For the teenager curious about the experience of having sex, but vaguely aware that pregnancy and disease are possible outcomes, the Family Planning of New South Wales website is reassuring. It says:
This youth friendly safe sex pack, encourages safer sexual behaviours to help prevent sexually transmissible infection and unplanned pregnancy.
Specially designed by Family Planning NSW, the experts in reproductive and sexual health, each safe sex pack contains:
* one condom
* one lube sachet
* step-by-step directions on how to correctly use a condom, and
* how to contact FPNSW for more information and support about sexual health.
All this comes packaged in a slim cardboard pack which easily slips into a pocket or wallet.
Yes, it says “safer” once, but “safe sex” twice, and that’s what the curious teenager is going to remember, especially when further information tells him, “Keep It Safe, Keep It Sexy”. Sexy, that’s what he wanted to hear.
But how safe is the condom? Well, “98 percent effective when used correctly every time,” sounds quite good, if not perfect, but “85 percent with typical use” sounds a bit risky – and, seriously, what would be the score of an average teenager?
“Safe sex” is one of the great deceptions of our age. It speaks volumes about the prevailing philosophy of sex (or lack of philosophy) but from a technical point of view it says not nearly enough. And yet it’s a slogan that has given many adolescents the confidence to start having sex while still in school, increasing their risk of pregnancy and sexually transmitted infections, including HIV.
This has been demonstrated by researchers at the University of Navarre in Spain. As part of a larger international cross-sectional study — Project YOURLIFE, on what youth in developing countries think and feel about relationships, love and sexuality — they asked nearly 9000 students aged 13 to 18 about the risk of being infected with HIV if a person has sex using condoms.
The study, led by public health specialist Jokin de Irala, found that one out of seven of the young people believed condoms are 100 percent effective. They also found that these “safe-sex believers” were collectively 82 percent more likely to have had sex than those without such a belief — although they were no more likely to use a condom the first time they had sex.
This points to what is known in public health circles as “risk compensation”. Writing in the BMJ Open last month the authors give the examples of public health measures such as compulsory car seat belts being accompanied by an increase in speeding, or sunscreen promotion leading to people baking themselves for longer on the beach. Indeed, their study shows that some teens are so reassured by the safety of condoms that they don’t even use them!
The teenagers in this study live in Catholic majority countries – The Philippines, El Salvador and Peru – where HIV infection rates are estimated at less than 1 percent and are even lower for young people. However, a significant proportion of the general population start sexual activity in their teens, putting them at risk of other sexually transmitted infections, and also HIV. “In all cases, condom use among young people is far from the recommended 100%,” the study authors note.
The study sample were from public and private schools in different areas of each country. All students aged 13 to 18 were invited to participate, and those who responded filled in a confidential and anonymous questionnaire which included questions about socio-demographic information, as well as the youth’s leisure activities, opinions, sources of information and communication with parents about love and sex. Schools arranged parental consent.
One in five of the students reported that they were sexually initiated (20.2 percent) but this was much more likely among those who believed there is no risk at all of contracting HIV if one has sex using a condom. Safe sex belief was more frequent among males than females, among Filipinos and Peruvians than among Salvadorians, among those with low or no religiosity, and among students attending public and coeducational schools, compared with private and single sex.
There was a similar correlation between believing condoms kept a girl safe from pregnancy, and becoming sexually active.
The authors comment:
“Some campaigns that promote condom use might be placing too much emphasis on their effectiveness, to the point of conveying the message that their protection is complete. Indeed, although agencies such as the WHO have used the term ‘safer’ sex instead of ‘safe’ sex for years, campaigns continue using the ‘safe sex’ message. [Examples are given] Ambiguous information only stressing condom safety may lead youth to think that sex using condoms is simply ‘safe sex’.”
Other research has shown that condom users have less interest in basic prevention measures such as delaying sexual initiation, avoiding casual sex or reducing the number of partners, which can undermine or cancel out the effect of using condoms. And this is the most likely interpretation of the reported behaviour of teenagers in the Project YOUR LIFE study.
The study is, by the way, the first of its type to test the relationship between safe sex belief and risk compensation behaviour among teenagers in three different developing countries. The authors conclude: “Overconfidence in condom effectiveness might indeed be contributing to the increase of sexual initiation among adolescents from these countries, and these results could also be relevant in other settings.”
A decade ago, confronting the HIV/AIDS pandemic, leading public health experts published a consensus statement in The Lancet medical journal setting out priorities for prevention. When targeting young people, they ordered the priorities thus:
* [F]or those who have not started sexual activity, encourage abstinence or delay of sexual onset
* After sexual debut, return to abstinence or be mutually faithful with an uninfected partner
* For the sexually active, support correct and consistent condom use – which “lowers the risk of HIV (by about 80-90 percent for reported ‘always use’)” and of other STIs and pregnancy.
In recommending the expansion of prevention programmes in and out of school they also said that “parents should be supported in communicating their values and expectations about sexual behaviour.”
No mention of “safe sex” there. Why is it that more than 10 years later the use of this misleading and harmful catch-phrase by agencies targeting youth persists? Which of them gives priority to abstinence and delaying sexual activity? In the light of the latest findings on safe sex belief and risk taking among teenagers, the “Keep it safe, keep it sexy” approach is scientifically and morally indefensible.
Carolyn Moynihan is deputy editor of MercatorNet.