How Safe is “Safer Sex”?

1. How Safe is “Safer Sex”?

2. Pregnancy • Percentage distribution of outcomes of teenage pregnancy,women aged 15 to 19, Canada, 1974 to 1997 http://www.statscan.ca/english/kits/preg/preg3.htm

3. Abortion Teenage abortion rates, by age of women at end of pregnancy, women aged 15 to 19, Canada, 1974 to 1997 http://www.statscan.ca/ english/kits/preg/preg3.htm

4. Abortion 2005 • Canada – 97,254 2007 • Alberta – 12,206 2006 • Canada – 91,377 2008 • Alberta – 12,537 http://www40.statcan.gc.ca/l01/cst01/health40a-eng.htm http://www.health.alberta.ca/documents/Reproductive-Health-2009-Update.pdf

5. Sexually Transmitted Diseases • Chlamydia • Genital Herpes • Human Papillomavirus • HIV/AIDS

6. Chlamydia

7. Chlamydia

8. Chlamydia • Is the most common bacterial STD. • Most commonly infects the urethra in males and the cervix in females. • Up to 50% of males might not develop any symptoms • Up to 80% of females will not develop any obvious symptoms of infection • Chlamydia can be cured with antibiotics STD: Taking Care of Yourself and Others. Alberta Heath and Wellness

9. Chlamydia “In females, untreated Chlamydia can infect the fallopian tubes and the ovaries causing pelvic inflammatory disease.” • This can lead to infertility in women. STD: Taking Care of Yourself and Others. Alberta Heath and Wellness

10. Chlamydia • The annual cost in the USA to deal with PID is $5.5 billion. • 25% of those who experience PID will likely experience an ectopic pregnancy and infertility. Lepine, L.A., et al. (1998). Severity of pelvic inflammatory disease as a predictor of the probability of live birth. American Journal of Obstetrics and Gynaecology. 178(5): 977-981

11. Chlamydia • Close to 63,000 cases of Chlamydia were reported in 2004, the highest number of cases since the disease became reportable in 1990. • Reported rates of Gonorrhea have nearly doubled from 14.9 per 100,000 in 1997 to 28.9 per 100,000 in 2004. • Syphilis is escalating in both males and females, but more so in males. 2004 rates for men were 15 times higher than in 1997 (6.3 vs. 0.4 per 100,000). Public Health Agency of Canada. Canadian Communicable Disease Report. 2004 Canadian Sexually Transmitted Infections Surveillance Report: Pre-Release. May 2006

12. HIV/AIDS HIV is transmitted through: • Unprotected sexual intercourse (vaginal, anal, oral); • Shared needles or equipment for injecting drugs; • Unsterilized needles for tattooing, skin piercing or acupuncture; • Pregnancy, delivery and breast feeding (from an HIV-infected mother to her infant) http://www.hc-sc.gc.ca/dc-ma/aids-sida/index_e.html

13. HIV/AIDS • “Condoms are roughly 90 percent effective in preventing HIV transmission.” Hearst, N. & Chen, S. (2004). Condom Promotion for AIDS Prevention in the Developing World: Is It Working? Studies in Family Planning. 35(1): 39-47

14. HIV/AIDS • HIV attacks the immune system, resulting in a chronic, progressive illness and leaving infected people vulnerable to opportunistic infections and cancers. • The median time from infection to AIDS diagnosis now exceeds 10 years. • AIDS is fatal. There is no cure. http://www.hc-sc.gc.ca/dc-ma/aids-ida/index_e.html

15. Genital Herpes • Caused by herpes simplex type 1 or 2 (HSV-1) or (HSV-2). • Herpes is transferred through direct skin to skin contact, including mouth to genital contact and hand to genital contact. • Some people are asymptomatic, however the virus can be transferred whether there are visible sores or not. STD: Taking Care of Yourself and Others. Alberta Heath and Wellness

16. Genital Herpes How common is Genital Herpes? • In the United States, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. • Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be due to male-to-female transmissions being more likely than female-to-male transmission. Genital Herpes - CDC Fact Sheet. Center for Disease Control and Prevention. Department of Health and Human Services.

