New Youth Sexual Health Campaign Pulls No Punches

Media Statement

22 November 2004

New Youth Sexual Health Campaign Pulls No Punches

A new television commercial has a strong message for teens, No Rubba, No Hubba Hubba. The commercial is part of the Ministry of Health’s campaign to reduce high rates of sexually transmitted infections (STIs) in teenagers. The campaign was launched at Parliament today by the Minister of Health, Hon Annette King.

The No Rubba, no Hubba Hubba commercial is set at a hip hop party, and uses a mixture of animation and ‘real people’. Sexually active young people are urged to use a condom - every time. Campaign materials also discuss the wider issues of youth sexual health – such as the consequences of having sex. Young people are encouraged to think carefully about the sexual decisions they make.

The Ministry of Health’s Acting Director of Public Health, Dr Doug Lush, says New Zealand’s high rates of STIs like chlamydia and gonorrhoea need to be tackled head on.

“I’m right behind the strong message delivered by this campaign, and make no apologies for it. We can pretend that our young people are not sexually active, and watch our STI rates continue to climb. Or we can be proactive and realistic and give sexually active young people the tools to protect themselves against chlamydia, gonorrhoea, HIV and other sexually transmitted viruses and infections.

Dr Sue Bagshaw, a youth sexual health specialist says that the campaign’s message to teenagers to use a condom is vital.

“Condoms protect against chlamydia, gonorrhoea and HIV. I see young people with STIs every day. Many of them don’t understand just how easy it is to contract, and pass on, an STI. As the campaign points out, if you pass on an STI to one person, they may pass it on to two people and so on. Before long a large number of people are infected.”

Dr Bagshaw warns that teenagers can pay a high price for risky sexual health practices.

“If left untreated, complications from chlamydia, for example, can include pelvic inflammatory disease, tubal scarring and subsequent pelvic pain, ectopic pregnancy and infertility.”

The No Rubba, No Hubba Hubba campaign runs from 22 November to the end of February 2005. The campaign uses a variety of media, including television, cinema, radio, outdoor advertising, magazines, print resources and a website.

Key numbers for the commercials are: SXH/030/101 – Hubba STIs (English), SXH/030/105 - Hubba STIs (te reo).

Comments from Key Health Agencies

Sexual Health Campaign Questions and Answers

Background:

General

Chlamydia

Gonorrhoea

Comments from Key Health Agencies

Family Planning is looking forward to this campaign, which we understand is likely to be controversial. There's no point in a public health campaign unless it reaches its target audience and causes them to think - and that's what we are looking forward to.
Dr Gill Greer, Family Planning Association, Executive Director

General Practitioners see young people with sexually transmitted infections every day. The risk of contracting these infections is greatly reduced by using a condom. We are pleased that this new campaign encourages sexually active young people to protect themselves when having sex.
Dr Jim Vause, President of the Royal New Zealand College of General Practitioners.

We need to do something about the increase in sexually transmitted infections in young New Zealanders, and the New Zealand Medical Association fully supports this campaign and its 'always use a condom' message.
Dr Tricia Briscoe, Chair, New Zealand Medical Association

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The New Zealand Venereological Society welcomes the Ministry of Health's Safer Sex Campaign. Messages supporting informed choice and condom use are essential to promote the sexual health and wellbeing of young New Zealanders.
Kitty Flannery, President, New Zealand Venereological Society

Māori Women's Welfare League encourages people to be aware of the need to practice safer sex and supports this sexual health campaign in principle.
Kitty Bennett, National President, Māori Women's Welfare League Inc

Congratulations to all involved in getting, hopefully, the first of New Zealand’s much needed sexual wake up calls out into the public arena, in this campaign. It is fantastic that we are finally talking about this, because STIs and unwanted teenage pregnancies are preventable. There are choices! Best wishes for a successful campaign and can’t wait for the next one……and the one after that!”
Dr Rosy Fenwicke

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The new sexual health campaign, with its focus on condom use, is timely, as HIV rates continue to increase in all risk groups - heterosexual, men-who-have-sex-with-men (MSM) and injecting drug users. The campaign will highlight the 'use a condom' message to young people throughout the country.
Rachael Le Mesurier, Executive Director of the New Zealand AIDS Foundation

