For Rari, or For me - the importance of clear communication

Over Christmas I watched a couple of You've Been Framed episodes - for me there is a guilty pleasure in a) having time to watch whatever is on the TV without having to worry about time and b) watching the everyday mishaps of people's lives, with the clear knowledge that a fall on the bum may have hurt at the time but was unlikely to have long lasting consequences because the video has been sent in for other people's viewing.

There was one programme which profiled children's adventures. Amongst many funny head butting birthday cakes, being frightened by talking Christmas tress and mowing down the Christmas tree with the life size toy care, there were two particular clips which highlighted the importance of good communication.

The first was the birthday party of a girl still in a highchair so 2 - 3 years old. The family were singing happy birthday to you and she got quite upset and indignant - NO! Happy Birthday to me, happy birthday to me. The adults continued with Happy Birthday to you. Probably a lesson for another day - at that point in time the birthday would have been enjoyed more had they starting singing happy birthday to me. Or indeed pointing at the girl if they were going to continue with singing 'happy birthday to you'. Somehow the communication needed to change for her to feel happy and enjoy the moment.

The second, really made me laugh when the boy opened a toy car and someone said is that a Ferrari and the boy shouted no it is For me. Maybe there is a Rari in their family and in any case the boy heard its For Rari.

Both highlight that what is said doesn't have to be wrong to be misunderstood or problematic. And sometimes when I train professionals they will say well I told them the truth, I used the right words and pass the problem of miscommunication onto the young person. Communication is a two way thing, and when we are working in any professional role, but particularly with young people, it is our responsibility to ensure we are understood, and that we understand.

Of course, nothing I have said is new, but to communicate effectively we must recognise that the way that young people are accessing information and communicating with each other is changing (as indeed it is for all of us - how many managers would have baulked at the idea of being told a member of their team is sick by text 5 years ago, but accept it now; and how many of you will now say can you give me a few bullet points, sometimes to explain quite complex issues?).

So, when texting and social networking is common, many professionals have 10 minutes for a consultation with (young) people, and the world can be reduced into bullet points, when it comes to young people's sexual health only good communication that both parties understand will cut the mustard.

The links between sex, alcohol and other drugs

Last week I went to a policy focused meeting on the links between sexual risk taking and alcohol. At Brook we know that alcohol affects young people's sexual behaviour in a range of ways. It can give young people confidence to talk to someone they otherwise wouldn't, make the first move or to have sex they have decided they want.

They can also use it to explain away their behaviour, such as not using a condom or planning another form of contraception, and it can of course lead them to make choices about sex that they may later regret, or indeed to put themselves in unsafe situations where they can be hurt or abused, or indeed where they are violent themselves.

The evidence backs up our experience of working on the front line working with young people day in day out. I am really pleased government is going to look at joining up these issues - we know after all that young people's lives are joined up.

In trying to find a policy solution we must not lose sight of the massive cultural change that needs to take place - as one youth worker said to me 'what does it say about our culture that ADULTS (my emphasis) and young people need to go out and get absolutely pissed out of their heads so they can have the sex they want?'

Young people learn about alcohol from the adults around us - they learn from us that you drink if you are sad, drink if you are happy, to commisserate and celebrate. So all of us parents, carers, teachers, health professionals, youth, community and social workers must hold the mirror at ourselves if we want young people to develop positive attitudes to sex, drinking and keeping safe.

When sex isn't thrilling

I wrote earlier this week about Faye Weldon's interview where she described her early sexual experiences as thrilling.   Our early relationships and sexual experiences shape our thinking and expectations for the future. So whatever, or whenever we think or hope young people will start having sex we must hope that their early sexual experiences will be good.  

I was thinking about how this contrasts with the early experiences of so many young people that I have worked with over the years, and in particular remember working with a group of young mum's.   We were discussing their right to take control of their bodies following the birth of their babies, and how some of them were finding it difficult to say yes, say no or yes to that but not this with their partners, and that this was particularly true if they were with a new partner, who they felt believed their bodies were fair game because they had had children.

