1. Drugs and Alcohol Fuel for a Sexual Health Crisis Mark A. Bellis & Karen Hughes Centre for Public Health Liverpool John Moores University m.a.bellis@livjm.ac.uk

2. Clear Links? Young People having sex –When drinking – twice as likely to be unprotected –When drunk – three times as likely to be unprotected All individuals –30-40% of pregnancies in UK are unplanned –Drugs Image and Effects Other links –Drink and Drug use to cope with Sexual Problems –Drink and Drug role in Sex Crimes

3. Alcohol and Sex Drink to increase confidence and possibility of sex Problems for Safe Sex –Reduce inhibitions and increases risk-taking –Reduce potential to consider consequences –Help forget safe sex messages School children weekly alcohol doubled since 1990 –20% of males and 13% of females aged 15-19 say alcohol was a main reason for first sex –40% of sexually active 13-14 year olds were "drunk or stoned" at first sex Alcohol products frequently associated with sex Abrahamson, 2004; Bellis and Hughes, 2004; Boreham and McManus, 2003, Wight et al, 2000; Ingham, 2001

4. Vodka Shotz Marks & Spencer Love Potion V Vodka mix Stiffy’s Shots Cider, 5.3% 2 litres 2 litres 12 Units

5. Health Economics - Teens Badminton, Chester £6.00 Sex Usually Free Diversionary Activities Cider, Aldi 2 litres £1.49 12 Units Also buy you 2-3 Ecstasy Tablets or 10-15 Joints Average Pocket Money of £6.80

6. Nightlife and Sex Many people meet new sexual partners in pubs and clubs Calafat, 1998; Release, 1997; Bellis and Hughes, 2004 – Over 1/4 of clubbers state meeting sex partners as a major reason for going out (Europe) – Over half of clubbers have had sex with someone they met at a dance event (UK) Much higher levels of alcohol and drug use One night clubbing young people consume 12 units

7. Excess Alcohol Consumption and Chlamydia Health Protection Agency, 2004; Dodd et al, 2004; Deehan and Saville, 2003 % exceeding weekly limits Number of new diagnoses

8. Sexual Assault Drug rape –Alcohol main drug –Unlikely more than 10% reported Predatory Males –Targeting Drunk Girls Sexual Assault –7% Women (UK) Raped or Seriously Sexually Assaulted –North West 6810 offences (03/04) –Alcohol and Drugs factors for both victim and perpetrator Impacts –physical and mental health, sexually transmitted infections, unwanted pregnancy; suicide Prostitution –Loverboys → Problematic Use Home Office, 2005; The Roofie Foundation, 2001 Reported Drug Rapes (UK)

9. Sex and Drugs Drug users more likely to have –sex earlier –more sexual partners –unprotected sex –homosexual sex Schoolchildren –Use in last year almost doubled since 1998 Reasons for initiating heroin use (Italy) –control ejaculation –improving erection Amphetamine –Increases sexual desire and prolongs orgasm Cocaine –Strong aphrodisiac - prolongs sex – may lead to abrasions Ecstasy –Increases sexual desire and enhances orgasm –Impairs erection Viagra –8% of clubbers at UK dance event had used GHB –Strong aphrodisiac, used to forget safe sex messages Bellis and Hughes, 2004; Deehan and Saville, 2003

10. I’ve used Viagra a bunch of times……………. most appealing is that it reverses the impotence-inducing effects of drugs like cocaine, ecstasy and booze” (28 year old male, UK) I get so excited and horny after taking GHB that I’m totally disinhibited. I literally climb onto everything that looks male” (Female clubber, Holland) Calafat et al, 2003; Cook et al, 2001

11. Methamphetamine Chalk Tina Crystal Links - gay and other risk groups –Increasing in UK gay population? Australia –Crystal among ecstasy users increased 0% (1997) - 56% (2003) Used to initiate, enhance and prolong sex –Can hamper erection and ejaculation USA –Combined with Viagra Thailand –Undermining Sexual Health gains in Sex Trade

12. A Syphilis Outbreak 27 individuals with Syphilis had 1500 sexual partners in 12 months Many Co-infected with HIV Drug use predicted infection –2/3 of individuals had regularly used GHB I can use it as an excuse for behaviour that I would not usually get away with Spread associated with Air Bridges?

13. Press Clippings for Sex Abroad British 16-34 year olds made 17 million visits abroad (2002) Sexually Transmitted Infections, Termination & Contraception Requests Summer and Christmas Peaks

14. UKs Most Popular Youth Operator Summer 1999 Mission Statement Get the mother of all Hangovers Try sex in the Surf Wake up in the wrong hotel Drink all your duty free on Day One

16. Sex and Substance Use Abroad Alcohol Use –5+ Days/week increases from 25% to 90% Ecstasy Use –5+ Days/week increases 5% to 41% of users Those arriving without a sexual partner (75%) –Half have sex –Quarter have sex with > 1 partner –Quarter have unprotected sex –Fifth have unprotected sex with >1 partner –20% males, 4% females - sex with non-UK resident Having Sex predicted by Drug Use Bellis et al, 2004

17. British Casual Workers in Bars and Clubs in Ibiza Drug Use –87% Cocaine Length of Stay –14 weeks (Mean) Sexual Behaviour –Those arriving without a sexual partner (85%) 81% had sex in Ibiza; 61.5% had unprotected 58% sex with more than one person; 48% unprotected >1 person 30% sex with a non UK resident Not limited to locations abroad? (Hughes & Bellis, in prep)

18. Sex, Substance Use & Travel in the UK South of England –High casual sexual activity among tourists –1 in 4 single holidaymakers had sex with at least one new partner UK resort staff –2/3 males and 1/3 females had 2 or more partners during holiday season Unsafe sex –Most common on one night stands –Linked to alcohol Eiser and Ford, 1995; Hennink 2000 You get drunk, you get them into bed, it's the last thing you think of. I only put a condom on when she tells me to.

21. Summary Declines in Sexual Health closely linked to Binge Drinking & Recreational Drug Use Nothing known about alcohol and drug related interventions to tackle sexual health Absent in Sexual Health & Teenage Pregnancy Reviews Individual effectiveness reviews share Trust, Knowledge, Access and Timeliness Opportunities Drug and Alcohol imagery in Sexual Health Joint initiative – e.g. Diversionary Sexual “effects” of drugs – key intelligence Dance Music Tourism within and outside UK Understanding Tourism - Timing and Targeting Integrated approach to Nightlife

22. Club Health 2006 Ibiza

24. Rubber Lover www.rubberlover.org.uk