Today is World AIDS Day with events taking place globally around the theme of Universal Access and Human Rights. You can follow discussions about the day with links to activities and organisations involved on twitter using the hashtags #WAD2010 and #PreventionRevolution

Access is an important but often overlooked issue within this area. Getting education to help people protect themselves from HIV or making care available for people with HIV/AIDS are both still major problems being faced worldwide. Particularly in resource poor communities. Women, children, sex workers, LGBT communities may find it more difficult to reach basic educational and health services, particularly in countries with gender inequalities or where homosexuality is illegal. A lack of critical reflection on the meanings of masculinity within research and care around HIV/AIDS can often mean mens’ health needs or problems can be overlooked or only focused on in negative terms.

Aside from funding and staffing issues, access to HIV services can center around transport and roads, availability of aid, poverty, housing, and education generally (particularly literacy programmes). Not to mention problems of rape and sexual violence, domestic abuse and availability of medication.

Access isn’t just about treatment services for those living with HIV/AIDS but also around prevention and treatment programmes. Which can often be blocked by moral or political opposition or apathy. Which is why access and human rights are interlinked. People deserve the right to have accurate information to help them protect themselves from HIV or gain appropriate care and support if they are positive.

The theme of access for the coming year is an important one and hopefully will be an opportunity for health care staff, educators and researchers to focus on a broader definition of the term. Access also applies to the education, training and support of staff working in health and social care in HIV/AIDS. We still have problems with a lack of open access for many academic journals covering issues staff need to be aware of and that should be something we all press for in the next twelve months.

Easily available and high quality education programmes for staff also need to be based on the specific needs of communities, encourage capacity building and are constructivist in nature – using the lived experiences and local contexts of staff to inform their teaching. Currently much teaching, while well intentioned, is delivered in a context-free, top down and short term fashion. Illustrated here with these wonderfully reflective pieces by Matt Greenall here and here. This can result in programmes that tell people what they ought to do, but not how to achieve this – and how to amend messages if they don’t fit people’s personal or local needs. A lack of sustainability and support within programmes can also often leave communities disempowered and distrustful of research, education or health initiatives.

There can also be a problem around applying what we know. All too often funding for HIV programmes can lead to people deciding to do more research (a survey or focus group) without consulting the existing evidence base on this area which could well inform practice and save time. This is not to say there’s no place for research in HIV/AIDS. Just for practitioners to think carefully about what they are doing and why they are doing it. Critical reflection on both our research and teaching in this area is essential if we wish to improve upon current care and outcomes for the communities we serve.

Health educators and researchers working in this area often struggle themselves with limitations of time, money and demands of funders and local/national politics. Not to mention barriers caused by internalising homophobic, sex negative and gender/class/tribal judgements. With a call to consider access it is important we focus more critically about the teaching we offer and how this work can have meaningful outcomes that include and work with communities.

A couple of examples of this in action can be found in the recent Distance Learning for Health conference which brought together health educators who shared examples of good practice and reflected on ways to improve their work internationally. A review of the event and access to presentations given can be found here. While Contestations provides space for practitioners, activists and educators to debate and think critically around topics related to healthcare that often are oversimplified or overlooked. And, as you can see from Matt Greenall’s posts above are crucial to reflect upon if we’re to improve our understanding of health and human rights.

Finding ways to share knowledge and educational resources can be a powerful approach to tackling HIV/AIDS, but equally importantly allows us to remember that HIV is not the only health problem the world is facing. Thinking about access to education and creative ways of providing this can also allow us to consider additional issues that are impacted upon by HIV but can also be ignored because of a focus on HIV/AIDS. Things like maternity services, mental health, disability, tackling poverty, or managing non communicable diseases, or infections such as TB or malaria.

I will share more on the blog about programmes I hear about in expanding access to education and prevention and would be keen to hear from bloggers, institutions or organisations who are finding creative ways to introduce empowering, critical and reflexive educational programmes with health care staff on HIV (and related issues).

In the meantime if you are thinking these are interesting issues but ones you cannot contribute to directly, here are 10 things you can do in the fight against HIV/AIDS.

There’s been a lot of interest online today about a 1969 Public Service Advert – ‘VD is for everybody’, which shows a range of people who could have a sexually transmitted infection. You can see it here:

Having been flagged up on Boing Boing debate has centred on whether the advert was counter productive and seemed to endorse STIs, or whether it was highlighting how anyone could be at risk from infections – even ‘nice’ people like you (as the song goes).

What’s interesting about this advert is it’s not unique in public health messaging around STIs. In fact the ‘you can’t tell by looking’ theme has run across sex advice campaigns for years. For example this 1948 US advert for the US Navy shows you can’t be sure who has an STI (while rehearsing the women-blaming angle that can often subtly or not so subtly underpin campaigns of this kind – see also the ad at the start of this post!).

It’s also found in this UK public information advert by the Department of Health’s ‘Condom Essential Wear’ campaign.

@mngreenall has found a couple of international examples such as this Nigerian campaign featuring Femi Kuti

And this more sinister advert from Kenya’s Ministry of Health

While South African HIV prevention organisation LoveLife have a fascinating overview of their media/behaviour change campaigns. A similar global archive of different sexual health campaigns (some commercial, some governmental) can be found at the wonderful Sex Smart Films.

The plan within all of this kind of messaging is to challenge the stereotype that STIs can only affect certain people and that anyone could potentially get or share an STI. They also flag up how many STIs can be symptomless so you may not always know you have one. The former two adverts focus on telling people about risk and where to get help, while the latter one focuses on risk and prevention (condom use). That may say more about changing cultural values in media to allow prevention messages to be shared. Often symptom and treatment messages are easier to talk about in health media, although even then barriers can exist over how frank an advert can be.

Debates continue on how best to share STI messaging in public health campaigns. Humour, blame, shame, fear or reassurance can (and have) all been used to try and get the public to be more aware about their sexual wellbeing. Critics often claim hosting any campaign that talks about STIs frankly could ‘glamourise’ them or make it seem they’re ‘acceptable’, or only appeal to the ‘worried well’. While defendents of public sexual health campaigns argue adverts can destigmatise STIs, alert people to the risk of having an infection, encourage getting tested, and make it clear they are commonplace but that doesn’t mean they’re problem free and shouldn’t be tackled.

Practical barriers can also impact on sexual health media – politicians may be anxious about endorsing widespread public health campaigns on this issue. Charities and NGOs may run campaigns but often from particular positions (meaning some messaging can fit the blame/shame angle more than others). Television companies can also be skittish about what advertising they’ll allow and ad agencies may be keen to create something that’s shocking or visually striking but may not be particularly helpful or accurate.

Unfortunately in a lot of cases adverts are not run for any length of time, nor is their impact evaluated. Indeed for many governments, charities or organisations the belief that an advertising campaign has reached the public is seen as the end of an intervention. The aim of adverts like this are usually to raise awareness AND change behaviour, but follow up to see if any impact has been made in either category is not always carried out. Meaning it is often difficult to be sure what, if any, impact such campaigns have had. (A good review on mediated public health campaigns can be found here which explores this issue in more depth).

The ‘you can’t tell by looking’ advertising message is not unique to 1969. Indeed it was being used long before this date and continues to be used globally in sexual health information programmes. Seeing what messages have been used in the past allows us to consider whether they may still work in the future, what other approaches you could try instead, and most importantly to ensure any public health campaign starts with a built in evaluation plan to assess impact.

It’s great people have been thinking critically about public health messaging on STIs, so while people are eager to talk about it why not think about why kinds of campaigns you would like to see – and share examples of good and bad messaging you find online.

Update: Thanks to all of you who’ve been sending me examples of media campaigns for sexual health, I’ll add more as I get them – and any evaluations of activity also welcome!

Today sees the launch of FPA’s Sexual Health Week 2010, with the focus of this year’s event aimed at the over 50s. Entitled ‘Middle Aged Spread’ it’s the first dedicated sexual health campaign aimed at this age group with the message for people in the 50+ bracket who are starting new relationships that they can get an STI “as easily as someone in their 20s”.

This may come as a surprise to those more used to associating sexual health problems with younger people. Indeed we’re only too aware of the prevalence of sexually transmitted infections in the under 25s - partly due to a lack of sex education and other negative factors, and partly due to better detection and treatment of infections.

However, we are also aware those in the over 50s are an important group to target as they may well have missed out on sex education in their youth, may not have been part of a generation who particularly worried about condoms and safer sex (although certainly were sexually active), and who may mistakenly believe they are not at risk from STIs because they’re older. And of course being older doesn’t stop it being difficult to ask a potential partner to use a condom – particularly if you’ve not had sex with a new partner for some time. For women who’ve not passed the menopause pregnancy is still an issue and guys can still get someone pregnant although this may not always be something that’s considered as much in the over 50s. Tessera blogs in more depth about reaching baby boomer’s sexual health needs here.

While this campaign is focused more towards condom use and older people, sexual health week also addresses wider issues around sexual wellbeing. Events will be run across the UK on managing your own sexual health, negotiating condom use (and carrying condoms), confidence in relationships, accessing sexual health services and when to seek help for an STI. If you’re hosting something let me know what you did and how it went and I’ll feature it on a future post. And if you’re a journalist do find out what’s going on across the UK and report on what’s going on – it’s a great opportunity to focus on empowerment and positive messages around managing our sexual wellbeing and relationships health. All of which is important given recent research findings suggesting while people are aware of STIs and the need for testing and treatment 1 in 3 remain too embarrassed to seek help.

Thinking about contraception is also a part of sexual health week, and there’s an exciting new tool designed for practitioners and the public to assess their contraception needs – and find the right contraceptive for them. My Contraception Tool is a project shared between the Family Planning Association and Brook, in collaboration with Maldaba Ltd, and the London School of Hygiene and Tropical Medicine.

Sexual Health Week isn’t just happening in schools, colleges and healthcare settings across the UK, it’s also part of online advice giving (see above). Which has had a boost in the past week by new research from Julia Bailey and colleagues from UCL who reviewed the evidence on interactive computer based interventions for sexual health promotion which suggests these can play an important role in sexual health promotion. This didn’t come as particularly surprising news to those of us engaged in sexual health advice giving online and across social media, although it is heartening to hear initiatives being reviewed in this way. Future research on this issue also needs to focus on how such interventions/initiatives are established, evaluated and sustained as there’s an ongoing problem of work being reinvented, a lack of coordinated approaches and a problem of initiatives being measured on audience figures rather than any other impact factor. This will certainly be a topic worth returning to in future sexual health promotional campaigns and research.

