to knowledge about sex, sexuality and relationships comes from their own family, whether it is approached openly or not. Children quickly learn that some subjects are acceptable to talk about and others are not. Silence about sex within families, however, does not mean children are unaware of the issue. </p>
<p>In the absence of age-appropriate, accurate information, even very young children <a href="http://www.academia.edu/352680/Hatching_babies_and_stork_deliveries_Risk_and_regulation_in_the_construction_of_children_s_sexual_knowledge">make up stories to fill the void</a>. For some, sex becomes associated with fear and embarrassment. In adolescence, these children may be exposed to the very risks that opponents of sex ed believe it causes.</p>
<p>In <a href="http://www.tandfonline.com/doi/abs/10.1080/14681811.2011.609053#.V0-gH5N95Bw">my research</a>, many parents report that their own first learning about sex was surrounded by shame and embarrassment. As a result, many feel ill prepared to talk about sex with their own children. </p>
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<img alt="" src="https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124923/original/image-20160602-1925-1l97qh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sex ed should be the shared responsibility of parents and carers as well as the education system.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ktpupp/679287719/">Kate Sumbler/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p><a href="http://www.tandfonline.com/doi/abs/10.1080/14681811.2011.609053#.V0-gH5N95Bw">Most parents want</a> their children to grow up to be sexually healthy adults and do not want their children to share their own feelings of discomfort when it comes to sex. They also want schools to provide comprehensive sex ed, with the proviso that they want know what will be taught, when and by whom so they can complement the factual information their children learn with their own family values. </p>
<p>This has implications for how schools communicate with parents about sex ed. <a href="http://www.youthsexuality.com.au/files/9814/5801/5069/It_is_not_all_about_sex_Research_Report_16.3.16.pdf">Keeping parents informed</a> about the curriculum can support high quality parent-child communication about sexuality that, according to many young people, has been missing.</p>
<p>Central to much of the debate about young people, sexuality and sex ed is that the focus is on sex as a problem rather than as a strength to be celebrated and approached ethically and responsibly. High-quality sex ed should support young people to learn to express their ideas, emotions, questions, values and concerns and with potential partners. </p>
<p>Sex ed should be the shared responsibility of parents and carers as well as the education system. It should be inclusive, empowering, and should facilitate ethical sexual relationships. This requires not only knowledge but also <a href="http://www.palgraveconnect.com/pc/doifinder/view/10.1057/9781137405975.0001">skills such as self-reflection</a>, negotiating relationships with others and critical thinking.</p>
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<p><strong><em>This is the final article in The Conversation’s Changing Families series. Read the other instalments <a href="https://theconversation.com/au/topics/changing-families">here</a>.</em></strong></p><img src="https://counter.theconversation.com/content/60036/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne Dyson has received funding in the past from the Victorian Government, the Australian Research Council and the Western Australian Department of Health. </span></em></p>Good sex ed doesn’t lead to early sex, teenage pregnancy and STIs. It protects against them.Suzanne Dyson, Associate professor, principal research fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/578442016-04-28T10:53:27Z2016-04-28T10:53:27ZLyme disease: a ticking time bomb<figure><img src="https://images.theconversation.com/files/119664/original/image-20160421-27001-1itukb9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ixodus ricinus tick, which spreads Lyme disease in Europe.</span> <span class="attribution"><span class="source">Richard Bartz </span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>On any ranked list of nasty diseases transmitted by mosquitoes, ticks and fleas in the Western world, <a href="http://www.cdc.gov/lyme/"><em>Borrelia burgdorferi</em></a>, would have to lie near the top. These bacteria cause Lyme disease, which was <a href="http://www.ncbi.nlm.nih.gov/pubmed/836338">first recognised</a> in the US in the early 1970s among patients in Lyme, Connecticut. However, the oldest known case was the <a href="http://www.ncbi.nlm.nih.gov/pubmed/22426219">Tyrolean Iceman</a>, a 5,300-year-old Copper-age mummified individual, discovered in the Italian Alps.</p>
