News Analysis: No icebergs, no tombstones. But warnings on safe sex return

An alarming rise in cases of sexually transmitted diseases has prompted the Government to commission a new advertising campaign
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Against a backdrop of icebergs and tombstones, the voice of the actor John Hurt sounded a chilling warning of an impending Aids epidemic. It was seen as a classic among advertising campaigns.

Against a backdrop of icebergs and tombstones, the voice of the actor John Hurt sounded a chilling warning of an impending Aids epidemic. It was seen as a classic among advertising campaigns.

Designed to frighten people into practising only safe sex, the notorious "Don't Die of Ignorance" adverts launched by the Government in 1986 were hailed as a success in raising awareness on HIV and Aids.

But 16 years later, sexually transmitted infections (STIs) have soared to record levels and young people who missed the Aids scare of the late Eighties and early Nineties are engaging in increasingly risky sexual behaviour.

Among those aged between 18 to 30, one in nine is likely to contract a sexually transmitted disease, such as gonorrhoea, syphilis, herpes and a range of 20 other infections as well as HIV/Aids. The Department of Health has commissioned an advertising agency to devise a new safe-sex message for the under-thirties, the first important push since the notorious 1986 adverts.

The £2m campaign will not repeat the scare tactics, now seen as having been counterproductive and less effective than factual campaigns designed to dramatise rather than shock. An official at the Department of Health said there was a tendency, with the "fear-based" campaign, for people to think the message did not apply to them.

"It created the expectation of an HIV epidemic and, when that did not materialise, it distanced the audience. It may even have had a negative impact, making people think the warning wasn't relevant to them. So we will be looking for a different approach from fear."

Delaney Lund Knox Warren & Partners and Naked Communications, the partnership designing the new campaign, will try to overcome widespread ignorance about STIs by spelling out the real risks of catching one and the potential dangers to health.

The two-year campaign, to be launched in the autumn, will use radio, young people's magazines and electronic media to reach its audience at times when people are likely to be most receptive, such as Friday and Saturday nights when they are getting ready to go out.

DLKW, whose clients include the Halifax, Capital Radio and the Financial Times, also devised a government campaign to reduce teenage pregnancies. The chairman, Greg Delaney, said the target group would not respond to a didactic message. "They don't want to be told what to do," he said. "This campaign will be about getting under the radar, grabbing their attention in a populist and thought-provoking way rather than scaring them into ignoring the message."

A reminder is sorely needed, judging by surveys that have shown a worrying level of ignorance among teenagers about Aids and other sexual diseases. Four out of 10 boys aged 14 and 15 did not know Aids was an illness, research by the Schools Health Education Unit found, and the same number had not heard of HIV. This comes at a time when girls and boys are having their first sexual encounters earlier than before. A quarter of young women and a third of men lose their virginity before 16 and the average age of first sexual intercourse is now 16 compared with 17 in 1990 and 21 in the Fifties. By 24, nearly 20 per cent of men and 15 per cent of women have already had 10 or more sexual partners, a national survey of sexual behaviour published in The Lancet last year said.

Teenage magazines with risqué features on sex, and television programmes, especially soaps, have been blamed for encouraging young people to have a cavalier attitude to sexual health. The British Medical Association warned that young people had become increasingly "complacent" about practising safe sex, and as a consequence, the 18-24 age group was experiencing the fastest rise in STIs.

Doctors have called for much better sex education in schools, perhaps starting with children as young as seven, so all youngsters are aware of the dangers of promiscuity and unprotected sex before they become sexually active.

The BMA report said the number of STIs in the five years up to 2000 had doubled to 300,000. Cases of chlamydia, a primary cause of infertility in women, rose to 64,000. Those of gonorrhoea, which causes severe pain in men and can damage the fallopian tubes, doubled to 20,663. Cases of syphilis, which were at an all-time low in 1995, rose to 326.

More than 33,500 adults in Britain were infected with HIV at the end of 2000, which amounts to a rise of 10 to 15 per cent a year since 1996. The disease is uncurable, though lives can be prolonged with antiretroviral drugs that cost between £135,000 and £181,000.