All too often sexual health campaigns tend to be depressing, overly medicalised or focused solely on infection control – little can be heard about pleasure, desire, communication or assertiveness. They’re also characterised by being serious and worthy. There’s no real fun to be had in the campaigning world of sexual health – and perhaps that explains why people don’t engage with campaigns or find it very difficult to cope if they are diagnosed with an infection.

So I was pleasantly surprised to see one initiative around trying to liven up sexual health education, from Science Matters. They’ve created a series of soft toy microbes which can be used to talk about sexual health. So far these have been used in school lessons, for training educators, and in projects with young offenders (who have to pick different infections out of a grab bag). I’m hoping to report more on the use of these little critters in youth and adult education. In the meantime you might want to celebrate sexual health week with
Chlamydia
Gonorrhoea
Hepatitis
Herpes
HIV
Kissing Disease
Syphilis
Or perhaps a little egg or some sperm?

And I’ll leave you with one of my favourite reminders about condom use (poss NSFW) – and remember sexual health isn’t just an issue for the over 50s, or for one week a year Sexual wellbeing is something for all of us to promote, as much as we can, and as often as we are able.

The Health Protection Agency has released its most recent figures on Sexually Transmitted Infections (STIs) (including HIV) today. This is based on data collected from GU clinics across the UK annually. You can read the main report here. Those who’re of the more thorough/geekier persuasion may also want to look at the data summaries of STIs (including breakdown by region, ethnicity and age) available at STI Epidemiology in England 2009 and Trends in STI diagnoses. I would recommend reading and critically appraising the HPA report and datasets if you are interested in this topic – particularly if you’re writing about it for the media, blogs or using it in health education/practice.

What are the main findings and recommendations of the HPA report?
* Numbers of new diagnoses of sexually transmitted infections (STIs) in the UK rose by 3% between 2008 and 2009, continuing the trend of the past decade.
* The impact of poor sexual health is greatest in young heterosexual adults and in men who have sex with men.
* There is considerable geographic variation in the distribution of STIs with highest rates seen in urban areas of higher deprivation, reflecting concentrations of the population who are at greatest risk.
* Some antibiotics may become less effective (or even ineffective) in treating STIs in the coming years.
* Increasing sexual behaviour risk may be contributing to the rise in STIs and will have done so in men who have sex with men, but much of the change will have been due to the increasing application of more sensitive tests throughout the past decade and to the more recent expansion of Chlamydia screening of young adults in community settings.
* Prevention efforts, such as greater STI screening coverage and easier access to sexual health services, should be sustained and continue to focus on groups at highest risk.
* Health promotion and education remain the cornerstones of STI and HIV prevention through improving public awareness of STIs and HIV and encouraging safer sexual behaviour such as consistent condom use and reductions in both the numbers and concurrency of sexual partnerships.

Why are UK STI rates rising?
Over the past five years there have been several initiatives to improve testing and treatment for STIs. This has included
- more rapid testing (particularly pee in a pot tests) and screening for STIs such as Chlamydia and Gonorrhea
- greater targeting of the under 25s to have said testing (via GPs, community pharmacies, and GU clinics)
- improved data collection on STI rates via individual services and the Genitourinary Medicine Clinic Activity Dataset
- a shift in focus in public health campaigns from STI prevention and normalising condom messaging towards testing/treatment focus
- attempts to make services more accessible to young people with initiatives such as ‘You’re Welcome’
- sexual health services have been modernising and restructuring, with standards of care established and sexual health networks being created to try and improve sexual and reproductive health services

It would be naïve to claim all of these changes are responsible for the identification of record levels of STIs, nor that all of them have been effective. But it is worth noting (and the HPA report acknowledges) that some of the increased detection of STIs will be down to higher levels of screening. So from that perspective the figures are more positive – it tells us we are identifying and treating people with STIs more than in the past.

Alongside these healthcare initiatives there are other, less positive reasons why STI rates are rising in the under 25s. These include:

Our lack of comprehensive, quality sex education
Sex education remains patchily delivered across the UK with some places doing excellently, others not so well or even teaching negative messages (more information here and here). Young people generally are afraid of unplanned pregnancy (and overestimate rates of unplanned pregnancy), but less aware of STIs. This is particularly the case if education focuses on teaching the names of STIs and showing gory symptoms, but doesn’t explain how you get and prevent STIs or talk about how many are symptomless.

Public Health Campaigns
While we have had government led public health campaigns aimed at the under 25s for the past twenty years these have been patchy, underfunded, and subject to numerous changes in messaging resulting in confusing ideas shared (my insider view of the problems with UK government backed sexual health campaigning can be found here). Despite the limitations of sexual health campaigns from the previous government it is worth noting the current coalition appears to be doing little in the way of public health campaigning for sexual health services.

Access to and funding of services
GU clinics have traditionally been referred to as the ‘Cinderella service’ – not as well funded nor respected as other areas of healthcare. Getting appointments also remains a problem with some services struggling to give appointments in 48 hours or less. In many places waiting times can be weeks rather than days. While demands on services continue to increase, along with the workload of staff rising massively, funding to match these demands is not forthcoming. Perhaps unsurprisingly some staff aren’t always sympathetic which can be off putting. Meanwhile despite underfunding, over expectation and cuts, it is generally staff who are blamed if services don’t hit targets.

Aside from getting seen within services is the wider problem of people knowing how to find them. Many clinics still struggle with promoting their services to the public, or being open at accessible times.

To see how it works in practice, try this experiment. Imagine you’re 16 (or thereabouts). You still live at home. You need to find where a sexual or reproductive health clinic is in your area. Your school hasn’t provided you with any advice, you can’t ask your parents and your friends aren’t much help. Without using the internet, how do you find a clinic locally? Look around your neighbourhood. Can you spot any posters or leaflets? Is there information at your pharmacy or GP practice or library? Are there any youth centres or clinics offering support – and if so when are they open? If you find services are there any that are open at times you could get to? (To make it more challenging imagine you were under confident, struggled with literacy or language, or perhaps had very strict parents who needed to know your whereabouts – this may further limit what you would be able to access).

Silo working
While there is plenty of research on sexual health services and initiatives to improve waiting times, accessibility, youth friendliness and treatment/testing options, alongside evaluations of what works within sex education, we sadly do not see much in the way of collaborative working. This is often referred to as ‘silo working’ where individual practices, organisations or individuals may well have great ideas but do not share them together. Alternatively work may be replicated (including mistakes) or opportunities for collaborative practice are missed. While services are overstretched, underfunded and pressurised it is difficult to find the time or enthusiasm to network.

Culture, attitudes and sexual climates
Norms and values relating to sexual behaviour have undoubtedly shifted over the past few decades. Pre and extra marital sex is no longer viewed as taboo by the majority of the UK population. Contraception to prevent pregnancy has enabled people to have sex for pleasure. Discussions about sex within popular culture have become more prevalent and some may argue more explicit, although this has not been matched with education to enable people to negotiate a culture that may well feel more sexualised to some. New technologies, the internet and shifts within publishing have allowed easier access to sexual imagery. These are not in themselves a problem but may become one if people do not have the life skills to interpret what they see and enjoy respectful relationships.

Our media undoubtedly plays a role here by covering sexual health stories with a mix of salacious scandal mongering and moral judgement. Every time sexual health data is released the media’s approach is to hysterically report a crisis and speculate on the reasons for it, but at no point to campaign for any initiatives to improve sexual health. The media COULD help by being supportive about sex education, campaigning for more funds to GU services, highlighting how to access services (for local news) or providing accurate sex advice to help people negotiate pleasurable safer sex.

Confusing/mixed messages on safer sex
STI rates can be reduced by condom use. Many young people do use condoms, but they may not consistently use condoms with partners over time. And they may also not get screened for STIs before using a non barrier method of contraception. The focus on testing and treatment without including prevention messages means some young people assume regular testing is sufficient to cope with STIs. Clinicians and sex educators often give mixed messages with some suggesting regular testing is mandatory, others advocating self management and using barrier methods of contraception is better. So people can be confused about what the right approach to managing their sexual health should be.

Confidence and communication
Evidence suggests young women in heterosexual relationships find it difficult to negotiate condom use, while young men will use condoms but won’t necessarily mention them unless a girl does (for more on condom negotiating styles and gender see, for example here). Varying sexual health initiatives have attempted to encourage girls to carry condoms and insist on their use or enable young men to do the same. Some have also focused on clearer communication and negotiation skills both about safer sex but also around discussing other intimate and pleasurable topics together. Studies on men who have sex with men indicate older men tend to be more aware of condom use but there is still variable use within relationships and condoms tend to be used more for anal sex than during other activities like oral sex or masturbation. Both straight and gay couples can assume condoms only need to go on just before a man is going to ejaculate so have penetrative vaginal or anal sex without a condom, putting one on before a guy comes.

‘Risk’ and ‘responsibility’
Negotiating safer sex is more difficult when alcohol is involved, and most people do not assume their partner is likely to have an STI. When you’re thinking about how much you fancy someone you’re not necessarily considering their sexual history. There can also be the view that STIs are things that happen to dirty, bad or promiscuous people – other people, not you. Sexual health messaging – particularly through education and public health campaigns often overemphasise morality discourses of ‘risk’ or ‘responsibility’. These tend to be ineffective as many young people do not consider being intimate as inherently risky or irresponsible. Such an approach also assumes older adults act in different (and more ‘appropriate’) ways than younger people, which is neither fair nor true. Within much sex education and healthcare lies the subtext that ‘good’ sexual behaviour is always being prepared, always having condoms to hand and always effectively negotiating their correct use, while sober. What may be great in theory often simply does not happen in real life.

How did the media (and public) respond to this story?
The media response to this story was interesting. Most coverage I saw repeated the HPA’s press release pretty much, some adding additional comment about why STI rates were so bad (most of them missing key areas as outlined above). While the coverage was perhaps not as hysterical as recent discussions on young people and contraception or abortion, there was still very much a subtext of blame and judgement among much coverage. Accompanied by a lot of handwringing about the state of our nation’s sexual health with relatively little discussion of what we might do to improve our wellbeing.

The overwhelming majority of coverage did not clarify that much of the increased prevalence in STIs was down to testing initiatives and treatment programmes. The focus suggested the STI rates were solely down to young people having multiple partners.