It has been great seeing the sexual health sector come together to provide input into the development of the campaign as this provides an invaluable opportunity to extend the reach of the message, particularly to rangatahi.
Charrissa Makowharemahihi, Analyst, Māori Health Directorate, Ministry of Health

It is great to see a public health campaign recognising the importance of sexual health amongst our young people. As a community we need to recognise the need to encourage young people to make positive decisions by providing them with accurate information and a forum for open discussion. This campaign is one step towards making this happen.
Amanda Schulze, Auckland Sexual Health Service

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SXH Campaign Questions and Answers

Will promoting the use of condoms make my teenager more likely to have sex?

There is no evidence that increased sexual activity takes place because of the promotion of condom use. The overwhelming weight of the evidence demonstrates that programmes that focus on sexuality and discuss contraception, including condom-availability programmes, do not increase sexual activity. Furthermore, a number of programmes that discuss condoms or other forms of contraception and encourage their use among sexually active youth also delay or reduce the frequency of sexual intercourse^.1

Countries that have low rates of STIs and teen pregnancies generally have in place consistent, long-term sexual health public education campaigns. There is open and honest discussion about sex and sexuality at all levels of society. There is access to free or low-cost contraception.²

Isn’t it the role of parents to teach their children about sexual health – not the role of the government?

Parents have a vital role in teaching young people about sexual health. However, not all parents are comfortable talking to their teenagers about sex, and some may not have all the relevant information. A 2001 New Zealand survey found that school was the main source of information about sexual health for school students, followed by friends, then parents, magazines, books and television.³ Parents who want ideas about how to talk to their children about sex can find these at www.talkingwithkids.org/sex.html (link opens in new window)

Why aren’t you promoting abstinence?

Research into the effectiveness of abstinence campaigns shows that, while young people exposed to the programmes may delay sexual intercourse, when they do have sex they are less likely to use contraception and condoms, and have less knowledge of STIs and how to protect themselves.⁴ A recent study of 12,000 young people has also found that the graduates of abstinence programmes were nearly as likely as other young people to catch STIs such as gonorrhoea or chlamydia.⁵

The public health community has an obligation to support an approach that reflects what is actually happening. We know that significant numbers of New Zealand teens are having sex. One study found that over 20 percent of secondary school students were sexually active,⁶ while others put the figure of 14 and 15 year olds having sex at between 30 to 40 percent.⁷

Young people who are sexually active need protection to reduce their risk from STIs. Unfortunately, many young people don’t plan their first sexual experience and this campaign aims to help young people think realistically and be ready to protect themselves.

Solely promoting abstinence would mean withholding information from young people that could protect their health and fertility, and potentially save their lives.

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Why are you focusing only on promoting the use of condoms?

The campaign does not focus only on the use of condoms – it is much broader than that. The television commercials capture teenagers' attention and lead them to other campaign components. Campaign materials also discuss the wider issues of youth sexual health – such as the consequences of having sex. Young people are encouraged to think carefully about the sexual decisions they make. Parents and caregivers are encouraged to talk to their teenagers about sex, and to discuss the wider issues like understanding that sexual relationships involve caring, concern and responsibility.

The campaign is one aspect of the Ministry of Health's Sexual and Reproductive Health Strategy which also includes extensive work on the wider issues of youth sexual health carried out by sexual health providers. These providers will use the campaign as a springboard for their activities in the coming year.

The Health and Physical Education Curriculum for New Zealand schools also has an important role to play in providing young people with balanced, evidence-based information about sexual health and sexual activity. Through these programmes young people get the opportunity to examine attitudes and values relating to sexuality and rehearse refusal and negotiation skills that will equip them for future sexual relationships.

Why are you promoting condoms when they don’t work?

Condoms do work – used correctly and consistently they are an extremely effective method of contraception and of protection against sexually transmitted infections. They greatly reduce the risk of contracting several types of STIs including chlamydia, gonorrhoea, herpes simplex virus type 2 and syphilis.8 Bacteria and viruses such as HIV cannot pass through an undamaged condom.

