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Have we fallen out of love with safe sex?

Hayley* was enjoying a typical post-break-up night out when she bumped into a guy she’d known at secondary school. She hadn’t seen Aaron*, who’d been away in the army, for years but soon they were chatting like no time had passed. Catching up with an old friend was just the distraction she’d been hoping for and, as the night went on, the conversation quickly turned flirty – and they ended up going home together.

“I was probably being a bit immature but I’d known this lad since I was in high school,” the 24-year-old tells me. “We were drunk and I guess I thought because it wasn’t a stranger that it would be fine not to use a condom and, obviously, it wasn’t – and then I started to get chlamydia symptoms.”

After being diagnosed with the STI, Hayley beat herself up over not having raised the subject of protection with her hook-up. “I was really frustrated at myself,” she recalls. “I was saying to myself, ‘You’re stupid, why do you trust people? You need to start growing up.’” But frustration turned to disbelief when she found out from a mutual friend that the guy had apparently been complaining about STI symptoms before their encounter. “That means he recklessly went out sleeping with people unprotected anyway,” she says.

During the time when Hayley was having casual sex before meeting her current partner, she was on the pill but didn’t use condoms more than a “handful of times”. She says this was partly because they caused her discomfort but also because she felt awkward bringing it up.

“At the time, I foolishly thought ‘I don’t want them to think I’m a prude or that I’m boring,’” she says. “I’m actually really anxious about STIs but I wasn’t confident enough to bring it up – I had this thing in my head of wanting to please men.”

For Hayley, getting an STI that, if untreated, could have affected her fertility, was a wake-up call: “I didn’t see it that way but, by not using one, you’re really trusting somebody and you shouldn’t do that so easily.”

Despite the condom-on-a-banana lesson being a prevailing school sex education memory for many of us, Hayley isn’t alone in failing to practise safe sex. According to research by YouGov and Public Health England (PHE), almost half of 16 to 24-year-olds surveyed admitted to having sex with a new partner without using a condom. The same survey found that one in 10 sexually active 16 to 24-year-olds had never used a condom.

In 2003, more than 43% of men aged 16-24 who’d had sex in the previous four weeks said they’d used a condom every time, according to figures supplied to BBC Three by the National Survey of Sexual Attitudes and Lifestyles (Natsal). But, fast forward a decade to the most recent Natsal survey, and this figure had dropped to 36%. In the US, condom use among sexually active high school students also dropped from 62% to 54% between 2007 and 2017, according to Centers for Disease Control (CDC) data.

At the same time, rates of some STIs have soared. According to PHE, a young person in England is diagnosed with a new infection every four minutes. Their research also suggests that those aged 16-24 are most at risk of contracting an STI, and over half the reported cases of gonorrhoea and chlamydia in 2016 were in those aged 16-24, according to NHS figures.

Cases of ‘super gonorrhoea’, a strain of the disease that is resistant to the usual antibiotics used for treatment, were recorded in the UK this year and last year. And syphilis is also on the rise – in 2017 there was a reported 20% increase in cases between 2016 and 2017, part of a 10-year upward trend in England. While reported cases of chlamydia have dropped by 2%, sexual health experts have warned funding cuts may be preventing people from accessing services (though the government says that home-testing is now more widely available).

In an attempt to reduce STI rates, Public Health England launched a campaign at the end of 2017 to promote condom use and sexual health testing with people aged 16-24, recruiting reality star Sam Thompson to help spread the message. Government-backed ‘C-Card’ schemes also operate throughout the country, allowing young people to get free condoms from local pharmacies. So, if condoms are widely available and they’re still the only form of contraception that can protect against most STIs – why aren’t we all using them?

One possible reason for condoms’ decline in popularity is that other forms of contraception have become more widely used over time. NHS sexual health services have seen a spike in uptake of long-acting reversible contraceptives (LARCs) like the implant, the injection and intrauterine devices (IUDs, better known as the coil), which don’t require us to remember to buy them, or correctly apply them in the dark. The percentage of women who visited NHS sexual and reproductive health services for contraception reasons that were using a LARC has risen from 23% to 41% in the past decade. The contraceptive implant was only made available in 1999 and has steadily grown in popularity since.

Meanwhile, the humble condom hasn’t had a major design change since the 1950s. Experts aren’t certain when the first condom was created but they do know that, back in the medieval era, they were made from animal intestines. The first rubber condoms were created in the mid-19th Century. Initially, these were designed to cover just the head of the penis – it wasn’t until a decade later that rubber condoms became full-length. The first latex versions – thinner and more natural-feeling than thick rubber – weren’t produced until the early 20th Century.

These days, condoms do come in a wide variety of textures, such as ribbed and dotted, as well as different flavours (none of which really mixes well with rubber, let’s be honest). There are even, erm, helpful glow-in-the-dark versions, not forgetting female condoms, which launched in 1992 but never really took off, and dental dams (mouth condoms) – yes, really. But, these variations aside, condoms haven’t had a major redesign since 1957, when the first lubricated version was created. Why, then, is their popularity seemingly slipping now?

“The first few years when I was sexually active, the spectre of HIV was pretty enormous,” Samuel*, now 27, says of the fear and stigma that surrounded the virus when he was in his late teens. “We’d heard from the older generation that it was this thing that would definitely kill you – so I think I used to be a lot more careful about using condoms when I started having sex [a decade ago] than I am now.”

As well as seeing less about the dangers of HIV in the media in recent years, Samuel, who’s gay, also points to the availability of PrEP (pre-exposure prophylaxis), a drug you can take to stop yourself contracting HIV, and the development of antiretroviral drugs that can make HIV undetectable and untransmittable. HIV diagnosis rates are at their lowest since the turn of the millennium.

Research published last year found a link between the uptake of PrEP and a decline in condom use among Australian men aged over 16. The study, which involved 17,000 men in Victoria and New South Wales who have sex with men, found that PrEP usage among HIV-negative men in the sample had risen from 1% to 16% between 2013 and 2017, while consistent condom use had dropped from 46% to 31%.

“Our findings suggest that the rapid uptake of PrEP disrupted condom use,” study lead Prof Martin Holt told the Guardian. “However, it’s too early to tell the long-term effects of increasing PrEP use.” PrEP is available from the NHS in Scotland and in some locations in Wales and England as part of a trial project, and it can also be legally purchased from private sellers online.

“Other sexually transmitted infections don’t really feel as scary as HIV does, or they seem treatable by a round of antibiotics,” Samuel says. “If I’m having casual sex with someone, or with someone I’m not in an exclusive relationship with, I do feel bad if I don’t use a condom but I tend to get wrapped up in the moment and forget about it. Then I remember afterwards and freak out.”

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