tag:theconversation.com,2011:/global/topics/sexually-transmitted-infections-23071/articlesSexually transmitted infections – The Conversation2023-07-25T16:32:11Ztag:theconversation.com,2011:article/2082672023-07-25T16:32:11Z2023-07-25T16:32:11ZSTIs are on the rise – here’s how to navigate telling a partner if you’ve got one<figure><img src="https://images.theconversation.com/files/538584/original/file-20230720-23402-7sbh1p.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C7928%2C5297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-husband-wife-concentrated-on-solving-1589729899">GaudiLab/Shutterstock</a></span></figcaption></figure><p>Having dipped somewhat during the pandemic, sexually transmitted infections (STIs) are <a href="https://www.cdc.gov/std/statistics/2021/default.htm">on the rise</a> again around the world. In <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2022-report">England</a> and <a href="https://www.hpsc.ie/a-z/sexuallytransmittedinfections/publications/stireports/2022reports/">Ireland</a> in 2022, rates of chlamydia, gonorrhoea and syphilis exceeded levels recorded before COVID. The number of gonorrhoea diagnoses recorded in England was in fact the highest since annual records began.</p>
<p>Untreated STIs can result in serious <a href="https://www.who.int/news-room/feature-stories/detail/four-curable-sexually-transmitted-infections---all-you-need-to-know">health complications</a> for both men and women including infertility, increased risk of miscarriage and <a href="https://orwh.od.nih.gov/research/maternal-morbidity-and-mortality/information-for-women/sexually-transmitted-infections">stillbirth</a>, various cancers and <a href="https://www.ncbi.nlm.nih.gov/books/NBK525195/">reduced life expectancy</a>, among others.</p>
<p>So what do you do if you find out you’ve got an STI? Disclosing the infection is a double-edged sword. On one hand you are being honest, responsible and respectful to your partner (or partners), and protecting their health. </p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/if-youre-sending-intimate-photos-taking-a-selfie-is-legally-safer-heres-how-to-protect-yourself-209274?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">If you’re sending intimate photos, taking a selfie is legally safer – here’s how to protect yourself</a></em></p>
<p><em><a href="https://theconversation.com/four-ways-to-have-hard-conversations-with-your-friends-without-making-things-worse-207675?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Four ways to have hard conversations with your friends – without making things worse</a></em></p>
<p><em><a href="https://theconversation.com/planning-for-a-baby-why-both-men-and-women-should-consider-quitting-alcohol-before-and-during-pregnancy-198118?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy</a></em></p>
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<p>On the other hand, you may risk being shamed, discriminated against or isolated for disclosing your sexual activities, behaviours or preferences. This might be related to having multiple sexual partners, engaging the services of sex workers, or your sexual orientation, to name just a few.</p>
<p>While navigating these conversations can be difficult, cultural and societal attitudes towards sex and sexuality should not discourage you from disclosing your STI status. Letting sexual partners know if you have an STI is essential to the prevention, treatment and control of these infections.</p>
<h2>Honesty is the best policy</h2>
<p>If you receive a positive test, don’t panic. Consult with a healthcare provider as soon as possible. There are effective treatments available for several STIs. For example, a single course of antibiotics <a href="https://www.who.int/news-room/feature-stories/detail/four-curable-sexually-transmitted-infections---all-you-need-to-know">will often clear</a> chlamydia, gonorrhoea, syphilis and “trich” (trichomoniasis). </p>
<p>While it’s not possible to cure HIV or herpes, drugs called antiretrovirals can alter the course of the disease and <a href="https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics">reduce the risk</a> of transmission.</p>
<p>Disclosing an STI can be an uncomfortable and often embarrassing conversation. It’s totally normal to be anxious about your partner’s response and the potential effect on your relationship, whether casual or long term. </p>
<p>After you’ve told them, consider discussing how sexually active you have been in recent times, whether you have had sexual encounters with men, women, or both, and if you’ve sought medical treatment for the STI. Encourage your partner to ask questions, and give them time to think and process the news.</p>
<p>If you and your partner have been sexually active (with or without a condom) and you’re concerned about transmission, you could also provide them with information on where to seek STI testing (GP or local STI clinc) or direct them to reputable <a href="https://sh24.org.uk/">websites</a> where they could access a home testing kit.</p>
<p>If you are uncomfortable telling a sexual partner you have an STI, a healthcare professional can undertake contact tracing to maintain your anonymity.</p>
<p>It’s also important to disclose if you have an STI before starting a sexual relationship with someone new.</p>
<h2>What if a partner discloses that they have an STI?</h2>
<p>You will probably have lots of questions in relation to your partner’s STI disclosure as it may pre-date or overlap with your relationship. When asking these questions, try to be mindful of the language you use, and avoid placing blame.</p>
<p>Most importantly, get tested as soon as possible. An early STI diagnosis is the best opportunity for effective treatment, and prevention of health complications and further transmission. Visit your GP or local health centre for a physical exam and STI screening or alternatively, order an at-home testing kit online.</p>
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<img alt="Two young men talking on a bench." src="https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538585/original/file-20230720-17-gmnxzu.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">
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<span class="caption">Be mindful to avoid judgemental language when talking to a partner about their STI diagnosis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-man-sit-on-bench-talk-1065646313">Aliona Hradovskaya/Shutterstock</a></span>
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<p>Depending on the complexity of the testing required, you may have a number of days to wait for your results. Since <a href="https://www.acog.org/womens-health/faqs/how-to-prevent-stis#:%7E:text=A%20person%20with%20an%20STI,the%20symptoms%20of%20an%20STI%3F">STIs spread</a> by skin-to-skin contact or through transmission of bodily fluids, it’s best to abstain from sex while you await results. </p>
<p>If you do decide to have sex, it’s advisable to use a physical barrier such as a condom or dental dam to protect your partner. When used correctly and consistently, condoms offer one of the most effective methods of protection <a href="https://www.nhs.uk/conditions/contraception/male-condoms/">against STIs</a>, including HIV.</p>
<h2>Make this an opportunity</h2>
<p>Low health literacy can often instil unnecessary fear in circumstances like these. Whether it’s you or your partner who have an STI – or both – use this opportunity to do some research on sexual health. Educating yourself on suitable contraceptive methods, vaccines, signs and symptoms of STIs and the benefits of regular STI check-ups is vital to keeping yourself and others safe when sexually active. </p>
<p>Focus on evidence-based advice from <a href="https://www.sexualwellbeing.ie/">trusted sources</a> such as the US <a href="https://www.cdc.gov/std/default.htm">Centers for Disease Control and Prevention</a>, the <a href="https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)">World Health Organization</a>, and the <a href="https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/">NHS</a>, where you can find up-to-date fact sheets on STI symptoms and treatment guidelines.</p>
<p>If we think back to the height of the pandemic, disclosure of a positive COVID test was often associated with fear of judgement, social exclusion, discrimination and blame – much like an STI disclosure. However, as the pandemic progressed, so too did attitudes. </p>
<p>The COVID pandemic has also shown us the crucial role of early detection, rapid testing, and importantly, public health communication and education. All of these lessons should be applied to the global fight against STI transmission.</p>
<p><a href="https://doi.org/10.1016/j.eclinm.2021.100764">Stigma</a>, embarrassment, guilt, taboo and shame are words still too often associated with STIs. Overcoming STI stigma, much like COVID stigma, requires education, improving access to STI testing and treatment, and the promotion of inclusive conversations about sexual health.</p><img src="https://counter.theconversation.com/content/208267/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zara Molphy receives funding from Science Foundation Ireland for an education and outreach initiative 'Debunking The Myths - The Science Behind Our Sexual Health' (21/DP/9480). </span></em></p>It’s a conversation that can be awkward and uncomfortable, but here are some things to keep in mind.Zara Molphy, Head of Research Programmes, Department of Obstetrics and Gynaecology, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1883282022-12-14T13:13:45Z2022-12-14T13:13:45ZMpox, AIDS and COVID-19 show the challenges of targeting public health messaging to specific groups without causing stigma<figure><img src="https://images.theconversation.com/files/500108/original/file-20221209-33805-9vw3eu.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C1020%2C708&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fear-based public health messaging can both motivate and alienate at-risk groups.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AIDSCrisis1987/8d02dadb8af04606bed1a5f9f6100ba1">AP Photo/Gillian Allen</a></span></figcaption></figure><p>During infectious disease outbreaks, clinicians and public health officials are tasked with providing accurate guidance for the public on how to stay safe and protect themselves and their loved ones. However, <a href="https://doi.org/10.3390%2Fijerph19148550">sensationalized media coverage</a> can distort how the public perceives new emerging infections, including where they come from and how they spread. This can foster <a href="https://doi.org/10.1016/j.lanepe.2022.100536">fear and stigma</a>, especially toward communities that are already mistrustful of the health care system.</p>
<p>The racial and sexual <a href="https://doi.org/10.3389/fpsyg.2021.648086">stigma surrounding monkeypox</a> is what spurred the World Health Organization to <a href="https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease">rename the disease to mpox</a> in November 2022. While this is a step in the right direction, I believe more work needs to be done to reduce the stigma surrounding infectious diseases like mpox.</p>
<p>I am an <a href="https://profiles.dom.pitt.edu/faculty_info.aspx/Ho5747">infectious disease researcher</a> who studies HIV, COVID-19 and mpox. During the COVID-19 pandemic, I was the lead investigator at the University of Pittsburgh for a <a href="https://www.coronaviruspreventionnetwork.org/compass-clinical-study">national survey</a> looking at how COVID-19 has affected different communities. Effective public health communication isn’t easy when conflicting messages may come from many sources, including family and friends, other community members or the internet. But there are ways that public health officials can make their own messaging more inclusive while mitigating stigma.</p>
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<a href="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Posters promoting condom use reading " src="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500110/original/file-20221209-41828-ft8xxk.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"></a>
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<span class="caption">Tailoring public health messages to target groups could improve their reach.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/posters-that-promote-healthy-sexual-behavior-hang-inside-news-photo/160899714">Chip Somodevilla/Getty Images</a></span>
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<h2>Creating an inclusive message</h2>
<p>Inclusive public health messaging can motivate the public to make better decisions regarding their personal health and the health of others. This effort often involves engaging the communities most affected by an outbreak. Unfortunately, because these communities are heavily affected by the infection and tend to <a href="https://www.ama-assn.org/delivering-care/health-equity/impact-covid-19-minoritized-and-marginalized-communities">experience some form of inequity</a>, they are often blamed by society for spreading the disease.</p>
<p>COVID-19 drove an increase in hate crimes related to the pandemic against <a href="https://doi.org/10.1007/s12103-020-09545-1">Chinese and other Asian communities</a> in the United States. A <a href="https://healthpolicy.ucla.edu/newsroom/press-releases/pages/details.aspx">2022 UCLA survey</a> found that 8% of Asian American and Pacific Islander adults in California experienced a COVID-19 related hate incident.</p>
<p>Effective public health messaging can focus on the fact that while infections may first affect certain groups of people, they often <a href="https://doi.org/10.1098/rstb.2014.0111">spread to other groups</a> and eventually encompass entire communities. Infections are caused by bacteria, viruses and fungi. They don’t discriminate by race, gender or sexual orientation. Messages that focus on the pathogens, rather than the communities, may reduce stigma.</p>
<p><a href="https://www.cdc.gov/poxvirus/monkeypox/resources/reducing-stigma.html">Visually inclusive messages</a> are also likely to engage a greater portion of the community. Examples include making sure that the people represented in posters and flyers, images on TV and websites, and other informational material are from diverse backgrounds. This sends a more unified message that what affects an individual also affects the larger community.</p>
<h2>Avoiding blame and fear</h2>
<p>Many media outlets, especially on social media, use <a href="https://theconversation.com/does-scaring-people-work-when-it-comes-to-health-messaging-a-communication-researcher-explains-how-its-gone-wrong-during-the-covid-19-pandemic-174287">fear-based messaging</a> to report on infectious diseases. While this may reinforce certain protective behaviors, such as using condoms during sex, it may also increase stress and anxiety. Fear-based messages also <a href="http://dx.doi.org/10.1136/bmjgh-2019-001911">worsen stigma</a>, leading to increased discrimination against communities that are already vulnerable and mistrustful of health care. Ultimately, this leads people to avoid seeking health care and can worsen health outcomes.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/TRGZcNMR24o?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Normalizing sexual health could help reduce stigma around sexually transmitted infections.</span></figcaption>
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<p>Public health officials have often used fear-based messaging in response to sexually transmitted infections, or STIs, like <a href="https://doi.org/10.1016%2FS2352-3018(21)00078-3">HIV</a>, <a href="http://dx.doi.org/10.1080/01292986.2017.1384030">chlamydia</a> and <a href="https://doi.org/10.1080/01292980600857831">gonorrhea</a>. Sex itself is <a href="https://magazine.jhsph.edu/2022/stigmas-toll-sexual-and-reproductive-health">highly stigmatized</a> by society. I have found that some of my patients would prefer to avoid getting tested and treated for an STI rather than deal with the <a href="https://www.verywellhealth.com/the-stigma-stds-have-in-society-3133101">shame of having an STI</a>.</p>
<p>Making sexual health and STI testing <a href="https://doi.org/10.1016/j.eclinm.2021.100764">routine and integral</a> parts of overall wellness and health is an important step to reduce the stigma around them. Similarly, messaging that normalizes the challenges faced by people at risk for certain infections could help avoid causing shame.</p>
<h2>Tailoring the message</h2>
<p>Infections affect different people differently. <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">COVID-19</a> might be a mildly stuffy nose for one person, and it could be months in an intensive care unit hooked up to a ventilator for another. Messages that <a href="https://www.hsph.harvard.edu/ecpe/the-importance-of-getting-the-message-right-in-your-risk-communication-strategy/">focus on the successes</a> of medical and public health interventions that resonate with communities are most likely to be successful.</p>
<p>Different groups have different exposure risks as well. Mpox heavily affected gay and bisexual men in 2022. One reason why was related to how the virus is transmitted. <a href="https://www.cdc.gov/poxvirus/monkeypox/if-sick/transmission.html#">Prior research</a> suggested that mpox was largely transmitted by close skin-to-skin contact, but <a href="https://www.nbcnews.com/nbc-out/out-health-and-wellness/sex-men-not-skin-contact-fueling-monkeypox-new-research-suggests-rcna43484">emerging studies</a> raised the question of whether the 2022 outbreaks were being driven more by sexual transmission.</p>
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<a href="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person passing poster with health information on mpox" src="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500109/original/file-20221209-40125-yviwsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The 2022 mpox outbreaks predominantly affected gay and bisexual men.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/poster-on-commercial-street-in-provincetown-ma-on-the-issue-news-photo/1242177865">Jonathan Wiggs/The Boston Globe via Getty Images</a></span>
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<p>There was <a href="https://www.npr.org/2022/07/26/1113713684/monkeypox-stigma-gay-community">controversy</a> as to whether public health messaging should highlight sexual encounters as a potential transmission route. This can risk further stigmatizing gay and bisexual men versus potentially overlooking these key at-risk populations. <a href="https://www.scientificamerican.com/article/monkeypox-is-a-sexually-transmitted-infection-and-knowing-that-can-help-protect-people">Some advocates argued</a> that promoting the message that mpox was primarily transmitted by close contact would prevent resources and interventions from reaching the groups of people most affected by the disease.</p>
<p>One size does not always fit all when it comes to public health messaging. Multiple messages may be necessary for different groups of people based on their risk of infection or severe disease. An August 2022 Centers for Disease Control and Infection survey found that <a href="http://dx.doi.org/10.15585/mmwr.mm7135e1">50% of gay and bisexual men</a> reduced their sexual encounters in response to the mpox outbreak. Since late summer, <a href="https://www.npr.org/sections/health-shots/2022/08/26/1119659681/early-signs-suggest-monkeypox-may-be-slowing-in-the-u-s">mpox rates have been dropping</a> rapidly, and many experts think that both behavior change and vaccination may have contributed to the falling rates. Studies like these further support the importance of directly engaging with communities to encourage healthy behavior change.</p>
<h2>Trusted messengers</h2>
<p>Mistrust is also a barrier to effective messaging. Some communities may be mistrustful of medical and health care systems because of prior histories of exploitation, such as the <a href="https://www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study">Tuskegee study</a>, where researchers prevented Black participants from receiving syphilis treatment for decades in the mid-20th century, and ongoing fear of mistreatment.</p>
<p>Identifying trusted community champions and health care providers – especially ones who belong to that community – to deliver a public health message may increase its acceptance. One <a href="https://doi.org/10.1257/aer.20181446">2019 study</a>, for example, found that Black men were more likely to accept vaccines, medical advice and engage in health care services if they had a Black health care provider.</p>
<p>Effectively delivering public health messaging is a complicated and challenging process. But talking to and listening to the communities most affected by an outbreak can make a difference.</p><img src="https://counter.theconversation.com/content/188328/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Ho does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Prejudice and stigma can discourage the communities most affected by infectious diseases from seeking care. Inclusive public health messaging can prevent misinformation and guide the most vulnerable.Ken Ho, Assistant Professor of Infectious Diseases, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821142022-07-13T12:30:09Z2022-07-13T12:30:09ZManuscripts and art support archaeological evidence that syphilis was in Europe long before explorers could have brought it home from the Americas<figure><img src="https://images.theconversation.com/files/473438/original/file-20220711-26-m03ndy.jpg?ixlib=rb-1.1.0&rect=233%2C137%2C2193%2C1714&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does a painting from 1400 depict one of Jesus' torturers as suffering from 'saddle nose,' a common effect of syphilis?</span> <span class="attribution"><a class="source" href="https://www.clevelandart.org/art/1945.115">Detail of an Austrian painting c. 1400 of the Passion of Christ, The Cleveland Museum of Art</a></span></figcaption></figure><p>That the arrival of Europeans in the New World in 1492 led to a massive shift in the ecological landscape has been widely accepted <a href="https://www.smithsonianmag.com/history/alfred-w-crosby-on-the-columbian-exchange-98116477/">for the past 50 years</a>. Suddenly a trans-Atlantic exchange – maize for wheat, tomatoes for apples, tobacco for horses – meant that plants and animals were moving between continents for the first time.</p>
