Sexually transmitted infections (STIs) have skyrocketed in Spain.
Gonorrhea, syphilis and chlamydia have recorded the highest spike in the last three decades.
This is stated in the
2022 Epidemiological Surveillance Report on Sexually Transmitted Infections,
published at the end of January 2024 and prepared by the Ministry of Health and the Carlos III Health Institute.
Experts increasingly perceive the rejection of condom use and half a dozen testimonies corroborate this.
“It has happened to me so many times that they did not want to put on a condom that I rethink my faith in human beings.
Even, on some occasions, they took it away without consent,” says a 22-year-old girl, who prefers not to be identified, like the majority of the voices collected.
The report reveals that men are more affected by all sexually transmitted infections than women, although the increase is common in both sexes.
The age group between 25 and 34 years is the one with the highest number of cases in the three venereal infections mentioned.
Gonorrhea registers a great boom, with 23,333 cases reported in 2022, and doubles the figures of 2020. Chlamydia also increases to 26,518 infections recorded, which represents an increase of 266% compared to 2016. And the 734 cases of syphilis registered in 2002 they have risen to 8,141 in these two decades.
Figures that distance the Ministry of Health's objective of eliminating HIV and sexually transmitted infections as public health problems in 2030, included in the Strategic Plan for the Prevention and Control of HIV Infection and STIs in Spain.
“When I was 23 years old, I was diagnosed with a sexually transmitted infection.
“I broke up with my ex-partner, who took birth control pills, and I had seven or eight relationships without a condom by mutual decision,” says a 25-year-old young man from Valencia.
In his case, relationships usually occurred with “alcohol and drugs” involved.
The contagion was “a turning point” in his life to become aware, since doctors have spent more than a year curing the warts caused by the infection.
Although he has recovered, he goes for a medical check-up every six months.
Risky practices such as not using condoms are common among the younger population.
More than half of people between 15 and 29 years old have engaged in risky behavior at some point in the last six months and 19% have done so very frequently, according to the
Youth, Health and Wellbeing 2023 barometer,
prepared by the Foundation. Fad Youth.
Furthermore, 27.7% say that it pays them to have this type of intimate relationships.
Gender inequality
Cristina Epalza, a pediatric infectious disease specialist at the 12 de Octubre hospital in Madrid, has detected in her consultation that some adolescents have difficulties setting barriers when relationships are maintained with people around them.
“If they run into a stranger in an alley and are sexually assaulted, they know there is no consent.
Things start to get complicated in their heads when they do know the other person, but they are forced to exceed their limits,” she reasons.
The 22-year-old girl at the beginning of the report assures that most of the girls she knows have felt pressured in their sexual relationships “to the point of having to give in.”
Sara, a 25-year-old Valencian who prefers not to provide her last name, agrees.
“You meet someone one night and, if she says that the condom is tight or that she's not wearing it, you agree not to use it because you think that for once nothing will happen,” she explains.
Not knowing how to negotiate sexual relationships is a possible consequence of gender inequality, according to the deputy director of Sedra-Family Planning Federation, Raquel Hurtado, who works with young people in group workshops and individualized attention spaces.
Men are still in a position of power over women.
They, sometimes, do not know how to set limits because “they do not want to disappoint, they fear a fight or they feel guilty.”
She has heard more than once a phrase that reflects this inequality: “I must have done something to get us there.”
Low risk perception
In the age group with the highest incidence of gonorrhea, syphilis and chlamydia, between 25 and 34 years old, there is a feeling of immunity.
Epalza insists that it is something characteristic of a life stage in which one is not so aware of the risks.
A vision with which Hurtado agrees, who believes that “there is a general lack of concern because they think that infections are controlled and HIV no longer occupies the covers or major campaigns.”
The sexual health representative at the Spanish Red Cross, Cristina Ferrero Camacho, considers that the chronic nature of certain infections such as HIV has lowered the guard among the younger population.
On a bench in Ciudad Universitaria, in Madrid, two 19-year-old girls talk about their generation's relaxation in condom use:
—The subject of sex has been lost a little respect, it seems that the normal thing is to do it without a condom.
—The biggest fear is pregnancy, but since there is the morning after pill, you think that nothing can happen to you.
It has become normalized to go out partying, have sex with someone you don't know and do it without caution.
—Maybe the moment comes, you don't have a condom and you end up doing it anyway.
Lately diagnosed or untreated venereal infections can cause infertility, even in asymptomatic cases.
For example, cancer or warts, and in the case of women who contract syphilis and become pregnant, it can be transmitted to the fetus.
In the case of contracting HIV and it leading to AIDS, the consequences can be fatal if not controlled in time.
Some young people link the request to use a condom to a symptom of mistrust, an argument that Hurtado refutes: “You can trust me, but when you sleep with me, you also sleep with my entire erotic history.”
Furthermore, he warns about the myths of romantic love, which are still very present in sexual relationships.
The research director of Fad Juventud, Anna Sanmartín, explains that, on many occasions, in stable ties “the logic of trust comes into play to abandon the use of protection measures.”
Influence of pornography
Among the different factors that explain the increase in sexually transmitted infections, sexologist José Luis García highlights the “hypersexualization of society” and the influence of pornography, where “the condom is invisible.”
“Porn is the educational reference on sexual matters for most minors and the message that is transmitted is that having bareback relationships is the best,” he says.
Hurtado advocates eroticizing condom use and connecting prevention with well-being and pleasure.
Sexual education in schools, which is sometimes limited to teaching what a condom is and how to put it on, is insufficient.
This is what Sanmartín considers it, for whom it is necessary to “give other comprehensive tools.”
Dr. Epalza reiterates that “this is about respecting oneself and those in front of you, mental and physical health, and consent.”
The sexual and reproductive health law, whose reform was approved in February 2023, focuses on improving sexual education in educational centers and explicitly mentions the prevention of venereal diseases and infections.
“This issue must be addressed from childhood, just like healthy eating,” says Epalza.
Going to the hospital to have a test can be a barrier due to the existing stigma around sexually transmitted infections.
This is why the Ministry of Health intends to implement
autonomous samples so that people who doubt a possible infection can speed up the process, that is, instead of going to the center twice, once to tell their suspicions and another time to have samples taken, they can go directly with the sample from home.
Epalza also recalls that the law includes the concept of mature minor, by which,
From the age of 12, the healthcare provider must assess the maturity of the patient to be able to address a specific situation with them autonomously, without validation from their parents, always taking into account the greatest benefit for the adolescent.
The cost of condoms is another barrier argued by some of the young people interviewed.
Fernando, a 20-year-old from Madrid, explains that he has friends who, “because they want to save money,” do not use them.
The doctor proposes a greater number of free dispensing points.
In France they advocate this initiative among people between 18 and 25 years old.
The idea that condoms bother or detract from satisfaction is widely accepted.
Alberto, 33 years old, acknowledges that he has had unprotected sexual relations for a long time for pleasure, a position with which most of those interviewed agree.
This eliminates the main barrier to preventing the transmission of sexually transmitted infections.
The doctor warns: “No one puts on a seat belt in the car because they think it is more comfortable, they put it on because they know they are risking their life.”
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