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School education fails to improve condom use
Newsdesk
School-based education programmes may not be the answer to spiralling rates of sexually transmitted infections, analysis of a scheme in Scotland suggests. Healthy Respect, a classroombased education programme delivered by trained teachers and nurses, produced no change in attitudes or intention to use condoms and no reduction in sexual intercourse in those under 16 years of age. The lack of behaviour change was clearly apparent despite teenagers having more knowledge of where to access condoms and how to use them effectively. Teenagers in the UK have one of the worst sexual health records in Europe. In 2005, 16–19-year-old girls had the highest rates of chlamydia infection—at 1359 cases per 100 000 population—of any other group in the UK. Study leader (Janet Tucker, University of Aberdeen, Aberdeen, UK) said questions need to be asked about the likely and achievable improvements in sexual health from school education
schemes. “There had been considerable NHS Health Scotland investment and high hopes at the outset of Healthy Respect by the Lothian Health Board. But our findings are in line with previous findings in Scotland”, Tucker commented. “What is interesting is that knowledge and self-efficacy about getting and using condoms properly did improve, but there remained gender-specific attitudes to using condoms. Many young people of both genders did not believe they would be more likely to get a sexually transmitted infection if they did not use a condom”. A second phase of the project, running until 2008, is focusing on areas where the team feel more progress will be made, such as increasing access to drop-in centres. “Sexual health programmes at school alone will not substantially mitigate against the factors that are shaping young people’s risky behaviour”, Tucker continued. She added that governments should
stop funding unsustainable efforts and projects that are poorly thought-out. Martin McKee (London School of Hygiene and Tropical Medicine, London, UK) said there were “fundamental problems” with British society that needed to be addressed before tackling risk-seeking behaviour in young people, as highlighted by the recent UNICEF report. “The UK is an outlier in western Europe. How you go about bringing change is difficult and we need to have a national debate about what we are going to do.” McKee added that many English speaking countries were struggling to improve adolescent health but the UK also faces the problem of cuts in publichealth budgets and the most recent NHS reorganisation has hit local publichealth teams hard. “We have a problem across government that things are not properly implemented, and if they are, they are not evaluated”, he said.
The printed journal includes an image merely for illustration For more information on the effect of the Healthy Respect project see Eur J Public Health 2007; 17: 33–41; DOI:10.1093/ eurpub/ckl044
Emma Wilkinson
Herpes treatment may limit HIV transmission and progression Anti-herpes treatment in women coinfected with HIV and herpes simplex virus (HSV)-2 may reduce rates of HIV transmission between partners as well as clinical progression say a team of international researchers. A randomised study of around 140 co-infected women, who were not on HAART, showed that treatment with valaciclovir (500 mg twice daily) reduced levels of HIV in genital and plasma secretions. Valaciclovir therapy was associated with an almost 60% reduction in the frequency of genital HIV-1 RNA and a substantial reduction in virus quantity. Plasma HIV-1 RNA levels fell by 0·53 log10 copies per mL. Effects of treatment became stronger throughout the 3-month treatment period. Researcher Philippe Mayaud (London School of Hygiene and Tropical http://infection.thelancet.com Vol 7 April 2007
Medicine, London, UK) said the team was planning further studies to look at rates of transmission and whether anti-herpes treatment could slow down decline in CD4 counts. “What we wanted to show was a causal relationship between HSV activation and HIV replication in the genital compartment—the emphasis was on reducing transmission. We were surprised by the order of magnitude of the effects in the plasma compartment”, he commented. A paper published last year by the team showed that in women on HAART, HSV-2 infection promoted genital HIV-1 replication even when systemic HIV levels were under control. Mayaud added: “A large number of patients are not on HAART and don’t need to be on it straight away, and our study suggests that we can offer something that reduces transmission
and at the same time is a medical intervention for them.” Larry Corey (HIV Vaccine Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA) said the importance of HSV-2 had been underestimated because no one appreciated how frequently the virus reactivated. “This is clearly telling us that subclinical activations interact enough with HIV to significantly raise replication rates. There is the potential for real clinical benefits”, he said. Philippa Easterbrook, King’s College London (London, UK) said: “We need to see how it is going to compare to say, male circumcision, but I think what we may end up with is a combination of partly effective interventions to prevent transmission.”