<p>It was the same for pathogens, according to historian Alfred W. Crosby and his influential book “<a href="https://www.worldcat.org/title/columbian-exchange-biological-and-cultural-consequences-of-1492/oclc/930378865&referer=brief_results">The Columbian Exchange</a>.” Diseases like smallpox and measles, brought to the Western Hemisphere by the invaders, soon killed <a href="https://theconversation.com/how-smallpox-devastated-the-aztecs-and-helped-spain-conquer-an-american-civilization-500-years-ago-111579">almost the entire Indigenous population</a>. In return, Europeans fell prey to <a href="https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm">syphilis, a venereal disease</a> they picked up from the native people. Crosby’s idea about the exchange of diseases was an interesting one and it made for a good story, suggesting that with the arrival of syphilis in Europe justice of a sort had been done.</p>
<p>The only problem is that this syphilis scenario is wrong, according to <a href="https://doi.org/10.1002/ajpa.23988">ongoing research by paleopathologists</a>, scientists who study skeletal remains for evidence of disease. After decades of painstaking work, they have concluded that the syphilis-causing spirochete bacterium <em>Treponema pallidum</em> already existed in the Old World long before Columbus boarded his ship and sailed to Hispaniola.</p>
<p>As a <a href="https://scholar.google.com/citations?user=K6x0M5sAAAAJ&hl=en&oi=ao">women’s historian</a> who has studied documents and artworks for <a href="https://muse.jhu.edu/article/842358">evidence of syphilis in the medieval period</a>, I believe the paleopathologists are right. Like skeletal remains, paintings show life as it was. Even manuscripts, although more open to interpretation, can reveal the truth once readers open their minds to new possibilities. Here’s a sample of the evidence that <a href="https://www.arc-humanities.org/9781802700480/medieval-syphilis-and-treponemal-disease/">Europeans suffered from syphilis long before they reached the Americas</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="microscopic image of long white worm-like shapes" src="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Treponema pallidum</em> is a spiral-shaped bacterium that causes the disease syphilis.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/treponema-pallidum-dark-field-preparation-syphilis-image-news-photo/509391914">CDC/Susan Lindsley/Smith Collection/Gado via Getty Images</a></span>
</figcaption>
</figure>
<h2>Evidence from bones and teeth in the Old World</h2>
<p>In a cemetery in West Sussex, U.K., archaeologists uncovered the <a href="https://doi.org/10.1002/ajpa.22630">skeleton of a young man</a> with extensive damage to his skull, clavicles, arms and legs – a combination typical of syphilis. He died in the sixth century. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="skull with hole and areas where bone looks rotted away" src="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=604&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=604&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=604&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=759&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=759&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=759&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">View of a human skull damaged by late-stage syphilis, the kind of evidence paleopathologists can look for.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Skull_damage_from_neurosyphilis.jpg">Canley/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In St. Polten, Austria, a medieval cemetery holds the <a href="https://doi.org/10.1127/anthranz/2015/0504">remains of a child</a> age 6 with deformed teeth consistent with a diagnosis of treponematosis, perhaps a case of <a href="https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm">congenital syphilis</a>, when the <em>Treponema pallidum</em> bacteria are passed from mother to child during pregnancy or birth.</p>
<p>In Anatolia in western Turkey, the <a href="https://doi.org/10.1002/oa.802">skeleton of a teenager</a> revealed not only the same deformed incisors as in St. Polten, but also damage to the entire skeleton below the head. Involvement of both teeth and bones in the same specimen, and especially the large number of bones affected in this case, points to syphilis. The victim died in the 13th century – a couple hundred years before Columbus set sail. </p>
<p>And so it goes. While the absolute number of cases is not large, <a href="https://doi.org/10.1002/ajpa.22630">they keep turning up</a>. Some of the evidence appears in the remains of people who <a href="https://www.worldcat.org/title/origine-de-la-syphilis-en-europe-avant-ou-apres-1493-actes-du-colloque-international-de-toulon-25-28-novembre-1993/oclc/884173338&referer=brief_results">lived more than 2,000 years ago</a>.</p>
<p>There is an outstanding issue, however. Damaged bones and teeth seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to another form of the disease instead. <em>Treponema pallidum</em> appears in several strains. The subspecies that causes syphilis is the deadliest. But two other subspecies of the bacteria cause less serious, if still painful and unsightly, diseases called <a href="https://rarediseases.org/rare-diseases/bejel/">bejel</a> (also known as endemic syphilis) and <a href="https://www.who.int/news-room/fact-sheets/detail/yaws">yaws</a> that are <a href="https://www.merckmanuals.com/home/infections/bacterial-infections-spirochetes/bejel-yaws-and-pinta">not usually transmitted sexually</a>. Nowadays all three can be treated with antibiotics.</p>
<p>How then, to distinguish between the three subspecies and prove that the venereal form had existed in Europe all along?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="detail of medieval painting of Jesus in crown of thorns amid crowd" src="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In an early 15th-century painting, a discerning historian’s eye sees two soldiers (one in yellow, one behind red plume) with facial features indicative of advanced syphilis leading Christ to his crucifixion.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Master_of_the_Karlsruhe_Passion_-_Disrobing_of_Christ.jpeg">The Disrobing of Christ from the Karlsruhe Passion (detail), c.1440. Staatliche Kunsthalle Karlsruhe, Strasbourg</a></span>
</figcaption>
</figure>
<h2>Writers and artists recorded other evidence</h2>
<p>Documentary and artistic evidence can help settle the issue. Of all the pathogens known to humanity, only treponemes produce <a href="https://doi.org/10.1001/archderm.1970.04000070080012">such widely divergent outcomes based on climate and culture</a>, an important clue for finding evidence in manuscripts.</p>
<p>This fact explains my theory that medieval elites suffered more severely from treponematosis than peasants. Their wealthy lifestyle would have protected them from childhood infections their social inferiors picked up in their crowded and unsanitary households. But those childhood sicknesses would have had the benefit of triggering some future immunity in the peasantry.</p>
<p>If members of the elite reached sexual maturity without having had milder infections while growing up, they would be highly susceptible to contracting the disease for the first time during intercourse. A sore on the genitalia contains a massive dose of infectious bacteria compared with the small doses found on the shared clothing or bedding of the peasantry. Peasants who suffered a recurrence of the disease as adults could likely fend it off successfully because of their prior immunity. I contend this was not true for elites who then suffered more devastating illnesses.</p>
<p>In addition to dying young themselves, infected elites risked giving their children congenital syphilis, which often proved fatal to the next generation. Elites and their children died in such high numbers that some noble families <a href="https://global.oup.com/academic/product/the-crisis-of-the-aristocracy-1558-to-1641-9780198213147">had trouble maintaining their bloodlines</a>, a point noted long ago without making a potential connection to syphilis.</p>
<p>One royal who <a href="https://muse.jhu.edu/article/842358">I believe almost certainly died of syphilis</a> was king Edward IV of England (1442-83). One of his councilors wrote that he died of an illness difficult to cure even in a person of lesser status, a cryptic comment not previously understood by historians. But his statement perfectly fits the difference between venereal and endemic syphilis, evidence that suggests both diseases existed in 15th-century England. The <a href="https://yalebooks.yale.edu/book/9780300073720/edward-iv/">king’s symptoms and reputation for sexual promiscuity</a> help confirm my diagnosis.</p>
<p>Evidence for the presence of syphilis in the Old World also comes from art.</p>
<p>Doctors know that <a href="https://doi.org/10.1001/archderm.1970.04000070080012">syphilis can result in</a> “<a href="https://phil.cdc.gov/Details.aspx?pid=17626">saddle nose</a>,” in which spirochetes invade a patient’s nose and cause it to collapse in a distinctive way. Medieval artists from as early as the 12th century depicted this deformity in their work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Side view of man with a collapsed nose, paired with medieval painting of Jesus and a persecutor" src="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In a medieval painting, one of Christ’s tormentors has facial features reminiscent of a syphilis patient’s saddle nose.</span>
<span class="attribution"><a class="source" href="https://www.bl.uk/manuscripts/Viewer.aspx?ref=yates_thompson_ms_13_fs001r">L: British Journal of Plastic Surgery, Vol. 10, McLaren + Penney, The reconstruction of the syphilitic saddle nose: A review of seven cases, Pages 236-252, Copyright 1957–1958. R: The Taymouth Hours, England, mid-14th century. British Library, MS Yates Thompson 13, fol. 120v.</a></span>
</figcaption>
</figure>
<p>I believe they intended to show venereal and not endemic disease because they use saddle nose in depictions of sinful figures, including the men who tortured Christ or killed babies on the orders of King Herod.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Front view of man with a collapsed nose, paired with drawing of a monster with a snub-nosed face on a pair of legs" src="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A gryllus displaying the saddle nose deformity in a drawing from the early 1300s.</span>
<span class="attribution"><a class="source" href="https://www.bl.uk/manuscripts/Viewer.aspx?ref=stowe_ms_17_fs001r">L: British Journal of Plastic Surgery, Vol. 10, McLaren + Penney, The reconstruction of the syphilitic saddle nose: A review of seven cases, Pages 236-252, Copyright 1957–1958. R: The Maastricht Hours, Liège, early 14th century. British Library, MS Stowe 17, fol. 151r.</a></span>
</figcaption>
</figure>
<p>Even the silly gryllus, a medieval monster with a face and legs but no body, was a symbol of human depravity.</p>
<p>Examples abound. Historians have ignored good evidence – as plain as the nose on your face, so to speak – because they believed in the Columbian exchange. Regarding syphilis, however, that intellectual framework now appears outdated.</p><img src="https://counter.theconversation.com/content/182114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marylynn Salmon does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The idea that Europeans brought new diseases to the Americas and returned home with others has been widely accepted. But evidence is mounting that for syphilis this scenario is wrong.Marylynn Salmon, Research Associate in History, Smith CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1852972022-06-26T00:11:02Z2022-06-26T00:11:02ZMonkeypox is not a global emergency for now, says WHO. 3 things we need to know next about how it’s mutating and spreading<figure><img src="https://images.theconversation.com/files/470411/original/file-20220623-52182-eny4r6.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/monkeypox-virus-3d-illustration-zoonotic-poxviridae-2159713933">Shutterstock</a></span></figcaption></figure><p>The World Health Organization (WHO) has <a href="https://twitter.com/DrTedros/status/1540791694236344321">decided not</a> to declare monkeypox a public health emergency of international concern. <a href="https://theconversation.com/at-what-point-is-a-disease-deemed-to-be-a-global-threat-heres-the-answer-185547">This may change</a> in the future.</p>
<p>However, WHO Director-General Tedros Adhanom Ghebreyesus <a href="https://www.who.int/news-room/speeches/item/who-director-general-s-statement-on-the-report-of-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak">said</a> he was “deeply concerned” about the evolving threat of monkeypox, which he said had reached more than 50 countries.</p>
<p>There have been <a href="https://map.monkeypox.global.health/country">more than</a> 4,100 confirmed cases globally, including at least 13 in Australia.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1540818908927729665"}"></div></p>
<p>The WHO also acknowledged there were many unknowns about the outbreak.</p>
<p>Here are three things we know about monkeypox and three things we want to find out.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/at-what-point-is-a-disease-deemed-to-be-a-global-threat-heres-the-answer-185547">At what point is a disease deemed to be a global threat? Here's the answer</a>
</strong>
</em>
</p>
<hr>
<h2>3 things we know</h2>
<p><strong>1. Monkeypox is caused by a virus</strong></p>
<p>Monkeypox is a large DNA virus belonging to the orthopoxvirus family. Unlike the related smallpox virus, variola, which only affected humans, monkeypox virus is found in rodents and other animals in parts of Africa. </p>
<p>We know of two clades (virus groupings), and it is the less severe of the two currently <a href="https://theconversation.com/monkeypox-in-australia-what-is-it-and-how-can-we-prevent-the-spread-183526">circulating</a> outside Africa.</p>
<p>Orthopoxviruses are stable viruses that do not mutate much. Multiple mutations, however, <a href="https://www.statnews.com/2022/06/02/mutations-in-monkeypox-virus-explainer/">have been described</a> in the virus causing the current outbreak. </p>
<p>In the United States, at least two separate strains have been circulating, suggesting <a href="https://www.statnews.com/2022/06/03/genetic-data-indicate-at-least-two-separate-monkeypox-outbreaks-underway-suggesting-wider-spread/">multiple introductions</a> into the country. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-in-australia-what-is-it-and-how-can-we-prevent-the-spread-183526">Monkeypox in Australia: what is it and how can we prevent the spread?</a>
</strong>
</em>
</p>
<hr>
<p><strong>2. You can be infected for more than a week and not know</strong></p>
<p>It takes an <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.24.2200448">average 8.5 days</a> from infection to showing symptoms, such as enlarged lymph nodes, fever and a rash, which usually looks like fluid-filled blisters that erupt. People are infectious while they have the rash, and are usually infectious for about two weeks.</p>
<p>Children are most severely affected and have a higher risk of dying from the disease. Historically, in the endemic countries of Africa, <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010141#sec016">almost all deaths</a> have been in children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child with monkeypox lesions on limbs" src="https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470419/original/file-20220623-52323-3o78bp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children with monkeypox, such as this four-year-old girl, are at increased risk of severe disease.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=2329">CDC</a></span>
</figcaption>
</figure>
<p>The European epidemic is <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON392">mostly in adult males</a>, so this, together with better access to care, may explain the low rate of deaths in these countries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-in-a-name-why-giving-monkeypox-a-new-one-is-a-good-idea-185307">What's in a name? Why giving monkeypox a new one is a good idea</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. We have vaccines and treatments</strong></p>
<p>Vaccines work. Past vaccination against smallpox provides <a href="https://doi.org/10.1093/ije/17.3.643">85% protection</a> against monkeypox. Smallpox was declared <a href="https://www.cdc.gov/smallpox/index.html">eradicated in 1980</a>, so most mass vaccination programs ceased in the 1970s. </p>
<p>Australia never had mass smallpox vaccination. However, an <a href="https://wwwnc.cdc.gov/eid/article/24/4/17-1233_article">estimated 10%</a> of Australians have been vaccinated in the past, mostly migrants.</p>
<p>Vaccines protect for many years but immunity wanes. So <a href="https://wwwnc.cdc.gov/eid/article/27/4/20-3569_article">declining population-level protection</a> is likely responsible for the resurgence of monkeypox seen since 2017 in Nigeria, one of seven endemic hot spots in Africa.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man showing smallpox vaccine scar on upper arm" src="https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470421/original/file-20220623-52339-3o78bp.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"></a>
<figcaption>
<span class="caption">Even if you have been vaccinated against smallpox, protection wanes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/monkeypox-smallpox-vaccine-scar-on-young-2158715369">Shutterstock</a></span>
</figcaption>
</figure>
<p>Mass vaccination is not recommended. But vaccines <a href="https://www.who.int/publications/i/item/who-mpx-immunization-2022.1">can be given</a> to contacts of confirmed cases (known as post-exposure prophylaxis) and people at high risk of contracting the virus, such as some lab or health workers (pre-exposure prophylaxis).</p>
<p>There are also <a href="https://jglobalbiosecurity.com/articles/10.31646/gbio.12/">treatments</a>, such as vaccinia immune globulin and antivirals. These were developed against smallpox.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-we-have-vaccines-and-drugs-to-treat-it-183686">Monkeypox: we have vaccines and drugs to treat it</a>
</strong>
</em>
</p>
<hr>
<h2>3 things we want to find out</h2>
<p><strong>1. How much do these new mutations matter?</strong></p>
<p>The virus causing the current outbreak has <a href="https://www.statnews.com/2022/06/02/mutations-in-monkeypox-virus-explainer/">several mutations</a> compared with versions of the virus circulating in Africa. However, we don’t know if these mutations affect clinical disease and how the virus spreads.</p>
<p>The monkeypox virus has a <a href="https://nextstrain.org/monkeypox/hmpxv1">very large genome</a>, so is more complex to study than smaller RNA viruses, such as influenza and SARS-CoV-2 (the virus that causes COVID).</p>
<p>Experts wonder if the mutations have made it more contagious or changed the clinical pattern to be more like a sexually transmitted infection. A <a href="https://www.cidrap.umn.edu/news-perspective/2022/06/virus-causing-monkeypox-outbreak-has-mutated-spread-easier">study</a> from Portugal shows the mutations likely make the virus more transmissible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-is-a-dna-virus-unlike-coronavirus-heres-what-that-means-for-the-virus-and-us-184708">Monkeypox is a DNA virus unlike coronavirus – here's what that means for the virus and us</a>
</strong>
</em>
</p>
<hr>
<p><strong>2. How is it spread? Is that changing?</strong></p>
<p>Monkeypox has not been described as a sexually transmitted infection in the past. However, the current transmission pattern is unusual. There <a href="https://www.journalofinfection.com/article/S0163-4453(22)00335-8/fulltext">seems to be</a> a very short incubation period (of 24 hours) following sexual contact in some, but not all, cases. </p>
<p>It is a respiratory virus, so aerosol transmission is possible. But historically <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010141#sec016">most transmission</a> has been from animal to human. When there was transmission between humans, this usually involved close contacts.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1536532197397565440"}"></div></p>
<p>The rapid growth of the epidemic in non-endemic countries in 2022, however, has been all due to spread between humans. There may be <a href="https://www.npr.org/sections/health-shots/2022/06/25/1107416457/monkeypox-outbreak-in-us">many more cases</a> than officially reported.</p>
<p>We do not know why the pattern has changed, whether it is sexually transmitted or simply transmitted due to intimate contact in specific and globally connected social networks, or whether the virus has become more contagious. </p>
<p>The virus is found in the skin rash, mouth and semen, but this <a href="https://www.science.org/content/article/monkeypox-outbreak-mostly-affecting-men-sex-men">does not prove</a> it is sexually transmitted.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-this-is-an-entirely-new-spread-of-the-disease-184085">Monkeypox: ‘This is an entirely new spread of the disease’</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. How far will it spread? Does COVID make a difference?</strong></p>
<p>Will this spread more widely in the community? Does the COVID pandemic increase the risk? <a href="https://theconversation.com/how-monkeypox-epidemic-is-likely-to-play-out-in-four-graphs-184578">Possibly, yes</a>.</p>
