A scan might have found the cancer now killing Daniel van Roo. Instead his doctor gave him 50 STI tests, which van Roo believes was because he is gay.If I hadn’t taken action and if I hadn’t seen a doctor then, you know, then where I am is just where I am. But because I did do those things, I am probably going to be upset about it when I am laying in the hospital bed at the end.
The world’s biggest sex survey
When Sydneysider Juliet Richters hung up her conservative box-pleat school tunic in 1971, she was eager to sign up as a soldier in the much-trumpeted sexual revolution.
“I went off to university thinking my generation coming out of the Swinging ’60s had made a difference,” she recalls. “But I soon learnt little had changed – there were students who were actually shocked I was living with my boyfriend.”
That slow-burn revolution still consumes Richters but in a very different way. As a social scientist and professor in public health, Richters holds a prominent role in providing Australians with ongoing snapshots of their sexual health.
In 2002, while working in the National Centre in HIV Social Research, she joined a team of researchers, mustered together by Professor Chris Rissel, who began tracking sexual habits in minute detail through a random national survey involving more than 19,000 people.
Called the Australian Study of Health and Relationships (ASHR), it aims to build a reliable database that can be used by government and health workers to improve sexual health and wellbeing.
The survey, now taken at 10-year intervals, looks at issues including sexual trends, satisfaction and frequency rates, condom use and sexual infections, contraception, pregnancy and sexual difficulties.
Richters became team leader in the second survey in 2012 following the death of Professor Anthony Smith. It became the world’s largest sexual health study with 20,094 respondents between the ages of 16 and 69.
“Every question is meticulously designed with a ‘What can we do with the answer?’ approach in terms of sexual health policy,” says Richters.
Even seemingly trivial ones such as pubic hair fads. “We asked this because there were some health professionals who were a little concerned about the Brazilian trend [total hair removal] and what shaving and waxing can do to sensitive skin in that area,’’ says Richters.
The team is also asking questions that have never been asked before in a national survey. In doing so they have demystified a number of taboos. One of the most publicised of these was a paper on bondage, dominance and submission, which researchers found was not the perversion it is made out to be but a practice enjoyed by a largely well-adjusted minority.
“I used to say it didn’t get as many citations as the other 29 papers but it got us the most fan mail,” Richters says, laughing. “That has changed though since others began researching it overseas.”
At 61, Richters, who retires this year from her teaching post at the University of New South Wales, is now bunkering down for intensive preparation for the next survey in 2022.
To get this far, she says, was not expected. “When Chris, Anthony, Andrew [Grulich] and I kicked it off our funding expectations were low,” Richters recalls.
“We knew that in Britain and America, who had done their first national survey a few years before us, that funding was knocked back because the governments of the day [Margaret Thatcher and George Bush] thought it was too invasive.
“Researchers were forced to scrape the money together, often by going through private channels.”
When the Department of Health and Ageing in Australia came up with the money in 2001 for ASHR1 there was a collective cheer from the sexual health sector.
“Without it we are working in the dark,” says Professor Basil Donovan, of UNSW’s Kirby Institute, who has worked in many areas of sexual health, including the fallout from the AIDS epidemic in the ’80s.
“It tells us we aren’t as sexually interesting as we like to think,” he says with a chuckle, “but it also gives us the size and distribution of populations that are of public importance, for example, gay men and sex workers.
“It fundamentally looks at ourselves and what we do because otherwise all we have to go on are unrepresentative surveys mostly done by magazines marketed to teens,” says Donovan.
He describes Australia’s survey as braver than the British. “There were a whole lot of questions the Brits hadn’t asked because they thought it might have offended … ours is more robust.”
Richters says her first surprise when data came through on ASHR1, with its 73 per cent take-up, was that so many people enjoyed their sex lives.
“I’m saying that from a person who has worked in sexual health areas where we’d see problems every day,” she says.
The study showed 85 per cent of the people in heterosexual relationships found sex both pleasurable and emotionally satisfying.
It also showed 3 per cent of respondents had never had any sexual experience in their lives and about half of the 17-year-olds were still virgins.
“Disappointingly, only 50 per cent of heterosexual people who had casual sex reported having safe sex in the previous six months,” says Richters.
“But the good news was that contraceptive use at first intercourse had risen from less than 30 per cent in the 1950s to over 90 per cent in the 2000s,” she adds.
Other salient shifts in ASHR2 show that Australian couples appear to be having sex less frequently, down from 1.8 times a week to 1.4, but they are having broader repertoires of sexual practice. Richters says this drop in frequency can be explained by less “service sex” with women more comfortable in saying “no” and opting for quality rather than quantity.
The 2012 survey found that Australians appear to have more permissive attitudes towards homosexuality but have an even stronger expectation of sexual exclusivity in relationships. Also, the number of partners and range of sexual practices experienced by women are becoming more in line with those reported by men, suggesting a reduction in the traditional double standard.
According to Richters, outsiders often question the reliability of answers on something as personal as sex.
“It’s pretty much accepted that if you ask people how many alcoholic drinks they have per month, you can usually double what they say because the answers don’t stack up with Australian Bureau of Statistics alcohol sales tax figures,” she says.
“Sure, people lie about sex too, particularly in social situations, but if you design questions framed so they are judgement-free and have a point, then people not only tend to tell the truth but often tell of experiences they’ve never shared before.
“Our survey question with the highest ‘refuse to answer’ rate is about household and personal income,” the professor notes.
Richters says the hope is to make the next survey even more inclusive by perhaps extending the age group to include older people as well as those who have disabilities or health issues that impact their sex lives.
“We also want to revisit domestic violence to include questions about fear or control and about domestic violence in earlier relationships,’’ she says.
Richters is clearly proud of ASHR’s achievements, particularly its role in promoting calm and rational discussion on every aspect of sex.
But at the same time she is cautious of becoming, as she puts it, “too rah rah, go have sex because it’s good for your health”.
“There have been American studies that have found this but I’m not so sure what came first – the good health or the sex,” says Richters.
“And that approach is not fair on people out there who have no partners, have health issues that lessen their chance of having sexual relationships – or are simply happy and fulfilled without the need for sex.
“Sex is not like food. You don’t die from lack of it. Yes, it can be fun and pleasurable, but it is not mandatory.”
This article was first published in the print edition of The Saturday Paper on Jun 18, 2016 as "Sex and the study".
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