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Taboos: Could it be you?

Is chlamydia the new AIDS? asks Carrie Clarke

Sex can damage your health. That was the spring message spread by health promotion agencies. And not since the days of AIDS panics in the 1980s - remember TV ads of icebergs and national 'safe sex' mailshots? - has the message been promoted so vociferously.

The fpa (formerly known as the Family Planning Association) launched a booklet, Love STIngs, aimed at convincing youth that indulging in a fumble behind the bikesheds was potentially more damaging to their health than indulging in a cigarette. And the Health Education Authority (HEA) distributed hundreds of thousands of credit card-sized leaflets issuing warnings about chlamydia: 'the most common sexually transmitted infection (STI) in the UK.' Chlamydia, cautions the HEA, is 'on the increase, especially among people under 25 years of age...if you've ever had unsafe sex, you may be at risk, even if you feel perfectly healthy. Chlamydia is caused by bacteria that can stay hidden for years in either men or women, but if it's not treated, the long-term effects can be serious'.

When organisations known for having liberal attitudes to sex start sounding the alarm, a media frenzy is inevitable. And it came, with the Daily Mail leading the way. Under a headline that bellowed 'Invisible bug is leaving women infertile', the paper claimed that as many as 100 000 young women could find themselves unable to have children over the next decade (8 March 1999). The Mail and other papers made much of the fact that incidence of the disease among the young has reportedly risen by 56 percent over the past two years, with 22 000 new cases of infection in this age group in 1997. An edition of the BBC's flagship current affairs programme Panorama on 8 March ended with the doom-laden prediction that we face a future in which chlamydia will cause untold suffering.

Scary stuff - and very reminiscent of the HIV/AIDS panics. The parallel was made more obvious by the HEA leaflet's advice to those who have been at risk of chlamydia to call the National AIDS Helpline for further information. But like the fears about a raging heterosexual epidemic of HIV and AIDS, a panic is all this recent concern about chlamydia is.

There is no doubt that chlamydia is a nasty, insidious little disease, and it makes sense to be aware that it is around and about. It is easily transmitted and often symptomless. If it is left untreated, in both men and women, the infection can eventually make its way into the reproductive tract where it can cause problems. Without treatment, in some men it may affect the development of sperm and in some women it can cause pelvic inflammatory disease, leading to infertility or increased risk of ectopic pregnancy (where the embryo implants and grows in one of the fallopian tubes instead of the uterus). Recently, chlamydia has been linked to heart disease, eye infections and childhood pneumonia.

In truth, nobody knows to what extent the incidence of chlamydia is on the increase. The Public Health Laboratory Service reports that in 1997 there were 22 000 new cases of the infection among the young - a 20 percent increase in diagnoses. But this figure only relates to young people who attend genito-urinary medicine clinics, not to the population as a whole. It may suggest that a higher proportion of people who have referred themselves, or been referred by a doctor to a clinic, because of a suspected STI are identified as having chlamydia - but it doesn't necessarily imply that a higher proportion of the population is infected. Furthermore, increased publicity about chlamydia over the past couple of years is likely to have led to an increase in screening, so more cases will of course be found.

But in any case, chlamydia infection need not be a big deal - primarily because it is so easily treated by a simple course of antibiotics. And despite all the hype, chlamydia is not some new unfamiliar disease. Older readers may remember being diagnosed with USI (unspecific sexual infection) and in all probability that was chlamydia - before it earned the pretty name. The population includes many one-time chlamydia sufferers who aren't infertile, or victims of heart disease. While, if you're unlucky, untreated chlamydia can lead to infertility, the presentation of this outcome as the future awaiting sexually active 20-year olds is a gross exaggeration.

So why all the hype - especially from the sexual health agencies who should know better than anybody the real facts about the disease?

Perhaps a good part of the answer lies in the desire by the authorities to find new ways to promote sexual responsibility. Surveys suggest that at least one in five young people have sex before they are 15 and the prospect of young people having sex, especially outside of a stable relationship, is one that many seem to find unpalatable. The problem is that, whereas in the past a moral message - 'teenage sex is wrong' - could be delivered, in today's non-judgemental times it sits less easily on the lips. Instead, the message that teenage sex can damage your health is delivered in the hope that it might achieve the same effect.

In the late 1980s and early 1990s HIV/AIDS was used with some success to illustrate the argument that sex can have serious consequences for your health if not for your conscience. Fears about HIV have played a part in the transformation of attitudes to casual sex (now officially uncool) and the use of condoms (now officially cool). But as the years have passed and the spread of HIV has remained, in the UK, relatively slight among the heterosexual non-IV drug-using public, concern about it has declined. A study published in March by the Schools Health Education Unit, for example, found that concern about AIDS is falling among children aged 12 to 15. Part of the reason that has been given for an increase in sexually transmitted infections among the young has been precisely their lack of concern about AIDS, reflected in their reluctance to use condoms. This may concern AIDS campaigners; but the fact that teenagers seem to be contracting every STI apart from AIDS indicates that for most young people this disease is nothing like the problem it was made out to be.

Those who would rather young people didn't put it about have found, through the prism of chlamydia, a new post-AIDS way to issue the warning 'have fun now, you will pay later'.

For some, the comparison with AIDS is inescapable. Linda Lee-Potter could not resist using her Daily Mail column to revisit the notion that sexual disease is nature's replacement for divine retribution. 'Nature has ways of making us see sense', she opined, 'and in the same way that AIDS was a warning to gays to amend their promiscuous ways, the sexually transmitted disease chlamydia is now warning girls to keep their virginity firmly intact' (10 March 1999).

Stressing the threat of contracting chlamydia is the vehicle through which the danger of 'promiscuity' (now increasingly defined as having more than one sexual partner) can again be emphasised. It provides the opportunity for a new round of initiatives to warn young people about the perils of sex. And chlamydia in particular, the invisible disease, provides the perfect vehicle for doing so. Young women value their potential fertility. The threat that they could damage it - and not even know - through a single act of sex is understandably alarming. With chlamydia, it 'could always be you'.

The sexual health agencies that are pushing the chlamydia panic would make a better contribution to the nation's health by stressing that although chlamydia is common, it's a cinch to detect and treat. But then that might be seen as reassuring young people that sex can be safe - and that's not the message they want to convey at all.

Reproduced from LM issue 120, May 1999

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