The rise in sexually transmitted infections among young people is a major public health challenge. Since the mid-1990s infections like chlamydia and gonorrhoea have more than doubled in the UK and figures from the Health Protection Agency last month show no let up in the upward trend. Young people are at particular risk – four out of 10 cases of gonorrhoea in women affects the under-20s and more than one in 10 young men and women have chlamydia infection.
The government is introducing screening programmes to improve detection of diseases but there remains shortages in the provision of care. In many areas, there is a wait of up to six weeks for an appointment at a clinic. So more investment in services, particularly ones that are easy for young people to use, is essential.
But underlying the increase in sexual infections is a change in sexual behaviour. Young people are sexually active earlier than in the past and having more sexual partners. This is not surprising, given that children and teenagers are bombarded with images – music videos, adverts and so on – pervaded with sexuality.
So how can the sexual health of young people be improved? To have sex safely people need to be informed, be in a position to make a choice and be motivated to protect themselves and their partners.
Are young people informed? Improving sex education in schools, and making it mandatory, is a key step but we should all be fostering an atmosphere where sex can be discussed more openly.
Do young people make a conscious choice to have sex? Too often young women in particular do not make a choice, either because of abuse, coercion or peer pressure, or because alcohol or drug use impairs decision-making, condoms are forgotten and there is regret. Helping young people take control of their sex lives is central. This would be helped by a greater openness in discussing sex with peers as well as with parents and professionals.
And finally, are young people motivated to improve their sexual health? We often try to instil fear of pregnancy or disease. Perhaps we need to look at what motivates people to stay healthy. Young people who are determined to achieve some goal, whether in education, creativity or sport, may think twice before putting themselves at risk of an unwanted pregnancy or infection. But how do we instil such ambition? By giving all young people a sense that they have something to gain from investing in this society. In the context of growing social inequalities that is no simple task.
Dr Helen Ward is senior lecturer in public health at Imperial College London.