Safe sex: what's that then?

After a decade of Aids campaigning it seems the message still hasn't got through. Why worry, I won't get it, is now the response. By Hester Lacey

"If You're going for a paddle, put your wellies on" is the kind of jolly Nineties slogan that has superseded the grimmer Eighties safe sex warnings like, "Don't die of ignorance". It's hard to believe that anyone hasn't yet got the message. But last week the Health Education Authority (HEA) launched another pounds 500,000 initiative aimed at 16 to 24 year olds; its most recent survey showed that confusion and embarrassment surrounding safe sex is, in fact, on the increase. As many as 25 per cent of this group still feel embarrassed at bringing up the issue of condoms with a new partner and 30 per cent feel uncomfortable about buying condoms.

So, what's the problem? Surely in the up-front Nineties, buying a pack of three Extra-Sensitive is about as normal as buying toothpaste. Or perhaps not. Ask people about their safe-sex habits and at first they will claim that they follow guidelines to the letter. But carry on talking a little longer and they will confess that although they know what they should be doing, they don't always do it.

Richard, 20, Glen, Dave and Adam, all 21, and Beth and Ella, both 19, had settled in Glen's flat one evening last week to play poker and drink a few beers. "Of course, we all know what safe sex is," they chorused wearily, "it means using a condom." "So you don't get Aids," added Glen. "Or pregnant," said Beth.

And do they use them? "Nobody likes them," said Glen. "When you get a condom out, the girl thinks you think she's got something." "Or more likely that you've got something," said Dave.

But do they mind buying and using them? "I'd buy condoms if I might be expecting to get off with someone. But if she said there's no need to use one I'd be happy. I wouldn't, unless she wanted me to use one," said Glen. "I'll only buy them from a machine," said Richard. "Anyway, I don't need condoms, because I've had a steady girlfriend for nearly six months now and I know she hasn't been around."

Aids is low down on their lists of worries. "Straights can get it," said Richard. "Yes," said Adam, "but it's really difficult. You'd have to be doing something really weird." "You get Aids if you're on drugs and share a needle. There has to be blood," said Dave. "Just normal sex, you probably wouldn't get it. You'd have to be really unlucky."

"I know you should use condoms, but sometimes after a few drinks I might not bother," said Ella. "I'm on the Pill, so I can't get pregnant, and that's the most worrying thing. I think the chance of getting Aids is about one in a million or even a billion. It's really tiny."

"There's not much Aids round here," said Beth. "It's more an inner-city thing where there's loads of drugs." "You take drugs!" yelped Adam. "Yes, but not those kinds of drugs!" retorted Beth.

None of them were worried about herpes, or would have much of an idea how to recognise it. "They can cure that now," said Adam with conviction. (They can't, and it's on the increase.) Ella, the only student, was the only one to have heard of chlamydia, another sexually transmitted disease concerning the HEA. "It's very serious because you don't know you've got it. It can make you infertile," she said, correctly.

Both Ella and Beth would carry condoms only if they were going out to a party or clubbing, though Beth said she would keep them out of sight. "It's a bit tarty, I wouldn't be too up-front about it." And all felt that they knew their circle of friends well enough to attempt to "recognise" by sight who might be a sexual risk - which is impossible. "We know who goes with lots of people, sleeps around a bit, so you can avoid them," said Glen.

"You obviously can't really tell by looking, but I wouldn't take a risk if I knew someone had had lots of partners or was on drugs," said Beth. "Once," spluttered Glen, laughing through a mouthful of beer, "I pretended to put one on and didn't - and she didn't even notice!" Beth giggled, but Ella did not. "That's disgusting," she snapped.

Those who are old enough to know better may behave no more sensibly. "Condoms are horrible," says Sarah, 31. "I always think of them as being for young kids and students who are expecting a quick shag. I somehow think it's just not ladylike to carry them; I always leave it up to the bloke. Not that it's an issue that often," she adds hastily. "Anyway, I'm on the Pill, and because I know I won't get pregnant, I've taken a few risks in the past."

"I still don't particularly feel as if I'm following the rules, because they still aren't clear," says Steve, 32. "I have changed the way I behave because of Aids. I use a condom whenever I'm not in a long-term relationship, but not for oral sex - I can't work out whether that's safe or not. And can't you get herpes mouth-to-mouth?"

"Aids? I suppose there might be a slim chance. But herpes - I've never even given it a thought," says Daniela, 27. "I haven't used condoms for years."

These attitudes are not isolated. The HEA's evidence is by no means the only research that shows safe sex is not taken seriously by increasing numbers of young people. One of the most telling indications is the rise in cases of genital herpes - up by 59 per cent in just nine years. Doctors are warning of an "epidemic" to come. Earlier this year, Dr Frances Cowan of University College Medical School in London and a member of the Herpes Simplex Advisory Group, observed: "The evidence that people have changed their sexual behaviour isn't that great. The fact is that in a decade of Aids, when supposedly everyone has been practising safe sex and

using condoms, the overall prevalence of genital herpes has gone up. We know large sectors do not perceive themselves to be at risk."

Are there any grounds for complacency about HIV? At the end of June 1996, there were around 27,000 cases of HIV in the UK. The majority of these (around 72 per cent) are still found in high-risk groups: homosexuals and intravenous drug users. Statistically, contracting HIV through heterosexual sex is not a huge risk. Nevertheless, 18.7 per cent of cumulative reports of HIV to the end of June 1996 were transmitted through heterosexual intercourse, and only 12 per cent of these involved a partner with a high-risk background. That is a total of just under 4,500 cases, which may not seem like many. But becoming HIV positive is more likely than winning the national lottery, for example, and most people are prepared to have a flutter on that on a Saturday night, believing it "could be them"...

Marie Goldsmith, project manager of the new initiative at the HEA, points out that the subject has dropped out of the public eye. "Younger age groups were not exposed to the publicity of the late Eighties and early Nineties," she says. "And those who did get the messages need a constant reminder that HIV hasn't gone away. And while it's true that the HIV epidemic is not as great as was anticipated in the early Eighties, there are other sexually-transmitted diseases that people are not aware of. So many don't have obvious symptoms - such as chlamydia, which can lead to pelvic inflammatory disease, severe pain and even infertility. There is more stigma around infections than around unwanted pregnancies - that stigma is one of the biggest issues around the use of condoms."

Students, who have had the safe-sex message brought home to them since the first nano-second of Freshers' Week, are more likely to practise what is preached. "Everyone I know uses condoms - or says they do," says Eve, 20. "At university they promote safe sex all the time and it takes off a lot of the embarrassment. You can get condoms everywhere, they have flavoured ones in the loos." So, perhaps saturation ad campaigns can work. "Our initiative aims to help young people to plan ahead and carry a condom if there is any hint that they will have sex - or resist the pressure to have unprotected sex," says Goldsmith. "We also want to make them think positively about the raising the subject of using condoms. It's vital that young people don't throw out their condoms and think 'It will never happen to me'."