<p>We must also not drop the ball on surveillance in the wider community or <a href="https://www.acpjournals.org/doi/10.7326/M22-1748">stigmatise the LGBTQI community</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1528888390027984896"}"></div></p>
<p>Due to waning immunity from the smallpox vaccine globally and the spread of monkeypox to many countries already, we may see the epidemic spreading more widely. </p>
<p>If it does so and starts infecting large numbers of children, we could see more deaths because children get more severe infection. </p>
<p>So we should monitor globally for clusters of fever and rash, and <a href="https://www.epiwatch.org/media/EPISCOPE_JUNE_14_2022.pdf">misdiagnosis</a> as chickenpox, <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Hand_foot_and_mouth_disease/">hand foot and mouth disease</a>, herpes simplex or other diseases with a rash.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-monkeypox-epidemic-is-likely-to-play-out-in-four-graphs-184578">How monkeypox epidemic is likely to play out – in four graphs</a>
</strong>
</em>
</p>
<hr>
<p>Another factor is COVID. As people recover from COVID, their immune system <a href="https://www.nature.com/articles/s41392-021-00749-3#citeas">is impaired</a>. So people who have had COVID may be more susceptible to other infections.</p>
<p>We see the same with measles infection. This weakens the immune system and increases the risk of other infections for <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05469-7">two to three years</a> afterwards.</p>
<p>If the epidemic becomes established in countries outside the endemic areas, it may infect animals and create new endemic zones in the world. </p>
<p>It is important we do everything possible to stop this epidemic.</p><img src="https://counter.theconversation.com/content/185297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC and MRFF. She has been on advisory boards for Bavarian Nordic and received funding for a smallpox workshop she conducted in 2019 from Emergent Biosolutions, Bavarian Nordic, Siga technologies and Meridien Medical. She is on the WHO SAGE Smallpox and Monkey Pox Ad Hoc Advisory Group.</span></em></p>Monkeypox has spread to more than 50 countries and will continue to be monitored. Here’s what we know about monkeypox so far and what researchers want to find out.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1708522021-12-02T13:43:30Z2021-12-02T13:43:30ZWhy COVID-19 must be included in safer sex messaging on college campuses<figure><img src="https://images.theconversation.com/files/432516/original/file-20211117-21-ov80nw.jpg?ixlib=rb-1.1.0&rect=15%2C15%2C3464%2C2300&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little information is available to college students on stopping the spread of COVID-19 within an intimate relationship.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-couple-kissing-with-face-protective-mask-royalty-free-image/1265180786?adppopup=true">DisobeyArt/iStock via Getty Images Plus</a></span></figcaption></figure><p>With college students back on campus, and COVID-19 with us <a href="https://theconversation.com/is-covid-19-here-to-stay-a-team-of-biologists-explains-what-it-means-for-a-virus-to-become-endemic-168462">for the foreseeable future</a>, it has become increasingly clear that educators need to develop a <a href="https://www.healthline.com/health/healthy-sex/safer-sex-tips-positions-during-covid-19#covid-19-tips">new definition</a> of safer sex. </p>
<p>Although the virus is <a href="https://www.avert.org/coronavirus/covid19-sex">not a sexually transmitted infection</a>, students can <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html">spread COVID-19</a> through <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html">droplets and particles</a>, especially when within 6 feet of each other. That includes being intimate. </p>
<p>This is why sex education efforts need to inform students not only about sexually transmitted infections, HIV and unintended pregnancy, but also about ways to <a href="https://bestlifeonline.com/new-coronavirus-sex-guidelines/">reduce COVID-19 transmission risk</a>.</p>
<p><a href="https://profiles.ucla.edu/tamra.loeb">As psychologists</a> and <a href="https://www.researchgate.net/profile/Michele-Cooley-Strickland">educators</a> at the University of California, Los Angeles, who <a href="https://www.semel.ucla.edu/profile/gail-wyatt-phd">design interventions</a> to promote the health and well-being of college students, we are aware of the work that has gone into reopening campuses during the pandemic. But despite all the effort, some critical health needs of those students have been entirely overlooked. </p>
<figure class="align-center ">
<img alt="A group of college students on campus." src="https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432529/original/file-20211117-27-iq3bqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Much can be done to reduce COVID-19 risk for sexually active students.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/diverse-group-of-college-friends-royalty-free-image/887132600?adppopup=true">Ariel Skelley/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>The CDC missed a chance</h2>
<p>The Centers for Disease Control and Prevention produced <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/colleges-universities/considerations.html#section4">a lengthy document</a>, last updated in November 2021, about college campuses and COVID-19 transmission. The document offers suggestions on how to stop the spread of the virus in all kinds of scenarios, from communal eating to sporting events. But stunningly, we could not find a word about the potential for spreading COVID-19 within an intimate relationship. </p>
<p>This is particularly disturbing when one considers that college students could use some expert advice. Their decision-making skills are not <a href="https://doi.org/10.1016/j.jadohealth.2009.05.016">fully developed</a>, and many college-age students are <a href="https://doi.org/10.1016/j.jadohealth.2009.05.016">impulsive</a>. </p>
<p>Pleasurable and perhaps risky behaviors often win out over possible long-term negative consequences. Just look at the <a href="https://mashable.com/article/how-to-have-safe-sex-during-covid-pandemic-smarter-hookups">rates of STIs</a>, <a href="https://doi.org/10.1080/17538068.2017.1385575">HIV</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/19278182/">unintended pregnancy</a>: Compared with other age groups, the rates are <a href="https://doi.org/10.1080/07448481.2018.1549554">higher among college students</a>. </p>
<h2>Ways to avoid COVID-19</h2>
<p>The irony is that there is much to say and to promote about <a href="https://bestlifeonline.com/coronavirus-sex-new-york-guidelines/">reducing COVID-19 risk</a> for sexually active students. </p>
<p>Here are some evidence-based recommendations: Limit the number of sexual partners. Avoid sexual contact with anyone who has COVID-19 or symptoms. Use condoms and <a href="https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html">dental dams</a>.
Avoid activities involving transmission of fecal-oral material. Wear masks during intimate acts. Avoid kissing. </p>
<p>Also: Wash hands before and after sexual activity. Use clean sex toys. Sanitize areas where sexual activity occurs. Engage in <a href="https://www.avert.org/coronavirus/covid19-sex">self-pleasure</a>. And understand that those who are not symptomatic can still transmit <a href="https://www.cdc.gov/library/covid19/pdf/public_pdfs/2020-06-12-Science-Update_FINAL_public.pdf">COVID-19</a> and some <a href="https://www.aafp.org/dam/AAFP/documents/patient_care/sti/hops19-sti-manual.pdf">STIs</a>. </p>
<h2>Abstinence programs don’t help</h2>
<p>Many <a href="https://mashable.com/article/how-to-have-safe-sex-during-covid-pandemic-smarter-hookups">abstinence programs</a> are based on the premise that abstinence until marriage is the acceptable <a href="https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/human_rights_vol35_2008/human_rights_summer2008/hr_summer08_kantor/">standard of human sexual behavior</a>. </p>
<p>But research has shown that <a href="https://aspe.hhs.gov/reports/impacts-four-title-v-section-510-abstinence-education-programs-1">abstinence programs are ineffective</a> and often lead to increased rates of <a href="https://doi.org/10.1371/journal.pone.0024658">unintended pregnancy</a> and other high risk behaviors. That’s because they limit discussions of STI prevention and birth control; this effectively <a href="https://doi.org/10.1371/journal.pone.0024658">withholds information</a> from young people who are in the midst of making crucial decisions about their health and future.</p>
<p>Instead, <a href="https://doi.org/10.1097/GCO.0b013e3282efdc0b">research shows</a> that programs that provide accurate information in a nonjudgmental way about abstinence, contraception and STI prevention work better, particularly if they also promote communication, decision-making and <a href="https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/human_rights_vol35_2008/human_rights_summer2008/hr_summer08_kantor/">negotiation skills</a>. </p>
<p>These same programs could also add information about preventing the spread of COVID-19 while sexually intimate.</p>
<figure class="align-center ">
<img alt="A young woman on her bed is looking at her smartphone." src="https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432538/original/file-20211118-28-1i2jhps.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">By accessing COVID-19 test results via smartphone, students can easily share them with their intimate partners.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-in-bed-texting-on-phone-royalty-free-image/1311283313?adppopup=true">martin-dim/E! via Getty Images</a></span>
</figcaption>
</figure>
<h2>How schools can help</h2>
<p>Instead of ignoring the issue, university administrators should make sure students have the tools they need to avoid both COVID-19 and STIs. </p>
<p>For example, with just their smartphones, students can easily <a href="https://www.studenthealth.ucla.edu/services/covid-19-testing">schedule COVID-19 tests</a>, get the results and then share them with those they are intimate with. The same can be done with <a href="https://doi.org/10.1007/s10461-019-02718-y">STI, HIV</a> and pregnancy results. </p>
<p>Sharing those results with respect for confidentiality requires widespread promotional campaigns to normalize this new behavior. Schools or campus-based student organizations could ignite a trend on Twitter with a simple but memorable slogan. Here’s one we suggest: “Show me yours and I’ll show you mine.” That’s one of many Twitter-friendly lines that would encourage students to exchange electronic health records. </p>
<p><a href="http://95.138.156.120/article/06/01/2021/UC-San-Diego-offers-students-COVID-test-kits-by-vending-machine">Some campuses</a> already have vending machines <a href="https://newscenter.sdsu.edu/sdsu_newscenter/news_story.aspx?sid=78531">that contain free COVID-19 self-test kits</a>. Results are sent to students electronically. At UCLA, the self-test kits are placed near <a href="https://healtheducation.ucla.edu/what-we-offer/programs/bruin-love-station">sexual health vending machines</a>, which are stocked with condoms, lubricant, emergency contraception and other reproductive and sexual aids. </p>
<h2>Learning to interact again</h2>
<p><a href="https://doi.org/10.18865/ed.30.2.261">Communication between students</a> is critical, particularly when sharing intimate information. But after 18 months away from campus because of COVID-19, some have experienced <a href="https://doi.apa.org/fulltext/2021-00489-001.html">serious social and emotional impacts</a>. For many, peer-to-peer communication skills have declined. This awkwardness makes it particularly difficult when discussing sensitive subjects. </p>
<p>Again, the school can help. One way is to offer students breakout sessions in small groups. This could be done in-class or as extracurricular assignments. Either approach gives <a href="https://www.premiumschools.org/social-anxiety-disorder-college/">socially anxious students</a> – or those recovering from COVID-19 isolation – the outlet they need to interact in person with others. </p>
<h2>How parents can help</h2>
<p>Young people have been bombarded with sexual misinformation from both peers and media. But studies show that intergenerational communication about sexual activity can reduce <a href="https://doi.org/10.1542/peds.2015-0305">risky sexual behaviors</a>. And while sexual health education is <a href="https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm">effective at reducing unwanted outcomes</a>, it’s enhanced when <a href="https://doi.org/10.1016/j.pcl.2016.11.002">parents are involved</a>. </p>
<p>With the widespread impact of COVID-19, now is a great time to <a href="https://eisnerfoundation.org/">bring parents into the conversation</a>. But they are often an underutilized resource. Many haven’t had sexual health education themselves, they may not know what’s appropriate to share with their children and they may simply be <a href="https://doi.org/10.1016/j.pcl.2016.11.002">uncomfortable with sex topics</a>. </p>
<p>We are still in a time of considerable ambiguity, mistrust and confusion. That applies to both COVID-19 and sexual health. But there is one certainty: Young people need responsible adult guidance to secure a healthy future. And the sooner the better. In the grip of a pandemic, their lives may depend on it.</p><img src="https://counter.theconversation.com/content/170852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamra Burns Loeb receives funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Gail Wyatt, Phd works at University of California, Los Angeles(UCLA). She receives funding from National Heart, Lung, and Blood Institute of the National Institutes of Health, Cal Wellness Foundation, and Gilead Pharmaceutical Sciences. </span></em></p><p class="fine-print"><em><span>Michele R. Cooley-Strickland is the co-principal investigator of a grant with pending funding from the Eisner Foundation at UCLA. The title of the grant is "Plan A: Intergeneration STI, HIV, and Pregnancy Prevention – ‘Sex, Cookies, & COVID’.”</span></em></p>Schools have not adequately educated students about the increased risks of virus transmission when it comes to being sexually intimate.Tamra Burns Loeb, Adjunct Associate Professor, Department of Psychiatry and Biobehavioral Sciences, University of California, Los AngelesGail Wyatt, Dena Bat Yaacov Endowed Chair and Distinguished Professor of Psychiatry & Biobehavioral Sciences, University of California, Los AngelesMichele R. Cooley-Strickland, Project Scientist and Clinical Psychologist, Department of Psychiatry and Biobehavioral Sciences, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655582021-08-25T15:11:49Z2021-08-25T15:11:49ZOlder adults hesitate to talk about their sexual health – here’s why it’s a big deal<figure><img src="https://images.theconversation.com/files/414801/original/file-20210805-17-18putp3.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"> kupicoo/GettyImages</span></span></figcaption></figure><p>Globally, older people’s voices and experiences tend to be left out of discussions on sexual health and well-being. Their sexual health needs are stereotyped as insignificant beyond the reproductive periods of life. Yet sexual activity is, of course, happening among older adults and between older and younger adults – making them vulnerable to sexually transmitted infections. </p>
<p>Where access to <a href="https://apps.who.int/iris/handle/10665/251713">essential sexual health services</a> is limited – as in many countries in Africa – this vulnerability is a concern.</p>
<p>Research around <a href="https://pubmed.ncbi.nlm.nih.gov/31495889/">sexually transmitted infections (STIs)</a> in adults older than 50 is growing gradually, with <a href="https://journals.lww.com/co-infectiousdiseases/FullText/2013/02000/Sexually_transmitted_infections_in_older.12.aspx">evidence</a> of new cases and delays in diagnosis. The evidence also predicts a future increase in cases among older adults in developed and developing countries. Some <a href="https://pubmed.ncbi.nlm.nih.gov/29553175/">evidence</a> has already confirmed that older adults in African countries are vulnerable to new cases of sexually transmitted infections. Gonorrhoea, syphilis and HIV are at the top of the list. </p>
<p>Despite the emerging evidence, sexually active older adults are confronted with systemic, cultural and individual barriers in accessing the services they need. And it starts with a conversation on their sexual health. Among the barriers are the stigma around contracting STIs, poor attitudes of health professionals and unavailability of age-appropriate health services. </p>
<p>Existing <a href="https://pubmed.ncbi.nlm.nih.gov/29553175/">research</a> shows a lack of strategies to promote open communication on sexual health needs in African countries. In addition, there is little contextualised research on the unmet need for sexual health communication in later life. </p>
<p>Our <a href="https://isaconf.confex.com/isaconf/forum2020/meetingapp.cgi/Paper/132888">research</a> sought to identify some of the common sexual health needs and concerns among older adults in Nigeria. We also explored barriers to communicating these needs and how these barriers could be removed. </p>
<p>We found that older adults and their healthcare providers are sometimes overwhelmed by other health needs. Conversations on their sexual health needs are relegated to the background. Tensions and contradictions around personal beliefs, subjective well-being, cultural expectations and health system responsiveness also emerged as critical constraints. </p>
<h2>Sexual health needs and concerns</h2>
<p>We conducted 16 focus group discussions with adults over the age of 50 in two cities (Ibadan and Lagos) in Nigeria. We used a story about sexual behaviours in old age within the Yoruba cultural context to stimulate the discussion. The aim was to explore how older adults conceived of sexual health concerns and shared them with their peers and those they felt could be of help or support to them.</p>
<p>Participants’ sexual health concerns differed by gender. </p>
<p>Most men were concerned with the use of their penises for sexual activities. They were interested in enhancing their sexual pleasure and that of their partners during sex. In their view, any decline in the functioning of the penis in old age was a serious concern. Erectile difficulties, low libido, premature ejaculation, and slower arousal were common concerns among older males.</p>
<p>Women were more conscious of the changes to their bodies and the need to adjust accordingly. The female participants believed that their bodies were fragile and unable to cleanse themselves, which could lead to illnesses. Some felt sexual intercourse should be minimal in old age because of perceived consequences such as developing fibroids and the likelihood of contracting a sexual infection. The women were also concerned about vaginal dryness, vaginal bleeding, STIs, and low sexual urge.</p>
<p>Stigma and name calling dissuaded older women from sharing their sexual concerns. Often, they preferred talking about menopausal issues. In this sense, older females believed that low sexual desire and disengagement were signs of “sexually ageing well”. </p>
<p>Participants spoke about how they discussed sexual concerns with nurses. Here too there were differences between men and women. </p>
<p>Women acknowledged that they could get help from healthcare providers but preferred to ignore their problems. </p>
<p>Men preferred to express their sexual health concerns and seek help or solutions from restricted spaces, such as private rooms in health facilities or one-on-one interaction with their physicians. Older men were worried about losing their social respect. The believed they would be labelled as perverse if they decided to open up about their sexual health concerns during hospital visits. </p>
<p>Older males compared notes with peers and close associates on sexual performance. Such conversations sometimes provided cues on medical and non-medical measures that could stimulate sexual desire and enhance their sexual performance. A few older female adults expressed unwillingness to share their sexual concerns with their peers. </p>
<p>In some ways, both women and men appeared willing to share their sexual health concerns with others. However, they emphasised “trust” and “safe spaces” for discussion as major considerations.</p>
<p>The participants said they did have sexual health concerns – including how to satisfy partners sexually. But they felt constrained from sharing these concerns openly with nurses, physicians or relatives. Spaces to seek care, and opportunities to discuss such needs, are limited.</p>
<p>There is a need for social campaigns around sexual health communication to make it easier for older people to talk about it.</p>
<h2>Opening up the conversation</h2>
<p>Studies on <a href="https://pubmed.ncbi.nlm.nih.gov/31495889/">sexual health communication</a> among older adults are urgently needed. Healthcare providers and systems must be able to act on emerging sexual health needs and diseases.</p>
<p>The need is partly being shaped by the risk of reversing the gains achieved made in addressing STIs among young people. Dating and sexual activity takes place between age groups. </p>
<p>Counselling, testing, and treating everyone without bias or discrimination is a cardinal <a href="https://www.who.int/hiv/pub/progressreports/2016-progress-report/en/">strategy</a> in mitigating the stigma attached to STIs and achieving age-friendly <a href="https://pubmed.ncbi.nlm.nih.gov/31495889/">sexual healthcare services</a>.</p><img src="https://counter.theconversation.com/content/165558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ojo Melvin Agunbiade receives funding from the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No – B 8606.R02), Sida (Grant No: 54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z). The statements made and views expressed are solely the responsibility of the Author.
