The Government's current piecemeal approach to sexual health means that programmes and services are delivered in an ad hoc manner, writes Ann Nolan.
As prevention-educators, it is the experience of Dublin Aids Alliance and the Red Ribbon Project that young people are complacent about HIV and STIs (sexually-transmitted infections), having grown up after the huge media visibility which characterised HIV/Aids in the 1980s and early 1990s.
One of the greatest challenges for us is to break through the bombardment of messages targeted at people aged between 18 and 35 and encourage them to take one very simple but in some cases life-saving message on board: choose safe sex.
The incidence of STIs in Ireland continues to rise. The most recent figures published by the Health Protection Surveillance Centre reported a 12.1 per cent increase in 2004. There has been a 174 per cent increase in reported STIs in Ireland between 1994 and 2003, and we know that this may herald a future increase in sexually-acquired HIV.
In Ireland, despite a reduction of almost 10 per cent in the number of HIV infections in 2004, and a further reduction in the first two quarters of 2005, the number of people testing positive for a virus which is largely preventable remains significant.
A total of 356 cases of HIV were diagnosed in Ireland in 2004 and 148 new cases were reported in the first two quarters of 2005. This downward trend, while welcome, should be interpreted with caution, as it may not continue in future years.
Speaking at the European Aids Conference in Dublin recently, Dr William Powderly said there was a danger that many people no longer viewed HIV as a problem in Ireland. Given the rise in STIs, he felt that young people had either not heard or did not believe the messages about practising safer sex.
Findings published this week in the annual report of the Joint United Nations Programme on HIV/Aids (UNAIDS) and the World Health Organisation indicate decreases in the rate of HIV infection in certain countries. However, the findings also indicate that comprehensive and consistent prevention efforts are needed to slow the epidemic.
Dublin Aids Alliance and the Red Ribbon Project have put the apparent complacency among 18/35-year-olds about practising safer sex at the top of their agenda.
A "teaser" sexual health education campaign has been running on outdoor media in Dublin and Limerick since November 7th. In advance of World Aids Day on December 1st, the "Do You Choose It?" campaign encourages young people to talk about sex as a first step towards negotiating safer sex.
We believe that this campaign - featuring advertising on billboards, buses and trains as well as the distribution of information packs, condoms, postcards and beer mats in bars and clubs in Dublin and Limerick - will encourage discourse about sex and safer sex practices.
However, we are aware of the limitations of an advertising campaign and believe that a long-term comprehensive strategy is urgently required to tackle rates of STI and HIV infection.
Reflecting on the message from UNAIDS and the World Health Organisation, we are calling on the Government to develop and resource a "National Sexual Health Strategy".
Aspects of sexual health have been addressed in various Government strategies, including the National Aids Strategy, the Crisis Pregnancy Strategy, "Youth as a Resource" and the National Health Promotion Strategy. However, a specific strategy dedicated to sexual health has yet to be developed.
The Government's current piecemeal approach to sexual health means that programmes and services are delivered in an ad hoc manner, with limited inter-sectoral collaboration, planning or development at local, regional or national level. This situation means that we have no sense of how current programmes might or might not be reducing sexually-transmitted HIV or STIs throughout the country.
It is tempting to believe that this generation of young people is highly educated about sexual health - given the sexual health programme being taught in schools and almost continuous exposure to sexual references in advertising and on TV - but the STI figures suggest otherwise.
While lifestyles may have changed in Ireland over the past 20 years, our attitudes to sex and sexuality and to safer sex practices remain taboo subjects. In short, we are not talking about safer sex.
This is despite the fact that age at first intercourse is becoming progressively younger, often resulting in multiple sexual partners over a longer period of time. Research suggests that young women, in particular, lack the skills necessary to negotiate safer sexual relationships with men. Despite gender equality in education and employment, which those aged between 18 and 35 rightly expect nowadays, research shows that women who carry condoms are "labelled" and assumed to be promiscuous by their female and male peers.
As organisations working to promote and provide sexual health education, we are faced with the realities that the fear of becoming pregnant continues to override concerns about STIs or HIV; that HIV is believed to be confined to gay men and injecting drug-users in spite of the fact that heterosexual transmission of HIV is now the primary route of infection in Ireland; and that many young people feel they will not contract STIs from "people they know".
We believe the "Do You Choose It?" campaign will encourage young people to ask questions about sex and adopt safer sex practices. But a sustained and longer-term approach in the form a National Sexual Health Strategy is urgently needed.
Ann Nolan is executive director of the Dublin Aids Alliance