Over the past hundred years, we have made great strides forward in science and clinical. From drug breakthroughs to prosthetics, precision robotics to artificial hearts, health care today facilitates longer, healthier lives, improving overall public health.
Sexual health advances are no different. Family planning has saved millions of people’s lives worldwide. Our knowledge of sexually transmitted infections has grown. The relationship between health and HIV has improved immeasurably since the 1990s. With an ever-greater understanding of sexual and reproductive health, society’s sexual health looks set to improve further.
To understand what got us to where we are today, here are the most influential sexual health advances over recent history. From ART to PrEP, these are the advances that have and are changing sexual and reproductive health for the better.
1. Anti-Retroviral Therapy (ART)
HIV is historically one of the world’s largest and deadliest pandemics. Even today, 36.9 million people across the globe are infected with the HIV virus, according to 2017 World Health Organisation data.
Since HIV first came into contact with human beings, 70 million people have been infected, whilst some 35 million people have lost their lives to HIV. The numbers are shocking, but anti-retroviral therapy has had a huge impact on extending and improving the quality of lives for HIV-positive people.
In the 1980s, society entered a state of panic that spread faster than the HIV virus itself. ART has helped to change the way we see and treat HIV. Though it isn’t a cure, the treatment allows those who contract HIV to live longer, healthier lives. In 1996, the total life expectancy of a 20-year-old person with HIV was 39 years. By 2011, that number had risen to 70 years.
We are also seeing significantly fewer deaths. In the UK, for example, where 98% of the 102,000 people infected with HIV are on ART, there were only 428 AIDS-related deaths in 2017.
When you consider that just thirty years ago people who contracted HIV/AIDS had slim chances of survival, it’s clear the progress that has been made.
We’re not, however, in the clear. Progress towards the UNAIDS 90-90-90 2020 targets for prevention and treatment have stalled. In 2017, 75% of people knew their HIV status, 79% of those were accessing treatment, and 81% of those were virally suppressed.
We are still some way off meeting the 2020 targets — in some countries, the numbers are growing — but ART has had a monumental impact on the treatment of HIV and AIDS across the globe, especially when you consider the millions of deaths we experienced just a few decades ago.
Contraceptives are arguably the greatest clinical advancement of the twentieth century. The introduction of the pill in the UK in 1961 not only reduced the number of births, they empowered women. Without the pill, society would be a very different place.
Take births. According to ONS statistics, the average family size of a family in 1944 included 2.2 children. By 1971, this had fallen to 1.9. Today, we are experiencing an all-time low of 1.76 children per family. Whilst some of this is down to better sexual health education, this trend wouldn’t have occurred without the development, introduction and widespread adoption of contraceptives.
But what does this mean? Whilst gender issues are far from over, in 1961 lives for women were very different to today. Expected to stay at home and look after children and the house, few women were able to engage in long-term careers.
Thanks in part to the contraceptive pill, women were able to take control of their own lives. With fewer children on average, and with women choosing to delay childbirth past thirty, women can fulfil their potential in all walks of life, including science.
Though there are still controversies around contraceptives, both religious and scientific, over 70% of women in the UK have taken the pill at some point in their lives. With current tests on male contraceptives, the humble pill may have a big impact in the next few decades too.
3. PrEP (pre-exposure prophylaxis)
Whilst almost everyone in the UK is aware of the pill, and most have heard of ART, few will have an understanding of PrEP. But the impact it could have is huge, even though at the moment, it is only now being trialled in England, Scotland and Wales as part of IMPACT, first started in September 2017.
Unlike ART, PrEP is a drug taken by HIV-negative people in order to avoid contracting HIV during sexual intercourse. Used primarily by people who are at high risk of contraction. PrEP in the UK is taken in pill form, Truvada. In all major studies, of those that took Truvada as recommended, no patient contracted HIV. It’s a major breakthrough for those who are in relationships with HIV-positive people. Though if not taken as directed, the efficacy is reduced.
Potentially this could improve the lives for the 36.9 million HIV-positive people across the globe, reducing risks, and facilitating normal, healthy sexual relationships. Though we’re still at the trial stage in most countries, this has the potential to be the biggest breakthrough sexual health advance of the twenty-first century.
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