He is affiliated with the Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. </span></em></p>In a Nigerian study, both women and men emphasised “trust” and “safe spaces” when discussing sexual health.Ojo Melvin Agunbiade, Senior lecturer, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1573182021-03-18T01:32:42Z2021-03-18T01:32:42ZWhat is Mycoplasma genitalium, the common STI you’ve probably never heard of<figure><img src="https://images.theconversation.com/files/390232/original/file-20210317-21-14e4lym.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-man-hands-holding-his-crotch-769304695">from www.shutterstock.com</a></span></figcaption></figure><p><em><a href="https://www.fpv.org.au/for-you/sexually-transmissible-infections-blood-borne-viruses/mycoplasma-genitalium">Mycoplasma genitalium</a></em> (MG) is a sexually transmitted infection (STI) with many of the hallmarks of its better-known counterpart, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chlamydia">chlamydia</a>.</p>
<p>You can have MG without knowing it, or have symptoms; it can affect men and women, and it can be treated with antibiotics. </p>
<p>However, unlike chlamydia, we only have a limited number of antibiotics to treat it, due to a quirk in its cellular structure and the growing threat of antibiotic resistance. The antibiotics we need to use with resistant MG can also, uncommonly, have serious side-effects.</p>
<p>Here’s what you need to know about this common STI.</p>
<h2>What is it? How do I get it? How common is it?</h2>
<p>MG can affect both men and women, and is passed from person to person via their body fluids when they have sex. That can be via penile-vaginal sex or via penile-anal sex. Transmission via oral sex isn’t thought to be a big factor.</p>
<p>Several studies tell us MG is common, perhaps as common as chlamydia.</p>
<p>UK and US <a href="https://pubmed.ncbi.nlm.nih.gov/26534946/">data</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33560093/">show</a> 1-2% of the adult population have it (making it about <a href="https://pubmed.ncbi.nlm.nih.gov/31794495/">as common as chlamydia</a>), and it is as common in men as in women. </p>
<p>In research yet to be published, when we tested women who walked through the door of our sexual health service in Melbourne, 6% had MG, which was as common as chlamydia (7%) in women in the same study. Of women with MG, roughly the same number had symptoms compared to no symptoms. When we tested <a href="https://pubmed.ncbi.nlm.nih.gov/30882306/">gay men without symptoms</a> who attended our service, 10% had MG.</p>
<p>However, we’re not entirely sure how many people are infected with MG throughout Australia. That’s because Australia has yet to set up a formal surveillance network (we’re in the middle of setting that up at the moment). MG is also not a notifiable disease yet. That means doctors or laboratories don’t have to tell health authorities when they have a case.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mycoplasma genitalium, as 3D rendered image" src="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mycoplasma genitalium is a sexually transmitted infection that affects men and women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-mycoplasma-genitalium-3d-illustration-causative-1415788364">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>How do I know if I have it?</h2>
<p>If you do have symptoms, these can resemble those of chlamydia. So the best thing is to go to your GP or sexual health clinic for a checkup, as the treatments are different.</p>
<p>If you’re a man with symptoms, they can vary from mild to moderate and include:</p>
<ul>
<li><p>mild irritation, an itch, or a burning sensation when urinating</p></li>
<li><p>a penile discharge, which may be clear or more like pus.</p></li>
</ul>
<p>For women, symptoms may include:</p>
<ul>
<li><p>a vaginal discharge</p></li>
<li><p>bleeding or pain with sex</p></li>
<li><p>abdominal pain (which may be a sign of <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid">pelvic inflammatory disease</a>).</p></li>
</ul>
<p>For men or women who have anal sex, symptoms may include:</p>
<ul>
<li>an itch or pain inside the anus, anal discharge and sometimes anal bleeding.</li>
</ul>
<p>Your doctor will take a urine sample for men and a vaginal swab for women. For men or women who have anal sex, they will take a rectal swab, or you will be instructed how to take it yourself. Samples will then be sent for laboratory testing.</p>
<h2>How is it treated?</h2>
<p>Once diagnosed, you’ll be treated with a course of oral antibiotics for about two weeks. Unfortunately, you may need several courses to cure the infection due to <a href="https://pubmed.ncbi.nlm.nih.gov/32622378/">increasing antibiotic resistance</a>. And some of these antibiotics can have side-effects. Occasional, but serious, side-effects include an abnormal heart rhythm, rupture of tendons and nerve damage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-im-taking-antibiotics-when-will-they-start-working-107528">Health Check: I’m taking antibiotics – when will they start working?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens if I leave it untreated?</h2>
<p>If the infection is left untreated in women, it can cause similar complications to chlamydia. Some women go on to develop <a href="https://pubmed.ncbi.nlm.nih.gov/32701123/">pelvic inflammatory disease</a>, although less commonly than with chlamydia. Pelvic inflammatory disease could, in turn, lead to infertility. If you’re pregnant, it can, uncommonly, lead to premature birth or miscarriage.</p>
<p>If left untreated in men there are no apparent complications but the main risk is men can infect new partners and reinfect treated partners. And for gay men, there’s <a href="https://pubmed.ncbi.nlm.nih.gov/19194271/">some data</a> to suggest a link between MG and HIV, although further studies are needed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
</strong>
</em>
</p>
<hr>
<h2>Can I still be tested even if I don’t have symptoms?</h2>
<p>Current guidelines both <a href="http://www.sti.guidelines.org.au/sexually-transmissible-infections/mycoplasma-genitalium">in Australia</a> and <a href="https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/mycoplasma-genitalium-2018/">internationally</a> recommend testing people with symptoms, or sexual contacts of known cases. They <a href="https://www.thelancet.com/action/showPdf?pii=S2589-5370%2821%2900059-6">don’t recommend doctors screen</a> people <a href="https://www.theguardian.com/australia-news/2021/mar/17/gps-urged-not-to-test-gay-men-for-sti-super-bug-over-fears-it-will-become-more-antibiotic-resistant">without symptoms</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1371870337932132352"}"></div></p>
<p>When you screen, you have to be confident you have access to highly effective treatments, the treatments do not cause more harm than the condition itself and you have a good understanding of how often the condition progresses to cause complications.</p>
<p>For MG that balance is against screening currently. That’s because there are often no symptoms and we don’t yet fully understand how often the infection progresses to cause harm, although it seems to do so less often than chlamydia. The microorganism has also rapidly become so resistant to antibiotics we are having to use stronger and stronger ones, and multiple courses, to cure. This contrasts to chlamydia, which is easy to cure. </p>
<p>Not only do many antibiotics have side-effects, they affect the bacteria in people’s gut. These bacteria are important to keep us healthy, and if we bombard them with antibiotics it can affect our health and also lead to antibiotic resistance in a whole range of other bacteria, not just MG.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-know-why-bacteria-become-resistant-to-antibiotics-but-how-does-this-actually-happen-59891">We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/157318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Bradshaw receives funding from the NHMRC and ARC (government funding). Melbourne Sexual Health Centre has also received research support from Speedx Pty Ltd and Hologic Pty Ltd which are manufacturers of diagnostic assays for Mycoplasma genitalium. </span></em></p>You can have this STI without knowing it, or have symptoms, it can affect men and women, and it can be treated with antibiotics. Left untreated, it may cause complications.Catriona Bradshaw, Professor, Head of Research Translation and Head of the Genital Mycoplasma and Microbiota Group, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1503932020-12-06T09:56:17Z2020-12-06T09:56:17ZChildhood sex education reduces risky sexual behaviour: a Nigerian case study<figure><img src="https://images.theconversation.com/files/370782/original/file-20201123-23-3qldkd.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">Getty Images</span></span></figcaption></figure><p>The World Health Organisation has marked significant <a href="https://www.who.int/news/item/03-02-2020-the-changing-world-of-adolescent-sexual-and-reproductive-health-and-rights">improvements</a> in some aspects of adolescent sexual and reproductive health. Young people are having their first sexual encounters at a later age and are more likely to use condoms. But HIV infections in this age group are not decreasing and sexually transmitted infections remain high. </p>
<p>The World Health Organisation defines an adolescent as a person between the ages of <a href="https://www.who.int/southeastasia/health-topics/adolescent-health#:%7E:text=WHO%20defines%20'Adolescents'%20as%20individuals,age%20range%2010%2D24%20years.">10 and 19</a>. Adolescents make up <a href="https://www.unicef.org/infobycountry/Nigeria_statistics.html">22.3%</a> of Nigeria’s population. The country is home to <a href="https://www.ajol.info/index.php/afrij/article/view/94553">a third of all adolescents</a> on the continent. This is why any study on how to prevent risky health behaviours is important for the country’s future health. </p>
<p><a href="http://article.sapub.org/10.5923.j.ajmms.20170701.01.html">In Southeastern Nigeria alone</a>, the prevalence of sexually transmitted infections among adolescents has been placed at 17%. In addition, 32.5% of all unsafe abortions in this region are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071748/">among adolescents</a>. The prevalence of sexually transmitted infection and HIV among <a href="https://pubmed.ncbi.nlm.nih.gov/23133697/">adolescents in Nigerian universities</a> is high. This is due to high-risk sexual behaviours like unprotected sexual intercourse and multiple sexual partners. </p>
<p>Research has shown that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584331/">sex education</a> can help address risky sexual behaviour. It can also reduce teenage pregnancies as well as sexually transmitted infections and HIV. Access to sex education gives young people the opportunity to learn about their sexuality, sexual activity, safe sex and sexual abstinence. The knowledge equips them to make sensible sexual decisions. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584331/">But young people</a> in Nigeria rarely have free access to information about their sexuality. As a result, most find answers from questionable sources, which exposes them to even greater risks. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1877042815055573">Parents have the primary role</a> of educating their children about their sexuality. But cultural beliefs and taboos about sex can work strongly against their efforts. Another challenge is that even when the subject is approached, emphasis is often on abstinence-only sex education. </p>
<p>We conducted <a href="https://www.panafrican-med-journal.com/content/article/37/188/full/#sec7">a study</a> among young undergraduates at four Nigerian universities. The aim was to find out what type of sex education they were exposed to in childhood and how that influenced their sexual behaviour as university students. </p>
<p>We found that the rate of risky sexual behaviour differed among adolescents based on the type of sex education they received in childhood. The more information they were given by their parents, the less risky behaviour they engaged in.</p>
<h2>The views of adolescents</h2>
<p>We conducted qualitative research that involved collecting data from 24 adolescent undergraduate students in four universities located in Southeastern Nigeria. The <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1467-8551.12182">number of participants</a> is considered appropriate for a study of this nature.</p>
<p>The participants were within the 16 – 19 years age range. We focused on adolescent undergraduates who were separated from their parents or guardian and were staying either on or off campus. </p>
<p>Often, this group has greater autonomy, which could mean more opportunity to engage in sexual activity. </p>
<p><a href="https://www.panafrican-med-journal.com/content/article/37/188/full/#sec7">Our data</a> showed that most students who received abstinence-plus sex education reported consistent condom use, complete abstinence or one sexual partner. </p>
<p>We concluded from this that the fact that parents spoke to their children about contraceptives like condoms and the risks associated with multiple sexual partners was important for the child’s sexual experience as they grew older.</p>
<p>Our findings also showed unprotected sex and multiple sexual partners were much more prevalent among adolescents who were not exposed to quality sex education in early adolescence. </p>
<p>This was also true of adolescents whose parents were religious and authoritative and did not teach sex education during early adolescence. In addition, students who received abstinence-only sex education engaged in unprotected sex and multiple sexual partners.</p>
<p>Students raised in rural areas indulged in unprotected sex because of limited access to sex education during early adolescence. </p>
<p>These groups described the university as an environment to do most of what they were prevented from doing at home.</p>
<h2>What to do</h2>
<p><a href="https://www.jstor.org/stable/585623?seq=1#metadata_info_tab_contents">The important role</a> of parents when it comes to sex education has been shown in a range of research around the world. But sex education must happen at an early age. In addition it must be comprehensive enough to cover knowledge on contraception, and the consequences of multiple sexual partners and sexual initiation at a young age.</p>
<p><a href="https://www.panafrican-med-journal.com/content/article/37/188/full/#ref23">Mothers, unlike fathers</a>, are more available to educate their children about sex. But there is a need for both parents to see sex education as a joint activity and not the sole responsibility of mothers.</p>
<p>Programmes to improve the communication skills of parents should be organised. This has the potential to improve children’s sexual development.</p><img src="https://counter.theconversation.com/content/150393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents have the primary role of educating their children about their sexuality. But cultural beliefs and taboos about sex can work strongly against their efforts.Aloysius Odii, Lecturer, University of NigeriaNkechi G. Onyeneho, Researcher, University of NigeriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1334152020-08-18T19:46:17Z2020-08-18T19:46:17ZCondoms are the best defence against rising sexually transmitted infections<figure><img src="https://images.theconversation.com/files/353488/original/file-20200818-16-1v7faxy.jpg?ixlib=rb-1.1.0&rect=0%2C1056%2C6709%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clear and accurate information about condoms and sexually transmitted infections is one of the best tools to avoid sexual health risks.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Rates of sexually transmitted infections in Canada have increased dramatically over the past decade, despite earlier public health and sexuality education interventions that reduced the rate of sexually transmitted infections (STI). Between 2008 and 2017, the rates of <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-sexually-transmitted-infections-canada-2017.html#f23">chlamydia increased 39 per cent, gonorrhea 109 per cent and infectious syphilis 167 per cent, according to the Public Health Agency of Canada</a>. </p>
<p>A variety of factors has contributed to the increase, such as changing societal and cultural norms, barriers to accessing condoms and changes in diagnostic and screening practices. </p>
<p>Although PHAC tracks STIs, it doesn’t track the most important tool we have in preventing the spread of STIs: condom use. Instead, occasional government surveys and university-based research fill the gaps. People may not be using condoms at the same rate as before, but it is difficult to know for sure because there is a lack of data. </p>
<p>As sociologists of sexualities, we collected data on condom use as a part of a larger, first-of-its-kind study on sex and sexuality in Canada. Our findings show that about <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228981">one-third of adult Canadians who engaged in penile-vaginal intercourse during their sexual encounters used condoms</a>. One survey can’t track changes over time, but it can be an important piece of the puzzle of understanding who uses condoms, in what types of sexual encounters they are used, and why. </p>
<h2>Sex in Canada study</h2>
<p>Younger adults use condoms more often than older Canadians, even when accounting for other demographic characteristics: 42 per cent of 19- to 29-year-olds used condoms in their most recent sexual encounters, compared to 31 per cent of 30- to 49-year-olds and 19 per cent of 50- to 64-year-olds. Seniors (65 and older) were the least likely to use condoms: 11 per cent.</p>
<p><a href="https://theconversation.com/older-people-still-have-sex-but-its-the-intimacy-and-affection-that-matters-more-70196">Seniors are often thought of as non-sexual</a>, but they continue to be sexually active. They may not, however, <a href="https://theconversation.com/think-teens-need-the-sex-talk-older-adults-may-need-it-even-more-103815">have access to the information about condoms and safer sex that young people have in school</a>. Older adults should use condoms to protect themselves from STIs, but not enough research, resources or public policy initiatives are encouraging safer-sex practices within this group.</p>
<p>We find that condom use is also higher (31 per cent) among those with university degrees compared those without (22 per cent). These institutions may be offering effective sexual health education and initiatives, such as providing free and easy access to condoms, which may lead to increased condom use among graduates.</p>
<p>Our results also suggest that when people use other forms of birth control, condom use decreases. This may be because pregnancy prevention is a greater concern for Canadians than avoiding STIs, or that sex education does not focus sufficiently on STI prevention. </p>
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Read more:
<a href="https://theconversation.com/fun-sex-is-healthy-sex-why-isnt-that-on-the-curriculum-81020">Fun sex is healthy sex: Why isn't that on the curriculum?</a>
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<p>Last, we find that informal and formal sexual health education is associated with increased condom use. This includes men who learn about condoms formally, such as through school-based sex education, or informally, such as through friends or the internet. Women’s increased condom use was only associated with formal sex education during middle and high school. Without formal sex education that covers condom use, women may be more at risk of STIs.</p>
<p><a href="http://educ.queensu.ca/sites/webpublish.queensu.ca.educwww/files/files/Research/SPEG/SPEG%20Canadian%20Youth%2C%20Sexual%20Health%20and%20HIV.pdf">Sex education advocates and public health experts consistently report</a> that clear and accurate information about condoms and sexually transmitted infections is one of the best tools to avoid sexual health risks. Our findings give credence to those experts who have advocated for increased sex education curriculum in schools. </p>
<h2>More data needed</h2>
<p>Keeping sexually transmitted infection rates low is an important public health goal. For example, PHAC recently launched a <a href="https://www.canada.ca/en/public-health/services/reports-publications/accelerating-our-response-five-year-action-plan-sexually-transmitted-blood-borne-infections.html">five-year action plan</a> to monitor sexually transmitted and blood-borne illnesses. Although condom use cannot prevent the transmission of STI’s in all types of sexual encounters, they are an important prevention tool. Our study focused on penile-vaginal sex, but <a href="https://www.healthline.com/health/lgbtqia-safe-sex-guide#Overview">many other groups, sexual pairings and sexual activities would benefit from using condoms</a>.</p>
<p>Even though condom use is a key part of the plan to reduce STI transmission, measuring it has not been. We should know whether Canadians’ use of condoms is increasing or decreasing over time, and the best way to get that data is to include questions on condom use every year on annual surveys like the <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs.html">Canadian Community Health Survey</a>.</p>
<p>Our research also emphasizes the need for more data on people’s attitudes about condoms, their knowledge of proper condom use and the conditions that promote or inhibit the use of condoms. Future research should assess the implications of sex education curricula on young adults’ use of and perspectives about condoms, access to ongoing sexual health education and age-specific resources, and gendered attitudes and beliefs about negotiating condom use during partnered sex between men and women.</p><img src="https://counter.theconversation.com/content/133415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was supported by Social Sciences and Humanities Research Council of Canada Insight Grant 435-2017-0369: Tina Fetner (PI), Michelle Dion (co-I) and Melanie Heath (co-I).