It seemed most journalists did not consult the HPA report nor particularly interrogate the data. Those called upon to comment were not generally selected from GU services or sexual health research. Instead it seemed anyone who’d ever written something about sex, sex therapists or generalists on the topic were asked to give their opinion about young people and their behaviour rather than appraise or expand upon the HPA data. Some of the comments made by sex experts on twitter, broadcast and print media clearly showed they had also not consulted the HPA report but still commented on its findings. It is very worrying when both a journalist and the person they ask to explain a report have not actually looked at said data.

Additional input from experts and the public shifted the debate towards a more blame-focused narrative generally blaming young people, or repeating memes such as:
- young women are all victims, they cannot make decisions for themselves
- young men are all predators, who are at the mercy of their overactive sex drives
- feminism has caused young women to act like men
- Sex and the City has taught young women to be promiscuous
- Young men are being blamed for STI rates
- Young women are being blamed for STI rates
- Young men’s needs are being ignored
- Young women’s needs are being ignored
- Young people are feckless, irresponsible and simply don’t care about STIs
- ALL young people undoubtedly know ALL about STIs and cannot claim otherwise
- Sex education/pornography/rap music etc is to blame for rising STI rates
- STIs were not a problem for previous generations
- Scaring young people about STIs will put them off having sex and combat this trend
- Young people who get STIs (particularly repeatedly) should be punished/refused access to healthcare
- STI rates are just as bad in the over 40s, if not worse than in the under 25s

While some of these are more extreme than others it does show how often this debate is further hampered by moral and opinion based discussions that have very little to do with the realities of why young people get STIs. Rather than exploring reasons and finding solutions we are encouraged instead to blame, shame and generally judge people who have STIs – not focus on wider causes or feasible solutions.

What can we do about our STI problem?
This is not a case of us having a problem but not knowing what to do about it. Our epidemiological data for STI rates is improving every year, sexual health services are modernising and new initiatives for testing/treatment are available, alongside prevention messages and strategies to promote safer sex. We know quality sex education increases safer sex and the likelihood of people being able to communicate their sexual needs assertively while reducing coercive behaviour. We know that training up teachers and health professionals to talk about sexual health issues with confidence – and to see these issues as important is necessary. We know young people are interested in such information. We know services would work better with more funds and resources, and if collaborative working was encouraged – and if the media supported rather than scuppered sexual health initiatives.

There is no mystery here. We have ample evidence to fix this. We are failing to do so because our debates on this issue focus on blaming young people and those with STIs and not focusing on the systemic problems that need to be fixed. This is not to say people are not responsible for their own sexual health, but with our current haphazard approach we also do not enable people to take control over their sexual wellbeing.

Data like this always tells a story – about people affected by STIs. But it perhaps masks the discomfort, anxiety, nuisance, distress or fear having an STI may cause. It misses what can happen to relationships, people’s self esteem, or future fertility.

It’s very easy to sit in judgement on those who have STIs. Assuming you don’t have one (are you sure?) or you would never have unprotected sex. It is very easy to believe we’re facing rising STIs purely because of feckless youth. But it completely misses the point. This is a major health crisis – and it affects us all.

Sources of help, advice and further resources
Sexual Health Helpline call 0800 567 123
NHS Choices on Sexual Health includes resources, advice materials and the facility to find your nearest sexual health/genito urinary clinic by postcode
Manchester Sexual Health Network has created the most comprehensive list of related links on GU/SRH I’ve found
NHS Evidence – Sexual Health Services links to resources, data and research on sexual health in the UK

One thing that has marked this election is the growing focus on science issues. This has partly been down to the interest of some politicians in the subject, and mostly due to the activism of a number of scientists (natural and social), science journalists and bloggers.

The focus of these discussions has been around tackling key issues around science (funding, support, listening to expertise etc). And while it is really important these topics are being debated, I’d invite a step back to think a little bit more about the way politicians understand and use ‘evidence’ from science and healthcare in practice. Otherwise we may miss opportunities to work with politicians and inform political thinking – and in turn help the public on key issues around health, education, innovation and technology.

In order to explore some of these core issues I’d like to reflect on my experiences of working with the Department of Health (DH) on their sexual health campaigns, where I had the chance to see where there are major barriers to using, applying and understanding good approaches to sound science. Which results in misleading information and a lot of money wasted.

I began volunteering on the DH campaigns in 2001 and between then and 2008 I increased the work I was doing, eventually becoming both a consultant and spokesperson on the public sexual health campaigns RUThinking, Playing Safely, Want Respect? Use A Condom (see also their great ad campaign), and Condom Essential Wear. Most of which have now been updated for Sex and Young People and Sex, worth talking about (where I currently volunteer for NHS Choices answering questions on psychosexual health topics).

This work involved identifying core evidence to underpin key messaging and liaising with civil servants, ministers and PR companies to ensure accurate, accessible and engaging messages were shared at a variety of different audiences in diverse formats (print, online and broadcast media as well as live events like music festivals).

I came to this work through my background as an academic who teaches healthcare practitioners and policymakers internationally how to access, critically appraise and understand evidence. And through my research which has focused on the sex and relationships health topics of education, service improvement of reproductive health, and addressing psychosexual problems, with a particular interest in media and public health campaigning. All of which I apply via advice giving through educational events, practitioner training and the media.

I was honoured to be part of the campaigning work and believe there were a number of key areas where major achievements were made around getting sex talked about within the media, and particularly with young people. There were some great examples of innovative practice and in the activities I was involved in we ensured work was ethical, based on sound evidence, while still being engaging.

However, during the seven years of working on the campaigns I noticed a number of core problems. I don’t know if these are repeated within other government departments, but it would be worth investigating whether the issues outlined below are happening elsewhere. My hunch is they’re not unique to health.

It was for that reason I asked the Guardian’s Science Test of politicians (by Martin Robbins) to clarify how political parties intended to oversee and manage public health campaigns and associated PR companies.

Here are the key areas I noticed problems around the application and interpretation of research and evidence:

Bidding for contracts
The majority of public engagement activity run by the government (and via political parties) is organised through PR companies. That in itself is not problematic, PR companies are experts in ensuring messages reach the right people in a timely fashion. What is problematic is for health, education and other campaigns there seems to be frequent bidding process orchestrated by different government departments. Meaning several months on any contract will be spent preparing to bid to renew it (in competition with other PR companies). And until any bids have been renewed no new activity can take place. Which restricts the amount of work you can do to reach the public.

There is also the difficulty posed when a PR company is replaced. Where the company who has held the contract has built up their own contacts, messages, experience in delivering information and goodwill among the media. Because they are a commercial organisation this information remains with them if they lose the contract. Meaning the incoming agency has to begin from scratch building up these contacts, there is no organisational memory, and a lot of time lost in repeating activities. It also means experience built up on campaigns can be lost.

Uncertainty of messaging
During the time I worked on the DH campaigns there were periods where ministers were unsure about the direction in which they intended to go. That was not because they were engaged in a systematic review of the evidence which might help them decide, but because they were anxious about media and public responses to their messages. Particularly relating to sensitive issues like contraception, teenage pregnancy and STIs. It took three years to move the more fragmented ‘sex lottery’ campaign of 2003 into the national media run ‘Condom Essential Wear’ launched in 2006. [This was the first widespread government-backed public media campaign on STIs since the HIV/AIDS one of the 1980s]. Fear over how the press/public will respond led to haphazard delivery of messaging, also hampered by a limited budget.

It has also led more recently to overlooking evidence of good practice – which is about easier access to services, accessibility of testing and treatment, combined with prevention messaging. Instead the government has opted far more towards promoting testing, and has moved away from their 2006 approach which suggested prevention based messaging/normalising condom use. This appears to be based around cost decisions and attempts to deal with rising STI rates. While it is right that we alter messages depending on new information from research and evaluation, it is problematic if politicians and civil servants do not understand this process, or ignore it in favour of activity that is based around anticipated public opposition or healthcare spending cuts. And equally worrying given it muddles the public and healthcare staff around what they should be doing.

Reinventing the wheel
In the past decade our public sexual health campaigns have begun with the Sex Lottery, which became Playing Safely, which morphed into Condom Essential Wear and is currently Sex, worth talking about. And that’s just the campaign aimed at young adults. Teen campaigns for sexual health, general health and pregnancy have also morphed in similar ways. This has included new websites, logos, branding and core messaging for each iteration of the campaign. And within each development an additional range of agencies working on digital, creative, and marketing tasks. While material written for the web has been reused for some of these campaigns, in many cases new content has had to be created although again not always based on core evidence. It results in confusion to the public who are presented with different names, brands, and websites to find. Individual NHS trusts paying for their own sexual health websites that replicate content found on government ones wastes additional money. All of which results in a lot of activity, a lot of money spent, but no real sense of outcomes – the impact such campaigns have had. Sadly the focus of evaluation is often reduced simply to mentions within the media or visits to the campaign websites. Again indicating a lack of awareness of how to fully assess activity undertaken.

Flashy, gimmicky, but has it worked?
One aspect of the public sexual health campaigns has been a focus on getting young people involved. That has included viral videos, myspace pages, interviews with celebrities and texting services. More recently England’s Sexual Health Quiz was launched. Critics have questioned why this uses a kids vs parents approach (given evidence indicates competitive based education in this area is rarely successful). Other concerns have been expressed about the accuracy of the questions (particularly relating to cancer) and whether knowing how much water a condom holds really tells you anything about your ‘knowledge’ of sex and relationships, or your sexual health needs.

All of these activities are clearly costly, and most of them are focused online, which excludes large numbers of the population. We also have no idea how much they have cost, or what impact they have had. When asked, the Department of Health’s response to me was the latest quiz encourages ‘friendly conversation’ between parents and teens and provides right and wrong information. They had no information about whether this approach had been successfully piloted or was working to increase communication between parents and young people.

We have no idea whether, post election, the current quiz will still exist, or whether the data will be used to inform public health campaigning in the future.

Activity that doesn’t make the headlines
While we may be concerned over the quality of public engagement activity, there is the additional problem of campaigns that are paid for, but fail to reach the public or make much impact. For example one survey called ‘pulling pants’ was carried out for the DH by Tickbox which was to identify whether people chose ‘lucky pant’s to go out in. The survey indicated people spent time thinking about what underwear to wear – and clearly did have special undies they wore in the hope of pulling. But they did not put the same focus on taking condoms with them. This was a playful message, but actually quite important if you think about intentions to have sex. However, despite the survey being designed, run, data collected and the PR and polling company paid, it never made it to the media as ministers and civil servants were worried about the underlying messages. While I have a copy of the data, I do not have the costs for this particular project, but it would be equivalent to a standard public survey of 1000 participants spread across the UK.

