It wasn't until the ABC cinema was pulled down that I noticed the entrance to the Genito-Urinary Medicine Unit of the vast local hospital. There must have been a tiny path alongside the cinema, where patients could slink into the clinic, while a few yards away matinee-goers were enjoying Bond or Penelope Cruz. Cause and consequence: inside glitzed-up, risk-free sex, and round the back, the swabs and the samples.
Last week the House of Commons Health Committee delivered its report on sexual health. 'England,' it began, 'is currently witnessing a rapid decline in its sexual health.' This is a very big sentence. Imagine that the committee had reported that we were 'witnessing a rapid decline in cancer treatment', or 'heart disease'. It would have made the top of the news, and banner headlines. We do not expect to see major deterioration in our health, and yet that is what the committee is reporting.
Let's focus for a moment on one sexually transmitted infection, which the parents of young or teenage children might be most interested in - chlamydia. This disease, untreated, can lead to internal scarring and infertility. All the indications from pilot screenings are that one in 10 sexually active young women are infected with chlamydia, and that this number is set to grow. But in 70 per cent of women and in half of men, chlamydia is asymptomatic - you don't know you've got it. And clearly, the longer it goes untreated the greater the chances of damage and reinfection. To summarise in the most selfish way, our chances of grand-parenthood are being compromised by a silent destroyer. Not surprising, then, that the committee now recommends the immediate introduction of a national chlamydia screening programme.
Dream on. For the committee also points out that, despite the adoption in 2001 of the Government Sexual Health Strategy, there is now a crisis in treatment. It had been told by witnesses that within the past 18 months most of the clinics in north-west London had been forced to abandon open access to their facilities. Other clinics had booking systems where people phoned that morning for appointments, and where all appointments were taken inside 15 minutes. In Bristol 400 callers a week were turned away. You can imagine what the effect of this might be on an unsymptomatic young man advised to contact the clinic because a casual girlfriend has chlamydia. Why should he keep on phoning? And even if he does, is he going to abstain from unprotected sex for the next however long it takes to get him an appointment?
The system is not collapsing because it is starved of funds. More money has indeed gone into GU medicine. It is collapsing because it is being overwhelmed with demand. In five years, from 1996 to 2001, diagnoses of syphilis went up by 500 per cent (albeit from a low level), of gonorrhoea by 86 per cent and of chlamydia by 108 per cent. There were double digit increases in rates of herpes and (pass the marmalade) genital warts. Last Wednesday I was at the Royal Free Hospital to see Anthony Minghella and Elton John open a new garden at the Ian Charleson Day Centre for Aids patients. In her speech, the head of the centre mentioned the increasing incidence of HIV and hepatitis B infections. It was quite clear she believed the safe sex message was in danger of being unlearned.
Why are we behaving so stupidly after a period (following the Aids campaign of the late 80s) when we behaved so well? This is where we tend to have our John Knox versus La Cicciolina moment. We have a simultaneously puritanical and prurient culture, in which we talk about sex all the time, but are also ashamed of it.
TV shows are full of drinking and shagging, but there are no TV ads for condoms and programmes about STIs are pushed to the margins of the schedules. 'Family' campaigners press for our children to be ignorant, at the same time as ITV2 sells them endless sex.
It is unrewarding in many ways to represent the sensible tendency on sex. Just saying 'sensible sex' makes one sound like a nudist: someone enthusiastic and unattractive, who wants to take the danger out of life. If sex was safe, after all, there'd be much less of it around. But you can't help noticing that we share high teenage pregnancy rates with that other pru-prur culture, the United States, but not with countries like France and Germany. And even so the Health Committee comments in its report that schools, 'often (place) a mistaken emphasis on sex at the expense of young people's wider concerns about relationships'. I seriously doubt whether that is the problem, given that in many schools neither sex nor relationships are discussed. Last week I met a Health Committee member who was balking at the idea of 10- and 11-year-olds being told about masturbation. He had, he told me by way of explanation, gone to a Catholic school.
Even so, the committee urges that sex education should be a statutory part of the national curriculum, and not an optional, governors-willing bolt-on. Which is good and will help, but leads me to the next problem, and a thorny one for us sensible condom wearing nudists. If education is the determinant of good sexual behaviour, how come the incidence of clap in Sweden rose by 154 per cent from 1995 to 2000? Something similar has happened in France.
Time for more stats, some of them amazing. In England, since 1990, the average age of first intercourse has gone down from 17 to 16; the percent age of men who have had homosexual sex went up from 3.6 per cent to 5.4 per cent; the number of sexual partners in a lifetime rose 6.6 to 12.7 for men and 3.7 to 6.5 for women. And go figure this: anal sex for women went up from 6.5 per cent to 11.3 per cent.
It is true that sexual disease is most prevalent among marginalised groups. Sex is, after all, still free (except to the increasing number of men who admit to paying for it), while access to books and information isn't. But there is something else going on. People are having sex earlier and more exotically than before, and with that adventurousness comes some element of risk.
We could respond to this by letting the puritans take over, by going all sex-negative and seeking to stigmatise those who are caught out. This is very tempting. I can't help feeling that some of the current impulse towards religious schools (Catholic, CofE or Muslim) is generated by a sub-conscious belief that sex is better held at bay in such institutions.
The better alternative is to try and live with this new sexuality, while educating it and providing for its consequences. But this does mean that the purveyors of cultural attitudes towards sex - music, fashion, TV, magazines and cinema - have a huge responsibility. They must be straighter with their young customers, and recognise that if they're going to sell sex, they must sell the means to have good and safe sex, and the information on what to do if it goes wrong. The virtuous person (they must show) is not the one who doesn't get an STI, but the person who goes to the clinic and gets treated quickly.
And these people who make money from sex ought to help fund the organisations that seek to reach and educate the young. How about, for example the Warner Brothers chlamydia screening programme? That would help acknowledge the truth, that behind every cinema there's a clap clinic.