</span></em></p><p class="fine-print"><em><span>Nicole Andrejek 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>People may not be using condoms at the same rate as before, but it is difficult to know for sure because there is a lack of data.Nicole Andrejek, Research Assistant, Sociology, McMaster UniversityTina Fetner, Associate Professor, Sociology, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1183372019-06-10T20:08:08Z2019-06-10T20:08:08ZAround half of 17-year-olds have had sex and they’re more responsible than you think<figure><img src="https://images.theconversation.com/files/278261/original/file-20190606-2772-1u2sa6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia's teens get their sexual information from a variety of sources and seem to know a lot about STIs.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/plTEYtXwXok">Kevin Laminto/Unsplash</a></span></figcaption></figure><p>Just under half of year 10 to 12 students have had sex, according to research <a href="http://www.teenhealth.org.au">released today</a>. </p>
<p>They know more about sexually transmitted infections (STIs) than you might think and are using a variety of sources for their sexual health information.</p>
<p>But there’s room to improve condom use and STI testing for sexually active teens.
Only 13% of all those surveyed thought they were likely to get an STI.</p>
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Read more:
<a href="https://theconversation.com/good-sex-ed-doesnt-lead-to-teen-pregnancy-it-prevents-it-60036">Good sex ed doesn't lead to teen pregnancy, it prevents it</a>
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<p>In 2018, we surveyed 6,327 secondary students in years 10 to 12 from across Australia in all kinds of schools, for the Sixth National Survey of Secondary Students and Sexual Health.</p>
<p>We asked them a range of questions about their sexual health. These included where they turned to for information about sexual health, and how often. We asked if they liked their sex education. And yes, we asked about their sexual activity, or lack of it.</p>
<p>All up, 47% of students told us they had sex – defined as vaginal and/or anal intercourse regardless of the gender of the partner. </p>
<p>That might sound a lot. But rest assured, it was age-dependent. Year 10s were much less likely to have had sex yet (34% had ever had sex) compared to year 11s (46%) and 12s (56%).</p>
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Read more:
<a href="https://theconversation.com/do-i-need-to-shave-my-pubic-hair-before-having-sex-114614">'Do I need to shave my pubic hair before having sex?'</a>
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<p>Recent US reports suggest <a href="https://www.theatlantic.com/magazine/archive/2018/12/the-sex-recession/573949/">teens are having less sex</a> than they used to. The US Centers for Disease Control found between 1991 and 2017 the percentage of students who’d had intercourse dropped from 54% to 40%.</p>
<p><a href="http://www.publish.csiro.au/SH/SH14113">In Australia</a> since 2012, the rate has dropped 3% from 50%, which is within the margin of error, meaning there might be no actual decline.</p>
<p>The average age at which students had begun engaging in various sexual activities ranged from 13 for masturbation to 15 for mutual touching and oral sex. </p>
<p>The average age for the 47% who had experienced sexual intercourse in our survey was about 16 years old. This is slightly lower than other researchers <a href="http://www.publish.csiro.au/SH/SH14113">have found</a>. But our survey results may not represent Australian teens as a whole.</p>
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<a href="https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/278266/original/file-20190606-2750-1v8bek1.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"></a>
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<span class="caption">Of teens who were sexually active, most were in a relationship or had a partner about the same age.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/6mRo659CPmM">Japheth Mast/Unsplash</a></span>
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<p>Of those who were sexually active, most (76%) were having sex in their homes, in a relationship (65%) or with a partner about the same age as them (86%). </p>
<p>They largely reported responsible behaviours. These included discussing having sex (81%) beforehand and protecting their health (77%). They used condoms (56%) and/or the pill (41%).</p>
<p>In short, teens in Australia are doing pretty well in relation to sex. And this isn’t new: the findings echo what has been seen in previous versions of the same survey over the past 25 years.</p>
<h2>How about unwanted sex?</h2>
<p>We also continue to find about a quarter (28%) reported some kind of unwanted sex at some point in their lives. </p>
<p>“Unwanted” means very different experiences for different people. A quarter (23%) of those reporting unwanted experiences wrote in comments. Many suggested it was a sense of “meh” or “just wasn’t really into it at the time”. But they provided no indication of regret.</p>
<p>While the survey did not ask about rape or sexual assault, slightly less than 1% of all participants did write explicitly about such experiences.</p>
<p>Despite this, we found 93% wanted their last sexual encounter. Overall, 85% indicated they felt extremely good and happy about their last experience and fewer (less than 20%) reported feeling upset, worried or guilty. </p>
<p>Shifts in school-based sex education to include a greater emphasis on relationships and skills in communication might, in part, explain the good sex teens are reporting.</p>
<h2>How about smartphones and sexting?</h2>
<p>Some things have changed, like using the internet to find sexual health information. That’s almost double what was reported in 2013 (44% then, 79% now). This isn’t surprising, given the pervasiveness of the internet today – 88% did the survey on an internet-enabled mobile device.</p>
<p>Rates of sexting seemed to have gone down by about 3% across each of the specific behaviours asked about. Overall about a third of students had engaged in some form of sexting. For those who were sexting, it was mostly with a partner or friend and only a few times in the previous two months.</p>
<h2>Good marks, but room for improvement</h2>
<p>So when it comes to sex and sexual health, Australia’s students are receiving pretty good marks. But there is room to continue improving.</p>
<p>The levels of reported unwanted sex, and the complexity of it, suggest a more nuanced approach may be warranted. Talking to teens about unwanted sex could expand beyond rape, sexual assault and issues of consent to cover communicating about desires and pleasure in a relationship leading to hopefully less “meh”.</p>
<p><a href="https://kirby.unsw.edu.au/report/hiv-viral-hepatitis-and-sexually-transmissible-infections-australia-annual-surveillance">Rates of STIs</a> among young people suggest there is room to improve condom use and testing among sexually active teens. Only 13% thought they were likely to get an STI.</p>
<p>Luckily, Australian teens are having healthy conversations with partners, part of realising a happy, healthy and pleasurable sex life.</p>
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Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
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<img src="https://counter.theconversation.com/content/118337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher M Fisher receives funding from the Commonwealth Department of Health. </span></em></p>Australia’s year 10-12 students are getting good marks when it comes to sexual health, according to new research out today. But there’s room for improvement.Christopher M Fisher, Associate Profressor in Young Peoples Sexual Health & Sex Education, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1136672019-03-19T14:11:52Z2019-03-19T14:11:52ZPasha 11: Sexually transmitted infections in South Africa<figure><img src="https://images.theconversation.com/files/264131/original/file-20190315-28468-rrcidq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>South Africa has had to focus heavily on the fight against HIV and AIDS given the country’s high infection rates. As a result, sexually transmitted infections have often been ignored. </p>
<p>In this episode, Tendesayi Kufa-Chakezha – an epidemiologist and public health specialist at the country’s National Institute for Communicable Diseases – takes us through why it’s so important for people to get over the stigma of talking about sexually transmitted infections, and to make sure they get treatment. </p>
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Read more:
<a href="https://theconversation.com/preventing-sexually-transmitted-infections-why-south-africa-isnt-winning-111546">Preventing sexually transmitted infections: why South Africa isn't winning</a>
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<p><strong>Photo:</strong>
Orawan Pattarawimonchai
Condoms package on yellow pink background. A condom used to reduce the probability of pregnancy or sexually transmitted disease (STD). Safe sex and reproductive health concept. <a href="https://www.shutterstock.com/image-photo/condoms-package-on-yellow-pink-background-1136235002">Shutterstock</a></p>
<p><strong>Music</strong>
“Happy African Village” by John Bartmann found on <a href="http://freemusicarchive.org/music/John_Bartmann/Public_Domain_Soundtrack_Music_Album_One/happy-african-village">FreeMusicArchive.org</a> licensed under <a href="https://creativecommons.org/publicdomain/zero/1.0/">CC0 1</a>.</p><img src="https://counter.theconversation.com/content/113667/count.gif" alt="The Conversation" width="1" height="1" />
Why it's important South Africa doesn't ignore sexually transmitted infections.Ozayr Patel, Digital EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1115462019-02-13T13:22:47Z2019-02-13T13:22:47ZPreventing sexually transmitted infections: why South Africa isn’t winning<figure><img src="https://images.theconversation.com/files/258722/original/file-20190213-181619-mhgs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">STIs are a serious health threat. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Sexually transmitted infections (STIs) are a serious public health issue. It’s estimated that globally, more than a <a href="https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)">million people</a> are diagnosed with one or more sexually transmitted infections like gonorrhoea, chlamydia or syphilis every day. What’s more concerning is that the prevalence of infection with chlamydia for example, have remained unchanged <a href="https://www.thelancet.com/commissions/sexually-transmitted-infections?dgcid=homepage-tile_banner_STI">over the past 10 years</a> despite better screening in developed countries.</p>
<p>As the name suggests, STIs are spread mainly through sexual contact. This includes vaginal, anal and oral sex; some infections can also be spread by non-sexual means – for example, from mother to child during pregnancy or childbirth. </p>
<p>STIs can have devastating effects on sexual, reproductive and general health. They can also lead to a number of complications. If left untreated chlamydia and gonorrhoea can cause damage to reproductive organs and result in long term complications such as infertility. People can even die if certain STIs such as syphilis are left untreated, or if they have complications such as pelvic inflammatory disease in the case of chlamydia. </p>
<p>To make matters worse, STIs increase the risk of <a href="https://www.catie.ca/en/pif/spring-2012/stis-what-role-do-they-play-hiv-transmission">HIV infection and transmission</a>. This is because the body’s response, which is meant to help fight the sexually transmitted infection, causes a concentration of “activated” immune cells in the infected area. It then becomes easy for HIV to infect and replicate in the immune cells that are “activated”.</p>
<p>So it’s cause for concern that South Africa, with – <a href="http://www.hsrc.ac.za/uploads/pageContent/9234/SABSSMV_Impact_Assessment_Summary_ZA_ADS_cleared_PDFA4.pdf">7.9 million people living with HIV in 2017</a> – also has a high volume of STIs.</p>
<p>In <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205863">2017</a> there were an estimated 2.3 million new cases of gonorrhoea, 1.9 million new chlamydia cases and 23,175 new syphilis cases among women aged between 15 and 49. Among men of the same age there were an estimated 2.2 million new cases of gonorrhoea, 3.9 million new cases of chlamydia and 47,500 new cases of syphilis. </p>
<p>These high numbers of STI cases in South Africa have partly been due to inadequate prevention and treatment gaps. Some people with STIs such as chlamydia, may go untreated because they don’t show any symptoms. </p>
<p>Better STI screening for high risk clients – regardless of symptoms – and better training of healthcare workers is necessary. In addition, structural problems such as limited access to client-friendly STI detection and treatment services need to be addressed. Of course, all of this costs money, which is in short supply. That’s why the need for better prevention cannot be overstated. </p>
<h2>STI prevention in the past</h2>
<p>Prevention of STIs other than HIV has largely taken a backseat while the country focused on HIV prevention. HIV prevention concentrated on reducing the number of sexual partners people have, increasing the correct and consistent use of condoms, early detection and treatment, and promotion of male circumcision. These measures were of some benefit in preventing other STIs. </p>
<p>But the increasing availability of <a href="http://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable">antiretroviral drugs and advances in research</a> have brought a new message to people living with HIV: an HIV positive person with an undetectable viral load can’t transmit the virus to their HIV negative partner. </p>
<p>This message, however, does not directly address the transmission of STIs other than HIV. It focuses on HIV and how to manage it, but forgets that people with HIV may be vulnerable to other STIs. </p>
<p>Pre-exposure prophylaxis – another HIV prevention tool – involves taking antiretroviral medication to prevent HIV infection. <a href="https://prepfacts.org/prep/the-research/">Research</a> has shown that, if taken consistently and as intended, it can reduce the risk of acquiring HIV. But pre-exposure prophylaxis doesn’t protect people from other STIs. </p>
<p>Services to test for and treat STIs are included in pre-exposure prophylaxis services as a way of assessing levels of unprotected sex and sexual risk taking among users. But the take home message about the prevention of STIs in these settings is not clear. What counselling on STIs are pre-exposure prophylaxis clients receiving or should they be receiving? How should pre-exposure prophylaxis be promoted without compromising STI prevention? </p>
<h2>Renewed focus on STI prevention</h2>
<p>Strategies to prevent STIs must take into account the changes and advances in HIV prevention and treatment. Policies must answer a number of questions.</p>
<p>For instance, how can having fewer sexual partners, the correct and consistent use of condoms, the early STI detection and treatment of oneself and one’s partners, and male circumcision be made “fashionable” when HIV is not the death sentence that it used to be? </p>
<p>And what’s the best way to communicate that the knowledge of infections in oneself and the partner are key to preventing both HIV and other STIs? </p>
<p>It’s also important to explore how best to design prevention services that communicate how STIs and HIV happen in the context of transient, short-term or longer relationships. Policy makers need to understand, too, how people can be empowered to form, maintain or terminate relationships in a manner that does not place them in harm’s way with respect to HIV, STIs or intimate partner violence.</p>
<p>All of these issues must be urgently considered if South Africa is to tackle its STI problem as effectively as it’s been able to deal with HIV.</p><img src="https://counter.theconversation.com/content/111546/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tendesayi Kufa-Chakezha 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>STI prevention was largely driven by HIV prevention. With changes in HIV prevention initiatives that don’t really take into account other STIs, there’s need to refocus STI prevention.Tendesayi Kufa-Chakezha, Epidemiologist and Public Health Specialist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/986342018-07-01T08:37:47Z2018-07-01T08:37:47ZUganda’s new sex education framework will do more harm than good<figure><img src="https://images.theconversation.com/files/224442/original/file-20180622-26561-4e32cl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Abstinence campaign posters in Uganda.</span> <span class="attribution"><span class="source">Flickr/Jake Brewer</span></span></figcaption></figure><p>Uganda <a href="http://uganda.unfpa.org/en/news/government-uganda-launches-national-sexuality-education-framework">has launched</a> its first ever guideline on sex education. The National Sexuality Education Framework 2018 aims to provide a formal, national direction for sex education within Uganda’s schools, ensuring that all programmes adhere to the same approach.</p>
<p>The problem is that Uganda’s society holds very traditional values. This is reflected in the country’s policies and laws, like the <a href="https://www.newvision.co.ug/new_vision/news/1338049/president-museveni-signs-anti-gay-law">“anti-Gay law”</a> which came into force in 2014 and criminalises homosexuality. </p>