The increase in HIV across Britain and much of Europe prompted Angus Nicoll, director of the Public Health Laboratory Service, to say last month that the risk of encountering sexual partners infected with HIV was again increasing. In the British Medical Journal, he said: "Since increasing numbers of people are living with HIV, levels of sexually transmitted infections that facilitate HIV transmission are rising, and sexual behaviour is getting more risky, the danger is that HIV transmission rates could rise again."

The original campaign, which ran from 1986 to 1990 and featured television adverts, posters and leaflets sent to all 23 million households in the UK, had inauspicious roots. It followed years of delay and indecision by Margaret Thatcher's Government over how to publicise the danger of Aids. News emerged later that tens of thousands of pounds were wasted as slogans were banned, work was pulped against the advice of Aids experts and the Prime Minister balked at the idea of referring to anal sex.

Two TV adverts, one featuring icebergs crumbling into the sea and the other depicting the word "Aids" chiselled into a gravestone, were criticised for failing to provide information about the virus or safe sex. The Department of Health spokes-woman conceded: "While the early campaigns successfully raised the general awareness of Aids, there was little understanding of the virus that caused it. Education was also needed about how to protect against the virus."

For the latest campaign, which is part of a £47.5m sexual health strategy, the department has researched extensively into the most effective and credible way to address young adults. Research from Holland showed that safer sex campaigns could "positively affect attitudes and intentions", the spokeswoman said.

The National Aids Trust welcomed the safer sex campaign. A spokeswoman said there was an urgent need for better awareness about sexual health because a doubling of STI rates in the past five years was creating a potential "public health crisis. But we should not return to the shock tactics of the Eighties," she said. "More sophisticated messages need to be employed. Efforts to promote safer sex should be undertaken in a positive manner which recognises the individual's right to a healthy and pleasurable sex life.

"The new campaign should not be HIV-specific because this would run the risk of overstating the HIV risk in the population. Rather, there needs to be better awareness of the health harms caused by a range of sexually transmitted infections, in particular, chlamydia, gonorrhoea, herpes and syphilis, as well as better awareness about HIV."

To shock or note to shock?

Isla Hurley Brunt, age 20, London

Isla Hurley Brunt, a student and part-time receptionist, welcomed the campaign, but believed it needed to be more hard-hitting.

She thought the Government's measured approach would not work with her generation and advocated a return to the "shock" advertising used to raise awareness of Aids in the early Eighties. "Young people are less frightened and less aware of sexually transmitted diseases and Aids, especially heterosexuals. Some of us need to be reminded of the dangers and scared into changing our lifestyles," she said.

She added that while many of her peers did not routinely practise unsafe sex, there was considerable ignorance about sexually transmitted diseases.

David Orr, age 21, Edinburgh

David Orr approved of the Government's approach to raising awareness of sexual health issues.

Mr Orr, who is president of Edinburgh University's Student Union, said he remembered the Government's first major Aids campaign featuring tombstones and a stark "don't die of ignorance" message. However, he failed to understand the depth of the issue at the time.

"The fact that I can recall an advert which I saw when I was very young means that it made a big impact on me but I'm not sure if we should sacrifice facts for the fear factor," he said.

He felt that the controversy surrounding a campaign could sometimes hijack the message.

Anthony Wilinson, age 19, Darlington

Achieving a balance between shocking people and urging them to consider the issues would be the most effective campaigning method, said Mr Wilkinson. Heapproved of the Government's decision to launch a campaign but said he felt insulted by some of the current material used by the Department of Health to deliver advice on sexual health. He hopes for a mature and intelligent campaign.

Unemployed Mr Wilkinson said: "A lot of young people feel patronised by posters and leaflets that have a heavy-handed 'we know best' slant to them. A preaching message just provokes the teenage rebel in young people so I hope this campaign will be more than just that."

Emma Lyttle, age 22, Belfast

The abiding images Emma Lyttle remembers from past campaigns are the shocking ones. But while the vivid and disturbing images have remained, the message behind them has often been forgotten or misunderstood, she said.

Miss Lyttle, a law student, thought hard-hitting campaigns had caused interest and controversy without necessarily increasing awareness.

"There is certainly an awareness of what Aids is now and that it can kill you but there is also a mistaken assumption it is contained and under control," she said. She felt her generation had become immune to shocking images.