Age	number	male	female
13	1	1	0
14	3	1	2
15	9	2	7
16	18	6	12
17	29	15	14
TOTAL	60	25	35

The majority (56) were heterosexual, 3 were MSM (men who have sex with men) and 1 admitted to being bisexual. 70% were self-referrals, 28% were referred by other practitioners and the other 2% were referred by Caritas. 65% were still attending school, 18.3% were working (all doing unskilled work) and the other 16.6% were unemployed. Only 3 of the 35 females (8.5%) were on regular contraception. All 3 were on the pill. Partners 50% (30 patients) described their last partner prior to the consultation as casual, in many cases where even the first name of the person was unknown. This, of course, makes partner notification (contact tracing) impossible. 35% (21 patients) described their last sexual partner as regular. However partnerships even a few weeks old are called such (or even gharajjes). To my mind this and the high rate of regular partner change underestimates the true prevalence of casual sex. (The remaining 9 patients declined to divulge details.) Comparing the rate of casual sex over the last 7 years one finds no appreciable change Condom use The majority 66.6% admitted to never using condoms, 16.6% said they used them sometimes and only 3.3% claimed to use them always. (The information was not available in the remaining 8 patients). Comparing the rate of condom use, (as a percentage of new patients per individual year) over the years 2000 -2006. It is clear that the vast majority do not use condoms and there has been no change in this pattern over the years. Type of sex 50% admitted to vaginal sex only while 5% gave oral sex as the only type practised. 32% admitted to anal sex at least occasionally. Anal sex is a well known high risk factor in the acquisition of many STIs, HIV in particular. Oral sex is considered by many youngsters as safe and devoid of risk. While not as risky as anal or vaginal sex it is certainly not risk free and its association with syphilis, herpes and gonorrhoea for example are well described. Drug use 28% (17 of 60) admitted to the use of illicit drugs. The most prevalent was marijuana (16 patients). Other substances were coke (4) ecstasy (2) and heroin (2). Age of sexual debut The median age for sexual debut is around 16 years for both men and women which is identical to the UK average. These figures are identical to those of 2005 when this type of information was first elicited. Of the 25 males only 3 used a condom on their first encounter, and 8 of the 35 females claimed that one had been used. Diseases diagnosed All patients are screened for all the common STIs irrespective of the presence or absence of signs and symptoms, as per BASHH (British Association of Sexual Health and HIV) guidelines.

Non-specific urethritis	3
Muco-purulent cervicitis	8
Chlamydia trachomatis	4
Ano-genital warts	7
Candida albicans	8
Bacterial Vaginosis	6
Pelvic Inflammatory Disease	1
Herpes genitalis	4
Neisseria meningitides(throat)	2

All patients were offered HIV testing and counselling. 13 patients (21%) refused the test. Of those tested all were negative. DISCUSSION Having sex for the first time at an early age is often associated with unsafe sex. This is due to lack of knowledge, lack of access to contraception, lack of skills and self efficacy to negotiate contraception, having sex while drunk or stoned or inadequate self efficacy to resist pressure. It is to be emphasized that all data above are restricted to a sub-group of young people who present to the GU Clinic. They are not necessarily representative of the Islands young people in general. Nonetheless I feel it is pertinent to highlight the fact that at least a section of very young people are having very unsafe sex. This is not only casual in nature abut also highly risky in terms of almost universal condom non-use. The fact that 32% admit to high-risk anal sex is also of concern. Substance abuse is also seems to be common (28%) which is probably is an underestimate due to under reporting. The rates of casual sex and condom non-use are depressingly consistent over the years. It is clear that whatever efforts are being made in terms of sex education in our schools, and/or Health Promotion messages are clearly not enough or are not working. In my opinion it is high time we thoroughly revised both with an open mind. The overriding, indeed the only attached agenda, should be the well-being of our young people. This we need to do with urgency before we are hit by a crisis and then forced into counter-productive knee-jerk measures.