<p>As a result of this social conservatism, the new sex education framework is based on religious and cultural values that instruct abstinence only teaching. Students are taught the virtue of premarital abstinence and marital faithfulness. They are also taught traditional gender roles for men and women and that masturbation and same-sex sexual relationships aren’t normal. </p>
<p>This formalises what has already been happening. Uganda has taken an abstinence-only approach in schools for a long time. The framework just makes it a matter of national policy. </p>
<p>But it doesn’t fit the reality. Many young people are already sexually active. We know this from the high rate of pregnancies and unsafe abortions in the country. One of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555492/">leading causes</a> of death and disability among young Ugandan women are pregnancy-related. </p>
<p>To understand what policies would make more sense for the sexual and reproductive health of young people, I conducted research among <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2017.1315933">students</a> and sex education <a href="https://www.tandfonline.com/doi/full/10.1080/13691058.2018.1463455">teachers</a> in secondary schools in Kampala, Uganda’s capital, between 2008 and 2013.</p>
<p>My findings confirm that Uganda’s abstinence-only approach is problematic for a number of reasons. It limits students’ choices and it prevents them from trusting, accessing and using contraception. This in turn puts them at a higher risk of pregnancy, sexually transmitted infections and unsafe abortions. </p>
<p>The framework also shelters students from understanding and questioning harmful gender roles and stigmatises students who don’t adhere to society’s morally-accepted norms and values. </p>
<h2>Safe sex strategies</h2>
<p>Uganda has incorporated sex education into primary and secondary schools for over 15 years. It was introduced as one of the <a href="http://allafrica.com/stories/201612070075.html">responses</a> to the HIV/AIDS epidemic, and so focused on prevention. </p>
<p>The government implemented a programme <a href="https://hivhealthclearinghouse.unesco.org/library/documents/piascy-helping-pupils-stay-safe-p5-p7-handbook-teachers">called</a> the Presidential Initiative on AIDS Strategy for Communication to Youth. This programme received a lot of international <a href="https://www.hrw.org/news/2006/02/01/tale-two-presidential-initiatives">criticism</a> for only providing the “abstinence” option to students, as opposed to one which teaches condoms and other contraception use as well. </p>
<p>Because of this, non-governmental organisations also started implementing <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2015.1111203">comprehensive approaches</a> to sex education in Ugandan schools. These aimed to provide positive, accurate and complete information about sexuality and to include discussions about gender, relationships and homosexuality. </p>
<p>When the Ugandan government <a href="http://www.monitor.co.ug/News/Education/At-least-100-schools-tricked-into-teaching-homosexuality/688336-3192576-10r641y/index.html">realised</a> that some of these approaches were teaching homosexuality, it decided to launch the new framework. </p>
<p>But my research shows that this could do more harm than good. Research from elsewhere shows that sex education programmes are <a href="https://powertodecide.org/sites/default/files/resources/primary-download/emerging-answers.pdf">more effective</a> when they promote contraception because it allows young people who are not abstaining to have safe sex. Teenagers need complete, accurate information to protect themselves against unwanted pregnancies and sexually transmitted infections, including HIV. </p>
<h2>Impact of policy</h2>
<p>I conducted in-depth interviews, held focus group discussions and observed lessons with 55 students and 40 teachers. </p>
<p>My findings confirm that Uganda’s moral approach means many students either don’t use contraception or don’t use it properly. This puts them at risk of pregnancy or infection. For instance, some said that they had learned condoms can break easily and that hormonal contraception, like the pill, can make them infertile or have a baby with disabilities. Many indicated that a condom is only 99% safe and that they cannot trust that 1%.</p>
<p>The findings also showed that abstinence-only education does not acknowledge structural factors, like gender and power relations, which make young people feel pressured to live up to gender norms. This could mean they become vulnerable to unsafe sexual practices, such as transactional sex whereby they exchange sex in return for money, gifts or school fees. </p>
<p>As for the teachers, I found that their personal values – and whether they think comprehensive sex education is good for the students or not – isn’t an issue for all of them. Many felt that they were held back by the reality of the school system: certain content cannot be taught, and teachers fear they may lose their job if they deviate from the norm. </p>
<h2>What can be done</h2>
<p>Because the new framework means that morality, justified by culture and religion, will continue to be institutionalised in the schools’ regulations and curricula, teachers will continue with the abstinence-only approach. </p>
<p>This presents a challenge for those working on sex education. They will need to think, and work, outside the box to ensure that young people in countries like Uganda can enjoy their sexual and reproductive health and rights despite conservative policies. </p>
<p>It is possible. In 2014 Burundi <a href="https://www.rutgers.international/news-opinion/news-archive/burundi-embraces-comprehensive-sexuality-education">adopted</a> a national module for comprehensive sex education in schools which meets international standards. <a href="http://cajnewsafrica.com/2014/07/17/burundi-teachers-receive-training-on-sex-education/">Previously</a>, sex and sexuality was a taboo subject, and, like Uganda, contraception was frowned upon. However, reforms in the educational system created opportunities to adopt a more comprehensive approach. This was partially <a href="http://share-netinternational.org/wp-content/uploads/2016/06/agendasettingreport.pdf">driven by</a> Burundi’s “Vision 2025” which flags high population growth as a barrier to long term development. Access to family planning was perceived as one of the key strategies to curb rapid growth.</p><img src="https://counter.theconversation.com/content/98634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Billie de Haas conducted her PhD research in collaboration with Rutgers, the Dutch expertise center for sexual and reproductive health and rights. She is an active member of Share-Net International, knowledge platform for sexual and reproductive health and rights.</span></em></p>Uganda needs to face the reality that many young people are sexually active and need information to protect themselves.Billie de Haas, Assistant Professor of Population Studies, University of GroningenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/931262018-03-14T19:45:21Z2018-03-14T19:45:21ZAn STI epidemic in young people does not signal sexual abuse<figure><img src="https://images.theconversation.com/files/210235/original/file-20180314-131581-1cx9f27.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It isn't helpful to jump to conclusions about child sexual abuse.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/indian-boy-writing-notebook-1042826587?src=1kCSB2W2Dc48kZAlq7bLDQ-6-19">Raj Rabidas/Shutterstock</a></span></figcaption></figure><p>Over the past two weeks, a number of commentators <a href="https://www.theaustralian.com.au/national-affairs/indigenous/aboriginal-leaders-add-their-voices-to-calls-for-abused-children-to-be-removed/news-story/592cd9268f244f58b827287f55c97778">have called for the removal of Aboriginal children</a> with sexually transmissible infections (STIs) from their families. This has resulted from the wrongful conflating of rates of STI notifications with child sexual abuse. It’s important to delineate these two issues. </p>
<p>Young people living in remote Aboriginal communities, especially those aged 15-29 years, <a href="https://kirby.unsw.edu.au/report/aboriginal-surveillance-report-hiv-viral-hepatitis-and-stis-2017">have high rates</a> of STIs such as chlamydia, gonorrhoea and syphilis. But stating all STI cases among young people are related to child sexual abuse isn’t helpful in dealing with either a serious public health matter or the well-being and safety of vulnerable children.</p>
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<em>
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Read more:
<a href="https://theconversation.com/northern-australia-syphilis-outbreak-is-about-government-neglect-not-child-abuse-44597">Northern Australia syphilis outbreak is about government neglect, not child abuse</a>
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<h2>More STIs in Indigenous communities</h2>
<p>In 2016, the rate of chlamydia <a href="https://kirby.unsw.edu.au/report/aboriginal-surveillance-report-hiv-viral-hepatitis-and-stis-2017">notifications among Aboriginal people</a> aged 15 to 29 was 4,602 per 100,000 – compared with 1,479 per 100,000 for their non-Indigenous peers. </p>
<p>For gonorrhoea, this was 1,825 compared with 173. </p>
<p>The rate of <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-infectious-syphilis-outbreak.htm">young Aboriginal people</a> infected with syphilis was 173 per 100,000, compared with 15 per 100,000 in non-Indigenous peers, driven largely by an outbreak occurring over the last six years across northern and central Australia.</p>
<p>The significantly higher notification rates among Aboriginal young people are skewed by the higher numbers in remote areas, where rate differences are even greater.</p>
<p>The reasons for these rates of STI diagnoses are complicated and complex. They include poorer outcomes in many of the social determinants of sexual health: education and health literacy, access to health services, racism (in the form of stigmatising social institutions), income and employment rates. All of these are <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091711">known to be determinants</a> of higher STI rates in populations globally. </p>
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Read more:
<a href="https://theconversation.com/social-determinants-how-class-and-wealth-affect-our-health-64442">Social determinants – how class and wealth affect our health</a>
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<p>STIs are also driven by risk behaviours such as inconsistent condom use, early sexual debut, partner changes and alcohol misuse. A <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/26859805/">recent study</a> of 2,877 young Aboriginal people found the median age of sexual debut to be 15 years – around 50% of the participants had their sexual encounter before, and 50% after.</p>
<p>The same study found most people had sex with similar aged peers. The median number of partners in the last year was one, and inconsistent condom use was common, especially when alcohol and or other drugs were involved. All of this isn’t that different really from non-Aboriginal Australians. </p>
<p>The risk of acquiring an STI in remote Aboriginal communities is also influenced by issues including demographics and mobility. The <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/3235.0">median age of Aboriginal people in Australia</a> is 22 years (a peak time for sexual activity) compared to 36 years for non-Aboriginal counterparts. </p>
<p>Short-term and temporary mobility, especially between remote communities and across borders, also <a href="http://caepr.cass.anu.edu.au/research/publications/move-indigenous-temporary-mobility-practices-australia">peaks in young Aboriginal adults</a>, typically aged 17 to 25. This happens to occur also when young people begin to explore and expand their immediate social networks.</p>
<p>What is different between non-Aboriginal and Aboriginal people living in remote areas is the underlying prevalence of STIs in the latter communities. </p>
<p>Among 16- to 19-year-olds in remote communities, <a href="http://sti.bmj.com/content/89/Suppl_1/A371.3">prevalence has been estimated</a> at 13% for chlamydia and 12% for gonorrhoea. </p>
<p>This compares to prevalence rates of <a href="https://www.mja.com.au/journal/2014/200/3/chlamydia-prevalence-young-attenders-rural-and-regional-primary-care-services">around 3% for chlamydia</a> and way less than 1% for gonorrhoea and syphilis among heterosexual non-Aboriginal people of the same age, living in urban areas of Australia. </p>
<p>With such high prevalences, it’s not surprising young people having consensual sex with each other in remote Aboriginal communities are diagnosed with STIs more often than non-Aboriginal peers in mainstream Australia. </p>
<h2>What about STIs in children and young people less than 16 years?</h2>
<p>A small proportion of STIs reported each year occur in people under 16 years of age. Around 97% of these cases in people aged less than 16 years occur in young people aged 13 to 15 which relate to two issues: early sexual debut with similar aged peers or sexual abuse.</p>
<p>In rare cases, STIs have been detected in those under 12 years of age. According to personal communication with the Northern Territory’s Department of Health, there were five cases in total of either chlamydia or gonorrhoea in 2017. No cases of syphilis were reported in children less than 12 years. All of these cases have been reported and investigated, by the relevant authorities. </p>
<p>Sexual abuse is never acceptable. All of us need to do more to ensure every child and young person in these communities can live in a safe environment. </p>
<p>It has been recently reported by the Northern Territory Police Department that <a href="http://www.abc.net.au/news/2018-02-22/indigenous-groups-urge-government-to-address-tennant-creek-abuse/9473002">around 700 cases of suspected “child sexual offences” </a>have been notified over the last five years in young people aged less than 16 years. </p>
<p>It’s important to note that a large number of these are likely to be the result of mandatory reporting. Mandatory reporting occurs when young people under the age of 16 are known to have a partner with an age gap of more than two years, or where there is any suspicion of sexual abuse, or when a person under the age of 14 is known to be engaging in sexual activity. </p>
<p><a href="https://aifs.gov.au/cfca/publications/mandatory-reporting-child-abuse-and-neglect">Mandatory reporting is required</a> by anyone (parent, teacher, clinician or any other person) who becomes aware of such activity. </p>
<p>Given around half of young people in remote areas have commenced sexual activity before the age of 16, it’s not surprising a significant number of notifications have been reported to authorities. These notifications annually represent around 0.01% of the Aboriginal population in this age group.</p>
<h2>What needs to be done</h2>
<p>As is the case in many remote communities across Australia, there has been a failure to adequately address STIs even in people over the age of 16. Commonwealth, state and territory governments have a responsibility to address these issues holistically with programs that have resonance for young Aboriginal people. </p>
<p>Education, child protection and health departments all have a role to play. More resources are desperately required from Commonwealth, state and territory governments to address this gap in public health. </p>
<p>Further, thinking outside the square to address STIs holistically is required. Building resilience in young Aboriginal people, tapping into the agency that young people already have to reduce risk from STI acquisition, or curbing alcohol through supply reduction measures should be considered as solutions to addressing STIs in remote areas including in larger centres. </p>
<p>A basic principle of any communicable disease outbreak is to quickly respond to diagnose and treat all cases. The ongoing syphilis outbreak and the sustained rates of other STIs in remote Australia, is a case in hand where an urgent public health response is required. </p>
<p>Among other measures, this will require a large, well-resourced response to screen and treat a large proportion of young people in the affected areas within a relatively short time period. Aboriginal community controlled health services and other primary care services can achieve this if properly resourced.</p>
<p>There are examples of successful approaches to address STIs through well-resourced Aboriginal community controlled health services and these need to be built upon. </p>
<p>The program from <a href="https://www.mja.com.au/journal/2008/189/8/epidemiology-sexually-transmitted-infections-anangu-pitjantjatjara?inline=true">Nganampa Health</a>, an Aboriginal community controlled health service, that has developed and implemented a comprehensive approach to addressing STIs has shown a reduction in rates over a number of decades and needs to be expanded to other regions of remote Australia. </p>
<p><em>Donna Ah Chee, CEO of the Central Australian Aboriginal Congress, and Olga Havnen, CEO of the Danila Dilba Health Service, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/93126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Ward is a recipient of NHMRC Research Grants to address STIs among Aboriginal communities including a Centre for Research Excellence.