We went on to discuss negotiating sex and using condoms.  'Condoms may make sex last longer' 'yuk make it last longer who wants to do that' was pretty much the consensus.   I remember leaving the group feeling quite sad.  And as I have said before, every day at Brook we see so many young people who are negotiating sex well and making decisions that are right for them - and we also see young people who don't feel in control of their bodies, their relationships or their lives. 

We must create expectations for young people that sex should be positive and rewarding - something they choose, want, enjoy and take responsibility for - even thrilling - if we are going to change the way young people choose and experience sex.  If we don't we will be failing the thousands of young people who would rather not have sex, don't know if they have had sex, and certainly don't experience the thrill that it can bring if the circumstances are right.

The meaning of SHAG?

When I was nine or ten I asked my brother what shagging was.  He was older than me so he knew apparently.  I am not sure he did know exactly what it was though.   We giggled when he told me his version of what sex was.  Inside I wondered why anyone would 'shag' (whatever it was it sounded weird).  At University I was involved in the SHAG group - we were the sexual health awareness group. 

SHAG has many meanings, but in a country where sex, sexuality and sexual health is still dogged with stigma, shame and prejudice it is not helpful for public health leaders to say SHAG is now an acronym for different sexually transmitted infections (I think it was syphillis, herpes, anal warts and gonorrhoea) as was reported in the press a couple of weeks ago.

Again, important for all of us to remember that most people want to, can be and are responsible about sex, sexual health and contraception.  Lets help them be, by encouraging people to be responsible and creating a positive culture about sex and sexuality.  The alternative is guilt and shame which we know doesn't change behaviour. 

Human Papilloma Virus - the case for a vaccination programme

Yesterday the Health Protection Agency announced new findings that at least 10% of young women have the human papillomavirus by the age of 16. HPV leads to increased risk of cervical cancer in women. We now have a vaccination for HPV which saves lives.

We urge government must urgently implement a vaccination programme for girls and boys before they become sexually active and ensure suffficient resource is available to do so. A key human resource is of course the school nurse, part of our workforce so badly affected by the NHS deficit and a service seriously underfunded.

Most times I speak to school nurses, they are compassionate, passionate about public health and desperate to do more, to have more opportunities to build genuine relationships with children and young people, rather than a snatched moment here and there as they rush from duty to duty, school to school. Dialogue about implementing a HPV vaccination programme will necessarily involve dialogue about how to ensure there are enough school nurses, with enough resource to do the job. And I sincerely hope the opportunity will be taken to ensure serious conversation about the wider role of the school nurse in promoting children and young people's public health as well.

Finally, a vaccination programme is not a universal panacea, it is only part of the solution. It must be backed up with proper education about sex and relationships, opportunties for children and young people to develop skills, hopes and aspirations and a change in culture so young people expect much from the relationships and sex they choose to have.

Talking SHARP

Brook is currently funded by the Camelot Foundation (www.camelotfoundation.org.uk)to run a project called SHARP (sexual health advocacy and research project). The project aims to train and support young people to be researchers and advocated on sexual health issues that matter to them. After a residential event a group of young people have begun exploring issues with their peers. Their first piece of research focuses on sexual health services. Yet again their findings confirm that they want any services to be close enough to get to, open when they want them to be, and friendly towards young people. These don't seem like big asks, however if young people still feel it necessary to tell us this is what they want, then clearly we haven't got there yet.

So let us imagine as sexual health service providers we get this universal access right. Young people know where we are, trust us to be nice to them and can get to us easily. As we work to get this bit right, we also need to find creative ways of motivating young people to think about contraception before they have sex. Last week one young man involved inour work told us that it was the chance to get tested for STIs and free condoms that motivating him and it struck me we often focus on finding out about those who don't access services and that we need to invest a bit more resource in finding out more about the stories of those young people who do access services and do use contraception successfully, so we can learn about the motivators and barriers, and develop our strategies and approaches accordingly.

Alcohol and sexual cultures

My week didn't start too well. About two hours ago my leg got trapped in the tube door. My lovely clean trousers have a big black mark on them and I am now going to be speaking at the NAZ (find out more about NAZ at www.naz.org.uk) conference taboos and mixed messages : sexual health promotion among black and minority ethnic youth this afternoon feeling grubby. This coupled with my guilt at forgetting to send Dad a card for fathers day is not, i hope, an indicator of how Monday is going to pan out.