<p>Lyme disease is one of the fastest growing vector-borne diseases in the Western world – the threat it poses has become increasingly apparent in recent years. Estimates suggest that more than <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879353/">300,000 people</a> are diagnosed with the disease each year in the US and more than <a href="http://www.ncbi.nlm.nih.gov/pubmed/19367096">65,000 cases</a> a year are diagnosed in Europe. However, the true number of people affected is probably underestimated due to under-reporting and the <a href="http://www.lymediseaseaction.org.uk/about-lyme/tests/">limitations of current diagnostic tests</a>.</p>
<p><em>Borrelia burgdorferi</em> is a spirochete (corkscrew-shaped bacterium) that consists of more than 20 sub-species, five of which can cause disease in humans. <em>Borrelia</em> can flourish inside the tick, where they migrate from the gut to the saliva glands. In this way, they can penetrate human skin when a tick takes a blood meal and disseminate via the blood to multiple tissues. To survive and establish infection, <em>Borrelia</em> <a href="http://www.ncbi.nlm.nih.gov/pubmed/26747708">mutates</a> in a number of ways to become invisible to the host’s immune system.</p>
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<span class="caption"><em>Borrelia burgdorferi</em>.</span>
<span class="attribution"><span class="source">Centers for Disease Control and Prevention's Public Health Image Library</span></span>
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<p>The main vector for transmitting the bacteria in Europe is the deer tick, <em>Ixodes ricinus</em>, but other <em>Ixodes</em> species act as vectors in the US and in Asia. Humans can become infected after being bitten by an infected tick. However, as <em>Ixodes</em> ticks can also transmit other pathogenic bacteria and viruses, it can be hard to diagnose Lyme disease among the potentially large number of infections that may have been contracted as a result of the tick bite, meaning it often goes untreated. </p>
<p>But it’s not just ticks we have to worry about. Lice, fleas, and mosquitoes have also been found to contain <em>Borrelia</em>. Worrying, <em>Borrelia</em> bacteria may also be transmitted <a href="http://www.medicaldaily.com/lyme-disease-contagious-clues-hint-it-may-be-sexually-transmitted-disease-267964">from person to person</a> through saliva, organ transplants, <a href="http://www.ncbi.nlm.nih.gov/pubmed/8014507">blood transfusions</a>, <a href="https://www.lymedisease.org/lyme-sexual-transmission-2/">sexual contact</a> or breast milk. It has <a href="http://www.scientificamerican.com/article/mothers-may-pass-lyme-disease-to-children-in-the-womb/">also been suggested</a> that Lyme disease could be transferred to a foetus via the placenta, however this has yet to be proven.</p>
<h2>What <em>Borrelia</em> can do to people</h2>
<p>Some individuals develop a bull’s eye-like rash, called <a href="http://www.lymediseaseaction.org.uk/about-lyme/rashes/">Erythma migrans</a> at the site of the tick bite, three to 30 days after infection. As infection spreads, <em>Borrelia</em> can also affect other skin sites, the nervous system, the joints or the heart. Brain infection is a rare but potentially serious complication, arising in 15% of untreated Lyme patients who go on to be very ill. This can also cause permanent neurological injury.</p>
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<img alt="" src="https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119665/original/image-20160421-27017-12gai7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hitting the target.</span>
<span class="attribution"><span class="source">Hannah Garrison/wikimedia</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Because of this wide range of non-specific symptoms, patients often don’t get a clear diagnosis or treatment options. When Lyme disease is suspected, laboratory tests to detect specific antibodies against <em>Borrelia burgdorferi</em> can help confirm the diagnosis – although these are <a href="http://www.lymediseaseaction.org.uk/about-lyme/tests/">far from perfect</a>. Some patients, about 10-20%, can develop a debilitating chronic condition called <a href="http://www.cdc.gov/lyme/postlds/">post-treatment lyme disease syndrome</a>, with symptoms that include arthritis, fatigue, muscle pain and minor cognitive impairments such as headaches and sleep disturbances.</p>
