DOES
ENCOURAGING USE OF BARRIERS DECREASE THE INCIDENTS OF STI’S?
WORKSHOP
REPORT
This
workshop was attended by delegates from:
Belgium, Norway, Greece, Israel, Hungary and
the United Kingdom.
The following questions were addressed:-
1.
What is the evidence that barriers prevent STI’s?
Delegates agreed
that barriers do prevent STI’s. The percentage of transmission prevented varies
with different bacterial and viral infections. There is no good scientific
evidence concerning the exact percentage of transmission prevented, but this is
substantial and in the opinion of the delegates over 80% for most sexually
transmitted infections. Their clinical experience does suggest it does not
reach 100% prevention.
This substantial
impact of both male and female barrier methods in preventing a transmission of
STI’s meant there was unanimous agreement that the use of barriers should be
encouraged.
The delegates
felt that a very high percentage of people in their countries were aware of at
least a male condom, so the session moved to the second question.
2.
Why don’t people use barriers?
Numerous reasons
were put forward to answer this question. These were roughly divided into poor
access, no desire to use and being unable to use barriers correctly. The
reasons are summarised below.
Poor Access:-
v
Cannot afford, e.g. sub-groups of
population like young teenagers, those with learning disorders
v
Do not know where to obtain, although
widely available in most countries
v
Cannot travel to distribution point
v
Worried about being seen at
distribution point, this was a particular problem in rural areas of Hungary
Do not want
to use:-
v
Unaware of benefits
v
Do not care about partner, e.g. when
using sex workers
v
Perceived low risk
v
Interferes with pleasure
Unable to use
correctly:-
v
Spontaneous unplanned sex without
condoms available
v
Alcohol
v
Drugs
v
Within an abusive relationship
v
Lack of knowledge of correct use
Having
identified barriers to use of condoms despite evidence of a substantial health
gain, the delegates moved on to address the third question.
3.
How can we encourage use?
There were many
suggestions from the different countries represented at the workshop. All
agreed that sex education was important. Some countries started early at the
age of 9, but in others not until the age of 13 or 14. The age of which it
should be delivered and how it was to be delivered was vigorously debated with
no consensus obtained.
Examples were
given of innovative schemes in the different countries. In Norway, condoms are
available free of use over the internet with the cost paid by the state. All
young teenagers are taught within schools how to use condoms and then issued
with a certificate expertise in condom use.
In Israel,
condoms are freely available in vending machines in school toilets.
In the United
Kingdom, various schemes are found within the country. These include subsidised
vending machines in youth clubs and other locations used by vulnerable groups
and the C Card Schemes. The C Cards are cards that look like credit cards which
are issued to anyone who has been instructed in the use of condoms, they can
then be used at different venues to obtain a free supply.
The group
concluded that it was appropriate for the state to subsidise or supply free of
charge condoms. It noted that better health gain per euro could be obtained if
these were targeted at vulnerable groups.
The take home
messages from this group were as follows:-
Take Home Messages:-
1.
Use of female and male condoms does
prevent the transmission of sexually transmitted infection although this is not
100%.
2.
General encouragement to use barrier
methods is not enough, it is important to ensure there is an understanding of where
to obtain them, how to use them and why.
3.
The state should be encouraged to
subsidise or provide free condoms. Better health gain per euro will be obtained
if targeted at vulnerable groups.