17. How common is Herpes?

18. Genital Herpes • Symptoms are blisters and ulcers in the genital area • Females - usually have outbreaks on the vulva, near the anal opening or internally on the vaginal walls or cervix • Males - the blisters and sores appear most often on the penis, on the scrotum or near the anus. STD: Taking Care of Yourself and Others. Alberta Heath and Wellness

19. Genital Herpes • In a study tracking women over a two year period, the rate of infection for those who used condoms was 28.9% versus 44.3% for those who did not use condoms Oberle, M.W. et al. (1998). Herpes simplex virus type 2 antibodies: high prevalence in monogamous women in Costa Rica. American Journal of Tropical Medicine and Hygiene, 41: 224-229.

20. Human Papillomavirus (Genital Warts) How common is HPV? “70% of the adult population will have had at least one genital HPV infection over their life time” Canadian Guidelines on Sexually Transmitted Infections 2006 Edition. Public Health Agency of Canada

22. Human Papillomavirus (Genital Warts) HPV is divided into two categories, high risk and low risk • High Risk HPV is closely associated with cervical cancer • Low Risk HPV is closely associated with genital warts Canadian Guidelines on Sexually Transmitted Infections 2006 Edition. Public Health Agency of Canada

23. Human Papillomavirus (Genital Warts) “Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection” • Infection among inconsistent condom users was 89.3 per 100 • Infection among consistent condom users was 37.8 per 100 Winer, R, L. Ph.D., et al. (2006). Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women. The New England Journal of Medicine. 354(25): 2645-2654

24. HPV infection in women can occur on the Cervix Vagina Vulva Inner thighs Perianal area Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department and Human Services For the male infections can occur on the Penis Urethra Scrotum Inner thighs Perianal area Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department and Human Services Human Papillomavirus (Genital Warts)

25. Human Papillomavirus (Genital Warts) “Given that HPV infections can occur in and be transmitted by areas not covered or protected by the condom, correct use without breakage or slippage of the male latex condom could at most be expected to partially reduce the risk of HPV transmission.” Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department and Human Services

26. HPV Vaccine • the vaccine will NOT protect against all types of HPV that cause cervical cancer • the vaccine does not protect against all types of HPV • About 30% of cervical cancers will not be prevented by the vaccine • the vaccine does not prevent about 10% of genital warts HPV Vaccine Q & A – CDC Fact Sheet. Center for Disease Control and Prevention. Department of Health and Human Services. Found at http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm #hpvvac5 on February 8, 2007

27. Advice to Educators “Condoms do not provide 100% protection against STI…Sexual health educators have a responsibility to inform their students of the scientific evidence concerning the facts about the effectiveness of condoms.” Sexual health education in the schools: Questions & Answers. Sex Information and Education Council of Canada. (2005)

28. High Risk Behaviour • Students need to know that diseases can be caught by anyone who has genital contact with another person. • It is not just the people who run around from one partner to another “Using longitudinal data from 242 women who had only had one sexual partner, we found that the risk of acquiring cervical human papillomavirus infection was 46%...at three years after first intercourse…” Collins, S., Mazloomzadeh, S., Winter, H., Blomfield, P., Bailey, A., Young, L.S, et al. (2002) High incidence of cervical human papillomavirus infection in women during their first sexual relationship BJOG: An International Journal of Obstetrics and Gynaecology 109(1): 96–98

29. A little knowledge can be a dangerous thing… A lot of knowledge doesn’t seem to make a difference anyway • Low test scores - 57% reported not using a condom • High test scores – 49% reported not using a condom • Low test scores – 33% reported more than two sexual partners • High test scores – 39% reported more than two sexual partners Jones, N. R. & R. Haynes. 2006. The association between young people’s knowledge of sexually transmitted diseases and their behaviour: A mixed methods study. Health, Risk & Society. 8(3): 293-303

