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Lord McColl of Dulwich: I should like to confine my remarks to the important medical facts about anal intercourse, which is practised by heterosexual and homosexual people. In fact, anal intercourse between male and female is commonly used as a form of contraception, which may account for the rapid transmission of AIDS in some areas.

As the noble Lord, Lord Quirk, pointed out in a previous debate, the rectum is lined with a delicate gut epithelium, or lining, which is only one cell thick, measuring a very small fraction of a millimetre. That is in marked contrast to the lining of the vagina, which is a tough skin-like structure many cells thick. As the rectal lining is so delicate, it is frequently damaged by intercourse and therefore infected with a variety of hostile germs, the most severe being AIDS, hepatitis and a virus leading to anal cancer, together with the usual venereal diseases of syphilis, gonorrhoea and other infections. The vaginal lining, being much thicker and of tougher material, is more robust and resistant to infection, even to AIDS, unless there have been previous breaches in the lining due to venereal disease.

In addition to the damage to the lining of the rectum, the tight and powerful muscles that surround the anal canal can also be damaged and those subjected to persistent damage can even become incontinent. In one series, the rate of incontinence has been one in three. Of course, when anal intercourse is practised on infants, the damage is even more severe and devastating. Cases have been recorded of infants as young as six months being subjected to this practice.

The use of condoms is said to reduce the danger of anal intercourse, but in one series there was a breakage rate of 32 per cent, which was six times more common for the same group during vaginal intercourse. The slippage rate was 21 per cent, which was three times more common. Stronger, thicker condoms have passed laboratory tests, but they are not used consistently because of discomfort and decreased

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sensation. (This was recorded in a paper published by Silverman et al, in the journal Sexually Transmitted Disease, 1997, vol. 24 at page 14.) The failure rate of condoms for vaginal sex in one series was 52 per cent. Some 52 per cent had experienced condoms bursting or slipping off in the previous three months. (This was recorded by Kirkman et al, British Journal of Family Planning, 1990, vol. 15 at page 107.) Condoms have a pregnancy failure rate among the most motivated couples of 5 to 15 per cent. According to Williams in the British Medical Journal, 1995, vol. 311 at page 807, the main factor in unplanned teenage conception is contraceptive failure, not the lack of contraceptive knowledge and availability. Condom failure has become the leading cause of unwanted pregnancy, according to the British Medical Journal, 1996, vol. 312 at page 1059.

There are, of course, inherent flaws in latex condoms and those flaws are at least 50 times larger than the AIDS virus. Incidentally, the AIDS virus is 450 times smaller than human sperm, so it is no surprise that the effectiveness of condoms for AIDS prevention is much worse than for contraception. That was pointed out by C.M. Rowland, the editor of Rubber Chemistry and Technology.

Having dealt with the dangers of anal intercourse in terms of infection and damage, the question of mortality should also be considered. Of 100 teenagers who continue to smoke 20 cigarettes a day, half of them will take, on average, 20 years off their life. Of 100 teenagers who practise anal sex, all of them, on average, will take 20 years off their life. As most males start anal sex at the age of 21, we would prefer them--from the medical point of view--not to begin this practice any earlier. I therefore see no point, medically, for lowering the age of consent.

Lord Walton of Detchant: I defer to the medical advice and opinion given by the noble Lord, Lord McColl of Dulwich. Every word that he said about the constitution of the anal canal, the rectal mucosa and the risks of HIV infection is absolutely right. But those same risks apply to the condition of the anal canal and the rectum at the age of 18, 20, 21, 24 or, indeed, at any age.

I have agonised before deciding to speak in the debate because I find this to be an agonisingly difficult issue. It is so easy to understand and appreciate the absolute sincerity of those who speak on both sides of the argument. I personally find the whole idea of anal intercourse distasteful and even abhorrent. That is a view that I have held throughout my professional life. However, homosexuality has been a fact of life through the centuries. We need only look back to see that many notables in history, such as Alexander the Great and, indeed, an enormous number of distinguished people in public life--actors, politicians, scientists and others--have openly confessed to their homosexuality. Furthermore, there is increasing evidence, which is, I believe, now incontrovertible, that homosexuality is not a perversion produced by events in early childhood or even in the teenage years, but that it is genetically determined. It is a characteristic inborn

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in the individual as a result of their genes. That, I believe, is one of the most important facts to be considered.

I should like to make one more point. When I was president of the General Medical Council, we agonised over the issue of whether advice should be given to underage girls and boys on matters related to contraception, abortion and so forth. We were then advised that, under the Family Law Act, valid consent, given by an individual of 16 years of age, is as valid as if given by an individual of full age. Then along came the Gillick judgment in the case of Gillick v. West Norfolk and Wisbech Area Health Authority. Mrs Gillick went to the courts to try to prevent doctors and other healthcare professionals from giving advice to her teenage children without her consent. Eventually, under that judgment, it was accepted that there were circumstances when, with total confidentiality, if a young person could not be persuaded to consult his or her parents, it might be valid in the interests of health to offer contraceptive or other appropriate advice, even under the age of 16.

I have the greatest possible respect for the views held by the noble Baroness, Lady Young. Since I came to this House 11 years ago, I have admired her support for universities, medical research, her consistent support for family values and her spirited advocacy of many other important matters, often based on her long-held and sincere Christian beliefs. She has won the respect of Members on all sides of the Committee. However, on this occasion, I have to say that I find myself in disagreement with her--but only for a few reasons. Why is it that the British Youth Council, NCH Action for Children (established by the Methodist Church), the Family Welfare Association, the Save the Children Fund, the National Children's Bureau and the NSPCC all favour this Bill? Furthermore, why do the medical opinions--after the most careful and earnest consideration--of the British Medical Association, the Royal College of Psychiatrists, the Health Education Authority, the Royal College of Nursing and the All-Party Parliamentary Group on AIDS all favour this Bill? A number of good reasons may be put forward.

No one in this House would ever condone the horrors of paedophilia or of child abuse. However, medical evidence states that, by the age of 16, people's sexuality is established and is unlikely to be influenced by any of their experiences beyond that age. A second, most important point--and one which arose as a result of the Gillick judgment--is that even though that legal judgment may be clear; namely, that in certain special circumstances a doctor could give advice on issues such as contraception and abortion to a young boy or girl under the age of 16, at the time there were many doctors who--although they had accepted that advice and had received consequential advice from the General Medical Council--felt unable and unwilling to give such advice because they believed that they were condoning an illegal act.

The same issue arises in this situation. Of course anal intercourse presents a much greater risk of HIV transmission for homosexual and bisexual men than

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most other types of sexual activity. As the BMA pointed out, in genital urinary medicine clinics the Department of Health figures showed that one in 17 men were found to be HIV positive. Many of them had clearly been infected for years, some having plainly acquired the infection before the age of 18.

It may be argued that if a young man of 16 seeks advice about his sexuality and whether it is right or wrong, whatever way he is protected, to have anal intercourse--which, as I said, I abhor--if the amendment were to be agreed, many doctors would now feel that, in giving health promotion advice to such individuals under the age of 18, they were condoning an illegal act. The same would be true of teachers and youth workers. For that reason, continued criminalisation of this activity for those under 18 is likely to prevent a significant number of young gay men seeking professional advice. It is also likely to inhibit some professionals--

4.30 p.m.

Baroness Knight of Collingtree: I am grateful to the noble Lord. We have heard a great deal today about the advice that is necessary for young people of 16--and possibly even younger--on the subject of homosexuality. Can the noble Lord say whether it is general practice, when giving such advice, to give warnings about the dangers of this act, about which we have heard a great deal?


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