STI cases more alarming amongst adults compared to teens

I don’t like how the reporter used this phrase “And 7 in 10 cases involved young adults: Among those under age 20, two-thirds were female, while the opposite was true for those over 20. ”
http://www.channelnewsasia.com/stories/singaporelocalnews/view/1030606/1/.html

Rise of STIs “especially alarming”, says Health Minister
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It reinforces the mistaken believe that teenagers are responsible for most cases, where actually teens make up about 1/10 of cases only only. “Young adults” in health-speak, refer to the 20-40s, who are indeed the bulk of STI patients (7/10 cases) . (rough classification: below 20 children/adolescents, 20-40 young adults, 40-60 middle age, 60-80 young-elderly, 80 on old-elderly. Older adults in general refer to the post-50 or 60)
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This mistaken belief that teens make up 7/10 cases fuels the public pressure for emphasizing abstinence FROM SEX in sex ed. Abstinence is possible perhaps for most teens, but once they get into their 20s and 30s, it borders on the ridiculous. But education is for LIFE , not for NOW
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If people understood the situation, they’ll realise sex ed should be about how to have sex healthily, so that when they are post-20 adults and engaging, they can take care of themselves. Teens who are taught to not have any sex, and are not given enough info, will get to their 20s and 30s engaging in behaviors they believe are healthy, but are in fact not. (eg. using 2 layers of condoms are actually very dangerous, and not safer than just 1)
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Singapore’s public health messages to the public focus on “Abstinence from CASUAL sex”, not “Abstinence” per se, (
http://www.hpb.gov.sg/aids/page3.htm
) which is a far more practical advice we need to educate teens with.

Is it more ethical to lie or tell the truth?

 

Now this question is really posed to those who believe that

- humans , male and female, straight and glbtq, etc have inalienable human rights

- informed consent is important

- education/ decreasing ignorance or misinformation enables people to make better choices

- morality should not be legislated or imposed, but can be promoted

 

 

For those who believe teenagers should receive abstinence-only education, or that people with HIV deserve it, I’m not talking to you here, please come back another day.

 

 

Now, the question: Are there instances where it is more ethical to lie to the public than to tell the public the truth?

 

(I’m not referring to personal relationships eg. when you tell a dying relative there is hope because you don’t want him to go into despair, or you tell your best friend she’s beautiful to help her with her self-esteem)

 

 

This was the situation I was specifically pondering over:

 

 

There is a huge difference in societal attitudes towards HIV vs cervical cancer. HIV is many more times stigmatized compared to cervical cancer, even though both are STIs and primarily transmitted through sexual activity.

 

My hypothesis:  Knowledge that cervical cancer is caused by the sexually transmitted virus HPV is much much lower than the knowledge that HIV is an STI (this has been shown true by research). This ignorance results in a much much lower stigmatization level for cervical cancer.

 

I believe that its because cervical cancer has always been “marketed” as a cancer, and people are asked to do PAP smears to detect and stop it early. Seldom is it “marketed” as an STI. In fact, looking through my old science text books, STI brochures and posters at the DSC clinic in Singapore, cervical cancer does not appear in big words.

 

The HPV virus as an STI is “marketed” by its less dangerous symptom : genital warts. And genital warts IS stigmatized.

 

HIV is definitely “marketed” as an STI.

 

 

 

As a result of this ignorance, many more people are willing to discuss cervical cancers openly, and PAP smears can be advertised and encouraged openly.

It does not suffer from the similar backlash that HIV early detection suffers from. My dad has openly asked my mother and I to get the Cervical Cancer vaccine, but he will never think of asking either of us to do an HIV test………

 

 

 

 

This is where my dilemma comes in, and I’ll like to hear from other human rights supporters.

 

What is the ethical thing to do?

 

 

In this case, ignorance actually protects.

 

 

Should we then keep up this public ignorance?

 

Or should we educate people appropriately, risk stigmatizing cervical cancer, and driving people to hide their symptoms rather than seek help?

 

 

 

Ad used to promote condom use to prevent HIV infection. The caption reads : Cause AIDs ain’t sexy .  
http://www.afa.org.sg/awarenesscampaign/CosAIDSIsntSexy.asp

 

 

Ad promoting papsmear to detect and treat cervical cancer early. Caption: power over cervical cancer. 
http://www.pocc.sg/

 

Naturally, the next question would be this:

 what if we “rebrand” HIV, along the lines of cervical cancer?

Let’s acknowlege that HIV image took off on a bad start and lets try to start with a clean new slate.

Let’s stop the name HV and AIDs, lets call it…… cancer of the immune system, or white blood cell cancer.

Let’s not say HIV test; let’s call it CD4 viability test or NAT(nucleic acid test) or something like that.

Let’s not say retriviral treatment, lets call it chemotherapy …..

Let’s start this from scratch , and do the marketing we’ve done with cervical cancer.

After all, the 2 aren’t so different.

Both spread through sex
Both lethal if not detected and treated early
Both with significant life-prolonging rates with optimal treatment when detected in the earliest stages

What do you think?

Ethical?
Feasible?

(i’m putting up 2 advertisements used in singapore for comparison and hope i don’t get sued for copyright. Look at the cervical cancer one : what if we used exactly the same thing, but changing all the cervical cancer labels for the new HIV labels? )

Singapore’s Invisible Abused Women

I’ve heard it been said more than a few times. Women in Singapore have it good, maybe even better than men, what are they whining about for? What do you need AWARE for?