Last week I was pleased to see the attention on the links between sex, alcohol and other drugs in the newspapers. A few years ago whilst at the National Children's Bureau I worked on a youth participation project on the issue (www.ncb.org.uk). Young people told us time and again that we need to do more to help them understand the links, and develop skills in identifying, assessing and managing risk. They also reminded us that whilst we have a smutty culture around sex and young people feel embarrassed or ashamed to talk about it with a partner they are much more likely to use alcohol and other drugs as part of their sexual experience.

Recent research by Brook in Blackburn found that 67% of young people said they were more likely to have unprotected sex when they were drunk. The facts are clear, we need to overcome our cultural reticence about sex as part of our commitment to helping them build healthy relationships and look after their sexual and emotional health.

A bit of respect!

I was leaving a Brook Centre yesterday just as it was opening. About 12 young people had settled in the waiting room within the first few minutes. As always I listened and watched for the intimidating young people that the papers write about – I couldn’t see them. I looked for the noisy and uncontrollable youth that people talk about on the bus – I couldn’t see them, and I looked for the sexually irresponsible young men that dads warn their daughters about – there were none to be seen.

The young women and young men sitting in this waiting room were waiting patiently for their turn, talking to each other and supporting one another. They were excited, nervous, worried, brave, responsible and respectful. Are they unusual? Not in my experience. As I left the Centre I said to the receptionist that I would love to bring those adults who fear or condemn young people to observe this waiting room. Her response: ‘as long as you are good to young people, they are good to you. The trouble is, if you bring someone who doesn’t like young people into the room, they smell it and the mood changes, so it wouldn’t really work’.

Many of our European neighbours have very different attitudes to young people. They want young people to be happy, to be safe and responsible in their intimate relationships. We rightfully continue to look for evidence of the effectiveness of our work but how do you measure the impact of care, respect and attention on young people’s sexual health? A randomised control trial won’t do it – but if you want to visit a Brook waiting room you will see that it works. As Dona Milne said in her reply to an earlier blog yes we need to involve young people and listen to their views, but they don’t really ask for much, a bit of respect, a friendly service and people who like them. I agree with her and in my experience when you really enjoy young people’s company you keep on learning, you keep on living and you keep on laughing. A win-win situation.

'Love in the time of phone porn' - a response

An article in Tuesday’s Guardian (Love in the time of phone porn, 29 January 2007 http://education.guardian.co.uk/egweekly/story/0,,2001171,00.html) again highlighted the worrying levels of sexual imagery that young people are exposed to via television, magazines and a range of new media including bluetoothing on mobile phones. The article rightly underlined the importance, in this environment, of sex and relationships education (SRE) in schools that counters the potentially damaging messages about sex and relationships that young people are likely to have received through the media.

Improving Personal, Social and Health Education (PSHE), the curriculum subject in which teaching about sex and relationships takes place is certainly important. Brook believes it is an entitlement for all children and young people and should be made part of the national curriculum. Unfortunately, however, PSHE is not the universal panacea. For decades young people have been telling us they need more reliable, consistent, open discussion about sex, gender, relationships, body image and so on. More recently young men in particular have been telling us the education they receive at home, at school and in the community was not helping them learn how to be good at relationships and to understand sex. They tell us they turned to pornography for this vital information, and as technological change races on the dissemination of porn via the internet and bluetooth has become ever easier to access. But porn in turn is confusing and reinforces stereotypes, fears and concerns.

The Guardian article talks a lot about the role of schools, but much less about the responsibilities of us all as parents, uncles, aunts, brothers, sisters and family friends. No one person or organisation can bring about the cultural change we need so that when young people decide to have relationships and sex they are emotionally ready, can communicate well, respect themselves and their partners and take responsibility for and enjoy sex. Many things have changed since Brook first opened its doors in 1964 to provide contraception for unmarried people, not least the explosion in the number of ways in which people receive information about sex. However, the need for reliable, objective information and advice and our shared responsibility to provide it remains as great as ever.