Another activity that did make the headlines, but not in any great way, was the Alesha Dixon photospread run in 2008. It produced a series of gorgeous photos, but hardly any media outlets picked up on it (if memory serves only a couple of online editions of tabloid papers ran it). Which again represents a lot of money spent for very little return. [This is not a criticism of Ms Dixon who showed a genuine commitment to a campaign on a topic very few celebrities will be associated with]

It is not unusual within mainstream research or any public engagement activity for ideas to change, for messages to occasionally fail, or for problems to arise. But in relation to the cost of these campaigns – particularly when front line services are being cut – this is a worry. Not least when you add it to the fees for the more online activities, surveys run and time lost while rebidding for contracts.

Part of the problem of messaging being ineffective is the timing of them – Valentine’s Day, for example, is such a busy period to get any media pickup. But it’s also not a particularly good time to run public sexual health messaging – a better time would be around Christmas/New Year when people are more likely to have unprotected sex.

Policy/public health education and the role of the PR Company
By far the biggest problem around evidence-based approaches to public messaging is related to PR companies. In 2008 the Telegraph reported the government were spending approximately £1million per week on polls and focus groups and it may be the figure is far higher if you factor in consultations, and other public facing activity such as websites run by different government departments.

This issue has not really been fully explored and I think a canny journalists might be able to identify a far larger spend than already suggested.

These surveys and focus groups are not run to identify people’s key problems or needs, nor to improve services or our wellbeing. Instead they are run to collect information that will be used to inform media activity. Because nowadays most journalists won’t cover stories unless they can pin them to a survey or similar.

This wastes time and money on a number of levels. It firstly overlooks existing evidence on health, education or business that may well be useful to help us understand or deal with an issue. Peer reviewed research is rarely consulted or used to underpin such activity. Instead we see a number of leading questions used to get answers that in turn will generate headlines and discussions points for radio. Which can work if you have a spokesperson allied to a campaign that can translate that information into accurate and contemporary advice. But this is sadly not often the case given the use of PR companies of spokespeople who may not be the best qualified within an area to interpret and share information.

Research to inform public health is led by PR companies, not academics/practitioners
Over the years there has been a shift within public health campaigns where instead of being informed by key academics/practitioners about current evidence of best practice there is now the approach that the PR Company comes up with the idea for an activity as well as being responsible for promoting it.

A key example, and one that led me to resign from supporting the Department of Health’s sexual and reproductive campaign, came from the new PR agency they appointed. They had heard about some research covered in the Daily Mail where researchers counted the number of mentions of alcohol in the media. They suggested the same approach be used, but focusing on condoms.

Their recommendation was for someone (an academic) to observe the media over an unspecified period, and from that they could indicate how little condoms were mentioned in the media, and flag this up as a problem. They also incorrectly claimed no similar research had ever been conducted on this before (because they had not found any in searches they had undertaken).

Civil servants at the Department of Health seemed impressed with this idea. My opposition to it ran as follows. Such an activity if carried out correctly is very time consuming and costly. It would require very clear parameters around what media would be studied over what period. Given that we already know condoms are not mentioned much within mainstream media there is probably little point in doing such an in depth activity. But given we also know that integrating safer sex messages into mainstream media works see here and here and here and here, perhaps using that knowledge might allow us to bypass the research and focus instead on working directly with journalists – particularly in television where often plot lines in soap operas can be requested to focus on core issues (e.g. sexuality, bullying, teenage pregnancy). My advice was ignored.

On 20 February the Department of Health announced they had commissioned research that looked at media coverage of condoms in a report called ‘Mis Selling Sex’. The report still has not been publicly launched, and there is no clear information on who did the analysis, how it was conducted, and how much the activity cost. Moreover, there is no clear information on how the findings would be implemented outside of talking to television companies, which, as we already have seen, could have been done without having to do a full-scale study.

It is sadly a common problem within health research where people repeat studies, but in the case of a government department being advised they did not need to do this research – and could have used their money elsewhere – it is worrying such advice was ignored. If we do not see particular changes within mainstream media, this work will have been wasted. And even if we do see such messages in media they need to be sustained and supported.

What did I learn from my time in the field?
It would be wrong of me to imply those working on various government health campaigns are not doing their best or lack good intentions. My experience of working with ministers, civil servants and the PR companies behind the campaigns suggested a lot of well meaning people. There were also a few practitioners like me who volunteered our time and skills to inform campaigns and improve sexual health.

However, high staff turnover, fear of the response of the Daily Mail, a reliance on ‘desk based’ research and the focus towards ‘policy based evidence making’ rather than ‘evidence based policy making’ meant many good ideas were blocked, and weaker activities green lit.

Given sexual and reproductive health services are so underfunded, and yet given our equally worrying rising STI rates, it is vital any activity we undertake is cost effective, appropriate, built on evidence and evaluated. And that it directs people to the services they need. Spending money on campaigns that do not achieve this means people won’t go for help and while services continue to struggle with lack of funding.

I wonder how much better we may have done if money simply had been spent on improving services, and telling people where they could find them?

As mentioned I cannot speak for the rest of the activities run in different government departments but it is my belief that money and time has been wasted elsewhere. It is also my belief that politicians and civil servants will continue to struggle after the election because they are not supported by the public or by scientists/practitioners to use evidence to inform policies and services.

While we debate science and how important it is, we need to be aware of the real life problems encountered on the ground that means very often poor practice is allowed to continue because nobody is adequately checking what is being done, and few practitioners volunteer to ensure good services can be offered.

Please, while you’re campaigning for science, think about offering your services and scrutiny to ensure we can stop wasting time and money in the name of government backed health research and education.

You may have seen or heard the news coverage yesterday suggesting a link between rising rates of Syphilis and hooking up via Facebook.

It came from a statement made by the Director of Public Health in Teeside who in a press release suggested an association between social networking and STIs. This was snapped up by the Sun, then the Telegraph. Both of whom ran with lurid headlines that Facebook was linked to a rise in Syphilis. Many other news outlets quickly, and unquestioningly, picked up on the story which soon went global.

But of course it is much more complicated than the media might suggest and you can read my deconstruction of the story and questions journalists should have asked about the statements from Teeside’s Director of Public Health here.

As the story has spread over the past 36 hours it has been a mixture of astoundingly poor media coverage, misleading health information, and superb examples of public challenge and sex education.

Here’s how it’s unfolded…

#Syphilis became big news
During the course of yesterday #syphilis became a trending topic on twitter. It began with inevitable questions of why people were talking about Syphilis and led to a thorough debunking of the study by bloggers (linked to above) and questions about what Syphilis actually is. Folk went looking on Wikipedia and elsewhere to find out more.

As discussions unfolded it became obvious that people are still very ignorant about this STI. Some seemed to think it no longer existed or saw it as something from history. Others reacted with revulsion talking about their neighbourhood being adversely affected by being linked with Syphilis, or expressing concern they might be exposed to infection. Judgemental attitudes about those who might have or get Syphilis abounded, many of which had a misogynistic subtext with promiscuous women seen as the source of the problem. General statements about Syphilis also indicated a lack of awareness of symptoms, prevention or treatment.

The sex educators step in
Seeing an opportunity to answer questions about Syphilis myself and sex educator colleagues from Bishtraining and Scarleteen joined in discussions, shared links to accurate resources on Syphilis and other STIs We encouraged people to share this through their blogs, social networking sites, on twitter and by word of mouth to friends and colleagues. We invited them to debunk myths about STIs, and highlight symptoms, prevention and treatment for Syphilis.

Poor media coverage continues
This morning it seemed like the Sun had developed some awareness of the damage they had caused, as they ran a feature focusing on how to spot Syphilis. However, this was actually an activity in further reinforcing judgemental stereotypes about the STI with a list of dictators and criminals from Hitler to Al Capone used as case studies with the infection. A few symptoms were described, but not accurately, and no information was given about where to get help if one was worried about STIs.

Meanwhile, the Telegraph pulled off an astounding feat of journalism where they followed up the Syphilis story they were partly responsible in starting, but reported it as though this was nothing to do with them, while citing a list of other cases where Facebook had been linked to various social problems.

Birmingham set a good example
Continuing with Teeside PCT’s message, health practitioners from Birmingham seemed to endorse the ‘social networking increases syphilis story’, with reports in Birmingham Mail describing risk taking among youths hooking up via social networking sites and a massive recent rise in Syphilis.

Again, this was challenged by bloggers and sex educators. And it turned out to be another case of inaccurate press reporting. The Outreach Worker Julia Hyland quoted in the story has given me this statement “I did not claim to be an expert in this field and the figures quoted did not come from me, I have called the Evening Mail they told me their figures came from Heartlands [another health trust in Birmingham]”

Julia’s prompt (and brave) response, along with a challenge from the University of Birmingham alerted the paper to their inaccurate reporting and the problematic story from Teeside. Birmingham Mail removed the story from their website.

In the mainstream media no such clarifications or removals have been made. Teeside PCT and their Director of Public Health have seemingly made no such efforts to challenge or clarify. Practitioners are still chasing them for further information (see links in my blog post from yesterday).

Health media seems out of touch with the story
While we might expect the mainstream media to provide poor sexual health coverage, we should expect better from the health press. Sadly this didn’t seem to be the case with Nursing Times leading on the story in a completely uncritical way.

NHSChoices were questioned on twitter why they had not challenged or followed up this story. They responded with “No plans to cover it. No evidence to assess & just a wildly OTT headline”, although they noted “We’ve got a wealth of evidence-based info on sexual health & STIs” (while fairly explaining they don’t offer training to healthcare professionals as they’re a public resource).

Worryingly, although NHSChoices do have excellent resources on Syphilis which practitioners have been using as public information throughout this situation, there seemed to be no consideration from the organisation they should be publicising these resources as the Syphilis story continued to trend. This is despite their remit being public outreach with a specific twitter, blog and website facilities for this purpose. Only when prompted by several sex educators/consultants (particularly Matthew Greenall and Bishtraining) did they start sharing links on Syphilis. These were eagerly picked up and retweeted by NHS Trusts and other parties, but were done only after pressure was applied and 1.5 days after story went global.