For more information see N Engl J Med 2007; 356: 790–99; DOI:10.1056/NEJMoa062607 and N Engl J Med 2007; 356: 854–56; DOI:10.1056/ NEJMe068302
Emma Wilkinson 249
Digital Vision
School education fails to improve condom use
School-based education programmes may not be the answer to spiralling rates of sexually transmitted infections, analysis of a scheme in Scotland suggests. Healthy Respect, a classroombased education programme delivered by trained teachers and nurses, produced no change in attitudes or intention to use condoms and no reduction in sexual intercourse in those under 16 years of age. The lack of behaviour change was clearly apparent despite teenagers having more knowledge of where to access condoms and how to use them effectively. Teenagers in the UK have one of the worst sexual health records in Europe. In 2005, 16–19-year-old girls had the highest rates of chlamydia infection—at 1359 cases per 100 000 population—of any other group in the UK. Study leader (Janet Tucker, University of Aberdeen, Aberdeen, UK) said questions need to be asked about the likely and achievable improvements in sexual health from school education
schemes. “There had been considerable NHS Health Scotland investment and high hopes at the outset of Healthy Respect by the Lothian Health Board. But our findings are in line with previous findings in Scotland”, Tucker commented. “What is interesting is that knowledge and self-efficacy about getting and using condoms properly did improve, but there remained gender-specific attitudes to using condoms. Many young people of both genders did not believe they would be more likely to get a sexually transmitted infection if they did not use a condom”. A second phase of the project, running until 2008, is focusing on areas where the team feel more progress will be made, such as increasing access to drop-in centres. “Sexual health programmes at school alone will not substantially mitigate against the factors that are shaping young people’s risky behaviour”, Tucker continued. She added that governments should
stop funding unsustainable efforts and projects that are poorly thought-out. Martin McKee (London School of Hygiene and Tropical Medicine, London, UK) said there were “fundamental problems” with British society that needed to be addressed before tackling risk-seeking behaviour in young people, as highlighted by the recent UNICEF report. “The UK is an outlier in western Europe. How you go about bringing change is difficult and we need to have a national debate about what we are going to do.” McKee added that many English speaking countries were struggling to improve adolescent health but the UK also faces the problem of cuts in publichealth budgets and the most recent NHS reorganisation has hit local publichealth teams hard. “We have a problem across government that things are not properly implemented, and if they are, they are not evaluated”, he said.
The printed journal includes an image merely for illustration For more information on the effect of the Healthy Respect project see Eur J Public Health 2007; 17: 33–41; DOI:10.1093/ eurpub/ckl044
Emma Wilkinson
Herpes treatment may limit HIV transmission and progression Anti-herpes treatment in women coinfected with HIV and herpes simplex virus (HSV)-2 may reduce rates of HIV transmission between partners as well as clinical progression say a team of international researchers. A randomised study of around 140 co-infected women, who were not on HAART, showed that treatment with valaciclovir (500 mg twice daily) reduced levels of HIV in genital and plasma secretions. Valaciclovir therapy was associated with an almost 60% reduction in the frequency of genital HIV-1 RNA and a substantial reduction in virus quantity. Plasma HIV-1 RNA levels fell by 0·53 log10 copies per mL. Effects of treatment became stronger throughout the 3-month treatment period. Researcher Philippe Mayaud (London School of Hygiene and Tropical http://infection.thelancet.com Vol 7 April 2007
Medicine, London, UK) said the team was planning further studies to look at rates of transmission and whether anti-herpes treatment could slow down decline in CD4 counts. “What we wanted to show was a causal relationship between HSV activation and HIV replication in the genital compartment—the emphasis was on reducing transmission. We were surprised by the order of magnitude of the effects in the plasma compartment”, he commented. A paper published last year by the team showed that in women on HAART, HSV-2 infection promoted genital HIV-1 replication even when systemic HIV levels were under control. Mayaud added: “A large number of patients are not on HAART and don’t need to be on it straight away, and our study suggests that we can offer something that reduces transmission
and at the same time is a medical intervention for them.” Larry Corey (HIV Vaccine Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA) said the importance of HSV-2 had been underestimated because no one appreciated how frequently the virus reactivated. “This is clearly telling us that subclinical activations interact enough with HIV to significantly raise replication rates. There is the potential for real clinical benefits”, he said. Philippa Easterbrook, King’s College London (London, UK) said: “We need to see how it is going to compare to say, male circumcision, but I think what we may end up with is a combination of partly effective interventions to prevent transmission.”
For more information see N Engl J Med 2007; 356: 790–99; DOI:10.1056/NEJMoa062607 and N Engl J Med 2007; 356: 854–56; DOI:10.1056/ NEJMe068302
Emma Wilkinson 249
Digital Vision
School education fails to improve condom use