‘Putting the sexy back in sex’: What’s the solution to rising youth STIs?

For all the talk about Gen Z and celibacy, there’s not much attention given to the many young people who actually are having sex. Research suggests STI rates are rising among younger cohorts (although they are also climbing among midlife and older adults), and that safe sex practices like using condoms, regular testing and contraception, may be declining.

But what’s driving this? What do young people want when it comes to sexual health, and what actually makes a difference?

STI rates rising

The latest surveillance report from The Kirby Institute (UNSW Sydney) provides a comprehensive look at HIV, viral hepatitis and sexually transmissible infections (STIs) in Australia.

Chlamydia is the most common STI, with 70 per cent coming from those aged 15 to 29, although rates have remained stable. HIV diagnoses continue to decline. Meanwhile, over the past decade, infectious syphilis diagnoses have doubled, while gonorrhea diagnoses have surged 211 per cent.

So, what’s behind the surge?

“Unfortunately, there’s not one single answer,” says Denton Callander, an associate professor in the Sexual Health Program at Kirby. But he says declining condom use, particularly with casual partners, may be one reason.

Another may be the natural peaks and troughs that characterise infectious outbreaks. “Right now we’re still on the upswing, but hopefully because research teams and our clinical partners are paying attention to this we can start to combat things in the next few years,” he says.

While notification data only captures confirmed cases, Callander says data shows “young people are not getting tested as frequently as they probably should.”

“Priority populations”, including Indigenous and transgender people, tend to test at even lower rates, partly because of the stigma and discrimination they can face within health settings, he adds.

Decline in contraception use and safe sex practice

Several recent studies suggest most young Australians aren’t using condoms. Researchers propose several reasons for this, including viewing them as just contraception, rather than STI prevention; thinking unprotected sex is normal; and viewing condoms as uncomfortable or disruptive.

A 2024 report from The World Health Organisation revealed an “alarming decline” in condom use among sexually active adolescents in Europe, with almost a third reporting using neither a condom nor the contraceptive pill at last intercourse.

Jennifer Power, deputy director of the Australian Research Centre in Sex, Health and Society at La Trobe University, says, “a lot of the conversations and education that happened about condom use, particularly related to STIs, came from the urgency of HIV.”

As the spectre of the HIV/AIDs epidemic fades from the public consciousness – particularly the heterosexual population – STI prevention may feel less urgent.

Matthew Vaughan, population health division director at ACON, says this is less true of the queer community, which fosters “strong cultures of care” due to this history and because LGBT youth are often excluded from relationships and sex education in schools.

When it comes to contraception, Professor Deborah Bateson from The University of Sydney’s medical school says there has been “an increasing move away from hormonal methods by young women in Australia,” partly due to aversion to side effects that can come with hormonal contraception, as well as growing popularity of “natural” contraception, often spruiked by social media influencers.

Despite this growing disenchantment, Bateson points out hormonal methods have never been more accessible, with newer technologies like the progesterone-only pill and a novel oestrogen pill available, alongside new subsidies for reproductive health treatments. She is also researching new, non-hormonal methods to give women more choices.

Australia’s first at-home cervical test

Proud Euahlayi/Kooma woman Grace Toombs, 24, founded June, Australia’s first at-home cervical screening test, after her own frustrations with the health system.

Having spent most of her teenage years with severe menstrual pain that was dismissed or ignored by medical professionals, it wasn’t until she started studying medicine in Sydney that she was finally diagnosed with stage three endometriosis.

The diagnosis also led to her gynaecologist discovering high-grade abnormalities (precancerous cells) in her cervix through a pap smear.

“In that moment, I thought, ‘far out’. I live in a major city, I’m 21, so I wasn’t even supposed to get screened [The National Screening Program covers those 25 and up]. Imagine what other women are going through who live rurally or don’t have access to healthcare or the high health literacy I do,” she says.

June, which launched last year, allows patients to self-swab at home after completing an online questionnaire.

Results are sent to 4Cyte Pathology and reviewed by a GP. Their cervical test screens for all strains of human papilloma virus (HPV), a common STI that usually has no symptoms and clears on its own, but can cause serious illness (it’s the most common cause of cervical cancer).

June also offers a separate at-home STI test.

Australia is on track to eliminate cervical cancer by 2035, which Bateson puts down to Australia’s HPV vaccination program and relatively high screening rates, the latter of which has been aided by the introduction of self-testing swabs in 2022 (as opposed to the speculum).

“I wanted it to feel like self-care, and so we are really shifting the narrative culturally around how women think and feel about their sexual and reproductive health.”

Grace Toombs, founder of Australia’s first at-home cervical screening test

For Toombs, offering an at-home test is about providing an alternative to the clinic experience, which remains daunting for many young people.

“It’s giving women the autonomy to do their test at home and to have it show up in a beautiful box that feels like you’ve ordered something from Mecca.”

Flipping the script on condoms

Nikhil Daftary started condom brand Moments after his wife admitted she felt shy and ashamed buying condoms.

“That’s when I looked at the condom shelves at supermarkets and pharmacies and realised most condom packaging revolves around men,” he says.

Moments is part of a generation of new condom brands putting pleasure front and centre, with features like flavours, textures and extra lubrication. Most of them target women, with bright, stylish packaging, and adopt the language of female empowerment and sexual wellness.

Daftary says he wanted the brand to more closely resemble beauty products, and be something people would be comfortable keeping on their bedside table.

Of course, other options like dental dams and the internal condom exist, although Bateson says education around these remains limited.

Doxy-PEP, an oral antibiotic taken within 72 hours of having sex and recently available Australia-wide from GPs, has been shown to be effective in preventing STIs, particularly syphilis and chlamydia.

While Vaughan says data on its uptake is still in its nascency (and there are concerns about anti-microbial resistance), it can be effective for those prone to STIs.

Who bears responsibility for safe sex?

The growing sexual wellness category mainly counts women and the queer community as its audience – which makes sense given these cohorts have typically been excluded from conventional narratives about sex. But does this leave men behind?

Earlier this month, Senator Jane Hume questioned why condoms were only available in the women’s change rooms at the Parliament House gym, but not the men’s.

Heterosexual women tend to bear the burden for contraception and can feel pressured into unprotected sex, while one in three women and one in five men have been victims of “stealthing”, the practice of removing or tampering with a condom without a sexual partner’s consent.

“We know that men want to take responsibility, and that’s why we just need more products they can use,” says Bateson, who would like to see greater investment from government and the private sector into technology young people – of all genders – actually want to use.

Let’s talk about (safe) sex

For Power, talking to young people about sexual health is about having open conversations that go beyond “clinical, individual outcomes”.

Given most kids turn to the internet for sexual health information, this may look like parents or schools equipping them with the critical tools to understand and assess what they see – even if this includes unrealistic pornography or extreme online content.

One of the most memorable advertisements to come out of Australia’s response to AIDs was the infamous Grim Reaper campaign, which only aired for three weeks due to concerns it stigmatised gay men.

On the other hand, campaigns led by the gay community leant away from this fear-based tone towards a sex-positive one.

This has been credited with having a significant effect in reducing the transmission of HIV among gay and bisexual men, and many public health campaigns since have taken a similar approach.

“If we try to frame it as ‘this is the thing that you must do to protect yourself from scary gonorrhea’, that’s not very sexy. It’s about putting the sexy back in sex,” says Callander.

“Most people really enjoy sex in one way or another, and if we frame discussions about health in more positive lights, less about risk and more about how to make sex excellent for you and your partner, this is a more realistic and helpful approach.”

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