Bloggers and sex educators did the job the media ought to have done
There have been some real heroes in this story – aside from Bishtraining and Scarleteen who gave up several hours of their day yesterday and today to challenge and educate, HIV consultant Matthew Greenall has tirelessly chased up information on social networking and STIs and challenged the inadequate handling of this issue from the NHS and Nursing times. Ben Goldacre has been chasing Teeside for more information and sharing his frustrating experiences with them on twitter. Jo MacIver supported Outreach Worker Julia Hyland and encouraged other bloggers (including myself and Ben Goldacre) to hold fire on attacking the story until she had properly investigated the Birmingham angle. Countless people on twitter took up the challenge of being sex educators and shared links to STI awareness and debunked the media coverage. In particular @regordane @silv24 @Heresy_Corner @DrMarkBurnley @The_MediaBlog and @viviane212 were active in challenging, questioning and keeping this story trending.

The past 24 hours continue to show us how many media and healthcare staff don’t seem to understand social media. Mainstream media with only a few exceptions (here, here and here) have failed to ask basic questions over accuracy of story. Some healthcare organisations have also failed to critique the statements coming from Teeside, or have not responded promptly to issue. To date nothing has been said by either the Department of Health or the Health Protection Agency.

It has been left to bloggers and sex educators volunteering their time to actively engage through social media to challenge this story and share accurate information.

Ironically in a story about the evils of social networking, it has been social networks that have challenged the story and turned it from a piece of scaremongering into an internationally shared opportunity to spread sexual health awareness.

There are still many questions to be answered – not least from the papers who spread the story, and from Teeside’s Director of Public Health. Facebook has not really become involved as yet and there is speculation on whether they might take action (and in what form).

In the meantime, let’s not lose momentum on this story. We can all continue to be sex educators and media critics. We can find poor coverage and alert readers to why it is bad. And we can keep telling or friends, neighbours, colleagues and folk we’re connected to via social networks about STIs, how to prevent them, and where to get treatment if we think we’re at risk.

Several papers carried the worrying story today suggesting links between social networking sites and sexually transmitted infections (STIs)
Facebook ‘linked to a rise in syphilis’ – Telegraph
Facebook ‘sex encounters’ linked to rise in Syphilis in North East – Metro
Sex diseases soaring due to Facebook romps – The Sun
Web casual sex sparks syphilis rise – Press Association

All of which sounds pretty scary. Are we really facing a syphilis epidemic linked to social networking? Where did the story come from? It seems to have been sparked by claims in the papers made by the Director of Public Health for Teeside, Professor Kelly, that the region has seen a rise of reported syphilis cases from 10 in 2008 to 30 by the end of last year.

According to press reports Professor Peter Kelly, claimed to have found a link between the rise in syphilis cases and young people using social networking sites. The details of how this was researched and measured have not been clearly reported. So it is unclear whether this is a health practitioner describing mapping of STIs to social behaviour; results of an epidemiological study on STIs in the North East; or speculation based on patient information that there could be a possible association between syphilis and using social networking sites. [A separate picture of sexual health in the NorthEast as compared with the rest of the UK that gives you an idea about the accuracy of these claims can be found here and a breakdown of regional data for STIs (including syphilis) is here - with thanks to Ben Goldacre]

Several papers document ‘research’ that indicates widespread social networking site use in the North East that’s higher than the UK average. Although it is not completely clear where this evidence comes from. Is it data the papers have included, or the information Teeside PCT were using.

While syphilis is an STI that’s on the rise, we have to be careful with headlines like this. They may sound dramatic but the first rule of understanding potential links between behaviours and infections is to remember correlation is not the same as causation. Just because some young people do seem to be using social networking sites for meeting others for sex it doesn’t mean that is directly responsible for rising STI rates.

Health professionals are often panicked by media moral crusades and currently anxieties over social networking sites are running high. Young people do report using such sites as well as other mobile technologies. So understandably practitioners may well question about such behaviours during consultations and form the conclusion that social networking sites are the cause of many sexual health problems.

However, just having this opinion doesn’t mean it is true or directly linked and would need closer investigation. Consultant Matthew Greenall is currently trying to find out from Middlesborough PCT what research was undertaken by Professor Paul Kelly to inform his view that social networking sites and STIs are directly linked. NHS Middlesborough’s press release that seemingly started the media coverage states “Unprotected sex, especially with casual partners, is the biggest risk for syphilis. Social networking sites are making it easier for people to meet up for casual sex. It is important that people avoid high risk sexual behaviours and practise safe sex to protect themselves from sexually transmitted infections”. However, additional quotes within newspapers make a more specific link between syphilis and social networking sites – so it is unclear if additional interviews were given, or whether the Professor has been misquoted. Or whether the papers just made up additional quotes (hey, we know that happens). At this time a number of practitioners are investigating exactly what was said and what evidence there may be about risks posed by social networking sites to the youth of Teeside.

As the story spread across Twitter several bloggers questioned the accuracy of the story, beginning with Science Punk who spotted the piece first, through to Enemies of Reason and Dungeekin who both provided a satirical take on the media coverage of the story. Meanwhile My Sex Professor highlighted issues around syphilis using the story as an opportunity to reinforce health messages and Heresy Corner discussed the prevalence of syphilis and the claims made in this story. The excellent Tabloid Watch focus more specifically on the discrepancies between the statements from Prof Kelly (which seem to be more about safer sex) and the media scaremongering. Similar discussions also come from The Media Blog and Roy Greenslade at the Guardian (read the comments for this, NHS Teeside respond to criticise Greenslade but apparently not the Telegraph or Sun’s bad coverage).

Within the online discussions it became obvious the link between social networking sites and syphilis was questionable. In fact the whole story appeared flawed as it seemed to have accepted a practitioner’s concern about rising STIs but no clear measure that they were linked to social network use. [If it turns out this is not the case and there is robust data to support the claims I’ll update this blog accordingly]. Indeed even if young people are using such resources to set up meetings with other people which lead to sex, the problem is presumably about a lack of safer sex when they meet, rather than the hook up itself? This wasn’t clear from media coverage and it would be worrying if health practitioners were being judgemental about sexual behaviour. The issue is about unprotected sex, not who you sleep with (or how you get to meet them).

No breakdowns were offered in the research about who the 30 people were with syphilis. Were they all straight? Had they all contracted syphilis from social networking sites – and how was that proven? How was ‘using’ social networking sites defined and measured? Were there any other STIs that were also associated with social networking hook-ups? And how were these connections assessed?

We rarely expect the media to deconstruct a moral panic story, particularly if it is about social networks or sex. However on this occasion it seemed that as well as not fully investigating a story before spinning it into an STI crisis, the reportage deliberately misrepresented aspects of social networking sites.

Facebook was named as the cause of the syphilis outbreak, and yet if you read the statements from Professor Kelly Facebook is not mentioned. Social networking is described. So why did Facebook get the blame compared with other networking sites? Could it be the papers who were leading on the story are owned by Rupert Murdoch who in turn owns Myspace social networking site, who are a competitor of Facebook?

The take home message from this case is it seems to be an example of practitioners speculating on the cause of a rising STI rate, the media spinning this into a causally linked epidemic, and then further manipulating the story to have a pop at their rivals.

What’s lost in the case is the issue of syphilis itself. It is an infection that currently predominantly affects gay men (in the UK) but is on the rise in heterosexuals. It needs addressing as although we have worked hard to raise awareness of highly prevalent STIs like Chlamydia, the public may believe Syphilis is an infection of the past. And may have no idea what symptoms to look out for or how to prevent the infection.

Some have argued the attention the story has generated has also raised the profile of syphilis, so that’s a benefit of the poor media coverage. Indeed #syphilis has become a trending topic on twitter as a result. Unfortunately if the focus remains on poor media coverage or the myth that Facebook causes syphilis then the opportunity to raise sexual health awareness will be lost.

Let’s show social networking can do good as well as the often claimed evil. Find online coverage of this story and use the comments to highlight the suggested link is not concrete, the media coverage is scaremongering, but most importantly to share accurate information on syphilis prevention and symptom spotting. Then tell your friends to do the same.

What’s the difference between sexual, reproductive, psychosexual and relationship health?

Sexual health refers to dealing with either sexually transmitted infections, or physical or psychological sexual problems (also called sexual dysfunctions).

Reproductive health refers to your fertility – either advice on getting pregnant, information on contraception, supplying contraception (to prevent pregnancy), or helping you deal with an unplanned pregnancy.

Some clinics specialise in sexual health, sexual problems or reproductive health, other services will offer treatment or advice for any of these issues.

Psychosexual health services tackle deep-seated sexual problems that could be caused by psychological and/or physical factors.

Relationship counselling services help with problems ranging from sexual communication difficulties, to jealousy and coping with arguments or life after infidelity or divorce.

These services are dependent on your location – there may be more services available in certain countries/states. The politics or religion of different countries/states may affect service delivery or approach. Many clinics offer free support and advice, some private clinics do charge a fee, as do some doctors in certain countries – if you live outside the UK check your health care policies for more information.

Many sexual health services particularly those for sexually transmitted infections are often overwhelmed by patient demand. Part of the reason for this is that people pick the wrong service for their needs – so consult the list below to ensure you get the right help at the right time. And tell your friends so they get it right too!

Your Doctor (GP/Family Practitioner)
What can they offer?
• Advice about contraception and prescribe (and sometimes provide) contraceptives for you
• Advice on sexual problems (dysfunctions)
• Health checks relating to sexual problems (e.g. pain during/after sex, loss of erections)
• Information about menstruation, menopause, fertility (getting pregnant), pregnancy and abortion (termination), pregnancy testing
• Physical examinations of your genitals (including smear tests for women or testicular exams for men)
• Referrals to counsellors or other specialists in the case of sexually transmitted infections, sexual dysfunctions, previous or current sexual abuse, genital cancers
• Assessment and testing/treatment for STIs
• Advice about pregnancy/fertility, antenatal and postnatal support
• Advice and referrals for termination of pregnancy (in countries where abortion is legal)

Your doctor or practice nurse can perform external and internal genital checks, swabs and blood tests. They can test and treat you for STIs, or related infections. Depending on your location they may be able to provide you with condoms or refer you to a condom clinic. In many countries, GPs are the main providers of contraceptive services, so they’re not shy about talking about sex. Some people do feel embarrassed discussing sexual health with their doctor, particularly if they’ve known their doctor for a long while – or in cases where they may have an STI through an extra-marital affair or unprotected sex. If you would prefer to see someone you don’t know as well, you can either speak to a different doctor at the practice or go to a Genito Urinary Clinic for STIs or Family Planning/Reproductive Health Clinic for contraception/fertility advice (see below).