<p>Unfortunately, there is currently no vaccine available against Lyme disease. However, there are measures that can mitigate the risk of infection, including avoiding tick-infested areas, wearing personal protective measures to reduce the risk of tick bites and the use of <a href="http://www.ncbi.nlm.nih.gov/pubmed/11450675">antimicrobial treatments</a> following a tick bite. </p>
<p>Timely treatment for Lyme disease is crucial to prevent illness and avoid long-lasting symptoms. Early stages of Lyme disease can be effectively treated with antibiotics, but patients with the chronic variant may require months or even years of treatment before it resolves. Unfortunately, some physicians still view antibiotics as the only solution to this disease but chronically infected patients require multidisciplinary care – addressing all simultaneous infections, providing immune support and management of any other health complications.</p>
<h2>Tackling the threat</h2>
<p>The effects of the disease on so many body systems, and the debilitating impact on the life of the affected patient, have triggered a crisis that has far-reaching implications for public health and policy. When people get diagnosed with Lyme, they make a shift to a life of increasing uncertainty, particularly from a lack of adequate and credible information.</p>
<p>It’s clear, given the rise in clinical cases across the world and the number of people who continue to suffer even after antimicrobial treatment, that Lyme disease is spreading rapidly. For example, in the US the number of annual reported Lyme cases <a href="http://www.ilads.org/lyme/lyme-quickfacts.php">has increased about 25-fold</a> since the national surveillance began in 1982. </p>
<p>Many aspects of the disease mechanisms, such as the chronic condition, remain controversial or evolving, due to the scarcity of robust evidence-based data. There is not even one consistent terminology that defines “chronic Lyme disease”. More measures are also needed to resolve the crippling uncertainty surrounding the infection. We need more research to help develop reliable diagnostic tests, identify sub-populations of patients who are most likely to benefit from antibiotic treatment, and ultimately to ensure that Lyme disease does not become a pandemic reality.</p><img src="https://counter.theconversation.com/content/57844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hany Elsheikha is affiliated with The European Scientific Counsel for Companion Animal Parasites (ESCCAP) of UK & Ireland. </span></em></p>How a microbe from the ice age could wreck your life – and how to protect yourself.Hany Elsheikha, Associate Professor of Parasitology, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/473292015-09-17T10:07:02Z2015-09-17T10:07:02ZThe secret sex lives of older people that can make us rethink our idea of intimacy<figure><img src="https://images.theconversation.com/files/94995/original/image-20150916-11959-10s5xcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s not often you see people over-50 having sex on screen. It’s so rare, in fact, that the sex scenes in 45 Years, the recent film about the approaching anniversary of a retired couple, became one of the <a href="http://www.thetimes.co.uk/tto/arts/film/article4533325.ece">main talking points</a> in its coverage.</p>
<p>And yet a sizeable minority of people continue to have active sex lives into their 70s, 80s and even beyond. A recent study found that a <a href="https://theconversation.com/people-in-their-eighties-have-sex-get-over-it-36931">third of over-70s had sex at least twice a month</a>. So why do we so often shy away from talking about or portraying something so common?</p>
<p><a href="ageing.oxfordjournals.org/content/early/2015/07/14/ageing.afv083.abstract">A report</a> published earlier this year found that those with a sexual partner tended to rate their quality of life as higher than those without one, although some <a href="http://www.ncbi.nlm.nih.gov/pubmed/17378188">studies</a> have placed greater emphasis on relationship status and social engagement. When I interviewed a number of over-50s about their (heterosexual) sex lives for a <a href="http://www.sciencedirect.com/science/article/pii/S0277953602001806">qualitative study</a>, I found that many who were still in sexual relationships rated them as very or extremely important. </p>
<p>The reasons for the participants’ emphasis on sex included strengthening their relationship with their partners but also pleasure. For some women, sex had improved with age, which they related to feeling more relaxed because they had more sexual experience and no longer feared becoming pregnant. </p>
<h2>STIs in older people</h2>
<p>Understanding the importance of sex to many older people has serious health implications. In the past, sexual health campaigns in the UK have focused predominantly on young people, who are more likely to have unintended pregnancies and sexually transmitted infections (STIs). But now a growing <a href="http://www.ncbi.nlm.nih.gov/pubmed/21365382">body of evidence</a> tells us that older people in developed countries are increasingly diagnosed with STIs.</p>
