Thinking beyond ‘risk’ narratives when it comes to young people and sexual behaviours

As university students across the UK begin their new terms, it is the beginning of a new chapter of learning as well as the forging of friendships many people keep for life.  However, might there be risks associated with being a university student, such as catching a sexually transmitted infection (STI)?  The Daily Mail recently headlined a piece “A QUARTER of students catch an STI during their first year at university – and half are too drunk to remember who gave it to them”, based on a recent poll of recently graduated students.  The Huffington Post also ran an article about the survey findings.  This post considers the Mail’s piece.

What was the poll about?

The survey, conducted by the website www.shagatuni.com, included 2,177 young adults who had recently graduated.  Firstly, the website is a ‘dating’ site for students.  It describes its sole purpose as ‘to help students meet up for sex’ and it continues ‘if you want to find sexy students at your university who just want a shag, JOIN UP!’.  All survey respondents self-reported being single throughout their period at university.  The survey, therefore, used a very particular population of young people to obtain their data.  Whenever a survey draws its respondents from a very particular group then it limits the generalisations that can be made to other people, in this case to all university students.

So, of students who were signed-up to a particular ‘dating’ site, for (repeated) casual sex, and who remained single throughout their 3 or 4 years at university, and completed the survey…23% said they were diagnosed with a STI.  Let us be clear, this does not mean that a quarter of all university students are going to get a STI in their 1^st year, but this very particular group said they got one.  So the headline ‘A QUARTER of students catch an STI during their first year at university’ is simply not true, and could be deemed sensationalist. But the more accurate headline ‘A group of highly sexually active young people report multiple partners and catching a STI’ might not be that interesting.

How accurate were the numbers in the story about background STI rates?

The article refers to the report, Sexually transmitted infections and chlamydia screening in England, 2012, in Public Health England (PHE) Health Protection Report, published June 2013, which presents the most recent information on trends in STI diagnoses and a summary of chlamydia screening activity in England.  The report compiles data collected from genitourinary medicine (GUM) clinics, and for chlamydia also from the Chlamydia Testing Activity Dataset.  They include all diagnoses, including repeat diagnoses.

The total [new cases of STIs] was up by five per cent on the previous year and 46 per cent higher than 2003, when figures were first collected.

The article states that all STI diagnoses increased by 5% in the past year and by 43% over the past decade.  The PHE report does indeed cite the former figure, so the article has provided an accurate figure for total diagnoses.  The report does not contain the 43% figure; indeed, PHE issued a press release, in which it warned caution was needed in comparing recent data with older data, due to changes in data collection methods in 2012. Thus, the article author may have used 2003 figures and calculated the increase to 2012 as 43%, but may have done so without the caveat in mind.  A problem with comparing numbers across years in this way is that it is a naive way of looking at these kinds of data, as it ignores what else may be driving up the numbers, such as an increase in testing efforts (i.e. the more you look then the more you’ll find), more sensitive molecular tests being used to identify infections.   The article does not include this information for readers to bear in mind when contemplating the statistics.

Rates are highest among the under-25s, with nearly two-third of chlamydia cases, and more than half of gonorrhoea infections, occurring in this age group.

The article flags both chlamydia and gonorrhoea infections occurring most often among people aged under 25 years.  Let’s unpick these claims.  Yes, chlamydia is an infection that disproportionately affects young people.  However, 7,440 of 25,525 cases (29%) of gonorrhoea were among heterosexual young people.  The report did not give diagnoses by age or by men who have sex with men, but gonorrhoea is the most commonly diagnosed STI among men who have sex with men. So that sentence in the article is slightly misleading. Gonorrhoea may be increasing due to various reasons, including: HIV is increasing, and having HIV increases the risks of catching STIs; and put simply, the more you look the more you find, which means if we test more for it then we find more.

Gonorrhoea rates are increasing particularly rapidly – they have risen by a fifth in the last year. This is thought to be because of a new super-strain of the disease that cannot easily be treated with antibiotics.

The article also favoured the suggestion that resistant strains of gonorrhoea are leading to increased diagnoses.  In fact, between 2010 and 2011, there was a decline in resistance, which has bought some time to tackle the threat of multi-drug resistant gonorrhoea. So, the article was a bit misleading with their sentence.

Overall, the article does not present diagnoses by gender, ethnicity, by heterosexual or men who have sex with men populations or by geographical area.  Instead, the article is extremely heteronormative, including the image used on the website.

What are the real facts about STIs and young people?

I am a sexual health researcher, and have conducted research with young people, mostly heterosexual young people aged 16-24, on chlamydia.  I reported the findings HERE and HERE.  Young people have told me that they think of chlamydia as a problem of ‘others’, in particular a ‘promiscuous’ group of young people like students. Chlamydia is a common infection, affecting around 1 in 10 young people; therefore, it is not a problem of ‘others’.  It is a STI that all sexually active young people should be aware of, particularly as it can affect men’s and women’s fertility.  It is also a STI that can affect people who have only had one or two sexual partners, and I have tested such young people as positive for chlamydia in a study that offered chlamydia screening in various community settings.  Articles such as the Mail’s, which describe ‘promiscuous’ (read deviant) young people getting STIs, paints a picture of STIs as only a problem of a particular group of young people when this is not the case.  Many of the young people I have engaged in sexual health research also reported poor knowledge of chlamydia, as I reported in this article. Sex is pleasurable for many people, including [shock] young people! If we as a society don’t educate our young people to help them to make safer choices, then who are we to then brand them deviant when they take risks?