42. Promoting safe sex

Overview 

Some epidemic-causing diseases can be passed from one person to another during sex, usually in semen, vaginal fluids or blood. Some of these diseases can continue to be spread through sex, even after the person has recovered from the disease. “Sex” means any kind of oral, vaginal or anal sex, or sharing of sex toys. Some epidemic-causing diseases that are known to be passed through sex are:

• Zika virus
• Ebola virus disease
• Marburg fever
• Lassa fever

There are many other diseases, such as HIV/AIDS, which can be passed through sexual activities. Promoting safer sex is an important public health message that can save many lives. Having “safer sex” means protecting yourself and your partner from diseases that can be transmitted during sexual activity.

When to promote safer sex?

During outbreaks of Zika, Ebola, Marburg fever or Lassa fever, it is important to include messaging about safer sex. Messages should include:

• How the disease is transmitted through sex
• How to practise safer sex

While safer sex messaging is very important to prevent the spread of epidemic disease, it is only one way that community members should protect themselves from becoming ill during outbreaks of the above diseases. Especially in the cases of Ebola, Marburg and Lassa fevers, the diseases are also spread through other close contact with infected people, not just sex. Practising safer sex alone will not protect people from these diseases. Safer sex is only one way to prevent disease. It should not be the principal focus of your messages during an epidemic.

Messages about safer sex during epidemics should promote:

• Use of male or female condoms when having sex.
  • Condoms are a barrier and block any infectious semen or fluid that may transmit an infection.
• Other ways (instead of sexual intercourse) of sharing intimacy with sexual partners

Key facts about Zika:

• A pregnant woman can pass Zika to her unborn baby which can cause severe brain defects in the baby
  • Pregnant women who live in or travel to places where Zika is present, or whose sexual partners live in or travel to places where Zika is present, should be instructed to go to a health centre for a check-up and to discuss Zika risk with their healthcare provider.
    • In these cases, it is best not to have sex during pregnancy, or to use condoms during the whole pregnancy.

• If women are planning a pregnancy and live in an area where Zika is present, it is important to discuss the risks, protect both partners from mosquito bites, and consider postponing pregnancy until after the outbreak has ended

• A man or woman who has Zika can pass Zika to his or her partner during sex for up to six months after acquiring the infection (whether they were sick and showed symptoms or not).

Key facts about Ebola, Marburg and Lassa:

• Men who have recovered from Ebola, Marburg fever or Lassa fever can pass the disease on to another person during oral, vaginal or anal sex

• Men who have recovered from Ebola or Marburg should use a condom for at least 12 months from when they got sick or until their semen tests negative twice for the virus.
• Men who have recovered from Lassa fever should use a condom for at least three months after they get better.

What to do and how to do it

Social mobilization, messaging, and behaviour change

1. Make sure you understand the facts, and how diseases including Zika, Ebola, Marburg fever and Lassa fever can be transmitted through sex.
2. Remember that sex is only one way of transmitting these diseases, and often it is not the main way.
   • Talk to your volunteer coordination/team leader or local branch health office about which prevention methods should be emphasized during your community visits.
3. Remember that sex can be a very sensitive, taboo or embarrassing topic for people to talk about. You may have to change your approach or way of communicating to get your messages across.
4. Carry out social mobilization and behaviour change communication activities in an outbreak of Zika, Ebola, Marburg fever or Lassa fever. (See Important points above and Action Tools Communicating with the community and Social mobilization and behaviour change.)
   • Make sure you know and can demonstrate how to use a male and female condom correctly.
5. Be respectful of the culture:
   • Consider speaking to men and women separately
   • Consider speaking separately to adolescents. Remember that adolescents often experience stigma and difficulties in accessing sexual health information and services. Yet, most people initiate sexual activity during adolescence, so it is important to support them to ensure good sexual health choices and decisions.
   • Do not push people to share views on this topic in front of others as some may feel uncomfortable
   • Do not make assumptions based on stereotypes. For example, do not assume a person has certain attitudes about sex based on their age, gender, profession, or ethnicity
   • Remember that providing sexual health information is important, even if it is a sensitive topic in many cultures