Risky Business

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In the morning light, the reception area of the women's clinic of the Mortimer Market Center in central London could almost pass for a college common room, with pop playing on the radio, bright posters on the walls and 20-somethings sprawled on functional furniture, feigning an air of nonchalance. But there is nothing lighthearted here. This five-story sexual-health clinic and others like it form the front line against a nasty trend that is sweeping Britain and much of Europe, the consequences of which could be infertility or even death. New cases of sexually transmitted diseases (STDs) — including HIV/AIDS, gonorrhea and syphilis — soared by almost 300,000 in the U.K. between 1995 and 2000, and public health authorities predict that by 2005 the number of Britons infected with hiv will have increased by nearly 50% from 2000 levels. In the Netherlands, syphilis has risen 111% since 1999. Last year in Sweden, cases of chlamydia were up 60% over 1997. And though the figures embrace a broad spectrum of the population, young people seem particularly susceptible: in the U.K., those aged 18 to 24 have the greatest risk of contracting an STD. In Italy, chlamydia in the 14-24 age group is rising 10% annually. In the Netherlands, incidence of gonorrhea among the 15-24s has doubled since 1999. Sure, an increase in the number of people getting tested, plus more sophisticated diagnostic equipment, may account in part for the rise. But there's a bigger, more basic problem: increasing numbers of young people, unmoved by the potential perils of life in the era of AIDS, are having unsafe sex. "There is a much lower perception of risk," says Giovanni Rezza, director of the AIDS study group at Italy's national health institute. Though some European governments and educators are on top of the trend, it has caught others flat-footed. But if they want to reverse it, they will have to change the attitudes of people like Paula Muller, 26, a strategy consultant in Amsterdam, who admits that she doesn't always put safety first. "If you don't have any condoms with you," she says, "you might opt to forget." How did such complacency set in? It seems like only yesterday that safe-sex advertising campaigns featured tombstones and disturbing testimonials from those dying from AIDS. The lethal effects of the virus dominated the headlines, and condoms became de rigueur. But time has diluted the power of the message. "People have become used to it," says Ulrich Marcus, an AIDS and STD expert at Berlin's Robert-Koch-Institute. "AIDS is no longer considered extraordinary." Another reason the first post-HIV generation is so casual about the disease, say experts, is because of improvements in ways to treat it, particularly the arrival of antiretroviral drugs. And misinformation persists: a recent study by the music network MTV across 15 countries revealed that 20% of respondents thought only people from certain nations could contract HIV/AIDS, and 15% believed only people who shared needles were at risk. Such ignorance is worrying in and of itself, but what is of more concern is that it seems to be leading to careless behavior. In a survey last year of 15-to-25-year-olds in the Netherlands, 60% said they always use condoms, down from 80% in 2000. And in a survey last year of 18-to-24-year-olds throughout France, 71% of young men said they had used condoms in the course of 2001, down from 83% in 1998.

As overall attitudes and behavioral patterns have changed, the manifestations of STDs have changed too. In the U.K. for the past three years, more heterosexuals than homosexuals have been diagnosed with HIV. Italian officials have noted that a rising proportion of HIV cases are contracted via sexual activity, rather than drug use. Authorities in at least three European countries worry about the impact of immigration on the transmission of HIV. "Although the majority of those catching the infection are still homosexuals, we see more and more heterosexuals," says Henriette Laursen, director of the Danish AIDS Foundation. "One of the explanations is what we call imported infection, and it is obvious that the group of immigrants and refugees is often left behind when it comes to information about and prevention of AIDS." The reappearance of syphilis has taken many health workers by surprise. In both France and Britain, the recent outbreaks have been mainly among clusters of homosexual men. The disease, which can lead to brain damage and even death if untreated, responds to antibiotics. That's why it was thought to have been almost eradicated from several European countries: in France, says the Health Ministry, it was so rare that doctors had stopped looking for symptoms (a sore in the genital area followed by violent rashes). Chlamydia is worrying because in addition to being one of Europe's most virulent infections, it is also among the most silent. In women the disease, which frequently has no symptoms, can cause pelvic inflammatory disease; in both sexes it can lead to infertility. Chlamydia is caused by bacteria, and can easily be treated — if diagnosed. It's a "mass disease," says Kristina Ramstedt of the National Institute of Public Health in Sweden, where 86% of all chlamydia cases are found in the 15-29 age group. In Denmark, where 14,735 cases were diagnosed in 2000, authorities believe the real number may be as high as 30,000. Says Kirsten Lomholt, national program coordinator of the Danish Family Planning Association: "We only see the tip of the iceberg." The cost of venereal disease is soaring — German insurance companies pay $900 million annually to treat AIDS, and the HIV/AIDS cost to Britain's National Health Service is up to $1.4 million an infected person. Governments are also struggling with how to finance, and how to frame, the prevention message. In the 1980s, the height of AIDS hysteria, Germany's Federal Center for Health Education got $25 million a year for its media-education campaign. But since the mid-1990s, it has had to make do with $9 million a year. England has earmarked $68 million for a national strategy to curtail the spread of STDs. (Not a moment too soon: a recent report revealed that in some parts of the country, waiting times for appointments at specialist STD clinics have doubled in the past six months.) The message may be as important as the money. "Scare campaigns are no good," says Ramstedt, noting they can send those for whom the message is intended into denial. Says Sarah Creighton of the Mortimer Market Center: "If it's so terrifying they can't take it on board, it isn't going to work." So health officials are looking for better ways to promote safe sex. Earlier this year, France kicked off a new campaign by handing out free female condoms to women on the Paris Métro. The French government has set aside $58 million for a three-year anti-AIDS campaign to begin this year. The British Medical Association has called on the country's soap operas to feature more AIDS-related plotlines. To stop the STD numbers from getting even higher, safe sex has to become sexy again.