With a continuing rise in STIs, Katie Mackintosh reports on what is being done to improve Scotland's sexual health
The primary six pupils at Glasgow Academy are giggling delightedly at the rude words and diagrams being drawn on their teacher’s board. They are learning about the life of Susan as she moves through early childhood into puberty and beyond, until her story comes full circle and she herself becomes a mum. The week before, they were learning about respect and responsibility, and while they were clearly thrilled to be told by a grown-up that they have a responsibility to tell their friends if they smell – albeit in a respectful way – their reaction at the end of the lesson when they were told they would be moving onto puberty and relationships next time revealed where their real interests lay. This is the one they’d been waiting for. So whether they were sitting on the edge of their seats, hands straining in the air, or slouched nonchalantly at the back of the class, pretending not to care, it was clear that the presenter had their full attention.
As is to be expected, the children are full of questions. Some display the innocence of youth, such as, “If a pregnant woman goes underwater, can the baby still breathe?” Or the slightly more mischievous, such as, “What happens if a baby farts in the womb?”
Others display a real maturity that puts paid to arguments that they may be too young to be discussing such issues. One boy wants to know if there is any truth in the reports he heard being discussed on Radio 4 while riding to school with his mum, that drinking alcohol while pregnant can actually be good for the baby. While another girl wanted to know if there were any differences in terms of health benefits for the baby if it is born by caesarean section or traditional womb birth.
And the presenter has some questions for them too. When Susan goes to university, she gets a boyfriend, who the pupils name Mac.
“How can Susan and Mac get to know each other better?,” the pupils are asked.
“They could go into a room and shut the door,” shouts one boy, to peels of laughter from the boys and disapproving tuts from the girls.
“Mac could take Susan to the park and they could sit by the pond and watch the sunset,” suggests another boy as he turns to the gaggle of girls, fluttering his eyelashes.
The class decide that Mac and Susan like what they see in each other and fall in love. “But what does love mean
But what does love mean 
,” they are asked. While many great minds going back thousands of years have struggled to answer that very question, primary six are happy to give it a go.
“It means falling for someone and thinking they are perfect, but then sometimes you find out they are not,” says one girl. “It means having to tell a girl that her bottom doesn’t look big,” adds one boy, equally astutely.
The key point is that no question or answer, no matter how silly or complicated, is dismissed. However, the result is that the presenter is still being bombarded with questions as she is packing up to go onto the next class of primary sevens.
Clearly, young people have a lot of questions about the fundamental facts of life. However, how and who is best to answer them is the challenge currently facing the Scottish Government.
In England the debate about sex education has recently been reopened as a result of the UK Government’s announcement that by 2010, “age appropriate” sex education lessons will become mandatory for children from the age of five. While at present the lessons are compulsory for students from the age of 11, under the new curriculum, all children in state schools in England will learn about body parts and animal reproduction from the age of five, about puberty and intercourse from the age of seven, and about pregnancy, contraception and safe sex from the age of 11. This has already sparked heated debate down south about whether the move will take control away from parents, and from faith groups who are concerned about faith schools not being able to opt out of the mandatory programme.
However, as education is devolved to Scotland, this will not apply north of the border. Moreover, as Scotland has no national curriculum, currently there is no legal requirement for Scottish schools to teach sex education, only guidance, so it is left to the individual schools to determine how this is delivered.
For the pupils at Glasgow Academy learning about Susan and Mac, the school and parents selected the Positive Steps programme. The programme, which is delivered to pupils in primary six and seven, has been designed to bring in aspects of sexual health in the context of the life cycle, explains Derek Sharkey, chief executive of the charity Positive Steps.
“It’s all about informed choices,” says Sharkey. “It’s saying to children that they need to be aware about things that can affect their health so they can make the right choices for them.”
The organisation has a number of presenters who can go to the schools and deliver the programme, or alternatively, they have resource packs that can help guide teachers to deliver it themselves. While he accepts that some teachers may feel uneasy about delivering the classes themselves, he says that he thinks it should be part of the curriculum.
“Dealing with it separately can mark it out as something different or taboo,” he explains. “I think it normalises it if the teacher is the one telling the kids about it.
“But I realise that some feel uncomfortable about their relationship with pupils. It can be difficult to be talking about English one minute and sex the next,” he adds.
However, he also says that it is simply impossible to cover everything in a few short lessons, and so a key part of the courses is to get the young people feeling comfortable talking about the issues in the hope that it will give them the confidence to continue the dialogue at home with their parents.
