The year Daniel (not his real name) was born, an infamous television ad was launched. It featured a grim reaper rolling a bowling ball towards a group of people – men, old ladies, mothers with babies – standing in the place of pins. A shaky, ominous voice intoned: “At first only gays and IV drug users were being killed by AIDS, but now we know every one of us could be devastated by it. If not stopped, it could kill more Australians than World War II.”
It was 1987, and at that time more than 70,000 cases of HIV/AIDS had been reported to the World Health Organization. It was expected that up to three million cases of HIV/AIDS would develop within the next five years.
While the grim reaper ad was indeed pretty grim, it was deemed necessary due to an almost 100% death rate from HIV/AIDS at the time. And it was effective. Many people who were a little older in that decade still shudder at any mention of the ad. (A similar campaign ran in the UK.) As one person says: “We thought that if we had sex, we would die.”
It’s 2015, Daniel will soon be 28 and things are very different. In Australia, there is very effective treatment available for HIV/AIDS. And it would seem the fear around the virus is mostly gone. As a young gay man, Daniel is in the demographic most vulnerable to HIV, yet he was never wholly concerned about it.
Then, one day recently, he went to get a routine sexual health test. Upon admitting to the nurse that he had had unprotected sex with a new partner, the mood suddenly shifted. She told him that in the past week they’d had three people his age come in and be diagnosed with HIV.
“When she said that, my heart just stopped,” Daniel says.
After lots of questioning, his partner admitted he hadn’t been tested. And, yes, he had had unprotected sex with other men, multiple times.
Daniel recalls his partner’s reaction: “He said ‘Look, it’s just the media beating up the sexual health rates, it’s not that serious.’ We hadn’t actually had a sexual health conversation, which was probably even more stupid.
“I was a mess. The thing wasn’t so much that I would become sick and potentially put my life in danger. It was more the issue that I would have done it to myself. I’d have to go to my parents and to my family and to my friends and to my employer, and tell them I’ve done this incredibly stupid thing to myself when I could have just used a condom during sex.”
Daniel was tested and, after a nailbiting wait, was told he was all clear. But many people have not been so lucky. In fact, almost 30 years since the grim reaper ad, the rate of HIV in Australia is increasing – steadily and alarmingly. A 2012 report from the Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research) showed the number of people diagnosed with HIV in Australia is at a 20-year high, and predicted HIV rates in Australia will rise by up to 73% over the next seven years.
Last year, experts gathered in Melbourne for the 20th International AIDS Conference. While many important conversations were had, Associate Professor David Wilson from the Kirby Institute says it was a concern that leaders were ignoring these increases at home. He says: “It’s somewhat alarming in that, politically, the government has decided to sign up to declarations where they’re committing to large declines in HIV infection, but over the last 10 to 15 years we’ve only seen steady increases.”
Awareness about HIV/AIDS in Australia seems to be remarkably low. Daniel now only ever has sex with a condom, but he says many people – particularly young people – haven’t got the message. “Before this happened I did have protected sex, but not all the time. You know, you use a condom, but you might forget it one time, you might think better of it another time. There’s the idea that, well, you’re safe. If you want to have sex with some guy you know in your bedroom, not in a toilet, not in some seedy club, but just in your own home, surely you can’t get HIV that way.”
Alischa Ross, founder and CEO of YEAH (Youth Empowerment Against HIV/AIDS), agrees that many people, especially young people, have become complacent. When she tells people about her work, they often remark: “Oh, AIDS… We’ve got a cure for that now, don’t we?”
Ross says: “We have seen such a neglect in broader community awareness programs that…we have seen the largest rise in new HIV diagnoses in the last couple of decades.”
Most HIV awareness campaigns are targeted at groups of people deemed most at risk, primarily men who have sex with men. But as homosexuality becomes more acceptable in the mainstream, young people are getting their information from different areas, and targeted campaigning is missing people.