Useful links
NHS Choices has a dedicated section on sexual health
Patient.co.uk (links, resources and helpsheets on a variety of health issues)

Genito Urinary Clinic/Sexually Transmitted Infections Clinic
What can they offer?
• Tests and treatment for sexually transmitted infections.
• Advice about contraception (some clinics also prescribe contraceptives and provide condoms – at some clinics these are free).
• Information about safer sex.
• Advice on how to tell a partner you have an STI – some clinics will notify your partner(s) for you.

These clinics (also sometimes known as ‘sexual health clinics or centres’) will test and treat you for STIs, and provide safer sex advice and information. Some clinics work on an appointment basis, others on a ‘drop-in’ system, or a ‘first come, first served’ basis. Some have set times for teenagers, women or men to attend. You may want to telephone first to check appointment times and whether there’s a waiting list for treatment. You shouldn’t have to wait long to get an appointment, but in many countries where there is high demand for services the wait could be longer. You can get condoms from Genito Urinary Clinics.

Useful links
NHS Choices: Sex, worth talking about includes guides to sexually transmitted infections, including locate your nearest clinic and symptoms and signs of STIs
Planned parenthood’s guide to STIs (also available in Spanish)
Go ask alice! (your sexual health questions answered)
STIQ answers common questions about STIs, testing and treatment

Family Planning/Reproductive Health Clinic
What can they offer?
• They can advise you about contraception and give you contraceptives
• Information about how to get pregnant, or options if you have an unplanned pregnancy
• Pregnancy testing and referrals for termination of pregnancy (abortion) if you require it
• Smear tests for women

These clinics can perform smear tests (internal exams for women), and offer contraception and pregnancy advice. They can provide contraception such as birth control pills or injections, or condoms. If you want contraception only, then make an appointment at one of these clinics. If you think you have an STI, it’s better to see your GP or Genito Urinary Clinic.

Useful links
Family Planning Association guide to contraception, pregnancy and STIs
Brook sex advice for under 25s
Planned Parenthood advice on contraception, STIs and sexual and reproductive health – in English and Spanish
Marie Stopes global reproductive health advice source

Your Pharmacist
What can they offer?
• Home pregnancy testing kits (some pharmacies will do the tests for you)
• Over the counter treatments for cystitis, thrush, period pains (menstrual pains), folic acid (for those planning to get pregnant or during pregnancy and breastfeeding)
• Condoms and lubricant
• Give you contraceptives as prescribed by your doctor

In some countries, community pharmacists are taking a more active role in health care. For problems such as thrush or cystitis you can get confidential advice from your pharmacist. You can also get condoms, the morning after pill (emergency oral contraception), and lubricant from many pharmacies. In parts of the UK, US and Europe, you may also be able to be tested and treated for certain STIs by your pharmacist. If you think you have Chlamydia or Gonorrhoea, the pharmacist can provide you with a urine kit, which you return to them or post to a local laboratory. Results are returned in a few days and you’ll be given the all clear, provided with antibiotics by the pharmacist, or referred on to a Genito Urinary Clinic or your doctor if further tests or treatment are required. Not every pharmacy can offer this service, those that do will usually advertise testing with posters or leaflets. All pharmacies should be able to signpost you to your local Genito Urinary Clinic who will be able to help.

Psychosexual Therapy (Also known as sex therapy)
What can they offer?
• Identification and treatment of psychosexual problems (e.g. erectile dysfunction, loss of desire)
• Overcoming sexual problems due to past or present sexual abuse
• Dealing with sexual problems due to worries about sexuality
• Sexually compulsive behaviour
• Referrals to other healthcare services (e.g. urology, gyneacology) if needed

Many countries offer psychosexual advice and services. In some cases, they are free to patients with severe sexual problems, although have to be referred through a medical doctor, and can have a long waiting list. In countries where psychosexual services are free, patients can also book to see therapists privately. This cuts down the waiting time, and will cost money, but allows the client choices who they get therapy from (e.g. a religious person may prefer to have sex therapy from someone who understand and respects their religion; a lesbian or gay client may prefer a ‘pink shrink’). In other countries, psychosexual services are entirely private, and have to be paid for. These services may not be covered by medical insurance, check your policy. Some countries do not offer any services, or a limited number of therapists.

Useful resources
Overcoming sexual problems by Vicki Ford (Constable and Robinson)
Women who love sex: an inquiry into the expanding spirit of women’s erotic experiences by Gina Ogden (Womanspirit Press)
Our bodies ourselves: a new edition for a new era by Boston Women’s Health Book Collective (Touchstone Books)
Sexual health for men by Phillip Kell and Vanessa Griffiths (Class Publishing)
The new male sexuality by Bernie Zilbergeld (Bantam Doubleday)

Basrt (British Association for Sex and Relationship Therapy)
Sexual Dysfunction Association includes advice and support on male and female sexual problems
Women’s Health gynaecological and other women’s health advice
Male health information from the men’s health forum

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Relationship Therapy/Counselling (also known as couples counselling)
What can they offer?
Counselling for individuals and couples for issues like…
• Communication skills
• Increasing sexual confidence
• Overcoming common sexual problems
• Dealing with jealousy
• Coping with infidelity
• Reducing arguments
• Planning for parenthood

Relationship therapy is offered in different forms in different countries. In most cases the service is paid for by the client – but is often means-tested, meaning those on a low income may pay less. Medical and psychosexual services can refer clients to relationship therapists, and clients can refer themselves. Many religious groups or other support networks offer relationship therapy – again this may be free or paid for and evidence underpinning advice may be patchy. Medical insurance may not cover costs for relationship therapy – check your policy. Some therapists will tackle domestic violence and reputable therapists will not see a couple together while one party is being violent. If domestic violence is a problem within your relationship you need to alert your therapist to this as soon as you can.

Useful resources
Overcoming relationship problems: a self-help guide using cognitive behavioural techniques by Michael Crowe (Constable and Robinson)
Loving yourself, loving another: the importance of self esteem for successful relationships by Julia Cole (Relate Guides)
Gay relationships: how to find them, how to improve them, how to make them last by Tina Tessina (Jeremy P Tarcher)
Relate
British Association of Counselling and Psychotherapy
Couple counselling Scotland
Relationships Australia
American association of sexuality educators, counsellors and therapists (AASECT)
BBC Relationships has a collection of resources and referrals addressing domestic violence

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Hopefully you can work out from the list above what service suits your needs best. If in doubt call the service/clinic and ask if they can help you. If they can’t they should be able to explain a source of support.

Where to get advice about your sexual, reproductive or relationship health by Dr Petra Boynton is licensed under a Creative Commons Attribution-Noncommercial 3.0 Unported License

1. Get educated – then share the knowledge
There are many ways to learn about sexual health and wellbeing. You can bring yourself up to speed with information about HIV/AIDS here (contains links to quizzes, resources, forums and advice sheets). Or you can test your knowledge with Avert’s Quizzes (on sex, pregnancy, HIV/AIDS, contraception). Teen site Scarleteen includes loads of frank and helpful information, as does Go Ask Alice!, Kinsey Confidential and Cory Silverberg at About.com’s Sexuality section.
You can also make use of Planned Parenthood’s toolkits and resources, while All About My Vagina explains how anyone can become a sex educator (with links to resource materials).

2. Bust those myths!
Despite education and advice, many people are still confused about HIV and AIDS. You might want to check out some mythbusting courtesy of About.com; questions, answers and papers about areas of confusion about AIDS from The Body while New Scientist lists the top 5 myths about HIV.

3. Don’t just focus on sex
HIV can be transmitted through sexual contact, but it is also passed on from mother to baby through breast milk, through blood transfusion (if infected blood is transfused – this is less common nowadays), by sharing needles, needlestick injury, or unsterilized/unhygienic needles or other sharps used routinely in healthcare. Further information on transmission can be found here. The problem with messaging around sex is we tend to focus on confusing or mixed messages, or advice that’s difficult to put into practice (for example asking people to be faithful in countries with massive gender inequalities). Instructing people they must abstain without discussing the contexts for why abstinence may happen, considering delay messages or thinking about when abstinence is not possible or wanted does not empower communities. It certainly does not protect those who are subject to sexual abuse and rape. Equally dangerous is instructing against condom use. Or telling people not to have sex, to be faithful or always use a condom without giving them any life skills to put these choices into action. Simplistic approaches that assume all people need is instructions to have HIV tests or simply ‘use a condom’ without addressing their wider social, economic, healthcare or personal needs is unhelpful and frequently counterproductive. Discussing sex only in the context of intercourse (vaginal or anal) leaves out wider contexts around relationships, desire, and coercion. We need to focus on clear messaging around sexual transmission of HIV (with actionable solutions and life skills offered), but not forget there are other means of getting the virus. This is of particular concern given a recent study from Swaziland that suggests 1:5 babies are infected with HIV through dirty needles or other clinical equipment.

4. Challenge and tackle inequalities
HIV is more prevalent in countries or communities where there are high levels of gender inequality, restricted access to healthcare, poverty, discrimination over sexuality (including transsexuality), and high levels of illiteracy. Challenging transphobia, homophobia, gender inequality, and discrimination against male, female and trans sex workers can help – for example in the views you hear from other people (particularly those working in health and social care or law enforcement), biased media coverage, or discriminatory practices expressed by organisations. You can also support campaigns that address poverty and literacy along with wider access to healthcare. You might even decide to become an activist – here’s an example toolkit for just this purpose.

5. Volunteer and/or fundraise
There are many ways of getting involved in tackling HIV, inequalities and poverty. You might want to volunteer on a sexual health helpline, or help out at an HIV/reproductive health clinic – on reception, as a health advisor/advocate, or interpreter (either using signing or different languages). Or you could always donate toys or magazines to clinics.

Unwanted clothing, shoes, blankets, toys can be donated to charities supporting those affected by HIV (particularly orphanages worldwide and clinics supporting the homeless, refugees or those fleeing domestic abuse).

You could give of your time locally – for example seeing if your local health or educational authority needs any support (which may include administrative duties that free up healthcare providers to see patients). You might want to prepare nutritious meals for people living with HIV, or if you’re currently breastfeeding you may want to donate some of your milk to feed babies whose mothers are HIV positive. Not all mothers have the option of donated milk or formula, more information for them can be found here.