30. A little knowledge can be a dangerous thing… A lot of knowledge doesn’t seem to make a difference either. • “Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms.” • “Although the adolescents may gain factual knowledge from their experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviours.” Diclemente, R. J., et al. 2002. Association of Adolescents’ History of Sexually Transmitted Disease (STD) and Their Current High-Risk Behavior and STD Status: A Case for Intensifying Clinic-Based Prevention Efforts. Sexually Transmitted Diseases.29(9): 503-509

31. What did you say your name was? • “Dr. Ameeta Singh, medical director of Capital Health's STD Centre and a consultant for Alberta Health, said many of those testing positive for the disease have told doctors they regularly had casual sex and can't identify their partners.” http://chealth.canoe.ca/channel_health_news_details.asp?news_id=10271&channel_id=16

32. What did you say your name was? • "The challenge has been that a number of people have said they don't know who they had sex with, so many of these individuals have been left untraced," said Singh. http://chealth.canoe.ca/channel_health_news_details.asp?news_id=10271&channel_id=16

33. More Condoms Please “In Botswana condom sales rose from one million in 1993 to three million in 2001 while HIV prevalence among urban pregnant women rose from 27 to 45 percent.” “In Cameroon during the same time period, condom sales increased from six million to 15 million while HIV prevalence rose from 3 to 9 percent.” Hearst, N. & S. Chen. (2004). Condom Promotion for AIDS Prevention in the Developing World: Is It Working? Studies in Family Planning. 35(1): 39-47

34. More Condoms Please • 256 couples • HIV Negative with HIV Positive • 124 couples reported consistent condom use • 121 couples reported inconsistent condom use • Approximately 5% of the inconsistent users became HIV Positive De Vincenzi, I. (1994). A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners. New England Journal of Medicine. 331(6): 341-346

35. “As AIDS Educators, we often publicly promote approaches that we would not countenance in our personal lives, such as the notion that it is acceptable for our spouses or children to have multiple partners, provided condoms are used.” Dr. David Wilson, a Senior Monitoring and Education Specialist for Global HIV/AIDS

36. What about abstinence education? • There is some evidence to suggest that abstinence only programs have an effect on the attitudes of teens in the short term • Delaying the onset of sexual activity reduces the number of partners one would have thus reducing the risk of contracting an STD. Borawski, A. E., et al. (2005). Effectiveness of Abstinence-only Intervention in Middle School Teens. American Journal of Health Behavior. 29(5): 423-434

37. What happened in Uganda? It was as easy as ABC. • A – Abstinence • B – Be faithful • C – Condom

38. What happened in Uganda? It was as easy as ABC. The number of women reporting multiple partners • 1989 – 20% • 2000 – 2.5% 13 – 16 year olds involved in sexual activity • 1994 – 60% • 2001 – 5%

39. What happened in Uganda? It was as easy as ABC. National HIV prevalence • 1992 – 30% • 2001 – 5% Those who ever used condoms • 2000 -16% Genuis, S. J. & S. Genuis. (2004). Managing the sexually transmitted disease pandemic: A time for reevaluation. American Journal of Obstetrics and Gynecology. 191(4):1103-12

40. What happened in Uganda? It was as easy as ABC. President Museveni • Widespread media campaigns • Educate everyone on modes of transmission and prevention • Fought the stigma and discrimination against people infected with HIV • Behaviour change was essential to the efficacy of this program Singh, S., Darroch J. E., Bankole A. (2003). A, B and C in Uganda: The Roles of Abstinence, Monogamy and Condom Use in HIV Decline, Occasional Report, New York: The Alan Guttmacher Institute, No.9.

41. Our comprehensive programs • DARE • MADD • BUTT Ugly • PARTY Program • Justice Education Theatre

42. What can we do? • What are some things that we could do as a community that might help put an end to this epidemic?

43. Resources www.faithandreason.ca/chastity www.lifecycle.com

44. Resources: Dr. Stephen Genuis

45. Resources: Pam Stenzel

46. Resources: Dr. Miriam Grossman

47. Resources: Laura Sessions Stepp

48. Resources: Helen Fisher

49. Resources: Adina Nack

50. The End