Warts and all

The UK government’s ‘National strategy for sexual health and HIV’ was published on 27 July 2001 (1). Despite being, as the document’s summary boasts, ‘the first national strategy for sexual health and HIV’, it was greeted as something so dull and medical as guidelines for dealing with chickenpox, or advice on eczema.

Nobody asked what business a government has with meddling in our sex lives. The idea that the government should see fit to spend an extra £47.5million on the ins and outs of intercourse proved uncontroversial (2). And nobody said, as they did of Channel 4 after it screened the controversial Brass Eye satire about paedophilia, that the department responsible for promoting such dirty-minded filth should be closed down forthwith. The only muted criticisms seemed to be that the government’s proposals did not go far enough.

Yet the ‘National strategy for sexual health and HIV’ is not like guidelines on chickenpox or eczema, because it is not dealing with diseases you just catch. It is dealing with diseases you catch because of how you behave – how you have sex, and who you have sex with. As such, this strategy represents yet another step by the government into the most intimate areas of our private lives, and yet another attempt to regulate and moralise about our personal behaviour. Why has this raised no alarm bells? Is this kind of intrusion really what we want?

It’s not as if you have to read the whole document to sense that something really quite creepy is going on. Page five, paragraph two, ‘sets the scene’ for the strategy by proposing a ‘comprehensive and holistic model’:

‘Sexual health is an important part of physical and mental health. It is a key part of our identity as human beings together with the fundamental human rights to privacy, a family life and living free from discrimination. Essential elements of good sexual health are equitable relationships and sexual fulfilment with access to information and services to avoid the risk of unintended pregnancy, illness or disease.’

A national government strategy to develop ‘equitable relationships and sexual fulfilment’? Why should politicians, elected to run the country, be concerned with people’s pillow-talk and orgasm rates? You may well not have voted for the government that houses health secretary Alan Milburn or his colleague Yvette Cooper – can you imagine them in your bed? Because if you’re young, poor, black, gay or a woman, that’s exactly where they’ll be.

The national strategy for sexual health and HIV is clearly not designed for People Like Us, who presumably know what to put where, how often and how safely. ‘There is a clear relationship between sexual ill health, poverty and social exclusion’, we are told. ‘The highest burden [of sexual ill health] is borne by women, gay men, teenagers, young adults and black and minority ethnic groups’ (3).

This strategy is for People Like Them – those who are apparently too stupid, foolish or rebellious to understand the dangers of having sex without three layers of rubber between themselves and their too-many partners. People Like Them cannot be left alone to make their own relationships and their own mistakes – they have to be tutored, watched and regulated at every blush and fumble.

‘Studies suggest there has been an increase in risky sexual behaviour, and that there is still ignorance about the possible consequences’, intones the document (4). But what is ‘risky’ sexual behaviour? Any sexual behaviour, it would seem, that the government does not approve of.

The chunks of the document that deal with HIV and AIDS are – as we now expect from this government – loaded with targets. ‘The target is to reduce by 25 percent the number of newly acquired HIV infections and gonorrhoea infections by the end of 2007’, states page 16. The only way this target could possibly be reached is by ensuring more people use condoms – in other words, changing the way they have sex.

More disconcerting are the targets for reducing undiagnosed HIV. The document proposes that, by the end of 2004, ‘all GUM (genito-urinary medicine) clinic attendees should be offered an HIV test on their first screening for sexually transmitted infections (and subsequently according to risk)’. This will enable the government to meet the targets of ‘increasing the uptake of the test by those offered it to 40 percent by the end of 2004 and to 60 percent by the end of 2007’, and ‘reducing by 50 percent the number of previously undiagnosed HIV infected people attending GUM clinics who remain unaware of their infection after their visit by the end of 2007’ (5).

Because people apparently cannot be trusted not to avoid catching HIV or giving it to somebody else, the government will use HIV testing to keep people’s fears about unsafe sex alive, scaring them into behaving responsibly. And it is going to make damn sure that those who have the infection know about it – and that they know about the responsibilities that go with that. A life with HIV, after all, is a life of fear, guilt, paranoid hygiene, self-restraint and constant trips down to the health centre. Why would anybody want to avoid being diagnosed?

As well as HIV, the national strategy for sexual health constantly raises the problem of ‘unintended pregnancy’. Maybe this formulation has been de rigeur in health circles for ages – but I had always thought that the problem pregnancies were unwanted pregnancies. An unintended pregnancy might come as a nasty shock – but surely the question is, not so much whether you planned to be pregnant, so much as whether you want the baby when you get pregnant.

In fact, around 40 percent of pregnancies in the UK are unintended – many of these are subsequently wanted. The emphasis on ‘unintended’ pregnancy carries with it a more subtle meaning – that any pregnancy that is not consciously planned, by the right people in the right way and with the right partner, is a problem.

Implicit in this document’s diatribe against risky sexual behaviour is the assumption that the only good sex is ultra-safe sex – done with the right person, at the right time, in the right way. In order to make this happen, states the government, ‘we need to foster a culture of positive sexual health’ (6). Creating this ‘culture’ effectively means ramming information down people’s throats and forcing them to open up about their sex lives at every available opportunity.

So the government needs to ensure that ‘everyone gets the information they need – without stigma, fear or embarrassment – so they can take informed decisions to prevent STIs, including HIV, and about services’ (7). For ‘informed decisions’, read ‘correct decisions based on government advice’. And ‘General practice and specialist health services need to make patients feel that they can discuss problems with their sex lives’ (8). The question of what happens if you don’t want to talk about sex with these professionals is left there, hanging.

The government’s interest in sexual health has not come out of the blue. As Dr Michael Fitzpatrick has argued on spiked, it is largely driven by a desire to create points of contact with those groups of people from whom it feels estranged – like poor people, teenagers, young adults and black and minority ethnic groups (9). People are worried about their health and they like having sex – so you can imagine that, deep within Whitehall, ‘sexual health’ seems one way to create a dialogue with people who seem interested in little else.

But even if the government genuinely believes it can get closer to people by opening up a dialogue about their sexual frustrations, predilections and infections, is this the kind of discussion anybody wants to be having with the government? Surely we would be better off keeping discussions about our sex lives to our friends and partners?

The ‘National strategy for sexual health and HIV’ is a consultation document. All I can say is, when it comes to having a national strategy for anything so deeply personal, just say no.

Read on:

The hidden cost of free condoms, by Dr Mike Fitzpatrick

spiked-issue: Love and sex

(1) The National strategy for sexual health and HIV

(2) The National strategy for sexual health and HIV, p4

(3) The National strategy for sexual health and HIV, p3, p9

(4) The National strategy for sexual health and HIV, p8

(5) The National strategy for sexual health and HIV, p35

(6) The National strategy for sexual health and HIV, p12

(7) The National strategy for sexual health and HIV, p12

(8) The National strategy for sexual health and HIV, p28

(9) The hidden cost of free condoms, by Dr Mike Fitzpatrick