A recent TV programme on “the secret life of students” followed a group of students in their first undergraduate year at Leicester University, including 18-year-old Aiden who was informed on screen that he had chlamydia. Aiden texted his friends about it before calling Josie, a previous sexual partner. Josie told her flatmates that it sounded “like a girl’s name” and then proceeded to text her friends about it too.
All of this information sharing led to a disparaging article under the headline ‘Got chlamydia. Banter!’ Who knew students found STIs so funny? in which the programme was described as “a shocking - but honest - picture of student life”, where STIs were seen as funny.
But in the desire to be outraged, the article ignored at least six positives that I saw happening: people discussing chlamydia and everyone knowing what it was; Aiden attending the clinic after two instances of unprotected sex, which is what we want young people to do, and getting tested, which may help to demystify the process for other young people anxious about going. He also notified previous partners when he discovered an STI, including Josie. Josie said she wanted to have kids one day and understood the possible risks associated with chlamydia and infertility – so she was not completely trivialising it – and Aiden seemed to adhere to advice to avoid having sex for one week to avoid STI transmission.
All these points were all ignored in favour of the shock narrative about STIs not being taken seriously.
Banter isn’t a dirty word
As a sexual health researcher, I’ve talked to young men and women aged between 16 and 24 about chlamydia. In one study I offered screening in non-medical settings including further education colleges in Scotland to explore the feasibility of such an approach.
I certainly heard “banter” being used by (mostly) men as a way of dealing with awkward conversations about chlamydia. They were often embarrassed to talk about it, especially within mixed-sex groups in colleges. I also used banter myself when approaching young men to talk about chlamydia, as this was a key way for me to help diffused tensions and put them at ease. I never trivialised chlamydia, but I certainly haven’t always used the “serious” tones that a sexual health adviser at a clinic might.
Many young men I spoke to preferred this approach to a clinic-based approach precisely because of this, supported by the findings another paper we published.
There is no chlamydia screening programme in Scotland, where I am based, but most tests are carried out with women 27% of tests in 2010 were performed on men’s samples. In my study the majority of the men had never had a chlamydia test before, and indeed had never been asked. I achieved a 60% uptake of chlamydia screening among men in one setting. Many said they did not want to attend a clinic as they thought them to be stigmatising and embarrassing.
In another study, published in the Journal of Medical Internet Research, I invited young heterosexual men aged 16-24 to help design a way of screening chlamydia via the internet, including a website. Many of them didn’t want a website that conveyed chlamydia as a joke. As adults, they wanted it to be presented in an adult way. They were also unsure whether text on existing sites was written by young people, so they were not sure about the authenticity. They were essentially wary of adults intruding into their world and masquerading as youth.
The men in this study had differences including being from mixed backgrounds – from middle-class to more disadvantaged groups. But the issue of embarrassment clearly emerged in both – even doctors and nurses have reported being embarrassed to talk to men about chlamydia.
Moral outrage is pointless
We need to set aside our moral outrage and dig a bit deeper into why STIs can sometimes be discussed in a way that can appear trivial.
Cultural forces influence young people’s sexual behaviour and we now have a wealth of research evidence which shows just how much reputations and social displays of sexual activity – or inactivity – matter. And social expectations hamper communication about sex. There is no point getting worked up when young people apparently “fail” in their behaviour and communication as this helps no one. Instead of condemning young people we should seek to see the positives wherever possible.
All young people need good quality sex education, which they are still not getting. This is not a call to ignore risky behaviour but about building a narrative that is based less on fear and disease and more on positive conversations with young people.