<p>STIs among the over-45s <a href="http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1215589014186">increased across different diseases</a> between 2009 and 2013, from an 11% increase in genital warts in men aged 45-64, to a 500% increase in syphilis in women aged over 65. The majority of diagnoses of all STIs in the older age groups were in men, but gonorrhoea and syphilis were highest among heterosexual women and men who have sex with men. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95164/original/image-20150917-7545-8g2b10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When it comes to older people’s bedroom habits we should forget the stereotypes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>As a result, some sexual health campaigns are now being aimed at older people. This year’s <a href="http://www.fpa.org.uk/sexual-health-week/pleasure-principle">Sexual Health Week</a> in the UK is focused on sexual pleasure and well-being – and one of the campaign’s five strands is aimed at educating professionals and the public about the sexual well-being of older people.</p>
<p>Campaigns that promote sexual pleasure are new, even though the idea of incorporating pleasure into <a href="http://www.tandfonline.com/doi/abs/10.1080/14681811.2012.747433">sexual health materials</a> is not. Young people in the UK are only just seeing such messages so it’s great that the sexual pleasure of older people is now being recognised too.</p>
<p>But infectious disease is only one factor that can affect pleasure and well-being. Long-term conditions and some sexual difficulties are more likely to be diagnosed in our 50s or later. <a href="http://bit.ly/1MpuaqV">These include</a> erectile dysfunction, which affects around 30% of men aged 65-74, and uncomfortable vaginal dryness, experienced by 20% of women in the same age group.</p>
<h2>Changing habits</h2>
<p>Another potential obstacle to having sex and the pleasure that comes with it is the availability of a partner, which can be a significant issue for older people who have experienced widowhood or ill health. <a href="https://theconversation.com/online-dating-could-have-been-made-for-older-adults-they-love-it-23344">There is evidence</a> that some older people are embracing technology and going online to meet potential partners for a sexual relationship. <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1763884">One survey</a> found that 38% of people aged 50-59 and 37% of those aged 60-69 had met their partners online.</p>
<p>We should perhaps also reconsider what we think about as sexual activity when it comes to older people. For one thing, <a href="http://www.ncbi.nlm.nih.gov/pubmed/22380585">many older people engage</a> in masturbation for sexual pleasure, countering the notion that it is a sexual act pursued only by the young. But there is <a href="spr.sagepub.com/content/21/5/595.short">also evidence</a> that ideas about what activities count as sexual become broader as we age. For some, actions such as playing footsie under the breakfast table can give the intimacy that sexual activity previously had.</p>
<p>While research into the sexual well-being of older people is growing, there are gaps that wait to be filled, particularly the ways that ageing intersects with gender identity, sexual orientation, social class, disability and ethnic group. Exploring these areas will develop our understanding of sexual pleasure in older age, and better inform services for those to whom sex is important.</p><img src="https://counter.theconversation.com/content/47329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharron Hinchliff receives funding from the Australian Research Council, Erasmus+, and the White Rose University Consortium. She is a committee member of the Sheffield Sexual Health Network, UK. </span></em></p>Our sex lives may change as we get older but those in sexual relationships still want the same things as the young.Sharron Hinchliff, Senior Lecturer, School of Nursing and Midwifery, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/448662015-07-30T05:16:51Z2015-07-30T05:16:51ZCould HIV-prevention pills actually increase infection risk by cutting condom use?<figure><img src="https://images.theconversation.com/files/89491/original/image-20150723-22811-1qtowp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s been hailed as a major breakthrough and one of the much-needed tools to “<a href="http://www.theguardian.com/commentisfree/2015/feb/26/hiv-treatment-game-changer-truvada-nhs-trial">end HIV</a>”. But there are <a href="http://betablog.org/re-thinking-risk-compensation-conversation-kim-koester/">also concerns</a> about pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by HIV-negative people to prevent them from becoming infected with the virus. Will people taking PrEP stop using condoms and could this actually lead to an increase in HIV and sexually transmitted infections (STIs)?</p>
