"آیا او باید راست بگوید". تبیین هویت ملی برای آمار سلامت جنسی فقرا در نیوزیلند

The sexual health statistics around sexually transmitted infections (STIs) in Aotearoa (New Zealand) suggest two things: many STIs are increasing, and the STI rates are high compared to other ‘similar’ countries. What sense do ordinary New Zealanders make of these figures? Focusing on heterosexual sex, this paper discusses lay accounts that sought to make sense of Aotearoa's STI statistics. In total, 58 participants (38 women, 20 men) aged 16–36 years (mean age 25) took part in 15 focus group discussions related to sexual health. Participants were mostly Pākehā (of European ancestry) and heterosexual. Data were analysed thematically. The predominant category of explanation was national ‘identity’ accounts. National ‘identity’ explanations invoked a particular New Zealand persona to explain the sexual health statistics. New Zealanders were characterised, sometimes contradictorily, as binge drinkers; poor communicators; self-sufficient and stoic; conservative yet highly and complacently sexual; and ‘laid back’, which was associated with a lack of personal concern about sexual health risk. The emphasis on national identity shifts responsibility for sexual health from the individual, and suggests agency lies beyond the individual, who is fully embedded in their culture and acts according to its dictates. In terms of sexual health, this suggests a need to consider whether, and if so how, national ‘identity’ might be meaningfully invoked and deployed in sexual health promotion initiatives.

Aotearoa1 has recently been claimed to be “the chlamydia capital of the world” (Weatherall, 2005) – a somewhat dubious area of world leadership. With the exception of HIV, Aotearoa appears to fare poorly overall compared to other Western/‘developed’ countries on sexually transmitted infection (STI) incidence – although international comparisons do need to be interpreted with caution. Regional laboratory-identified STI rates are consistently higher than national rates in Australia, the UK and the USA. Rates of chlamydia, the most common STI, in 2006 were 722/100,000 in Auckland, compared to 282/100,000 in Australia (STI Surveillance Team, 2007). Data generally show high and increasing rates of STIs like chlamydia and gonorrhoea, and increases in far less common STIs like HIV and syphilis (STI Surveillance Team, 2006 and STI Surveillance Team, 2007). Between 2002 and 2006, sexual health clinic diagnosed chlamydia increased 27.7% and gonorrhoea 52.1%; between 2005 and 2006, syphilis increased 44.7% (STI Surveillance Team, 2007). This pattern mirrors international trends (e.g., Parratt, 2003, Power, 2004 and Ross, 2002). Such sexual health statistics have raised concerns about the sexual health of our population, but the issue has not been one of significant national public debate. In this paper, I explore lay accounts of ‘cause’ around Aotearoa's sexual health status, as indicated by such STI statistics. Within health psychology, attention has for some time been given to lay explanations around health and illness (Hughner & Kleine, 2004), including sexual health (e.g., Manhart et al., 2000, Nicoll et al., 1993 and Pawluch et al., 2000). Variously referred to as lay beliefs, lay knowledge or lay epidemiology (Prior, 2003), the overall premise is that people's constructions affect their health-related choices and practices (Hughner & Kleine, 2004). Employing different theoretical frameworks, critical and discursive qualitative research has pervasively demonstrated (often gendered) constructions and discourses related to sexual health which act as impediments to sexual health (e.g., Gavey and McPhillips, 1999, Hillier et al., 1998, Waldby et al., 1993 and Willig, 1995). I use the term lay accounts to signal a discursive orientation, which recognises that these explanations are not simply neutral transmissions of knowledge (Blaxter, 1997 and Radley and Billig, 1996). Both literatures have illustrated the complexity and variety of lay explanations, their often patterned nature but simultaneous lack of fixity, and the way they relate to socio-cultural contexts (Pawluch et al., 2000). Lay accounts “result from the complex interaction of individual, cultural, social and political factors” (Hughner & Kleine, 2004, p. 396), and often differ remarkably from those accounts provided by experts. However, it is not simply a dichotomy: lay accounts often echo expert discourse (Shaw, 2002); individuals can also be theorised as ‘talking back’ at or ‘against’ expert discourse (Hodgetts, Bolam, & Stephens, 2005). Most research has focused on explanations for individual health or illness, rather than for populations (although see Blaxter, 1997). In this paper, I focus on lay accounts of population level indicators of sexual health. I am interested in lay accounts not from a ‘fact’ based perspective (are they ‘right’ or ‘wrong’?) but for what they can tell us about our topic of interest, including: the ways these issues are constructed; the ways in which blame and accountability are attributed and managed; the ways in which the topic is contextualised within individual's accounts of their broader lives; and the discursive resources available at a particular time for that topic, including expert accounts, and how these are, or are not, taken up (although see Radley & Billig, 1996). Expert discourse (e.g., published research, analysis, policy) offers the authoritative account of sexual health. With increasing recognition of the socio-structural basis of ‘risky’ sexual behaviours (Chan & Reidpath, 2003), various personal, social and structural factors have been identified as affecting (Westerners') sexual health, mostly in terms of whether individuals practice ‘safe sex’ or engage in risky practices. Personal factors include drug and alcohol use (Boyer et al., 1999, Millstein and Moscicki, 1995 and Roberts and Kennedy, 2006; although see Weinhardt & Carey, 2000), self-efficacy (Boyer et al., 1999) and assertiveness (Roberts & Kennedy, 2006), perceived susceptibility (Roberts & Kennedy, 2006), number of partners and age at first intercourse (Williams & Davidson, 2004), pleasure as a reason for sex (Hoffman & Bolton, 1997), and lack of, or inconsistent, condom-use (e.g., Roberts & Kennedy, 2006). An avalanche of research has identified diverse dislikes of, and reasons for not using, condoms among heterosexuals (e.g., Flood, 2003, Hillier et al., 1998, Khan et al., 2004 and Willig, 1995). Social and interpersonal factors include parental and other social support (Boyer et al., 1999, Millstein and Moscicki, 1995, Roberts and Kennedy, 2006 and Williams and Davidson, 2004), parent–child sexual communication (Hutchinson, 2002; also Williams & Davidson, 2004), peer norms, behaviours and affiliation (Boyer et al., 1999 and Millstein and Moscicki, 1995), including gendered roles and expectations (e.g., see Wight, Abraham, & Scott, 1998), and the experience of partner violence (Silverman, Raj, & Clements, 2004) or sexual abuse (Upchurch & Kusunoki, 2004). Structurally, school sexuality education has been associated with reduced risk (Wellings et al., 2001; see also Williams & Davidson, 2004), but it can be contentious, politically charged practice (e.g., Irvine, 2002). Socioeconomic factors and sexual health service access and provision may also be influential (Williams & Davidson, 2004).