Philip Hensher: Dispense the facts, not disapproval

Nobody much likes the huge rise in sexual promiscuity, but health policy must live with it
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The Independent Online

One of the unsung and most surprising successes of the 1980s Thatcher government is, surely, its policy on sexual health awareness. Soon after the first reports of Aids, governments everywhere were obliged to formulate public advice which, they ought to have known, would have very long-term implications.

Mrs Thatcher's ministers were, true, extremely unlikely people to be talking about the details of sexual practice. There was an apocryphal story of Norman Fowler asking his advisers what, exactly, "oral sex" meant. Nevertheless, at this distance, it does seem as if they got it right.

In America, for instance, the advice was for monogamy or abstinence - disastrous when the monogamy turned out to be serial, and the abstinence easy to lapse from. In France, incredibly, a whole school of advanced theoretical thought went on maintaining that the whole business was a conspiracy against the practice of enlightened sexual practice, and were actually listened to.

The British advice was, it's true, slightly quaint in tone. Probably everyone my age remembers that famous first advertising campaign, with the tombstones and the dry ice and the doomy voiceover. I have to admit that most of us, at the time, thought it was screamingly funny. All the same, most people at risk evidently paid some attention. The advice, boiled down, proved to be intensely practical, and if you listened to it, it worked.

There must have been some moral distaste about the message in parts of the government, but nevertheless, the gay community got a very clear explanation: it was not a question of how many men you went to bed with, but what steps you took to protect yourselves once you were in bed.

Curiously, that proverb about success having many fathers, but failure being an orphan doesn't seem to apply to the Conservative campaign - they ought to be prouder of it than they seem to be. We always talk about the need for "lessons to be learnt" after some conspicuous failure, but lessons can just as easily be learnt from a success like that. HIV spread in the 1980s much more slowly in Britain than was feared, because of the practicality of the advice, and because the message was steadily repeated over time.

In recent years, HIV infection and that of other sexually transmitted diseases have been on the increase. There have been various explanations of this, some very exotic indeed. There is a reckless cult of unsafe sex among some gay men. A new drug, crystal meth, started to be used by a very small number of clubbers, and was said to drive users into a sexual frenzy where all precautions were forgotten.

More to the point, may be the fact that the Government's commitment to sexual health information seems patchy. Very recently, the Department of Health announced a significant new initiative to spend £50m over three years on campaigns to combat sexually transmitted diseases. That has now shrunk dramatically. Caroline Flint, the Health minister, has launched a £4m campaign, directed towards teenagers and towards a range of STIs. The commitment to £50m over three years has, however, now gone, and there is no particular strategy in place. "Like other parts of the health service," Ms Flint said, "we are having to look at how we spend our money."

The way the Government sees these sexual health campaigns, pretty clearly, is as ad-hoc initiatives, to be embarked upon from time to time. It seems extraordinarily reckless. After all, young adults start being sexually active all the time, and their habits of hygiene will probably go on being what they were from the start. If that period in their lives coincides with a time when the government hasn't quite got round to mounting a gentle reminder, they might begin with responsible practices, or it might not be uppermost in their minds.

It wasn't encouraging, really, to hear Caroline Flint explaining that this new campaign "is not about encouraging promiscuity". Every health professional knows that what is needed in this area is brisk practicality, and not a tone of disapproval.

One of the main reasons that the 1980s campaigns were relatively successful was that the Department of Health more or less decided that it wasn't its place to have a policy on promiscuity as such. If Caroline Flint was answering objections from within government, that is really quite a depressing step backwards, and one would hate to think that those objections might lie behind the dramatic cutback in the commitment.

Nobody much likes or approves of the conspicuous rise in sexual promiscuity, but it is just something which health policy will have to live with. The challenge for government is to prevent a widespread change in lifestyle leading to an immense rise in STIs. All such infections impose a burden on public healthcare; those with HIV a very substantial one, of decades on highly expensive medication. And that is not even to mention the tragic waste and loss.

On the other hand, prevention is simple, easy to understand, and cheap, even free - how many lives have been saved by excellent charities which hand out free condoms in gay bars? The equation is a very simple one. Solid, credible, conspicuous information saves lives. A campaign like this should not be announced as a special initiative; that sort of investment in the future ought to be running steadily, and its effectiveness measured in figures rather than against moral principles.

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