And yet this too can present a number of challenges as some parents may feel uncomfortable or ill-prepared to answer their children’s questions about sex. In a bid to help parents, the Family Planning Association (fpa) has designed a course that aims to encourage parents and carers to take on the role of sex and relationships educator. Having recently branched out to Scotland, the Speakeasy course has been designed to help adults gain greater confidence in an area that can cause embarrassment and awkwardness for parents and carers. During the free eight-week course, the adults learn about puberty, STIs, contraception, and how to talk about sex and relationships in the context of family life.
“Children are naturally inquisitive so it is really important that adults are prepared to answer their questions - even if it is just starting off talking about body parts and building that up little by little,” explains Adam Stevens, fpa. “It is so important that parents have a dialogue with their children.”
However, what both of these approaches have in common is that they were chosen for children not by children. So what would they choose for themselves?
“About six years ago there were a number of concerns about the sexual health of young people in West Lothian,“explains Ruth Ritchie, service manager, Children 1st. “So the council decided to hold an extensive consultation with as many young people as they could get in touch with about what they wanted to do about it.
“The overwhelming response from the young people was that they wanted somewhere that was theirs. Somewhere that they could access on their own terms, when they wanted to, for whatever information and support they needed.”
The result was the Chill Out Zone (COZ) in Bathgate, a healthy living centre that has been designed for and by young people aged between 12 and 20. Run by the charity Children 1st, its aim is to improve the health and wellbeing of young people through the provision of a range of “young people centred” health and development services, such as a health clinic offering confidential medical services and a drop-in service with access to information and advice.
“We consulted with young people on everything,” says Ritchie, “from the services it should offer, the layout, to the colours on the walls. It really is their place.”
The main space in the centre is a large open-plan living area that includes a computer suite with free internet access and a café where the young people can get a free hot meal. Behind the scenes are the medical clinic and counselling rooms. As well as the drop-in service, the centre also runs health campaigns raising awareness of issues such as breast cancer, and runs support groups on issues such as self-harm and LGBT issues. Furthermore, while much of what the service does is related to sexual health, the centre also offers classes in anger management, careers advice, and food preparation.
Ritchie says it truly is a unique service that is guided by what the young people say is most useful to them.
“Some of the young people told us that they didn’t want to make appointments or have to speak with designated members of staff. They wanted to choose who they wanted to speak to,” she explains. “So all of our staff are trained to give advice.”
She continues, “Others did want to set up appointments but didn’t want to have to come in through the front door in view of everyone. So there is access to the clinic round the back.”
“My brother used to come here to get free condoms so he told me about it,” says one teenage service user. “I’d rather come here than have to sit in the doctor’s waiting room with everyone looking at me.”
“You can come here and talk to them about anything, really,” explains another. “I wouldn’t want to ask my teacher about some of the stuff I can ask here.
“And it’s good because it’s not like some of the other places that just give out free condoms and then send you to the doctors if you’ve got any other questions. You can talk to them here about what different types of contraceptives there are, and they can give you the pill or the injection if you want that instead. It’s your choice.”
Ritchie says that COZ works because it accepts that those choices are the young people’s to make, and the staff’s role is to help and support them to come to informed decisions. “That, and we make sure we ask them how they want us to do that rather than just assume it,” she adds.
While giving evidence to the Scottish Parliament’s Justice Committee on the Sexual Offences Bill, Children’s Commissioner Kathleen Marshall said she was pleased to see that Children’s 1st had consulted service users at COZ as part of their submission for the Bill. However, she added that she would also like to see the Scottish Government making more of an effort to engage and consult with young people.
Marshall said to Holyrood, “One of my greatest concerns about the Bill was that people were supporting or not supporting the law on the basis of what they assumed young people’s motivations were.
“Some argued that the current law might help young people resist peer pressure and if it was decriminalised, would we deprive them of that useful argument and push them into under-age sex? Alternatively, would it put them off seeking sexual health advice? All these arguments were being had but no one had asked young people.
“I think we need to have a wider and substantive consultation with young people to get their views and help us understand the reality of young people’s lives.”
As such, she says she wants to see a commitment from the Government to having a “robust” consultation with young people before the Bill progresses further.
While, Marshall’s own response to the Bill caused a media storm, prompting headlines such as, “Marshall: Let 13-year-olds have sex,” she says the truth behind her comments was less sensational but no less newsworthy.
“I think I gave a principled response that was completely manipulated,” she says.
“It is frustrating because there is a very serious debate here that I think gets siphoned down sinister routes that don’t reflect the truth of the matter, and pressures people and blinds them to what the real issues are.”