</span></em></p><p class="fine-print"><em><span>Belinda Hengel and John Boffa do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young people in remote Aboriginal communities have high rates of STIs for a number of reasons, including inconsistent condom use and poor access to health services.James Ward, Associate Professor, Infectious Diseases Research Aboriginal and Torres Strait Islander Health, South Australian Health & Medical Research InstituteBelinda Hengel, Post Doctoral Researcher, South Australian Health & Medical Research InstituteJohn Boffa, Adjunct Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/842102017-09-21T03:00:01Z2017-09-21T03:00:01ZPunishing one person for STI transmission weakens public health efforts<figure><img src="https://images.theconversation.com/files/186712/original/file-20170920-895-18as0ho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Is one person to blame if another gets a sexually transmissible infection (STI)? In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners. </p>
<p>The NSW government <a href="http://www.news.com.au/national/nsw-act/con-or-condom-uproar-over-changes-to-hiv-and-sti-disclosure-law/news-story/7e07c4f76526d4073f5f423e3303da07">last week</a> passed an amendment to the state’s <a href="https://www.parliament.nsw.gov.au/bills/Pages/bill-details.aspx?pk=3426">Public Health Act</a> that increased the associated penalties by doubling the maximum fines and adding potential jail time. </p>
<p>Section 79 (1) of the Act <a href="https://www.parliament.nsw.gov.au/bills/DBAssets/bills/BillText/3426/b2016-144-d26_House.pdf">now reads</a>:</p>
<blockquote>
<p>A person who knows that he or she has a notifiable disease, or a scheduled
medical condition, that is sexually transmissible is required to take reasonable
precautions against spreading the disease or condition.</p>
<p>Maximum penalty: 100 penalty units or imprisonment for 6 months, or both.</p>
</blockquote>
<p>In addition to increasing potential penalties, the amendment removed an earlier provision mandating disclosure of STI status, replacing it instead with the need for “reasonable precautions”. </p>
<p>This is a positive change for the law that reflects the best available research on STIs and transmission. Yet its coupling with increased penalties has sent a mixed message about sexual health in the state. </p>
<p>Further, the idea that punishing STI exposure or transmission will decrease rates of infection is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">not supported by global research</a> on HIV, and there is no reason to believe this would be any different for other STIs. </p>
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Read more:
<a href="https://theconversation.com/moral-responsibilities-to-disclose-your-hiv-status-to-partners-arent-so-clear-cut-51383">Moral responsibilities to disclose your HIV status to partners aren't so clear-cut</a>
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<h2>Laws across Australia</h2>
<p>Health law is pretty complex and mainly left up to each state and territory. Generally speaking, across Australia you risk some kind of punishment for knowingly infecting another person with what are often referred to as “<a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-2000-cdi2408-cdi2408g.htm">notifiable diseases</a>”. This list covers a range of infections but STIs include chlamydia, gonorrhoea, syphilis, HIV, shigella, donovanosis, and hepatitis a, b and c. </p>
<p>In some states, notably <a href="https://www.legislation.nsw.gov.au/#/view/act/2010/127">New South Wales</a>, <a href="https://www.legislation.tas.gov.au/view/whole/html/inforce/current/act-1997-086">Tasmania</a> and <a href="https://www.health.qld.gov.au/publichealthact">Queensland</a>, it’s an offence just to knowingly expose someone to an infection, even if they don’t actually become infected. While in other states, like <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiou86chLPWAhXDTbwKHbZXAYUQFggoMAA&url=http%3A%2F%2Fwww.legislation.vic.gov.au%2FDomino%2FWeb_Notes%2FLDMS%2FPubStatbook.nsf%2Ff932b66241ecf1b7ca256e92000e23be%2F8B1B293B576FE6B1CA2574B8001FDEB7%2F%24FILE%2F08-46a.pdf&usg=AFQjCNHWftaXq4M2CKSHQw-mCoyIC_27lw">Victoria</a> and <a href="https://www.legislation.sa.gov.au/LZ/C/A/SOUTH%20AUSTRALIAN%20PUBLIC%20HEALTH%20ACT%202011.aspx">South Australia</a>, health acts do not specify penalties for exposure or transmission, referring instead to the respective crime acts. For the most part, curable STIs do not rank as serious enough for criminal prosecution.</p>
<p>What is unique about NSW is that it uses the Public Health Act to single out STIs and describe specific punishments above and beyond other infections. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.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"></a>
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<span class="caption">Moving away from mandating disclosure of a person’s STI status to their partner is actually positive.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/photos/partners?photo=p3UCTiZIU6M">Photo by Gerrit Vermeulen on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Although laws in NSW seem unusually fixated on STIs, the move away from mandated disclosure in favour of “reasonable precautions” is a positive step. While disclosure may seem sensible on the surface, it’s not the most effective at preventing transmission. This is because disclosure requires that someone be aware of an infection and many people with an STI don’t realise they are infected. For example, <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">it’s estimated</a> nearly three quarters of chlamydia infections in young people in Australia go undiagnosed every year. Relying on disclosure can, therefore, give people a false sense of security. </p>
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<strong>
Read more:
<a href="https://theconversation.com/sexually-transmissible-infections-on-the-rise-in-australia-a-snapshot-68681">Sexually transmissible infections on the rise in Australia: a snapshot</a>
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<p>There are other more effective strategies than disclosure for protecting someone from infection. With HIV, for example, <a href="https://hptn.org/research/studies/hptn052">successful treatment</a> means the risks of transmitting the virus to another person are virtually nonexistent. Under the amended NSW law, treatment could quite rightly be considered a reasonable precaution to avoid transmitting HIV.</p>
<p>But the state’s Public Health Act is relevant to all STIs, not just HIV. For other infections, it’s less clear what precautions might be seen as reasonable. Condoms can offer protection from some infections, but not all, and they are <a href="http://onlinelibrary.wiley.com/doi/10.1363/3800606/full">rarely used</a> for oral sex. Given more and more chlamydia and gonorrhoea cases are <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">identified in the throat</a>, this is potentially problematic.</p>
<h2>Punishment doesn’t help</h2>
<p>Every year, there are over 100,000 STI <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">diagnoses across Australia</a>, the vast majority of which can be cured using antibiotics. Ultimately, public health initiatives aim to reduce new cases and lower the overall amount of infection.</p>
<p>It’s been suggested by public health experts that criminalising transmission can <a href="http://www.tandfonline.com/doi/full/10.1080/09581596.2015.1052731">undermine public health efforts</a> by reinforcing stigma and causing people to delay accessing testing, treatment and care. </p>
<p>And in <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">a review</a> of legal conditions around the world, researchers found that there was no link between laws criminalising HIV transmission and lower infection rates. The review also found such laws disproportionately impacted those who may experience marginalisation, such as young people and women. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stigma-and-lack-of-awareness-stop-young-people-testing-for-sexually-transmitted-infections-80265">Stigma and lack of awareness stop young people testing for sexually transmitted infections</a>
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<p>In reality, situations where an individual recklessly or wilfully places another at risk of an STI are <a href="http://www.hivmediaguide.org.au/media-tool-kit/hiv-in-the-news/criminal-cases-involving-hiv-transmission-or-exposure/">incredibly rare</a> and health officials have many options besides punishment. </p>
<p>As part of their core work, doctors and clinics counsel on and work with people to prevent onward transmission, and in some cases public health orders can be used to compel people to, among other actions, attend counselling and refrain from activities that might spread an infection. In the most extreme situations, criminal charges can be brought on the basis of grievous bodily harm.</p>
<p>Overall, a special and punitive focus to STIs risks further entrenching stigma and undermining the Act’s intent, which is to manage and reduce infection. If there is any hope of reducing STIs in Australia, laws must aim to foster an environment where people feel comfortable, able and willing to get tested and engaged with their sexual health. </p>
<p>While it seems unlikely a rush to prosecute those who expose others to STIs will spring up from this amendment, the law as it is currently written leaves open that rather serious possibility. In NSW and across Australia, health law consistently places the burden of prevention on one partner. In an ideal world, all parties to a sexual encounter take “reasonable precautions” to protect themselves and each other from infection.</p><img src="https://counter.theconversation.com/content/84210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Denton Callander receives funding from the Australian Department of Health, the Australian Research Council, the National Health and Medical Research Council, and the New South Wales Ministry of Health. </span></em></p>NSW has changed its laws imposing criminal penalties on someone with an STI who doesn’t take “reasonable precautions” to not infect their sexual partner.Denton Callander, Research fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/802652017-06-29T20:13:00Z2017-06-29T20:13:00ZStigma and lack of awareness stop young people testing for sexually transmitted infections<figure><img src="https://images.theconversation.com/files/176177/original/file-20170629-16098-ayqwd0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young people are disproportionately affected by sexually transmitted infections, but they face several barriers to getting tested.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/329424815?src=O1D50co2yM1DLph-xNC16Q-1-67&size=huge_jpg">from www.shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Sexually transmitted infections (STIs) have afflicted humans for as long as records exist, but despite significant medical advances, we are not managing to keep them at bay. Instead, we see rising infection rates and even the re-emergence of some old foes, including syphilis.</p>
<p>Young people are disproportionately affected by STIs. In New Zealand, 67% of chlamydia cases and 57% of gonorrhoea cases are among people between the ages of 15 and 24. This is not solely due to sexual behaviour. Young women, for example, are <a href="http://www.cidjournal.com/article/S0738-081X(13)00152-1/fulltext">more vulnerable to STIs</a> as the vagina’s natural defences to infection have not fully matured.</p>
<p>Early detection and treatment are crucial if we want to reduce infection rates. In <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12680/full">our research</a>, published today in the <a href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1753-6405">Australian and New Zealand Journal of Public Health</a>, we identify several barriers that stop young people from being tested for STIs. </p>
<h2>An ongoing battle against STIs</h2>
<p>Even in the presence of a human papillomavirus (HPV) vaccine and sophisticated antiretroviral therapy to manage human immunodeficiency virus (HIV), the pathogens that cause these STIs are not yet beaten. They continue to infect people, and we are perpetually in response mode. </p>
<p>Since the discovery of penicillin, antibiotics have been used to fight the bacterial STIs, such as chlamydia, gonorrhoea and syphilis. However, in many countries infection rates remain a serious issue. In New Zealand, <a href="https://surv.esr.cri.nz/surveillance/annual_sti.php?we_objectID=3969">rates of some STIs are higher</a> than in other countries. For example, diagnosed rates of chlamydia are around 1.4 to 1.7 higher than those reported in Australia, the USA and the UK.</p>
<p>What’s more, it has become apparent over the past few years that syphilis is staging a comeback. Rates of syphilis in the UK have <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/617025/Health_Protection_Report_STIs_NCSP_2017.pdf">doubled over the last five years</a>, and similar trends have been reported for <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">Australia</a>, <a href="https://www.cdc.gov/std/stats15/default.htm">the USA</a> and <a href="https://surv.esr.cri.nz/surveillance/annual_sti.php">New Zealand</a>.</p>
<h2>Antibiotic resistance and STIs</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176173/original/file-20170629-16075-jgg3s1.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">
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<span class="caption">The bacterium that causes gonorrhoea has developed resistance to every single class of antibiotics introduced for its treatment since the mid-1930s.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/air-bubbles-back-into-tubes-filled-326664926?src=pvOeEE5Aqjyr7JwK4HkApQ-1-82">from www.shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>Antibiotic resistance arises when an infectious microorganism is no longer susceptible to an antibiotic to which it was previously sensitive. If an infection has been identified to be resistant to a conventional treatment, it can usually be treated with an alternative antibiotic. However, the number of antibiotics available is limited, and multi-drug resistance is becoming a reality for several organisms. </p>
<p>The bacterium that causes gonorrhoea is one such organism. It has developed ways to resist every single class of antibiotics introduced for its treatment since the mid-1930s. The only options for first-line treatment for gonorrhoea are the extended spectrum cephalosporins. However, isolates with decreased susceptibility to cephalosporins have now been reported in several countries, <a href="http://sti.bmj.com/content/91/2/91.long">including New Zealand</a>. </p>
<p>After this antibiotic fails, there are no more treatment options. Without new therapies we face a return to the pre-antibiotic era, which would mean waiting for the body to naturally clear a gonorrhoea infection with only painkillers for comfort and months of abstinence to avoid onwards transmission.</p>
<h2>Barriers to testing and treatment</h2>
<p>Our research identifies several barriers to STI testing. One of the most common reasons young people don’t get tested is that they underestimate the risk of contracting an STI.</p>
<p>Some people, especially young men, were afraid of the test procedure itself, imagining it to be invasive and painful. However, a regular check during symptom-free times usually requires only a urine test.</p>
<p>Other barriers include the misconception most STIs are not serious, embarrassment about a physical examination, being too busy, and the cost of tests. Many study participants expressed a preference for a same-sex health professional, but most said they would not be deterred from having a test if that was not possible. </p>
<p>Finally, the stigma associated with STIs remains a pervasive barrier to testing. A diagnosis suggests a violation of social norms and values, such as engaging in unprotected sex, sex with multiple partners, or sex with disreputable partners. Some participants in our study reported they were worried about their reputation if they were seen going for a test.</p>
<h2>Consequences of STIs</h2>
<p>If left untreated, STIs can cause serious and painful health problems, such as pelvic inflammatory disease in women, which can result in <a href="http://journals.lww.com/stdjournal/Citation/1992/07000/Pelvic_Inflammatory_Disease_and_Fertility__A.1.aspx">infertility</a>. Among men, there is also some <a href="http://www.nature.com/nrurol/journal/v11/n12/full/nrurol.2014.285.html">evidence</a> that untreated STIs can lead to infertility. </p>
<p>Complicating matters is the fact that some STIs, chlamydia for example, usually don’t cause any obvious signs or symptoms. Nevertheless, timely detection and treatment is important to prevent future health impacts for the individual as well as the spread to others. </p>
<p>Our results imply that making people aware of their own risk and the severity of STIs may be one way to encourage early testing. Making STI tests free for everyone would remove the cost barrier. In New Zealand, STI tests are generally free to those under 22, but may attract a fee for older people who seek testing through their general practitioner. </p>
<p>The biggest challenge, however, is to lessen the social stigma associated with STIs. Normalising these infections by talking about them more openly with friends and family, as well as highlighting the importance of testing as part of general health care is a step towards overcoming these barriers and helping to bring down STI rates over time.</p><img src="https://counter.theconversation.com/content/80265/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayley Denison received funding from the Wellington Medical Research Foundation to conduct this research. </span></em></p><p class="fine-print"><em><span>Annemarie Jutel, Collette Bromhead, Elaine Dennison, and Rebecca Grainger do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite significant medical advances, rates of sexually transmitted infections are on the rise, including some old foes like syphilis.Hayley Denison, Researcher in Public Health, Massey UniversityAnnemarie Jutel, Professor of Health, Te Herenga Waka — Victoria University of WellingtonCollette Bromhead, Senior Lecturer in Molecular Microbiology, Massey UniversityElaine Dennison, Professor of Clinical Research, Te Herenga Waka — Victoria University of WellingtonRebecca Grainger, Senior Lecturer in Medicine, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/793552017-06-13T17:25:26Z2017-06-13T17:25:26ZA sex worker’s view on South Africa’s latest plans to beat HIV<figure><img src="https://images.theconversation.com/files/173632/original/file-20170613-485-13iqajb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Activists supporting the decriminalisation of sex work at the 21st International AIDS Conference in Durban, South Africa.</span> <span class="attribution"><span class="source">International AIDS Society/Abhi Indrarajan</span></span></figcaption></figure><p>South Africa recently launched <a href="http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf">a five-year plan</a> to improve the country’s response to HIV, TB and sexually transmitted infections. The plan was deemed necessary because of the persistently high rates of infections – the country has the highest TB and HIV rates in the world. </p>
<p>Sex workers are critical to the plan because HIV prevalence among them is extremely high. <a href="https://theconversation.com/a-long-road-ahead-to-reduce-hiv-among-south-africas-sex-workers-56176">Research</a> shows that more than half the female sex workers in South Africa’s three largest cities are HIV positive – but less than one-third are on antiretroviral treatment.</p>
<p>Crucial to the plan’s success is the ability of the country to meet two particular goals: implementing the <a href="https://theconversation.com/hiv-aids-and-90-90-90-what-is-it-and-why-does-it-matter-62136">90:90:90 strategy</a> for HIV (that 90% of people living with HIV know their status, 90% of all people with diagnosed HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy are virally suppressed). </p>
<p>The <a href="http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf">second</a> is that treatment, and other support, is given to vulnerable groups, such as sex workers.</p>
<p>But will the plan work? Some believe not. </p>
<p>One source of criticism has come from sex workers themselves. </p>
<p>Their case is set out in an open letter to the South African National Aids Council (SANAC) written by Zenande Dlamini, a sex worker and activist. Zenande and I are part of a writing collaboration and an arts-based project called <a href="https://issuu.com/move.methods.visual.explore/docs/kms_final_e-book__11_may_2017__300d">Know My Story</a>.</p>
<p>Zenande argues that the plan’s good intentions will be undermined by the fact that sex work remains a criminal offence in South Africa. This means that sex workers remain vulnerable. They don’t have the right to <a href="http://www.cge.org.za/wp-content/uploads/2014/05/CEG-Decr.pdf">protect themselves</a> – for example from police violence and intimidation – or get the health care they need because they’re <a href="https://theconversation.com/a-long-road-ahead-to-reduce-hiv-among-south-africas-sex-workers-56176">stigmatised</a> by health workers. </p>
<p>Her letter comes just months after the South African Law Reform Commission launched a long-awaited report on adult prostitution. The report, delivered 20 years after it was first mooted, failed to address the issue of <a href="https://theconversation.com/debate-around-sex-work-in-south-africa-tilts-towards-decriminalisation-59324">decriminalising</a> sex work.</p>
<p>Below is Zenande’s letter.</p>
<hr>
<p><strong>Dear SANAC,</strong></p>
<p>My name is Zenande. I am a sex worker. I am from the Eastern Cape. I am many things other than a sex worker: sex work does not define me. But in this context it is important that I classify myself as part of this vulnerable population.</p>
<p>A lot of lip service has been paid to sex workers in the country’s attempt to reduce the number of HIV, TB and sexually transmitted infections. Big, powerful meetings have been conducted to try and find solutions to our issues, especially in the field of health rights. I am grateful for that. And I see how well-structured the <a href="http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf">South African National Strategic Plan on HIV, TB and STIs</a> is for the next five years. </p>
<p>Realistically though, I’m worried.</p>
<p>My first problem is that the goal of <a href="https://theconversation.com/hiv-aids-and-90-90-90-what-is-it-and-why-does-it-matter-62136">90:90:90</a> is just not possible.</p>
<p>Your policy promises that vulnerable populations will get counselling from peers as well as support to stick to treatment regimes and information sharing. This, the plan says, will happen across the country.</p>
<p>But there’s no sign of it happening, nor do I think it can happen, especially in my birth province where poverty is rife. </p>
<p>Who is expected to make the 90-90-90 strategy work? Firstly, there are only two or three organisations that dedicate their energy to key populations. This is the case even in heavily populated provinces like Gauteng and the Western Cape. </p>
<p>Secondly, there are only a small number of peer educators across the whole country. They are expected to reach out to marginalised groups in rural areas. </p>
<p>On top of this, there are only a limited number of NGOs dealing with vulnerable people in provinces like the Eastern Cape. That’s where I work as a peer educator. My experiences have led me to voice my frustrations in this letter.</p>
<p>If the government really wants to improve testing and treating TB, HIV and other sexually transmitted infections it has to do more than just address health issues. It must empower organisations working with sex workers to address problems around gender based violence and human rights violations. </p>
<p>Change will only happen when peer-led organisations are supported more. </p>
<h2>Nothing will change</h2>
<p>Your policy identifies drug use as one of the critical drivers of HIV, TB and sexually transmitted infections. </p>