Spare cash? Well, the recession’s still on, but as the saying goes ‘every little helps’. Financial donations can be made nationally and internationally. If you do wish to donate I’m always happy to recommend trustworthy charities and healthcare providers working to treat and prevent HIV (and other health issues). The Terrence Higgins Trust are always worth supporting, or you might want to help the Jabulani Foundation whose innovative approach to healthcare was recently reported in The Lancet (sadly not open access).

You can save your pennies in a jar, or raise money through car boot or jumble sales, or even sell stuff on ebay and put your profits to a good cause.

Donating materials can also help – old computers, digital cameras, access to educational materials are always welcome in resource poor communities. Offering to help with fundraising (including creating advertising, designing and maintaining websites) is also welcome. Here’s an example of what one charity needs. Search on the web to find more you could contribute to.

Maybe you’re not able to contribute cash but have other skills you might share? Gardening, cooking, sewing/needlework, knitting or craft can be applied to help those affected by HIV/AIDS, raise funds, teach new skills, or generally raise awareness. Knitted items (hats, booties and baby clothing) are always welcomed by orphanages – although don’t forget clothing for toddlers and older kids (particularly shoes, kids do get through a lot of shoes!). You can donate your children’s unwanted items, with the added opportunity of raising their awareness about HIV.

Maybe you’re a drama buff, artist, musician or film maker – in which case those talents can be used to help people find new ways to share messages around HIV/AIDS, safer sex, communication skills, and desire.

If you’re good with words or numbers then why not volunteer to help people who might be struggling with HIV alongside other disadvantages related to literacy/numeracy. Help may well be appreciated with filling in forms, applying for benefits, balancing budgets, or following medical advice.

6. Target problematic practices
There are well meaning campaigns that promote abstinence only as a response to HIV. While it is appropriate to recommend delaying sex until someone is ready (and has sorted contraception/condom use), many abstinence campaigns focus on simply telling people not to have sex – with no additional information about relationships, pleasure, confidence, or negotiating skills. In particular suggesting adults abstain from sex until marriage without any additional sex education, and recommending this approach in countries/communities with major gender inequalities, does little to reduce the spread of HIV. For a balanced view about abstinence based educational approaches see Avert’s review, plus this systematic review from the Cochrane Collaboration indicating abstinence only approaches are not effective. Speak out against those who promote HIV programmes that are only focused on abstinence because it doesn’t reduce the prevalence of HIV.

Linked to some abstinence campaigns is anti-condom propaganda, promoted by some faith based organisations, governments and NGOs. This includes misinformation such as ‘condoms don’t work’, which is untrue. Of course no barrier method is 100% effective, if used correctly then condoms are 80-97% effective in preventing HIV transmission. Other claims include condoms usually break – again untrue if used correctly (in such cases condoms are 98% effective). Or that there are minute holes in condoms that the HIV virus is small enough to pass through. This is false. Condoms are a barrier method and the HIV virus cannot pass through latex or polyurethane condoms. More information about condoms and how to use them can be found courtesy of Planned Parenthood.

Here’s how to use the male condom


And the female condom

Use this awareness of what condoms do and how they are an effective method of preventing HIV transmission, and support educational campaigns that not only distribute condoms but also give people the life skills to know how to use them correctly and negotiate using them with a partner.

Remember, though, that just repeating ‘always use a condom’ mantra, handing out condoms or expecting people just to use condoms without addressing their individual needs is unlikely to be effective. Indeed where people are facing stigma, inequalities and violence handing them condoms and expecting them to use them is deeply disempowering. If you are working as an activist, educator, healthcare provider or are a client using sexual health services speak out against simplistic approaches that promote condom use or HIV testing in an uncritical way.

Unfortunately sexual health – particularly around HIV/AIDS – is often based on good ideas from well intentioned people, but not necessarily practices based on the latest evidence. To find out what’s going on you can use PubMed and Google Scholar to search for research papers, or organisations like MedFash or BASSH. The amazing Magnus Hirschfeld Archive (a multi language resouce) has lots of free tools to help improve your sexual health knowledge – including an online course about understanding STIs. Toolkits to help are also available via the WHO. If you work in education or healthcare ensure your staff are supported to learn about effective ways of promoting clear messages around HIV prevention or how to manage if you are HIV positive. Ask for additional training if you are a staff member or volunteer in this field and ensure you’re obtaining (and attending) continued professional development (and not just for the per diems or certificates – you need to show clear outcomes in your practice and benefits for your clients).

Added to this is the problem of staff who are working in the field of HIV/AIDS but may lack basic training, be unsupported or require more intensive supervision – particularly around reflecting on current evidence and how that might underpin their practice. Without this we see staff giving advice that goes outside their area, not referring to medical specialists when they should, or being highly negative/judgemental. You can do your bit, wherever you are in the world, by campaigning for open access to journals and free or low cost training and support for healthcare practitioners on how to find, appraise, synthesise and apply evidence. All of us who work in health research, activists, clients and academics can and should be pushing for high quality research that does not reinvent the wheel, drain or divert resources from healthcare provision, and can demonstrate practical results that build capacity and sustain communities. Which I appreciate is often difficult to do – that very fact should shame us into trying far harder to achieve it.

In many cultures there’s a mix of a lack of sex education, often a negative cultural attitude to sex, alongside sexual messages within the mainstream media – often with different messages for women and men (so men are expected to be hypersexual, women less so). So often people are not sure about HIV, what it is, how to prevent transmission, or what to do if you’re positive. Creating educational and awareness campaigns that aim at diverse audiences (teens, parents, LGBT, sex workers) and allow people to discuss any areas of confusion can really help. If you want to assess the effectiveness of an HIV intervention, this free toolkit by eminent researcher Doug Kirby is invaluable.

It’s no surprise that HIV is rising in countries where governments have not taken enough appropriate action against HIV or poverty, or to promote balanced sex education. Where politicians are opposed to/negative about pre-marital sex, homosexuality, drug users, or sex workers and do not invest in healthcare and education, then it’s not surprising their electorate suffer. Lobbying, protesting and drawing attention to how government’s do not tackle HIV effectively is one way forward – as is making the treatment and prevention of HIV an election issue. Make politicians accountable – and expose those who are not willing to tackle HIV. Remember HIV is an issue globally, it is easy to assume it happens to people who’re not like us in terms of where they live, their sexuality, gender and so on. In fact focusing on HIV as something that happens somewhere else, or to other people can mean we avoid tackling real inequalities on our doorstep, patronise those in other communities, or assume we’re not likely to become HIV positive or contract other STIs.

We can all find out our HIV status and practice safer sex.

Many people struggle with accessing services that provide education, prevention advice or treatment for HIV due to access to or availability of services. This may be simply because they cannot afford medications, or the cost of travel to get to clinics. Or it may be that services are available but clinic opening times and directions are unclear – or are not available at the time when you need to go (for example early afternoon or weekend for teenagers, evenings for adults). Alert clinics that aren’t making their availability clear. Offer to distribute leaflets or display adverts showing opening times. And campaign for low cost or free access to healthcare, drugs, education, baby milk (for infants who can’t have breast milk) and condoms. Practical campaigning on affordable healthcare, transport and road links, and joined up healthcare that addresses concurrent conditions is also vital (but again, frequently politically difficult, another alarm bell that we really can and should be doing more).

We’re all fighting to prevent HIV/AIDS but that doesn’t mean you shouldn’t question fundraisers that claim to make a difference. There are those who exploit this area, and even where there are well meaning campaigns they may be more about fashion than fundraising/awareness/empowerment. If you want to make a difference then the Buy Less campaign may be more appropriate

7. Healthcare practitioners and teachers – speak out!
As well as promoting more evidence based practices (see above), tackling colleagues who are judgemental about HIV/AIDS (or related areas – for example prejudiced towards homosexuals, transsexuals, sex workers or drug users), then work towards better training and support for them – and if this fails then complain to management and ensure they are not harming others with their views.

Challenge NGOs and funding bodies promoting that only promote abstinence only/anti condom messaging (see above), or who will only fund HIV programmes that don’t mention safer sex or other sex positive/educational messages. Or who simply push for condom use and testing with no other resources given. Where possible ensure your services do not take this approach and link with colleagues to ensure you offer a balanced service based on the latest evidence. If you are working in a resource poor country you may find making links with established academics/practitioners in other countries can help you access materials you need for your work (please email me if you’d like me to put you in touch with some).

If you are struggling to access drugs, medical supplies, sterile clinical products and syringes, or basic supplies like bedding or clothing, then again you may find making links with colleagues in other countries can help. Western medical students, for example, are often keen to fundraise, volunteer and access/share sterile items.

We’ve already heard about the political barriers to sorting HIV, but if you are experiencing this as a healthcare provider, educator, parent or volunteer then expose it – to local papers, through a blog (which can be anonymous if necessary), or through the HIV research/practitioner community. That might be discussing a school or health authority promoting negative or mixed messages, or denying access to condoms. Or national blocks on sex education, or politicians openly supporting AIDS denialism, being trans/homophobic, or harassing those with HIV.

If you don’t feel able to speak out yourself, then alert people like me and we can try and help you find ways to share your story anonymously.

8. Empower people to protect themselves
As well as becoming a sex educator (see point 1 above), encouraging peer to peer education initiatives can make a real difference to young people, although adult to adult peer support schemes work well too (for example to raise awareness among m/f/t sex workers, or gay men). The 15 and Counting Campaign provides a wide range of resources for setting up sex education activities – and to help people campaign within their communities for better access to HIV/sex education.

Alternatively, you may want to support existing HIV initiatives aimed at teaching skills and raising money for people who are affected by HIV. For example the Positive Beadwork Project.

You could encourage clubs and pubs to provide condoms, or work with HIV charities or health authorities to hand out condoms in social spaces. (Remember it’s not just about dishing out the condoms, it’s also about giving people the chance to ask about safer sex and relationships, pleasure and communication).

Supporting open access organisations like the (wonderful) Hesperian Foundation helps people learn more about their health and HIV – including how to prevent, treat, and live with the virus. Their books are free to those in resource poor communities (the rest of us quite rightly pay). Titles worth sharing are listed below (and many come in languages including Bengali, Chinese, Indonesian, Urdu, French and Spanish).