But was the media’s response indicative of a more serious underlying problem? For while many adults are clearly uncomfortable addressing the issue of under-age sex, could the bigger problem be that many simply find it hard to talk about sex full stop?
“Some adults find it very difficult to talk about sex,” agrees Sue Maxwell, Relationships Scotland, “and it is beginning to show in their health.”
Statistics released by ISD Scotland in July showed that some sexual diseases are now increasing at a faster rate among the over-35s than in younger people. They found that rates of syphilis are increasing at a faster rate among older men than in the under-20s – 31 times in the over-35s in the past decade, compared to nine time in under-20s - with similar patterns repeated for gonorrhoea and herpes in older women.
Why?
“When Respect and Responsibility was introduced three years ago, the whole focus of the strategy was solely on under-25s as they were deemed to be the most at-risk group,” Maxwell explains.
“However, with divorce rates and relationship breakdown on the increase, people in their 30s are often finding themselves in the process of changing relationships and in that sense, they are much more vulnerable.”
She continues, “Quite frequently, if they have been in a long-term relationship they haven’t had to negotiate safe sex. They might not know how to talk about issues like contraception with a new partner. Or they might be at the stage of their life when they are no longer concerned about fertility so don’t think condoms are necessary. So there is a need to teach them that sexual health is their responsibility, whatever age they are.”
There is also, she says, a need to make sure that that information is being given to older people.
“With people in their 60s, it is often assumed that they will have no sexual function and so will have no sexual health needs, they become asexual, in some people’s eyes.
“But this is, after all, the flower-power generation and with things like Viagra and lifestyle changes, people are seeing their sex lives extended, so it is very important that they are getting those safe sex messages too
people are seeing their sex lives extended, so it is very important that they are getting those safe sex messages too
.”
As such, she says she would like to see older people’s relationships and sexuality back on the agenda.
“It is not just about young people’s relationships. It doesn’t matter what age you are, you still have the same responsibility for personal sexual health.
“So more money needs to be put into raising awareness of sexual health across the lifespan, not just among young people.”
As it happens, the Scottish Government agrees. Earlier this month, it announced that it is developing a £1m marketing campaign for next spring that will be aimed at getting people to be more open about talking about sex.
“We’re committed to doing everything we can to improve the nation’s health – and that includes our sexual health,” explains Public Health Minister Shona Robison. “That’s why we are currently developing a marketing campaign which aims to promote better sexual health, focusing on the need for us to be more open and willing to discuss relationships and sexual health matters.
“Knowledge is power and by increasing knowledge and providing better information – for instance, about risk-taking behaviour – people will be able to make more informed choices.”
Because the truth is that Scotland’s sexual health remains poor. Later this month, ISD Scotland will publish its annual sexual health information report. However, if recent sexual health statistics are anything to go by, the report will not be cause for celebration. Preliminary figures released by ISD Scotland in July on STIs and other activity in GUM clinics for 2007 show that 22,906 acute STIs were diagnosed in such clinics in Scotland last year - an increase of 7 per cent on the previous year and a leap of 110 per cent since 1996. Overall, there was a 13 per cent increase in the workload in GUM clinics last year.
“Scotland is not very sexually healthy,” agrees Ailsa Splindler, National Director for Scotland, Terrence Higgins Trust. “We are pretty much bottom of the league in terms of Western Europe and pretty appalling on a global scale in terms of normal measures such as teenage pregnancies and STIs.”
What then does this say about the success of the national strategy to date?
“You never know with health promotion work how much success you’ve had. If we hadn’t done anything, would the statistics have been even greater? We just don’t know,” she says. “But either way, it is clear that it is not getting through to a lot of people who it needs to be reaching.”
She is, however, optimistic about the new campaign and hopes, in particular, that it will do more to encourage people to get regular screenings and raise awareness about STIs and their symptoms.
“There are a number of STIs, such as chlamydia that have few noticeable symptoms so are hard to self-detect.
“But we also know that 30 per cent of people with HIV are not aware they have it, which is far more serious.”
However, while she agrees that it is right that a campaign is being developed to target all ages, she adds that the increasing number of over-25s reporting STIs, many of whom she says will have had inferior sex education when they were young, is testament to the importance of getting those safe sex messages to people early.
While she accepts that for some, this is an uncomfortable issue, she says that quite simply, it is too important to ignore.
“For those who argue it is a child protection issue, I agree that we have a responsibility to protect children by helping them understand that they are sexual beings who live in a sexual environment and that they need to be informed to help them make informed decisions.”
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