<p>PrEP appears to be a highly effective method of reducing risk of HIV transmission. Adding to growing <a href="http://www.cdc.gov/hiv/prevention/research/prep/">international evidence</a>, the <a href="http://www.aidsmap.com/Pre-exposure-prophylaxis-PrEP-stops-86-of-HIV-infections-in-PROUD-study/page/2947319/">Proud trial</a> tested the use of PrEP with gay and bisexual men in England and found a reduction in HIV transmission of 86% amongst men who took PrEP every day. Truvada, the drug used in the Proud trial, is not currently licensed for use as PrEP in the UK. However, as a result of the findings, there has been a <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/make-new-hiv-protection-pill-available-on-the-nhs-say-sexual-health-campaigners-9387332.html">concerted effort</a> by HIV policymakers and community activists to make Truvada available as PrEP on the NHS as soon as possible.</p>
<p>Evidence to date has shown mixed results when it comes to continued condom use with PrEP. The Proud trial, which recruited participants reporting some but not exclusive use of condoms, found the number of people not using condoms remained the same throughout the study. STI rates across both trial arms – the group that received PrEP immediately and the group that had to wait 12 months – also remained similar. Evidence from three locations from the <a href="http://www.aidsmap.com/How-will-people-use-PrEP-iPrEx-users-talk-condoms-pills-anxiety-and-relief/page/2894961/">iPrEX study</a> in the US suggests that, although some younger participants reduced condom use, in most cases PrEP did not reduce condom use but did reduce stress, fear, and guilt.</p>
<p>We need to consider who might be willing to use PrEP. A <a href="http://www.bhiva.org/140404JamieFrankis.aspx">number of surveys</a> with gay and bisexual men in the UK have shown that men reporting lower levels of condom use and who are at higher risk of HIV are interested in PrEP. Introducing PrEP to this group might not necessarily reduce condom use, but could protect against HIV infections where condoms are not already being used. In this way, PrEP could fill a gap in HIV prevention for those individuals who find it difficult, or are unable, to use condoms as their main means of preventing HIV.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tried and tested protection.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Our <a href="http://bmjopen.bmj.com/content/4/11/e005717.full">PrEP research</a> in Scotland with gay and bisexual men, and men and women from migrant African communities, found that concerns about PrEP went beyond condom use. Participants in our qualitative study highlighted anxieties around the immediate and long-term side-effects of PrEP, a lack of trust that PrEP would work, and a belief that they were not at high-enough risk to merit taking a daily pill to prevent HIV. In addition, given that PrEP is not 100% effective, skills amongst participants in calculating risk reduction in relation to PrEP appeared to be mixed and will be an important factor in the effective “real-world” use of PrEP.</p>
<p>But our study also highlighted the fear that others would stop using condoms as a result of PrEP. One man compared the impact of PrEP to “women burning their bras” because he was concerned that other men would stop using condoms and threaten a 30-year history of HIV-prevention based on condom use. This suggests that many people still see condoms as the main HIV-prevention tool and demonstrates the need to engage with these fears and identify how PrEP might fit into, rather than disrupt, existing HIV prevention strategies.</p>
<p>Given the <a href="http://www.independent.co.uk/news/uk/home-news/pride-in-london-nhs-to-come-under-pressure-to-provide-miracle-hiv-prevention-pill-10349303.html">likely introduction</a> of PrEP in the UK in the not-too-distant future, we need to draw on existing evidence to encourage its equitable introduction into health services and access by those most at risk of HIV. There needs to be clear guidance and support for using PrEP in combination with existing HIV-prevention strategies, including condoms. We need to find acceptable, effective and clear ways of explaining PrEP to potential users and work to improve understandings and skills in assessing and reducing risk. </p>