HIV, Health and Your Community
Helping Health Workers Learn
Where there is no doctor: a village care handbook
Where women have no doctor
Where there is no dentist

9. Question bad science
Sadly there’s a lot of misinformation in the name of HIV/AIDS, and often this comes from science – or people pretending to be scientists. The worst offenders are the AIDS denialists, who not only promote their views across the internet, they’re also active within the media (see this recent report on the inclusion of an AIDS denialist movie at a cultural festival).

It is important to tackle AIDS denialists, and there’s a particularly useful list of resources here about spotting pseudoscience relating to this issue.

Added to this are those who (usually well meaningly) offer alternative treatments to those affected by HIV. There is no evidence that homeopathic remedies ‘cure’ or ‘prevent’ HIV, and those who promote such treatments – particularly when encouraging standard medical treatments for HIV (antiretrovirals) are discontinued – are extremely dangerous. Unfortunately there are some who are not averse to maliciously exploiting this virus and will offer a variety of cures, spells, amulets, or other products with the promise of curing or preventing HIV – but in fact simply a means of parting people with their money. We need to do more to stamp out quackery in this area and educate people to use established treatments and methods of prevention.

One of the major criticisms raised at the HIV/AIDS research community is about ensuring studies are focused, relate to/develop existing findings (rather than replicate them), and have measurable benefits to communities. Critics have argued that research in HIV may build academics careers but do little to enable people in ‘real life’ settings, or the focus on HIV detracts from other equally important issues within healthcare. While some of these accusations are often unfounded, there are questions to be asked about the quality of some studies on HIV/AIDS, and the ethical conduct of researchers. We should question any research on HIV/AIDS that doesn’t appear to have ethical approval, or does have approval but still seems to be putting participants at risk. Two examples of this come from sex workers in Cambodia and a Canadian study taking part on prostitutes in Nairobi. If you have concerns about ethical and governance issues in research then you should speak to the ethics committee overseeing the work. Established scientists can help if you need support with this (I can refer you to some if this is an issue for you).

We also need to be wary of research that doesn’t fit with the wider body of evidence (or contradicts it). Particularly in the case of studies that seem to be detracting from general HIV messages, or appear to promote anti-condom messages.

Studies and interventions that do not involve communities, sustain development or empower people are also a major problem. Particularly when they involve resource poor communities, or where literacy is an issue, or where access to wider healthcare and education is limited. More information on how this can have a devastating impact on communities (and how researchers, practitioners, activists and communities can resist this) can be found here.

Those of us working within research in sexual health/HIV need to do more to explain our methods, make evidence more accessible and directly applicable, and link carefully with communities where we’ll be working. It is important to work ethically and transparently, but also nurture community relationships as it is unfortunate that some studies are scuppered not because researchers were unprofessional, but the negative reputation of science resulted in opposition to research. PLRI are a good example of practitioners trying to achieve this.

10. Don’t forget, there are 365 World AIDS Days a year
It’s easy to think about HIV/AIDS on World AIDS Day, but not always so easy to remember it all year round. Hopefully the list of ideas above may give you some pointers for things you can do throughout the year that will make a difference. Setting aside time to regularly engage in an activity (like fundraising, volunteering or community education) means you don’t forget about HIV and you help those affected by it.

If you’ve found these tips helpful then please feel free to circulate widely.

I’ll leave you with a link to the official World AIDS Day site, and this short film from 2010 that reminds us why we cannot stop fighting HIV and supporting those affected

Posters for World AIDS Day 2011 can be downloaded here.

What made me start blogging?
Five years ago I sat down on a dark November evening and wrote my very first blog entry. It was a bit ranty. I’d been misquoted by a journalist and was anxious it would get me into hot water (again).

I didn’t have a game plan when I started blogging. My partner (who’s way more tech savvy than I am) thought it might be a good way of sharing ideas I was struggling to convey via the mainstream media (I was writing several advice columns in magazines at the time, as well as hosting a regular radio phone in for BBC Five Live).

I approached the blog as a form of therapy. I wanted to work with the media but was getting a lot of stick for it professionally (I’m an academic as well as a sex educator). Having a place to blog would allow me to correct any errors in reporting and disclose bad journalism. I even hoped it it might even let me bring evidence into sex/relationships reporting – and show it was possible to do so without things becoming worthy or dull.

One thing I felt sure of early on was this blog was something I enjoyed writing, but I wanted to be useful, and most importantly to deliver things about sex, relationships, science and journalism that readers wanted to know about. Which is why the blog has always been shaped by things you’ve asked for.

Readers make this blog (or “why don’t you have comments?”)
Last summer I asked regular readers to give me feedback on this blog and got some very helpful responses. It’s taken me a while to implement some of these, but I have now upgraded the blog to include the things you asked for – photos and images to liven things up, a better blogroll, summaries at the start of most entries so you can decide if you wish to read on. And categories. Something I didn’ think about five years ago and really wish I had. I’m now in the process of going back through all the 800+ posts and adding categories to them, which I hope will make this blog a lot more useful to you.

The one thing this blog doesn’t have is comments. I did start off having them, but encountered several problems. As I was offering advice within columns and websites elsewhere I hadn’t planned to also answer problems on this blog. However, not all readers understood this so I frequently found requests for advice on anything from infidelity to penis size included in discussions about blogs relating to research design or journalism ethics. This sometimes led to some readers mocking those asking for advice, which of course is completely unacceptable for me as an educator.

Moreover, I’ve always blogged openly – never behind a pseudonym. I work within the community on sex/relationships projects and educational activities (in the UK and internationally). This meant I was very accessible, and felt vulnerable when those whose comments were deleted or not posted, made very personal threats.

I found moderating the comments was time consuming and took me away from other educational activities which I felt were more worthwhile. So I decided to remove the comments option. When I’ve asked readers if they want them back the general response is ‘no’. That’s mostly from people who feel the blog’s a safe space to get information which they can use as they wish elsewhere.

Of course I strongly welcome respectful email feedback and am always happy to add information or correct errors within the blog. You’re always welcome to start discussions on other forums or your own blog about issues raised here. For now I’ve no plans to reinstate comments, but since I’m occasionally asked why I don’t have them I thought this was a good a time as any to clarify the issue.

Achievements so far
Having read back to 2004 I’m pretty pleased with this little blog. It’s nice to see it’s grown into a resource that people trust and enjoy reading.

The things I’m most proud to have written are activist blogs that highlight medicalisation, exploitation and abuse. These include the debates around female sexual dysfunction, questioning high street stores stocking ‘herbal’ erectile dysfunction drugs (not approved by the FDA), exposing the Advanced Medical Institute’s aggressive sales technique for men affected by premature ejaculation, or highlighting misleading media coverage of the availability of Viagra on the high street.

I initially planned to use the blog to set right bad sex coverage in the media (or occasions where I’d been misquoted). This has been a theme within the blog although I think it’s become more focused over time (although not necessarily less ranty than my very first post). I can’t say whether it’s made much difference to journalists, and I hope it’s not put people off working with the media. I’ve found it helpful to describe poor practice – not least because the general trend for ‘experts’ working with the media is to act grateful for any exposure, not publicly discuss poor experiences or document bad practice. Gems for me include an expose of GMTV sending a cab to my home at 6am on the off chance I might wake up and come to their studio. Or how a TV show wanted to discuss female sexual confidence without mentioning genitals or masturbation. Or some rather nasty experiences with snotty TV producers just after I’d had a baby. Not to mention the hilarious case of the science journalist who really took a dislike to me (and colleagues). Oh, and let’s not forget the journalist who wanted me to recommend them an ‘unethical psychologist’ .

Of course, the past five years have not been spent simply slagging off journalists. No. Sometimes I’ve also turned my gaze to bad science too. Where it’s been depressing to report on a carnival of studies which seem to set us back sexually. Studies complaining women orgasm too easily, or there’s a ‘clitorocentric conspiracy’ against the vagina, how sex with a partner is 400% better than any other kind of sex you might have, and you can tell whether a woman has vaginal orgasms by her walk.

Let’s not forget my other bugbears. The fake formula and shonky surveys and my goodness this blog’s a treasure chest for those. And if I’m not being irritated by that, then there’s always the problem of psychologists talking about celebrities, or the general ethical issues raised by Big Brother for me to moan about.

Of course, it’s not all been bad news. Anyone would think this blog is only about gripes and grumbles. I’ve always wanted to showcase a variety of sexual experiences within this blog and not just think about sex just for a Western audience. I’ll continue to discuss issues relating to sex and seniors; teenagers; disability; transsexuality; lesbian, gay and bi issues; open relationships; BDSM; sexual health; contraception; prostitution; pornography; reproductive health; pleasure; desire; asexuality; dating; psychosexual problems; showcasing great sex pioneers; talking about safer sex; and as many other topics as I can find for you to read about.

Where to next?
Unlike five years ago, I’m now thinking strategically about this blog – who it’s for, what it does, and seeking to find ways to assess any impact it may have. I’ve noticed over the years it sometimes deviates into areas that interest me, but may not appeal to all readers. So my aim is to ensure the focus of the blog remains around the core things you’re most interested in when you visit – sex, science, and media.

I’m currently involved in overhauling the site so in the new year I hope to have far more open access materials available for you – relationships and sex guides, information about sexual and reproductive health, more advice and links to sources of help, along with practical information for journalists, healthcare professionals, parents, teens and teachers.

I’ve been asked by many readers for more information about how to become an agony aunt/media sex educator, so I’ll be blogging about this – as well as how to write a sex blog – in the not too distant future.

I’ll also be making use of twitter soon, as sometimes I blog about issues people need to hear about fast (particularly developments in science/health), so hopefully that will make messages more accessible. I’ll let you know once I’ve sorted it.

Obviously I’d like to hear what you’d like to see. How would you like this blog to develop over the next year (or five!). Are there any particular things you’d like to see more/less of? Topics you want covered? People you’d like me to interview for the ‘quickies’ section of the blog? Campaigns you want covered? Let me know what your vision is for this blog.

So, happy fifth birthday blog. Big birthday kisses to those of you who’ve been with me from the beginning. For those of you who’ve only recently found this blog I hope you like it enough to stick around for the next half decade. I notice one of my favourite other blogs Mind Hacks has also celebrated it’s fifth birthday too, so congratulations to them.

Time to blow out the candles and make a wish. Of course, I can’t tell you what it is. You’ll have to come back in five years to find out if it’s come true.