Wednesday, 25 August 2010
Middle Age Spread
Once again, there are stories in the press about the rise of Sexually Transmitted Infections (STIs) in young people (under 24), with half a million new cases in the UK in the last year, a rise of 3% from the 2008 figures. There's an excellent analysis of the data and the media response by Dr Petra Boynton who also deals adeptly with an ill-informed response to the data by a Tory MP.
Although the problem is much more serious with the under 24s, they are not the only group at risk from not using condoms and from poor sex education. As Dr Boynton points out in her blog: 'Sexual health messaging - particularly through education and public health campaigns often overemphasises morality discourses of 'risk' or 'responsibility'... Such an approach also assumes older adults act in different (and more 'appropriate) ways than younger people, which is neither fair nor true'.
The Family Planning Association (FPA) has collected data showing that STIs are also on the increase in the 45-64 age group.
Statistics vary according to different sources. The Royal College of Nursing has noted a 93% increase in gonorrhea between 1999 and 2008 in this age group. A survey done in the West Midlands found that the most commonly diagnosed infection among the over 45s was genital warts – accounting for almost half (45 per cent) of the diagnoses – while herpes was the next most common (19 per cent). Cases of chlamydia, herpes, warts, gonorrhoea and syphilis all rose sharply between 1996 and 2003.
To go back to the actual numbers rather than percentages, according to the HPA's data, Table 4e(ii) shows that chlamydia increased from 1091 cases in 2002 to 2638 cases in 2008. Their data also shows an increase in herpes cases from 1613 to 2903 in the same age group over the same period. These are huge increases in percentage terms but still a small incidence in the population as a whole. So if you see shock headlines about huge increases in grannies with STIs, check the baseline figures.
However, whichever stats you look at, there is an undeniable increase.
One cause is heterosexual couples of that generation splitting up and starting to have casual sex again. For some of them, the thought of dating again is daunting enough, let alone the idea of buying and using condoms. Some people may never have used them. Women who have been through the menopause are mostly of a generation whose main concern was avoiding pregnancy; being on the Pill was considered enough protection and greatly superior to using condoms. The Pill was also seen as empowering women as they didn't have to rely on the man to provide contraception. In addition, the powerful HIV/AIDS adverts of the 80s are now a distant memory and may have come from a time when they thought the campaign didn't relate to them in their steady relationships (which they assumed/hoped were faithful).
A poll by the Royal Pharmaceutical Society of Great Britain found that almost 20% of the 45-54 age group admitted to having unprotected sex in the last five years with someone other than a long-term partner. And a Saga survey of around 8000 people found one in ten not using condoms even though they don't know the sexual history of their partner. Again, a sharp rise from a small number to a slightly larger number is a trend but not a crisis although it is a trend that needs addressing.
While some middle aged people had excellent sex education from schools or parents, many didn't. STIs were often seen as something only the promiscuous got. They may not know, for example, how STIs can be transmitted through non-penetrative sex or that they are at risk at all. And while some people may have plenty of experience, both in having sex and talking about it, not everyone does.
Part of the problem is that sex is often portrayed by the media as something for younger people; the thought of older people having sex or expressing any kind of sexuality can be a bit of a joke or cause (younger) people to wrinkle their noses.
There is a gender bias too, just as there is with younger people where boys are portrayed as predators and girls as victims or 'morally loose'. Older men who are still active are admired (see how many Hollywood stars are still getting the girl in movies well into their sixties) while active older women are a bit distasteful. The alleged Cougar phenomenon in the media is really about women in their forties - maybe early fifties - who look much younger, not grannies. The most explicit portrayal you're likely to see on TV is an advert for a denture product with an older couple kissing (no tongues). None of this helps some older people feel confident in talking about sex openly or seeking advice.
It's encouraging to anyone approaching this age group that the fun doesn't have to stop. But while some are happily embracing their new sexual activity, some older people who grew up in a time when sex was less openly discussed may also find it harder to talk to GPs and health professionals about sex-related matters, especially if they are much younger. They may not even want to admit they are having sex again.
The current government coalition is doing little in the way of public health campaigning for sexual health services for any age group but the Family Planning Association is trying to address the problem for older people with a Sexual Health Week from 13-19 September specifically aimed at people over 50.
So far there has been no media hype or hysteria about older sex as there has been once again with young people, laden with high-handed moral judgements and shock horror headlines. This may change once the campaign launches.
The facts are that there is a small but significant upward trend that is indicative of poor education and campaigning. Just as teenagers need to be equipped to have responsible sex in a factual, non-moralising way, so do older people. The week in September is a good start but without a sustained campaign, it could just come and go without making much of an impact. So, there is not a huge new phenomenon, the very fabric of our society is not at risk from feckless pensioners and irresponsible baby boomers but the government is failing both young and old