Christine Aziz explains why British prudishness is set to cost lives in the future

The new government strategy to tackle the rise in sexually transmitted infections could be too little too late. It seems many of us have spent years ignoring the safe sex message and are now paying the price.There's been an 80% increase in syphilis in the past five years, a 56% increase in gonorrhoea and a 76% increase in chlamydia - an infection that can lead to infertility, ectopic pregnancies and pelvic infections. At the same time, the number of new and known heterosexual HIV cases has risen by almost 40% since 1992. So what has gone wrong?

The present increase in STIs (sexually transmitted infections) is in stark contrast to the late 1980s and early 1990s when there was a notable reduction in cases. This was attributed to the HIV/AIDS awareness campaign, which graphically linked the infection to an untimely death and warned of the dangers of unsafe sex.According to the Terence Higgins Trust the safe sex message has since skipped a whole generation. 'There was the big HIV campaign in 1986 and after that it was forgotten,' says the Trust's Mark Graver. 'The government's new health strategy is welcome, but it is a little late. The HIV epidemic the government expected to see in the l980s didn't happen, but it could still occur if the safe sex message is not promoted effectively and people remain ignorant of HIV and AIDS.'

Grim reading
The latest Department of Health survey on contraception, conducted in 1997, reveals that only 50% of couples take precautions against sexually transmitted infections. The majority of those use condoms to prevent pregnancy, rather than to protect against STIs. Only four in 10 credited their use with fears over HIV and AIDS. At the same time, figures show only a third of women under 50 have even heard of chlamydia, currently the most common infection in the UK.

It is a shocking ignorance. And a dangerous one. It owes more to our Victorian outlook when discussing sex than to any personal shortcomings: it is just not done to have a public debate about it. It speaks volumes that the launch of a recent safe sex campaign by a Merseyside health promotion agency was ignored by the local newspaper for fear that it would cause offence.

Prudes
The British attitude to sex is, in fact, the major obstacle to any safe sex campaign in this country. 'Culturally and historically, the Brits are very prudish and coy when it comes to sex,' says Kirsteen Sheppard of the health promotion agency, HIT. 'It makes our work extremely difficult. Perhaps if we weren't so hung up, condoms would be available everywhere -and free.''Sex is marginalised in this country,' agrees Graver at the Terence Higgins Trust. 'We don't even have a coordinated programme of sex education in schools. Everything is left up to the school governors and it's generally taught in a scientific and brutal way and not linked to emotions and relationships.'

It would explain why some 8,000 teenagers under 16 fall pregnant in the UK every year - the worst record in Europe. Sex education is compulsory at secondary school (although parents can withdraw their children), but is only a government recommendation in primary school. With children as young as 10 and 11 having sex, it is too little too late. It also doesn't help when safe sex initiatives receive hysterical reactions -recall the furore over plans to make the morning after pill available in chemists and schools.

The government initiative
So how do we tackle the growing numbers of sexually transmitted infections? The government has recently announced plans to test much more widely for STIs and to target a screening programme for chlamydia. This will be backed by a major television and newspaper campaign on the dangers of STIs and an initiative to reduce new HIV infections by 25% in the next six years.

But is it enough? Professor John Ashton, Regional Director for Public Health in the North West where cases of STIs are particularly high, argues that the sexual health strategy also needs to promote greater cooperation between agencies dealing with sexual health issues. 'Traditionally they have all worked separately without pooling information. This has to be changed if we are to keep up to date with what's going on sexually.'

Challenging the British mentality
Changing ingrained attitudes, while not easy, has to be the way forward. Talking openly about sex - something alien to the British culture - is the only way to understand and react to current trends.'Sexual behaviour is dynamic and is always changing,' says Professor Ashton. 'In 10 years things have changed so much; women are behaving more like men sexually, people have more sexual partners than before and the baby boomers won't give up sex lying down. As a result we have a lot of sexually active older people.'

But we have to go a step further - taking a pragmatic look at emotive subjects such as prostitution (something we British are not always known for).'Sexual health cannot be addressed without looking at the legalisation of prostitution and massage parlours,' argues Professor Ashton. 'Without regulation it's impossible to trace the source of outbreaks of STIs. Outbreaks of food poisoning can be tracked to a particular food outlet, but this is impossible to do with an STI while the sex industry is unregulated.'

It's a call that is not likely to go down well with many sections of the sometimes hot-headed British public. We are a nation fast becoming known for reacting first, thinking later. But until we learn to break one of the last taboos in this country and talk openly, honestly and calmly about sex - to our children, our lovers, our friends and our GPs (men name sex as one of the most embarrassing things to discuss with their doctor) - we will never triumph over sexually transmitted infections.

And until we learn to divorce morality and emotion (who wants to contemplate their daughter having sex at 11?) from practicality and realism (many 11 years old are), we can never fully change the attitudes that have brought us to this point.It will be a long, hard journey, but one that we need to take.

The British way of STIs