<p>Finally, we need to address existing – and sometimes conflicting – <a href="http://www.aidsmap.com/PrEP-wars-debating-pre-exposure-prophylaxis-in-the-gay-community/page/2572027/">community concerns</a> about PrEP . We need to find ways of talking openly about what a range of HIV prevention options might look like, without moralising or judging individual practices. Good sexual health needs to recognise the dynamic lives of people affected by HIV. No matter how well PrEP might work, it alone will not be the magic bullet to end HIV.</p><img src="https://counter.theconversation.com/content/44866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa McDaid receives funding from the UK Medical Research Council, Scottish Chief Scientist Office and the National Institute for Health Research.</span></em></p><p class="fine-print"><em><span>Ingrid Young holds a fellowship funded by the Scottish Chief Scientist Office (CSO).</span></em></p>PrEP drugs to prevent people contracting HIV mustn’t disrupt existing sexual health strategies.Lisa McDaid, Programme leader, MRC/CSO Social and Public Health Sciences Unit, University of GlasgowIngrid Young, Research fellow, MRC/CSO Social and Public Health Sciences Unit, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/442752015-07-30T05:16:45Z2015-07-30T05:16:45ZHow to get more men using condoms – put the pleasure back into sex<figure><img src="https://images.theconversation.com/files/90150/original/image-20150729-30882-14odzyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Pleasure, excitement and intimacy are <a href="http://link.springer.com/article/10.1007/s10508-007-9213-0#page-1">powerful drivers</a> in young people’s sexual decision making. But they are rarely considered when it comes to strategies for reducing the risk of sexually transmitted infections (STIs) or promoting condom use.</p>
<p>Stubbornly <a href="http://www.hpa.org.uk/stiannualdatatables">high rates of STIs</a> in the UK, particularly among under-25s, demonstrate that the plethora of <a href="http://www.fpa.org.uk/campaigns/sexual-health-week">messages and campaigns</a> focused on risk of infection as the driver for condom use have failed to resonate with young people. Or more accurately, with all young people, all the time. It is time to move away from building messages around sex as a risk of infection or pregnancy, and instead to develop campaigns around sex as pleasure, intimacy and excitement.</p>
<p>Some <a href="http://thepleasureproject.org/">recent practice</a> <a href="http://jennyhiggins.net/publications/">and research</a> is starting to put the pleasure agenda in the foreground of sexual health. For example, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302567">recent empirical research</a> in the United States has highlighted how young people’s motivation to seek pleasure was the most important factor behind their lack of condom use. This priority means pleasure is a factor we can’t afford to neglect.</p>
<p>For young men, sex is also pivotal in the construction of their sense of masculinity. <a href="http://search.proquest.com/openview/8bf834a946e0656d72adfcb686deb761/1?pq-origsite=gscholar">Pressures on young men</a> to be good at sex, to take the lead and to maintain and sustain an erection are high. Condom use can threaten or undermine these imperatives by placing this performance at risk. Young men fear that the interruption to apply a condom may cause them to lose their erection and make them appear fumbling and unsure. It requires a level of negotiation and discussion which they can find difficult and embarrassing and it does not fit their conception of sex as spontaneous and exciting.</p>
<p>This combination means that, despite having the knowledge about its importance, condom use in itself constitutes a more immediate and significant risk to young men than that of infection, which is often seen as <a href="https://theconversation.com/have-young-people-stopped-fearing-sexually-transmitted-infections-44341">trivial and treatable</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90153/original/image-20150729-30882-18794y3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">That’s one way to get over the awkwardness.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Embracing and seeking to control risk is a <a href="https://books.google.co.uk/books?hl=en&lr=&id=_FSSAgAAQBAJ&oi=fnd&pg=PP1&dq=Lyng+Edgework&ots=TrXqmE5A2Q&sig=2ud7CoVQCLvt5qRgWORhX82xLag#v=onepage&q=Lyng%20Edgework&f=false">valued masculine attribute</a>. Consequently, being seen as sexually risky and adventurous by rejecting social conformities relating to safe sex can also <a href="http://www.sciencedirect.com/science/article/pii/S027795360500211X">enhance masculine status</a>.</p>
