Dáil Éireann debate -
Tuesday, 26 Mar 2002

Vol. 551 No. 2

Adjournment Debate. - Sexually Transmitted Diseases.

Mr. Coveney

Sexual health issues are of major importance to the health and well-being of young people. The facts underline the seriousness of the situation: some 70% of young people in Ireland have full sex before the age of 20, the proportion of teenagers having unprotected sex has increased by 30% between 1997 and 2000 and 46% of sexually active men and women with multiple partners do not use any form of contraception. Levels of sexually transmitted diseases such as syphilis, chlamydia, gonorrhoea, genital warts and HIV have increased dramatically. There continues to be a steady increase in the number of unplanned pregnancies. Perhaps the figure that really drives home the message is that GPs are now prescribing more than 250,000 morning after pills a year to young people.

To give a figure from an area with which I am somewhat more familiar, the Southern Health Board region, the number of attendances in the Cork STD clinic increased by more than 600% from 1990 to 2000. In 1990 a total of 909 people visited the clinic, a figure which rose to 5,068 in 2000. If this trend were to continue at this rate, some 25,000 people would visit the clinic in the year 2010. This may be something of an exaggeration but it hammers home the message that we are facing a dramatic increase – many have called it an epidemic – in STDs.

The seriousness of these diseases should not be underestimated. While genital warts, for example, may be inconvenient and painful to men, they can cause cervical cancer in women and diseases such as chlamydia can cause infertility in women and may also have further consequences. We know all too well the consequences of the spread of HIV. As policymakers and legislators, we are, therefore, facing a situation which has gone from bad to worse in recent years. While there have been some initiatives by the health boards, I have not detected anything on an annual basis or a response from the Government during the past five years.

As a young Deputy, I feel it is my responsibility, in the dying days of the Government, to raise this issue and try to have it prioritised. A number of things could be done. For example, in the area of education an initiative, the Relationships and Sexuality Education curriculum, was taken, but it transpires that less than 40% of primary schools and less than 80% of secondary schools are estimated to have implemented it. It is a joke – not a funny one – that our efforts to provide information and education on sex and relationships to schools have, unfortunately, failed.

We need to target parents, something not done to date, with information campaigns. The first thing we need to do is accept that young people are having intimate, unprotected sexual relationships. We should not be judgmental or take the view that young people should not have intimate sexual relationships but instead take a very responsible approach towards informing young people and their parents about the dangers of such relationships. This needs to be done proactively through a national well publicised campaign targeting both young people and parents.

I hope the Minister offers a reasonable and comprehensive response which sets out what has been done during the past five years. From what I have been told, very little has been done in this area as a result of which we have a dramatic increase in the number of STDs and a corresponding decrease in the health of young people.

Dr. Moffatt

On behalf of my colleague, the Minister for Health and Children, Deputy Martin, I thank the Deputy for raising this important matter. I am aware of the increasing numbers of sexually transmitted infections, STIs, in Ireland. I am informed by the National Disease Surveillance Centre, NDSC, the agency responsible for the collection of these statistics, that it has finalised the data for notified cases of sexually transmitted infections in 2000. The rising trend in STI notifications has continued in 2000 with an overall increase of 27% between 1999 and 2000. The number of cases increased by 86% between 1995 and 2000 and almost trebled between 1989 and 2000 and there has been a steady rise in notifications each year since 1994. Figures for HIV among the heterosexual category have also been increasing. Some of this increase may be attributed to improved reporting arrangements, particularly since the establishment of the NDSC in October 1998.

The rises in sexually transmitted infections are likely to be associated with increased unsafe sexual behaviour, particularly among young heterosexuals and men who have sex with men, although the rise in some infections such as chlamydia may also reflect increased testing for this infection. In addition, improved acceptability of STI clinic services and greater public and professional awareness of certain STIs may have contributed to the increases in reported cases.

In the National Health Promotion Strategy 2000-2005, published in July 2000 by my colleague, the Minister for Health and Children, Deputy Martin, it is acknowledged that sexuality is an integral part of being human and healthy sexual relationships can contribute to an overall sense of well-being. A strategic aim of the National Health Promotion Strategy 2000-2005, is "to promote safer sexual health and safer sexual practices among the population." The health promotion unit of the Department of Health and Children is involved in and supports a range of initiatives and interventions aimed at preventing and raising awareness of sexually transmitted infections. These include social, personal and health education which is being introduced in primary and post-primary schools in partnership with the Department of Education and Science and of which Relationships and Sexuality Education is an integral part and the national youth health programme which is being carried out in a partnership between the National Youth Council of Ireland, the health promotion unit of the Department of Health and Children and the youth affairs section of the Department of Education and Science. Its aim is to provide a broad based, flexible health promotion and education support and training service to youth organisations and to all those working with young people in the non-formal education sector.

In the context of this programme a training initiative called Too Hot to Handle, which addresses the issues of relationships, sexuality and sexual health with young people, is offered to youth workers and a national public awareness advertising campaign to promote sexual health is aimed at men and women in the 18 to 35 age group to increase awareness about safe sex and sexually transmitted infections. The overall goal is to increase safe sex practices and reduce the incidence of STI transmission and unwanted pregnancies among young people in Ireland. The campaign runs in third level colleges, places of entertainment such as pubs, clubs and discos as well as youth clubs.

This national programme has been running for several years and a new and revised campaign is being developed by the health promotion unit which will include an increase in the number of venues targeted. Following on from phase one of the Think Twice campaign, the health promotion unit is working in co-operation with the Southern Health Board in developing awareness raising initiatives and is developing a public information booklet to promote positive sexual health.

The aim of the booklet is to heighten awareness on such issues as pregnancy prevention, the effects of alcohol and drugs, STIs and safer sex. The health promotion unit also produces a range of awareness raising leaflets on STIs and safe sex practices which are available through health promotion departments in each health board. The health promotion unit also supports a wide range of local health board initiatives and interventions targeting specific at-risk groups such as the gay community and prostitutes which are aimed at lowering the incidence of HIV and STIs in these groups.

The report of the National AIDS Strategy Committee, NASC, entitled AIDS Strategy 2000, was published in June 2001 and makes recommendations for dealing with HIV-AIDS and other sexually transmitted infections in the coming years. My Department, through the three sub-committees of NASC – education and prevention, surveillance, care and management – work to implement these recommendations, one of which is that research be carried out on the knowledge, attitudes and skills of young people in relation to sexual health and diseases. The education and prevention sub-committee will examine this recommendation with a view to progressing our knowledge of sexual attitudes and behaviours in modern Ireland. Health board services for STIs and HIV have been enhanced over the last number of years. There are now six consultants working in the area of HIV and STIs, one of whom was appointed in the last few months. Five of these are in Dublin and one in Cork. A further consultant will be appointed in the Western Health Board during this year.

Education and awareness are the most effective tools in the fight against STIs. Despite the information available however the increased incidence of all major sexually transmitted infections is obviously of serious concern. The main messages in education and awareness programmes are that abstaining from sex altogether is a certain way of avoiding STIs and that for sexually active people who are not in "one faithful partner" relationships that the use of a good quality new condom, correctly used, is the single most effective defence against HIV infection and transmission. My Department will continue to give priority to the issue of STIs and will work with the relevant agencies in developing appropriate responses in this area.

I hope Deputy Coveney has learned of the activity in the various Departments regarding this matter.