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health matters Dr. Michael Routledge CITY in the and social well-being that requires a positive and respectful approach to sexual relationships free of coercion, discrimination and violence. While the ultimate responsibility for S making decisions related to engaging in sexual activity rests with the individual, it is important for society as a whole to have an interest in promoting positive sexual health. The benefits are many, and range from the prevention of sexually transmitted infection (STI) outbreaks, to the broad goal of having people lead happier, healthier lives. For public health officials, determining the best approach can be a challenge. The goal is to provide information and support healthy behaviours for those choosing to be sexually active, while not "promoting sex."And there is evidence that suggests the approaches being used are working. Let me explain. In 2007, a jump in Winnipeg's chlamydia and gonorrhea rates was identified, with the highest levels being in the 15 to 24 year old age group. The surge wasn't entirely unexpected – some of the increase could be attributed to newer and better testing methods. Still, Winnipeg's rates were among the highest in the country. STIs can lead to serious health problems, including infertility, cancer and death. Coming on the heels of an ongoing syphilis outbreak which began in 2003, and the knowledge that the rates of other STIs like hepatitis C and HIV also remained high, it was clear that additional action was needed. As a result, a strategy was developed which made a number of recommendations, including the need to provide information on STIs and how to prevent them to teens and young adults. Part of the follow up to these recommendations was the development 50 WAVE exual health is defined by the World Health Organization as a state of physical, mental early adult years. One of the reasons provided is that as young women start using oral contraceptive birth control, they see less need for condom use. While oral contraceptives are effective in preventing pregnancy, they do not prevent STIs. Some have the false belief that they of two social marketing campaigns – the "Pee in a Cup" campaign in 2010 which promoted the availability of urine-based testing for chlamydia and gonorrhea, and the "Heads Up" campaign in 2011 which promoted the use of condoms for those choosing to have sex. Research used in the development of the social marketing campaigns supported the idea that providing information on the impacts of teen pregnancy and STIs in a way that resonates with youth is effective. The "Heads Up" campaign, for example, is designed in part to empower teens to make decisions that are best for them, so that when they are choosing whether or not to engage in sexual activity, they make their decision based on factual information as opposed to more negative factors such as peer pressure. And there are indications that the array of strategies being used are working. In Winnipeg, recent data is showing a decrease in gonorrhea rates. Teen pregnancy rates have decreased in Winnipeg and many other jurisdictions. There is also some evidence that the age of sexual debut has risen in recent years in Canada, which suggests that more teens and young adults are feeling comfortable deciding to delay sexual activity. All of these findings are public health success stories. Combined with the successful response that brought the Winnipeg syphilis outbreak to an end, the evidence is there that the current population health approaches are producing positive results. For those who have sex, many are aware of and use condoms – another success. However, many do not. Condom use has been shown to fall in later teen/ would know if they or their partner has an STI. Others would say that STIs are something that doesn't affect them. Chlamydia in particular is commonly transmitted outside of "high-risk' groups because it often does not cause symptoms, which delays treatment. This is why current guidelines recommend chlamydia screening for all sexually active young adults. Despite the successes so far, we need to do more. That starts with being better able to track and report on indicators of sexual health such as STI rates. To that end, the Winnipeg Health Region's public health program will soon begin releasing population health surveillance reports, one of the first of which will be an update on STI rates in Winnipeg. But simply reporting facts and figures isn't enough. Information needs to be provided to audiences in a way that engages a discussion on these issues and continues the trend in positive health outcomes. There needs to be ongoing efforts to continue the partnerships between health-care professionals, schools and the community. Inevitably, that will invite more questions about the value of initiatives on sexual health. Fortunately, the outcomes suggest that the approaches being used are effective in helping young people make positive decisions about their own sexual health, and attain that state of physical, mental and social well-being that is free of coercion, discrimination and violence. Dr. Michael Routledge is a Medical Officer of Health with the Winnipeg Health Region.

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