“I think we do actually need to see more mainstream messages,” says Ross. “Because I think more young people identify as a young person first before they identify as being a young gay person.”
Daniel is a case in point. He doesn’t have a great number of gay friends and he’s not particularly active in the gay community, so he didn’t get information about HIV through those channels. He went to a conservative private school where they talked about the risks of pregnancy, but HIV was never mentioned.
A lot of sex education in schools mostly addresses heterosexual sex. If homosexual sex is discussed, it’s often treated as a totally separate thing, further marginalising the issue. Targeted messaging can also make heterosexual people think they are immune. And this is becoming a big part of the problem.
As Ross says: “What we hear from young people is that HIV is something that only happens to gay men or to African babies. To people in poor countries somewhere else, but not to them. But we’re seeing a large proportion of new cases occurring [from] heterosexual transmission. It’s a significant increase over the last few years.”
Not only is the rate of HIV steadily increasing, other sexually transmitted infection rates have catapulted – another indicator of complacency around sexual health. The Kirby Institute’s report suggests Australia is facing an ‘epidemic’ of the sexually transmitted infection (STI) chlamydia, with up to 80,000 people being infected each year.
“Chlamydia is largely affecting teenagers, teenage girls in particular, some as young as 12,” Wilson reports. “And we know that there are many more Australians out there who are undiagnosed; they’re not aware of it.”
Chlamydia is often asymptomatic, but if untreated can cause long-term damage, including infertility. This dramatic rise in STI rates shows there is a great deal of unsafe sexual behaviour occurring among young people, increasing the likelihood of contracting HIV.
The Kirby Institute’s research shows condom use is dropping, especially among young people. The Department of Health website states that almost 40% of sexually active students reported they only used condoms ‘sometimes’. And 13% said they ‘never’ used condoms.
With many people believing the danger of the AIDS crisis is ‘over’, using protection is not considered a high priority. Ross says some young people feel pressured by their sexual partners not to use condoms at all. “One of the things we’re hearing is people, particularly young women, saying that they can’t get an STI because they’re on the pill.”
Research by YEAH shows a lack of proper education is a leading cause of these perilous attitudes. A joint report with the Australian Youth Affairs Coalition revealed in 2012 that 50% of students receiving sex education in school are dissatisfied with it. And in Victoria, where it’s mandatory to teach sex education, one in 10 young people say they’re not getting any sex education at all. To counteract this, YEAH has started an initiative called Red Aware: providing mentorships for students to run peer-to-peer sexuality education programs in schools across the country. Ross believes the days of the grim reaper fear-based campaigns are over. To get young people to take their sexual health more seriously, they need to change the way that sexuality is discussed.
Wilson agrees there is a big disconnect between what young people are being taught and what is actually happening in their lives: “They’re told about sex at school; it seems very clinical or scientific. But for them it’s more about pleasure and romance and having fun. If education was different, it would tell [young people] that sex is a pleasurable, normal thing and encourage them, when they’re ready, to enjoy having a healthy sexual life. And part of that is to practise safe sex for their own health. Then it would be much more effective.”
YEAH encounters people who worry that talking about sex will just encourage young people to be more promiscuous. But the evidence suggests that if young people are not educated about sexual health, they are more likely to have sex younger and be engaged in higher risk-taking behaviours – the sort of things that have led to what YEAH labels “a sexual health crisis of epidemic scale”.
As Ross says: “If you do care about young people and you do want them to wait a bit longer, feel ready, feel in control of the decisions they make about their sexual lives, then for goodness sake start talking openly, honestly and earlier.”
Daniel was not old enough in the 1980s to see how serious the risks of practising unsafe sex can be. If things continue unchecked, the risk of infection will only increase. To protect people – especially young people – from serious threats to their health and future, we cannot afford not to talk about sex.
by Katherine Smyrk
» To learn more about YEAH’s campaign visit redaware.org.au.
This article first appeared in Ed#477 of The Big Issue.