Why are New Zealand’s STI statistics still growing?

Sexuality education has only been required to be taught in schools since 2001, and comprehensive sexuality education is still not taught in most schools. This means some young people have little knowledge about STIs, or how to protect themselves when they become sexually active. Parents are encouraged to take part in their child’s school consultation about health and sexuality education every second year.

In addition, the age of first sexual intercourse is decreasing both in New Zealand and overseas, and there are a greater number of young people who are sexually active with more partners.⁹

It is possible that the increased awareness of STIs generated by the campaign will lead to more people being tested, and a corresponding increase in identified STIs. This would be a positive outcome, as more people will be receiving treatment for STIs.

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Why is the campaign aimed at 15 year olds when the legal age for consent is 16?

Although the legal age for consenting sexual relations is 16, we know from surveys that some New Zealand young people are having sex before that age. Studies have suggested that between 30 and 40 percent of 14 and 15 year olds are having sex.¹⁰

We also know that people under the age of 15 are contracting sexually transmitted infections. For example, 74 of the 2327 cases of chlamydia in females diagnosed at sexual health clinics in 2003 were in those aged under 15, while 1063 cases were diagnosed in females 15 to 19.¹¹

Shouldn't parents be told if their daughters (and sons) are using contraceptives?

While it is the ideal for young people to discuss their sexuality with their parents, in reality, many young people are unwilling to do so. An American study showed that nearly half of young women would stop using sexual health services if their parents were notified. The same study showed that 99 percent would continue to have sexual intercourse. The study concluded that mandatory parental notification for contraceptives would potentially increase teen pregnancies and the spread of STIs.¹²

How does New Zealand youth sexual health compare to other countries?

New Zealand has a high number of unintended or unwanted pregnancies. A Dunedin study reported that out of its participants, 60 percent of pregnancies to women aged under 25 were unintended.¹³

New Zealand has high rates of abortions compared to other countries, as well as high ratios of abortions to known pregnancies, particularly among Māori and Asian women.14 In comparison with many European countries, New Zealand’s abortion rate (in 2002, 20 per 1,000 women aged 15 to 44) is at the higher end of the scale, along with the United States, Australia and Sweden.

New Zealand has a comparatively high rate of births to teenagers.¹⁵Our teenage birth rate (27.3 per 1,000 women aged 15 to 19) is third highest of 28 countries, behind the United States (52.1) and the United Kingdom (30.8). Among Māori women aged 15 to 19, the birth rate is 74 births per 1,000 women.

Rates of chlamydia and gonorrhoea have increased significantly in the last few years. Laboratory data suggest the incidence of chlamydia in the New Zealand population is considerably higher than in Canada, Australia and the United Kingdom.¹⁶

The World Health Organization classifies New Zealand as a ‘low prevalence’ country for HIV and AIDS. In the year ending December 2002, 136 people were diagnosed HIV positive; 112 were male and 24 female. However, the speed with which HIV can spread through communities leaves no room for complacency. Shifts in the characteristics of New Zealand’s HIV positive population and changes in the pattern of migration can alter the risk level significantly.¹⁷

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Why do some countries have better youth sexual health than us?

Countries that have comparatively good sexual health outcomes – particularly for young people – tend to have several common characteristics. These include open, honest discussion about sex and sexuality at all levels of society; consistent, long-term public education campaigns focusing on safety and pleasure; access to free or low-cost contraception; and they carefully work through the issues arising from cultural diversity and differing values.¹⁸

New Zealand’s Sexual and Reproductive Health Strategy, released by the Minister of Health in 2001, provides a framework for continually improving our sexual health outcomes, with a focus on national and international evidence, and best practice. Key components of a comprehensive service are prevention, early intervention, appropriate and accessible services and practical information.¹⁹

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Background

Information from Sexually Transmitted Infections in New Zealand: Annual Surveillance Report 2003

The 2003 annual report summaries STI data collected from 25 sexual health clinics (SHCs), 42 family planning clinics (FPCs) and 15 student and youth health clinics (SYHCs) across New Zealand. Data is supplemented by laboratory surveillance of chlamydia and gonorrhoea by 10 laboratories in the Waikato, Bay of Plenty and Auckland regions. This represents two thirds of the microbiology laboratories in these areas.

