Memorandum by Family Education Trust (HA
1. The Family Education Trust was founded
in 1971 to carry out research into the causes and consequences
of family breakdown, and to publicise the findings of such research.
2. The Trust has always made the welfare
of young people its special concern, and adopted the operating
title of Family and Youth Concern to express this. We are therefore
particularly concerned that the rapid spread of sexually transmitted
infections is concentrated amongst those in the younger age groups,
where such infections can result in maximum harm.
3. We note with regret that since the Committee
report of 11 June 2003, the sexual health crisis has worsened:
(a) The overall conception rates for under
16s have remained at much the same level since 1975
and the latest figures show a small rise in conceptions in under-18s
in England and Wales from 42.7 to 42.8 per 1,000.
(b) In 2003, for women resident in England
and Wales, the total number of abortions was 181,600, compared
with 175,900 in 2002, (a rise of 3.2% and the highest ever annual
total) and the under-16 abortion rate was 3.9 per 1,000 compared
with 3.7 per 1,000 in 2002.
(c) In 2003, the total number of new HIV
diagnoses was 6,606more than twice the number in 1998.
(d) Many non-HIV STIs continue to rise. Chlamydia
is now the commonest STI diagnosed in England, Wales and Northern
Ireland, rising by 8% from 82,558 to 89,431 from 2002 to 2003.
Syphilis is of particular concern because of the rate of increase
(28% in men 32% in women) from 2002-03. 
A. PROPOSED CHARGES
4. We are opposed to anything that would
act as a disincentive to overseas patients accessing services
for the detection, control and treatment of STIs, including HIV.
We note the HPA report of December 2004
which focuses on migration from high-risk areas such as sub-Saharan
Africa as a major factor in the heterosexual spread of HIV in
B. PROGRESS IN
5. The report (p 25) identifies the primary
causes of the deterioration in sexual health but gives no recommendations
as to how these primary factors may be modified. No country in
the world including Thailand has seen its HIV rates decline without
a decrease in promiscuous sexual partnerships. There
is an increasing recognition that condoms, even when used consistently
and correctly, cannot, in isolation from other behavioural change,
lead to improved sexual health as the following quotations show:
"The past decade has seen substantial
increases in high-risk sexual behaviours in the British population.
Although condom use has also increased, this is likely to have
been offset by greater increases in unsafe sex. "
"The possibility that presenting casual
sex using a condom as socially acceptable, enjoyable and safe
might increase sexual risk behaviour in the general public cannot
be dismissed. Condom promotion need not increase sexual activity
to produce a negative effect. "
6. The report (p.78) states that the committee
sees "no benefit in preventative approaches based primarily
around promoting abstinence". Since the report was published
however the evidence showing that abstinence has had a major part
to play in the dramatic reduction of HIV incidence and prevalence
in Uganda has continued to grow. 
There have been several authorities recommending that the lessons
learned from the Ugandan success be applied in other countries.
7. The experience of the USA is particularly
impressive. The conception rate in 15-19 year-olds fell by over
28% from 120.2 to 85.6 per 1,000 from 1990-2000. The comparable
figures for the UK were a fall of 7% from 68 to 62.8 per 1,000.
Abortion figures for this age group showed a 41% fall in the USA
from 42 to 24.8 per 1,000 whereas in the UK the fall was 2.6%
from 26 to 25.3 per 1,000. The teenage abortion rate is now lower
in the USA than in the UK. 
8. The only peer reviewed published evidence
of which we are aware that examines the reasons for these trends
in the USA from 1990-95, attributes two-thirds of the decline
in conceptions to single teenagers to increased abstinence. 
9. The latest figures show that teenage
abstinence is still increasing in the USA. The proportion of never-married
females at 15-17 years of age who had ever had sexual intercourse
dropped significantly from 38% in 1995 to 30% in 2002. For males
the comparable figures fell from 43% to 31%.
Though contraceptive use also increased at first intercourse,
there can be little doubt that such a large increase in teenagers
abstaining from intercourse will have made a substantial contribution
to the reduction in teenage conceptions to single mothers from
1995-2002 as it did in 1990-95.
10. One of our trustees predicted in 2001
that the increased availability of emergency pills from pharmacies
would be accompanied by an increase in STIs because the opportunity
to counsel and advise on, screen for and treat STIs, would be
lost without the encounter with a doctor or nurse. This prediction
has proved correct, though the link has not been proved to be
causal. We strongly recommend it would help improve sexual health
if the manufacturers of emergency pills were to place a warning
on the packet or product leaflet, that the user is at risk of
an STI as well as pregnancy, and listing contact details for further
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