<p>But there are no drug rehab centres that can work with my population to deal with drug abuse in the industry. </p>
<p>In addition to drug rehabs, sex workers need help to get out of the industry, if that’s what they want. At the moment they’re trapped. There are no programmes to help them exit the industry, for up-skilling, for bursaries. </p>
<p>Until this changes, nothing will change. </p>
<p>If I had the means, I’d give sex workers skills so that they had a plan B. </p>
<h2>Still a crime</h2>
<p>And then there’s the issue of decriminalisation. </p>
<p>I often hear the word criminal when it comes to sex work. Sex work is work. But until it is decriminalised, sex workers will remain victims of anyone who wants to boost their egos by beating us, raping us, abusing us and killing us.</p>
<p>And it’s not just clients we have to fear. We have condoms continuously confiscated by members of the South African Police Service – condoms that the health sector delivers to us. </p>
<p>Sex work needs to be decriminalised. </p>
<p>My own experience tells a story. I have tried to find other means of employment as I didn’t want to be on the wrong side of the law. I had dreams of being a nurse. I passed my matric and I applied for bursaries six times, without success. I had to drop out of varsity. I had to support two siblings and my own daughter. I had to protect my loved ones. </p>
<p>I would like to know: what crime have I committed? By rendering a consensual service to a client who needs it, I am a criminal. By ensuring that my siblings and my single mum have food on the table, I am a criminal.</p><img src="https://counter.theconversation.com/content/79355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susann Huschke receives funding from the German Academic Exchange Service (DAAD).</span></em></p>South Africa has launched a plan to tackle HIV, TB and sexually transmitted infections – but much depends on its implementation over the next five years.Susann Huschke, Postdoctoral Researcher in Anthropology, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/572612016-07-21T17:38:59Z2016-07-21T17:38:59ZThe search for answers to hormonal contraception’s role in HIV infection<figure><img src="https://images.theconversation.com/files/131412/original/image-20160721-32610-ftsewe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Injectable progestin contraceptives are particularly popular in sub-Saharan Africa.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>About 75% of HIV-infected people in sub-Saharan African between the ages of 15 and 24 <a href="http://science.sciencemag.org/content/sci/308/5728/1582.full.pdf">are women</a>. Many factors play a role in this gender imbalance. These include gender-based social disparity and a high prevalence of intergenerational sexual partnerships. </p>
<p>But research suggests certain types of hormonal contraceptives commonly used in this region could also play a role.</p>
<p>Injectable progestin contraceptives, like Depo-Provera, are particularly popular in <a href="http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(14)71052-7.pdf">sub-Saharan Africa</a>. They are effective and convenient. Instead of taking a daily pill, women can receive Depo-Provera injections every three months. </p>
<p>But studies suggest that women using this specific type of contraceptive are more susceptible to HIV. Most recently <a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70247-X/abstract">a large-scale study</a> conducted in Africa found women using injectable progestins were twice as likely to acquire HIV than women using no hormonal contraceptive. </p>
<p>This type of study cannot <em>prove</em> a particular type of contraceptive actually makes women more susceptible to infection, as it is just looking for an association between the two.</p>
<p>To really find out if contraceptives make women more susceptible to infection, you need to see how these drugs actually affect the systems that protect the body from infection. Such studies are more difficult to do in humans, so my colleagues and I decided to explore mouse models.</p>
<h2>What we learnt from mice</h2>
<p>We used mice to learn if Depo-Provera or levonorgestrel (LNG), a progestin used in hormonal intrauterine devices, affect the genital mucosal barrier. This barrier serves as a blockade to prevents virus and bacteria from infecting body tissues. In other words, it is a first line of defense against infection.</p>
<p>Epithelial cells on the surface of genital tract tissues are a vital part of this barrier. They are held tightly together by adhesion molecules that make it difficult for pathogens to penetrate tissue and establish infection. </p>
<p>But <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">we found</a> that mice treated with Depo-Provera or LNG have lower levels of several of these adhesion molecules. This means that genital epithelial cells aren’t held together as tightly, tissue becomes more permeable and virus more easily invades. </p>
<p>Our research shows these contraceptives increase mouse susceptibility to infection. But do similar changes in permeability also occur in women? </p>
<p>To find this out, we obtained cervical tissue from US women before and after they started using Depo-Provera. This showed Depo-Provera causes changes to adhesion molecules and tissue permeability <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">similar to those seen in mice</a>. </p>
<h2>Where do we go from here?</h2>
<p>Sexually transmitted infection and unplanned pregnancy are interconnected public health problems. Countries with a larger burden of infection typically also have higher infant and maternal mortality rates and a great need for <a href="http://www.ncbi.nlm.nih.gov/pubmed/23871397">effective contraception</a>. </p>
<p>Since Depo-Provera and LNG provide women with effective contraception, we wanted to learn if there are ways to counteract their ability to weaken the mucosal barrier. With this in mind, we also performed studies in which mice were treated with both Depo-Provera and oestrogen.</p>
<p>This combination strengthened the genital mucosal barrier and made mice <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">less susceptible to virus infection</a>. It also suggests a scenario in which women would receive Depo-Provera and a vaginal ring that releases oestrogen and an antiviral microbicide. </p>
<p>Before this can happen, research is needed to determine if Depo-Provera and an oestrogen-releasing vaginal ring protect non-human primates from viral infection. If positive results are seen, the next logical step would be clinical trials that explore if similar approaches also reduce a woman’s risk of acquiring HIV.</p><img src="https://counter.theconversation.com/content/57261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas L. Cherpes receives funding from the NICHD. </span></em></p>Studies have suggested that women using a particular kind of injectable contraceptive are more susceptible to HIV infection. Research in mice offers new insights.Thomas L. Cherpes, Associate Professor in the College of Medicine, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/581762016-05-25T12:10:28Z2016-05-25T12:10:28ZWhy sexuality education in schools needs a major overhaul<figure><img src="https://images.theconversation.com/files/122116/original/image-20160511-18140-1bruo3q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The narrative around sexuality education is one of disease, danger and risk.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Sex is dangerous and damaging. Men are predators. Women are victims. Only heterosexuality is acceptable. That’s what learners are taking away from sexuality education classes – if they’re even paying attention in the first place. These are <a href="http://contentpro.seals.ac.za/iii/cpro/DigitalItemPdfViewerPage.external?id=7866743463380547&itemId=1018868&lang=eng&file=%2Fiii%2Fcpro%2Fapp%3Fid%3D7866743463380547%26itemId%3D1018868%26lang%3Deng%26nopassword%3Dtrue%26service%3Dblob%26suite%3Ddef#locale=eng&gridView=true">the findings</a> of research about sexuality education in South African schools. </p>
<p>The findings deserve particular attention as the country’s Department of Basic Education prepares to roll out comprehensive sexuality education in schools. This forms part of the implementation of the multi-sectoral National Adolescent Sexual and Reproductive Health and Rights <a href="http://www.dsd.gov.za/index2.php?option=com_docman&task=doc_view&gid=578&Itemid=39">Framework Strategy 2014-2019</a>. The framework, says government, is an “action guide” to address “the gaps and challenges that
adolescents are faced with to fully realise their sexual and reproductive health and rights”.</p>
<p>There’s another project related to adolescent sexuality in the works, too: the Department of Health is launching <a href="http://www.timeslive.co.za/local/2016/05/10/Health-minister-wants-to-%E2%80%98wean-young-girls-away-from-sugar-daddies%E2%80%99">a programme</a> to decrease <a href="http://www.hsrc.ac.za/en/research-outputs/view/6950">transactional sex</a>, teenage pregnancy and gender-based violence.</p>
<p>Sexuality education currently falls under the <a href="http://www.education.gov.za/Portals/0/CD/National%20Curriculum%20Statements%20and%20Vocational/CAPS%20FET%20_%20LIFE%20ORIENTATION%20_%20GR%2010-12%20_%20WEB_E6B3.pdf?ver=2015-01-27-154251-017">Life Orientation</a> curriculum in South African schools. Its aim is to help learners make healthy and responsible choices around issues of sexuality and relationships. </p>
<p><a href="http://contentpro.seals.ac.za/iii/cpro/DigitalItemPdfViewerPage.external?id=7866743463380547&itemId=1018868&lang=eng&file=%2Fiii%2Fcpro%2Fapp%3Fid%3D7866743463380547%26itemId%3D1018868%26lang%3Deng%26nopassword%3Dtrue%26service%3Dblob%26suite%3Ddef#locale=eng&gridView=true">Our review</a> of research conducted on sexuality education in South African schools identified five major themes that point to a need to thoroughly rethink sexuality education </p>
<h2>The five themes</h2>
<p><strong>1) Danger, damage and disease</strong></p>
<p>Sexuality education focuses chiefly on the negative consequences of young people engaging in sex. These include the possibility of sexually transmitted diseases and HIV, of sexual violence and of pregnancy. Sex is characterised as something inherently risky. The positive or pleasurable aspects of sexualities don’t get much attention. Young people are told “what <em>not</em> to do” by teachers who adopt a morally authoritative stance. They instruct learners about the “correct” way to conduct themselves sexually – always in light of possible danger, disease and damage.</p>
<p><strong>2) Rigid gender categories</strong></p>
<p>Life Orientation sexuality education often reinforces a fixed gendered order that features prescribed roles that young women and men “should” embody. </p>
<p>For example, men are assumed to take the lead in sexual matters. Young women are encouraged to take responsibility for their own sexuality – while at the same time identifying themselves as “vulnerable” and “passive”. Young women are expected to police male sexuality. But they must also conform to prescribed gender practices where men’s desires and needs take priority. Boys and men are depicted as largely predatory and girls as victims of sexual predation. These contradictory gender messages unknowingly serve to undo some of the curriculum’s aims, particularly as sexual violence in the South African context is <a href="http://www.sciencedirect.com/science/article/pii/S0140673602083575">intimately linked</a> with gender inequality and the upholding of certain versions of masculinity that are enshrined in power and violence.</p>
<p><strong>3) Disconnection</strong> </p>
<p>Many learners say they feel disconnected from what they’re taught in Life Orientation sexuality education. They view the content as largely irrelevant to their lives; the classes are seen as repetitive, boring, overly authoritative and teacher-centred. Young people learn more from their peers about sex than they do in class. </p>
<p><strong>4) Heteronormativity and homophobia</strong></p>
<p>Same-sex relationships are considered unnatural, immoral, ungodly and <a href="http://www.lse.ac.uk/genderInstitute/pdf/graduateWorkingPapers/bintaBajaha.pdf">un-African</a> in many South African schools. This means that sexual and gender diversity is hardly discussed. Teachers and school managers often hold conservative beliefs, and parents are often strongly resistant; teachers are not properly trained in how to conduct sessions about sexual and gender diversity. </p>
<p>Added to this, many Life Orientation programmes maintain heteronormative concepts of gender. These help to foster a culture of heterosexuality and further marginalise lesbians, gays and bisexuals in the schooling system. </p>
<p><strong>5) Teachers’ responses</strong></p>
<p>When it comes to sexuality education, teachers are caught between contradictory values that aren’t always easy to reconcile: national policy and curriculum, the school, personal beliefs, and social and cultural pressures that are often conservative. </p>
<p>Teachers find it challenging to create open dialogue in sexuality education while at the same time maintaining discipline. They struggle with the multiple roles they’re expected to play in these sessions – teacher, confidante, counsellor, social worker. </p>
<p>Researchers have found that teachers’ confidence in teaching sexuality rises when they’ve been doing it for a number of years, have received formal training, are used to discussing sexuality with others and are working within a supportive school environment.</p>
<h2>Recommendations</h2>
<p>There are several ways to address these concerns so that the curriculum becomes more empowering and relevant for both learners and teachers.</p>
<p>Researchers argue that the model of stressing risk – in light of danger, disease and damage – and responsibility (to take up the “correct” path of behaviour) is limited. They point out that it doesn’t accurately represent the realities of youth sexuality, in particular the youth culture within which young people are immersed, the raced and classed environments in which they live and the diversity of sexual identities to which they ascribe. Sexuality education programmes should be designed to incorporate the positive and pleasurable aspects of sexualities in all their complexities, using young people’s preferred cultural expressions of sexuality. </p>
<p>Young people’s experiences and desires need to be taken seriously and their role within the education process appreciated. A learner-focused initiative that places the voices of young people at the centre of their sexuality education needs to be developed. </p>
<p>Sexuality education also needs to disrupt gender stereotypes – particularly those that privilege male power and desire – to move away from prescribing fixed gender roles to young learners, and to highlight fluidity and empowerment. </p>
<p>It’s crucial to undermine the heteronormativity and gendered binaries that currently exist in these programmes. One way to do this is to train teachers in the sexual and reproductive rights that underpin South Africa’s <a href="http://www.justice.gov.za/legislation/constitution/SAConstitution-web-eng.pdf">constitution</a> and much of its health legislation.</p>
<p>Teacher training more broadly is very important. Teachers must reflect deeply on their own assumptions about sexualities and gender. They need better support and spaces in which to debrief. It’s also important that they know about the protocols when dealing with reports of sexual violence or other sexuality-related difficulties.</p>
<p><em>Author’s note: Jonathan Glover, a Master’s student in Clinical Psychology at Rhodes University, co-wrote the policy brief on which this article is based.</em></p><img src="https://counter.theconversation.com/content/58176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Macleod receives funding from the National Research Foundation and the Department of Science & Technology for the Critical Studies in Sexualities and Reproduction SARChI Chair. She is a member of the Sexual and Reproductive Justice Coalition.</span></em></p>The messages that adolescents receive from sexuality education classes are frequently negative. It’s time for the curriculum to become more empowering for learners and teachers.Catriona Macleod, Professor of Psychology, Rhodes UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/513582015-12-03T04:32:06Z2015-12-03T04:32:06ZThe all-in-one solution to sexual health is on its way<figure><img src="https://images.theconversation.com/files/104145/original/image-20151202-22448-f7rnzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women would prefer a product that addresses multiple sexual and reproductive health risks at the same time.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>The current sexual and reproductive prevention methods have significantly improved the health and well-being of women and their families. But this is not enough. Worldwide each year there are still 85 million unplanned pregnancies, 21.6 million unsafe abortions, and nearly 300 000 <a href="http://www.guttmacher.org/graphics/ContraceptionWorks(Table).png">maternal deaths</a> from complications related to pregnancy and birth.</p>
<p>HIV remains the leading cause of death of women of reproductive age worldwide. <a href="https://www.guttmacher.org/graphics/MultipurposePreventionDevelopingWorld(IG)-800.png">Sub-Saharan Africa</a> has the highest burden. While anti-retroviral drugs are effective treatments, half of the women living with HIV in resource-limited settings can’t access them. And women’s HIV prevention technologies remain limited. Their use is often outside a woman’s sphere of control.</p>
<p>Enabling women to maintain good reproductive health requires innovative and improved prevention technologies. A revolutionary class of women’s sexual and reproductive health prevention products is being developed and may prove to be the linchpin to achieve the sustainable development goals that relate to women’s health.</p>
<p>Multipurpose Prevention <a href="http://cami-health.org/mpts">Technologies</a>, more commonly known as MPTs, are a new class of product in development. They deliver varying method combinations to simultaneously prevent HIV, sexually transmitted infections and unplanned pregnancies. </p>
<p>Although these technologies are complicated to develop, they are technically feasible. Since the field was launched six years ago, it has <a href="http://www.ncbi.nlm.nih.gov/pubmed/24188708">evolved</a> from an innovative concept. Currently there are over <a href="http://mpts101.org/mpt-database">20 products</a> being developed with nearly a dozen products in clinical trials.</p>
<h2>New methods of prevention</h2>
<p>There are many forms of innovative technologies being developed. Some combine contraception with prevention from sexually transmitted infections while others provide women who want to get pregnant with protection from HIV and other Sexually Transmitted Infections (STIs). Many do so in discrete forms that do not require partner negotiation. Some are designed to be used just before or at the time of a sexual encounter while others are long-acting products. </p>
<p><a href="http://mpts101.org/mpt-database">The innovations</a> currently being developed include:</p>
<ul>
<li><p>vaginal rings that release both hormonal contraception and an HIV prevention drug; </p></li>
<li><p>vaginal films and tablets that prevent HIV and herpes (HSV); </p></li>
<li><p>rectal suppository MPTs offering HIV and STI prevention for anyone engaging in anal sex; </p></li>
<li><p>new bio materials that will feel more like skin to make better feeling condoms; and other innovative technologies.</p></li>
</ul>
<p>The goal is to create an array of broad-spectrum prevention <a href="http://healthaffairs.org/blog/2015/11/02/mpts-combine-contraception-with-hiv-and-other-sti-prevention/#one">methods</a> which a woman can choose from to best suit her circumstances. But without increased investment in the research and development of these technologies, these powerful new prevention methods may never reach women’s hands.</p>
<h2>A benefit for all</h2>
<p>The intersecting nature of sexual and reproductive health risks is especially apparent in areas of the world where women have the least access to modern contraception and face the highest HIV and STI risks. </p>
<p>In 2012, young women in sub-Saharan Africa accounted for <a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12842/full">70%</a> (25 million) of the 35.3 million people estimated to be infected with HIV globally.</p>
<p>By reducing non-HIV sexually transmitted infections at the same time as HIV and unplanned pregnancy and health costs will be cut. In addition lives can be saved. If sexually transmitted infections such as herpes, chlamydia and human papillomavirus are left untreated they can result in infertility and cancers. Herpes and human papillomavirus also put women at greater risk of acquiring HIV.</p>
<p>Sub-Saharan Africa has the highest burden of <a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12842/full">herpes</a> where up to 80% of sexually active women are estimated to be infected.</p>
<p>It is no secret that improving women’s ability to plan and space children improves the economic well-being of families, saves millions of <a href="https://www.guttmacher.org/pubs/gpr/18/1/gpr180101.html">lives</a> and billions of dollars. Reducing the incidence of HIV and STIs also offers clear and well documented benefits to women, families, and economies. Doing it all at the same time will magnify these benefits. </p>
<p>And it is key to ending poverty and fulfilling the range of interlocking sustainable development <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">goals</a> that shape our interconnected futures. </p>
<h2>An all-in-one solution</h2>
<p>Women, providers and advocates of women’s health are enthusiastic about the multipurpose prevention technology. Combining prevention benefits into one product will be more efficient and will increase the number of women covered by this umbrella of prevention. </p>
<p>Early <a href="http://resource.cami-health.org/resources/ipsos.php">market research</a> shows an overwhelming preference for products that can address multiple sexual and reproductive health risks. And <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjo.2014.121.issue-s5/issuetoc">research</a> shows that HIV stigma is a barrier that prevents many women from seeking HIV prevention. It suggests combining HIV prevention and protection from STIs with contraception delivered in family planning settings will increase HIV prevention uptake for many women.</p>
<p>Researchers, health care providers, and funders from around the globe, including China, India, Kenya, <a href="http://www.wrhi.ac.za/Pages/ClinicalTrials.aspx">South Africa</a> and the US have forged in-country collaborations to ensure multipurpose prevention technologies will be desirable and accessible to those who need it most. </p>
<p>The <a href="http://mpts101.org/infographic-mpts">social benefits</a> of these technologies are far reaching. It ranges from educational attainment to reducing child mortalities, improving incomes, reducing inequity and having a positive impact on the environment. </p>
<p>For the young women in sub-Saharan Africa who bear a disproportionate burden of HIV infection, unwanted pregnancies and sexually transmitted infections, these technologies could be life-changing. </p>
<p>_This article is a version of a <a href="http://healthaffairs.org/blog/2015/11/02/mpts-combine-contraception-with-hiv-and-other-sti-prevention/">blog</a> originally written by Professor Helen Rees and Dr Bethany Young Holt, who is the director of the IMPT (Initiative for MPTs), a project of <a href="http://cami-health.org/about">CAMI Health</a> where she serves as executive director. CAMI Health is dedicated to the health empowerment of women and girls and is sponsored by the Public Health <a href="http://www.phi.org/">Institute</a>.</p><img src="https://counter.theconversation.com/content/51358/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Rees 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>Scientists are developing various products that can provide contraception and protection from sexually transmitted infections and HIV at the same time.Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.