General

Over the past five years the number of confirmed chlamydia and gonorrhoea cases diagnosed at SHCs has increased by 65.5 percent and 57 percent respectively.

Young people remain at high risk of STIs; 65 percent of chlamydia, gonorrhoea, genital herpes and genital warts diagnosed at SHCs are in those less than 25 years.

In the Auckland, Waikato and Bay of Plenty regions, chlamydia rates in 2003 were six times higher than reported in Australia and four times higher than the UK (excluding Scotland). Gonorrhoea rates were double that reported in Australia and the UK (excluding Scotland).

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Chlamydia

Chlamydia trachomatis infections are now the most commonly diagnosed STI in New Zealand.

3857 confirmed cases and 628 probable cases of chlamydia were reported at sexual health clinics in 2003.

1728 confirmed cases and 494 probable cases of chlamydia were reported at Family Planning Clinics in 2003.

312 confirmed cases and 9 probable cases of chlamydia were reported at student and youth health centres in 2003.

Chlamydia does not have any symptoms in approximately 70 percent of female and 50 percent of male cases.

Untreated infection can lead to the development of serious sequelae, including pelvic inflammatory disease (PID), ectopic pregnancy and infertility in females; and urethritis, epididymitis and infertility in males. Infants born vaginally to infected mothers can be infected during delivery resulting in neonatal conjunctivitis or pneumonia.

Between 2002 and 2003, the number of confirmed chlamydia cases increased by 13.4 percent in SHCs (3857 compared to 3401), 25.9 percent in FPCs (1728 compared to 1373), and decreased by 20 percent in SYHCs (312 compared to 390).

In FPCs, the chlamydia rates were highest in females aged 15 to 19 years and in males aged 20 to 24 years. In SHCs and SYHCs rates were highest in females less than 15 years and in males aged 15 to 19 years.

In SHCs the rate of chlamydia in M?ori was nearly three times higher than in those of European ethnicity. In FPCs chlamydia rates in male M?ori and Pacific peoples were three times higher than in males of European ethnicity.

Over the past five years, the total number of chlamydia cases (confirmed and probable) has increased by 53.8 percent in SHCs and 27.4 percent in SYHCs.

From 2000 to 2003, when the number of participating FPCs has remained stable, the number of confirmed chlamydia cases has increased by 226 percent.

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Gonorrhoea

Gonorrhoea does not have any symptoms in up to 50 percent of females and 10 percent of males.

Untreated gonnococcal infection may be associated with long term serious sequelae, including pelvic inflammatory disease in females and epididymitis in males.

The highest rates of gonorrhoea were reported in males.

In FPCs over 55 percent of case of gonorrhoea (confirmed and probable) diagnosed at SHCs and over 80 percent of cases diagnosed at FPCs and SYHCs were in those aged less than 25 years.

Rates of gonorrhoea were highest in females aged 15 to 19 years attending FPCs and SHCs, and in males aged 15 to 19 years in SHCs and those aged 20 to 25 years in FPCs.

High rates of gonorrhoea were found in males and females of Māori or Pacific peoples ethnicity, compared to European. For example, in the SHCs, the rate of gonorrhoea in Pacific peoples was nine times higher than those of European origin.

From 2000 to 2003, when the number of participating FPCs has remained stable, the number of confirmed gonorrhoea cases diagnosed at FPCs has increased by 119 percent.

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HIV

In 2003, 188 new cases of HIV infection were notified.

The trend of increasing incident of HIV in men who have sex with men continued with 93 cases. This was the largest number since 1991. Fourty-six of these were reported to have been infected in New Zealand, six in Australia and 19 elsewhere.

There has been a steady rise over the last 15 years in the number of people reported as being infected through heterosexual contact. In 2003, out of 60 heterosexually acquired cases, 31 were male and 29 female.

Over the last five years out of a total of 197 cases of heterosexually acquired HIV 161 (82 percent) acquired their infection overseas.