<p>However, it is not only young men who are resistant to condom use. <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302567">Research shows</a> that young women also have preferences for condom-less heterosexual sex, often citing condoms’ impact on feelings of intimacy and trust as important factors. And while gender stereotypes and masculine expectations mean that this “romantic” rationale is not typically associated with or acknowledged by young men, it doesn’t mean that, in the privacy of an encounter with their partner, the desire to be intimate and the pleasure of this closeness is not also privileged by young men.</p>
<p>Talking more about pleasure would enable us to better promote condom use among young men. It would enable us to explore alternatives to penetrative sex, discuss the nitty gritty (such as how to manage condom use without fumbling and embarrassment) and challenge the preoccupation with sex as a performance to be mastered. </p>
<p>Putting pleasure and excitement at the heart of our discussions with young men provides us with a coherent, inclusive and meaningful starting point from which to talk about sex. It brings policy and interventions alongside the interests of young men rather than in opposition to them and offers a space in which to address the concerns relating to masculinities that trouble them.</p><img src="https://counter.theconversation.com/content/44275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Eastham receives funding from the ESRC.</span></em></p><p class="fine-print"><em><span>Mark Limmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tackling men’s reluctant condom use comes down to the basics of how they view sex.Mark Limmer, Lecturer, Division of Health Research, Lancaster UniversityRachael Eastham, PhD candidate, Division of Health Research, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/443412015-07-29T10:41:11Z2015-07-29T10:41:11ZHave young people stopped fearing sexually transmitted infections?<figure><img src="https://images.theconversation.com/files/90119/original/image-20150729-30862-1mxj1z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The good news is that rates of teenage pregnancies are at <a href="http://www.theguardian.com/lifeandstyle/2015/jul/15/teenage-pregnancies-uk-drops-lowest-level-70-years">record lows</a>. In 2014 in England and Wales they were at the <a href="http://www.ons.gov.uk/ons/rel/vsob1/birth-summary-tables--england-and-wales/2014/index.html">lowest rate</a> since 1946, with only 15.6 pregnancies per 1,000 women younger than 20.</p>
<p>Unfortunately, rates of sexually transmitted infections (STIs) are still very high. There were <a href="http://www.ons.gov.uk/ons/rel/vsob1/conception-statistics--england-and-wales/2013/stb-conceptions-in-england-and-wales-2013.html">440,000 diagnoses</a> in the UK in 2014, and the under 25s are one of the most high risk groups. STIs have a high financial cost for testing and treatment: diagnoses of chlamydia alone cost the NHS <a href="http://www.fpa.org.uk/sites/default/files/unprotected-nation-executive-summary.pdf">£620m</a> in 2011.</p>
<p>Condoms provide effective protection against STIs but many people choose not to use them – around <a href="http://bit.ly/2xMf1uD">15% of under-25s</a> reported having unprotected sex with two or more partners in the last year. So why don’t young people use condoms? The most commonly given reason is the impact on <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2496933/">sexual pleasure</a> <a href="http://bit.ly/2xM1cfM">and intimacy</a>. Pleasure is of course a very important part of sex, so anything that is perceived to interfere with it is bound to be viewed negatively.</p>
<h2>Mixed evidence</h2>
<p>Some also argue that young people don’t use condoms because they aren’t scared of <a href="http://www.yourtango.com/2014208790/sexual-health-safe-sex-why-arent-we-afraid-stds-anymore">contracting STIs</a> anymore. Today, the majority of common STIs, including <a href="http://www.nhs.uk/Conditions/Chlamydia/Pages/Treatment.aspx">chlamydia</a> and <a href="http://www.nhs.uk/Conditions/Gonorrhoea/Pages/Treatmentpg.aspx">gonorrhoea</a>, can be cured quickly with antibiotics, while HIV can be managed and those who contract it can expect to <a href="http://www.theguardian.com/global-development/2015/jul/14/people-with-hiv-aids-live-nearly-20-years-longer-than-in-2001">live 20 years longer</a> than was the case in 2000.</p>
