How unprotected sex is fuelling the rise in sexually transmitted diseases in Europe – Firstpost

In September, for many of us, that feeling of going back to school is still there, no matter how long it's been since we left the classroom. However, for many young people looking forward to their first week or starting their studies again, the continued rise in sexually transmitted infections (STIs) could be a good reason to revisit policies on safer sex and condom use to ensure their studies aren't interrupted by an unwanted infection.

In September 2023, the UK Health Authority urged students to use condoms and get tested regularly for sexually transmitted diseases to prevent the spread of infections. This is wise advice for everyone, not just students.

The latest data from the European Centre for Disease Prevention and Control show that syphilis cases increased by 34 percent, chlamydia cases by 16 percent and gonorrhoea cases by 48 percent from 2021 to 2022.

Ireland – where I conduct my own sexual health research – has also seen a significant increase in STI cases, similar to Europe. Health surveillance data shows that between 2019 and 2022, chlamydia cases increased by 20 percent, gonorrhoea cases by 45 percent and syphilis cases by 14 percent.

The prevalence of sexually transmitted diseases is particularly striking among young people, especially those under 30. Women aged 20 to 24 have the highest reporting rate for all sexually transmitted diseases, with 3,088 cases per 100,000 inhabitants. Surveillance reports from 2023 show a 133 percent increase in gonorrhea cases among women aged 20 to 24 and a 55 percent increase among men aged 15 to 19 since 2022.

Gay, bisexual and other men who have sex with men (MSM) represent another important affected population group in Ireland, accounting for 84 percent of gonorrhoea and 71 percent of syphilis infections in 2022.

Data on STI rates among migrants in Ireland are scarce, but the rate of bacterial STI co-infection among new HIV diagnoses was 17 percent, rising to 26 percent among MSM. A significant proportion of new HIV diagnoses were among people from Latin America (24 percent) and sub-Saharan Africa (20 percent).

Europe-wide data from the European MSM Internet Survey (EMIS) – an anonymous online survey of gay, bisexual and other men who have sex with men – also show that migrants face barriers to practicing safer sexual behaviour.

Barriers may include inadequate knowledge about sexual and reproductive health, financial constraints, language barriers, and experiences of stigma and discrimination. Around one in five refugees experience sexual violence (likely a conservative statistic given the low reporting rates of rape and sexual assault), meaning they may be at increased risk of sexually transmitted diseases.

Compared to people born in their country of residence, the EMIS study reported higher rates of sex without a condom among refugees, asylum seekers and people who had immigrated to live openly as gay or bisexual.

Decline in condom use

The decline in condom use is a major factor contributing to the rise in sexually transmitted diseases, particularly among key populations such as young people and MSM.

So what is the reason for this decline?

Unfortunately, we don't know.

Our sexual health, like our health in general, is influenced by a complex interplay of individual, social and structural factors. This perspective is known as the socioecological approach, which considers the social, political and policy factors that shape individual behavior.

The impact of recent significant changes in the social, cultural and technological environment on sexual health is beginning to come into focus, but is still not sufficiently researched.

For example, the proliferation of smartphone technology has led to an increase in the use of online dating apps and the easy availability of pornography. There is evidence that increased pornography consumption is associated with a higher likelihood of condomless sex, while dating app users are more likely to contract gonorrhea and chlamydia.

The availability of pre-exposure prophylaxis (PrEP) has been instrumental in reducing HIV rates among MSM and is an important prevention tool. However, PrEP use is also associated with higher rates of STI diagnoses. Recreational drug use is another factor: MSM in Ireland who have been diagnosed with an STI are 53 percent more likely to use drugs.

Housing instability is linked to less safe sexual behaviour, while the number of homeless youth is increasing in Europe. For example, the number of young homeless people in Ireland increased by 57 percent between 2017 and 2022.

Immigration to Ireland is set to increase by 31 percent in 2023, which may play a role. The hurdles to accessing sexual health services for migrants are well documented, with national migrant rights organisation Nasc raising concerns about access to condoms.

How to meet the challenge

Developing interventions is key. Addressing socio-cultural and economic determinants of sexual health is also crucial. Improving education, access to housing and living conditions generally, especially for marginalized populations, requires careful planning and investment by governments. To stem the current rise in sexually transmitted diseases, an environment that supports people in taking care of their health, rather than preventing them from doing so, is essential.

Improving access to services is critical. The recent launch of SH:24, a free home testing service, has improved access to testing in Ireland. Peer-led community testing programmes have proven successful in Dublin but are lacking outside the capital.

We all have a right to a safe, healthy and enjoyable sex life. By ensuring the availability and universal access to culturally appropriate services, education and information, and by creating legal and policy frameworks that promote dignity, equality and non-discrimination, we can improve sexual health and stem the tide of sexually transmitted diseases in Europe.

Elena Vaughan, Research Associate, Health Promotion Research Centre (HPRC), University of Galway

This article is republished from The Conversation under a Creative Commons license. Read the original article.