From 1999 to 2003, 13 children were diagnosed with perinatally acquired HIV.

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Note:

The report summarises the epidemiology of STIs, using data from SHCs, FPCs, SYHCs and diagnostic laboratories in New Zealand. The figures presented may underestimate true infection rates because not all clinics and laboratories participate and STIs diagnosed by a range of other health care providers, such as GPs, are not included in this report. It is also important to note the denominator used in calculating disease rates. Rates based on clinic data use the total number of clinic visits, whether for STIs or other conditions, as the denominator. Rates based on laboratory data use the total ‘usually resident’ population, in the District Health Boards covered by laboratory surveillance, from the 2001 New Zealand Census.

HIV/AIDS surveillance is carried out in New Zealand by the AIDS Epidemiology Group. A more detailed account of AIDS/HIV in New Zealand is available in the publication; AIDS – New Zealand. Issue 54. August 2004.

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1 Kirby D. 2001. Emerging Answers: Research Findings on Programmes to Reduce Teen Pregnancy. Chapter 5. The National Campaign to Prevent Teen Pregnancy.

2 Hubermann B. 2001. The lessons learned: A model to improve adolescent sexual health in the United States. Transitions 14(2).

3 New Zealand National Secondary School Youth Health Survey 2001. 2003. Adolescent Health Research Group.

4 Kirby D. 2002. Do Abstinence-Only Programs Delay the Initiation of Sex Among Young People and Reduce Teen Pregnancy? Washington DC: National Campaign to Prevent Teen Pregnancy.

5 US Study of Teenage Sexual Disease Destroys Basis of Virginity Crusade. Guardian UK newspaper, 10 March 2004. Downloaded from http://www.commondreams.org/headlines04/0310-01.htm on 6 September 2004.

6 New Zealand National Secondary School Youth Health Survey 2001. 2003. Adolescent Health Research Group.

7 Dickson N, Paul C, Herbison P, Silva P, First sexual intercourse: age, coercion, and later regrets reported by a birth cohort. BMJ 1998; 316: 29-33.

Fenwick R, Purdie G. 2000. The sexual activity of 654 fourth form Hawkes Bay students, NZ Med J: 460-3.

8 King K, Levine R, Weaver M. 2004. Effectiveness of condoms in preventing sexually transmitted infections. Public Health Reviews: Bulletin of the WHO.

9 Fenwick R, Purdie G. 2000. The sexual activity of 654 fourth form Hawkes Bay students, NZ Med J:460-3

10 Dickson N, Paul C, Herbison P, Silva P, First sexual intercourse: age, coercion, and later regrets reported by a birth cohort. BMJ 1998; 316: 29-33.

Fenwick R, Purdie G. 2000. The sexual activity of 654 fourth form Hawkes Bay students, NZ Med J: 460-3.

11 Ministry of Health. 2004. Sexually Transmitted Infections in New Zealand: Annual surveillance report 2003. Population and Environmental Health Group, Institute of Environmental Science and Research Ltd.

12 Reddy DM, Fleming R, Swain C. 2002. Effect of Mandatory Parental Notification on Adolescent Girl’s Use of Sexual Health Care Services. JAMA, August 4, 2002 – Vol 288, No. 6, pp 710-14.

13 Dickson N, Wilson M, Herbison P et al. 2002. Unwanted pregnancies involving young women and men in a New Zealand birth cohort. New Zealand Medical Journal 115: 155-9.

14 Statistics New Zealand. 2003. Abortions Year Ended December 2002. Wellington: Statistics New Zealand.

15 UNICEF. 2001. Teenage Births in Rich Nations. UNICEF Innocenti Research Centre.

16 ESR. 2003. Annual STI Surveillance Report 2002: Porirua: Institute of Environmental Science and Research.

17 Ministry of Health. 2003. Sexual and Reproductive Health: A resource book for New Zealand health care organisations. Wellington: Ministry of Health.

18 Hubermann B. 2001. The lessons learned: A model to improve adolescent sexual health in the United States. Transitions 14(2).

19 Minister of Health. 2001. Sexual and Reproductive Health Strategy: Phase One. Ministry of Health: Wellington.

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