<p>While this idea makes sense, the evidence supporting it is mixed. Research has shown people’s <a href="http://journals.lww.com/stdjournal/Abstract/2006/03000/Incidence_of_Sexually_Transmitted_Diseases_and_HIV.13.aspx">beliefs about the seriousness of non-HIV STIs are not</a> related to their behaviour, suggesting that it doesn’t make any difference whether people think STIs are serious or not: they’re still likely to put themselves at risk. This is despite the fact that, if left untreated, they can cause complications such as infertility.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90124/original/image-20150729-30889-1q58ym2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Joint decision.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Fear of HIV, on the other hand, may well influence behaviour. The problem is that many people may not feel at risk of catching it, particularly non-black-African heterosexual people, who are statistically at <a href="https://www.gov.uk/government/statistics/hiv-data-tables">lower risk of HIV</a>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22404427">One study</a> showed heterosexual people who were at high risk of STIs and HIV underestimated that risk and many didn’t use condoms. This suggests that young people’s decision to use a condom or not may depend on whether they think they are at risk of an STI rather than how severe they think the consequences are.</p>
<p>We should also be aware that the decision to wear a condom isn’t always made by one person. Their partners may also be involved, and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2496933/">expectations</a> about their reaction (or a <a href="http://www.ncbi.nlm.nih.gov/pubmed/18725548">lack of discussion</a> altogether) may influence the choice. Getting caught in the “<a href="http://www.researchprotocols.org/2015/3/e82/">heat of the moment</a>” is a commonly cited barrier to condom use and experiments have shown that sexual arousal in men <a href="http://people.duke.edu/%7Edandan/Papers/PI/Heat_of_Moment.pdf">reduces their ability</a> to make decisions. </p>
<h2>Sex-positive approach needed</h2>
<p>So what can we do to change this situation? Previous educational programmes have often focused on the “<a href="http://pps.sagepub.com/content/9/5/455.short">dangers</a>” of unprotected sex. But <a href="http://www.tandfonline.com/doi/abs/10.1080/17437199.2012.703527#.VZu2uflVhBc">evidence suggests</a> that scaring people, in particular those who feel unable to change their behaviour, can just cause them to become defensive.</p>
<p>The fact that perceived loss of sexual pleasure appears to be the fundamental reason most people don’t use condoms highlights how important it is to address the positive aspects of sex, rather than solely focusing on the negative consequences. Finding a way to enhance sexual pleasure with condoms, or at least change beliefs about pleasure, is important. This could be as simple as improving actual sensation with condoms, from recommending thinner designs to revolutionary new materials such as <a href="http://www.newscientist.com/article/mg22429920.400-the-futures-flat-the-wondrous-world-of-2d-materials.html#.VZu6QPlVhBc">graphene</a>. Alternatively, it could involve persuading people that <a href="http://www.researchprotocols.org/2015/3/e82/">safe sex can be good sex</a>. </p>
<p>This sex-positive approach attempts to target an important driver of behaviour: motivation. We are primarily driven by our <a href="http://www.primetheory.com/">wants and needs</a> in any particular moment. Therefore, we need to make people want to use condoms, rather than making them feel that they should. To do this, we should focus on outcomes that are <a href="https://books.google.co.uk/books?hl=en&lr=&id=CoGNDeVdjoQC&oi=fnd&pg=PR1&dq=Self-Regulation+in+Health+Behavior&ots=ZpIV0qGSb2&sig=ZWdPGvVBnJL0bztN8z5a8cNQH6E#v=onepage&q&f=false">important to people</a> –- things that we know they want.</p>
<p>For example, when targeting smoking, focusing on appearance-related consequences may be more effective than focusing on health-related consequences, for people who value being attractive. Interventions to increase condom use should therefore focus on more immediate goals that young people care about, such as enjoying good sex or gaining social approval.</p>
<p>We certainly haven’t cracked the problem of getting people to use condoms yet. However, focusing on goals that are important to young people create an exciting new area for future investigation.</p><img src="https://counter.theconversation.com/content/44341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosie Webster receives funding from UK National Institute for Health Research, Health Technology Assessment Program, 10/131/01.
Views are entirely of the author and do not reflect the views of the funder or of UCL eHealth unit.</span></em></p>STIs might be easier to treat or manage but unprotected sex still comes with potentially serious risks.Rosie Webster, Research Associate in Digital Health and Sexual Health, UCLLicensed as Creative Commons – attribution, no derivatives.