 

 

Fact:

• Out of 3 pregnancies, 2 babies are born, 1 is aborted
• ¾ of women aborting babies are MARRIED — 1/3 are homemakers
• ½ of  10,000 STI cases per year – patients are between 20 – 30yrs, 1/3 – between 30-40yrs old, 5% amongst teens
• PAVe found in 2003 that out of 2,200 secondary and junior college students polled, 15 to 30 per cent had encountered family or dating violence. 
  

Alot of women actually know if their husbands are fooling around outside and know if they are at risk for STIs (sexually transmitted infections). Doing something about it is something else altogether.

2 things you can do to protect yourself from STIs if your partner is straying(and in many cases, with paid-sex). You can abstain from sex with him, or you can use a condom. Both of these actions lead to conflict. In many cases, these conflicts are violent and abusive, if not physically, definately emotionally and mentally so.

 

Then we tell these women, go seek a court protection order, go to the police, leave him.

(And even then, it’s only possible if they’ve been physically abused. It’s hard to convince anyone when it’s psychological abuse, when the victim lives in constant fear/depression. It’s hard to convince anyone, when the victim is living under the threat of contracting HIV/STIs, and not under the threat of being beaten. Such women tend to be invisible, even to close friends, because of the ‘shame’)

 

Well, easy to say. We can help these women go to the court, go to the lawyers, go to the police, and even help them out beyond abit during the initial period.

 

For them, the nightmare is the rest of their lives. How are they ever going to survive on their own? Most of these women are poorly educated, and any job that they can do will pay them peanuts, definately not enough for their children, or even themselves. Welfare in singapore is too insignificant for such women. These women are usually above 40, do not have secondary school education or even primary school education, are functionally illiterate. Its very hard for us to identify with such women, and we think that they are very few in number. Fact is, they are invisible to us because Singapore is a very class-stratified society and we don’t get a chance to get to know these women as part of our common reality. If you are reading this, chances are, you’re part of the educated lot with access to internet and have enough time to read blogs. Way beyond their league.

 

So, we can help them get out of their situation, but who is willing to help them for the rest of their lives? Are you willing to support one such woman forever? Their only hope since they were young was to depend on a man. Now that man has turned nasty. They are no pretty young things anymore, capable of finding a new man. That nasty man is all they’ve got.

 

HIV, STIs, abuse, even suicide; for many, these are the lesser evils compared to being neglected and alone in a meritocracy that pities no one.

 

HOW CAN WE POSSIBLY HELP THEM???????

Thorny issues with Sex

I’ll like to discuss 2 major points that were omitted by The Sunday Times when they published our(AWARE’s) letter ( 
http://mathialee.wordpress.com/2008/12/17/aware_sex_education/
 )regarding teenage sexuality. I suspect they omitted these points because they are really thorny issues, with no easy, non-controversial solutions. I see no easy way out as well, but still I think these issues should be brought out for discussion, in hope that someone reading might have good suggestions or a different angle to it. Definitely should not just sweep it under the carpet.

 

POINT 1

FACT:  If you’re female, being MARRIED is your biggest risk factor for getting and STI or unwanted pregnancy.

There is a common misconception that unwanted pregnancies and sexually transmitted infections (STIs) are a problem of teenagers. The fact is that in Singapore, teenagers account for only about 5% of the STI cases and about 10% of the abortion cases. About 2/3 of 12,000 – 14,000 abortions here are performed on married women, and 2/3 of the female HIV patients here are faithful wives who contracted the infection from their husbands.

When over 10,000 married women find themselves in the position of having to consider an abortion, every year, in a country like Singapore, where the education system is supposedly one of the world’s best, where condoms are easily available at any supermarket, convenience store and pharmacy, where birth control pills are available for a mere $5 for a month’s supply at public clinics, we really have to reconsider our current sex education system. 

Unlike many programs which focus on the teenage years of girls, AWARE’s program takes a lifelong approach. This makes sense to me, because what we learn in school is meant to see us through our entire lives. English, mathematics, science, health education, moral education – all these are as applicable to us today as they were when we were primary school students. Likewise with sex education, the overwhelming majority of people would have sex at some point in their lives, either when they get married, or before they do. 

Preaching against premarital sex gives the impression that sex within marriage is somehow safe. Vocal objections in the media to teenage sex, and laws protecting girls below the age of 16, give the impression that sex is safer for older people.  Sadly, the fact that the majority of abortion and STI patients are married, and are not teenagers, highlights the importance of equipping people with lifelong skills. The best age to start would be of course, at puberty, where schools provide the best platform and opportunity for giving our adults of tomorrow the information they need.

Taking a lifelong approach, we can see the limitations of the abstinence-only message.  The abstinence message is only useful for teenagers. The abstinence message is unhelpful in preventing over 8000 married women from having unwanted pregnancies each year. The abstinence message is unhelpful for the older person who has decided to engage in sex and is looking for ways to practice it safely. 

Telling people that being faithful would reduce their risk of getting STI infections is unhelpful for the faithful housewife who feels powerless to stand up to her philandering husband, whom she depends on financially. The abstinence and faithfulness messages are good messages, which are beneficial as a public health policy to reduce the total number of STI infections in the entire population, but they may not always be helpful at the individual’s level.

We need to tell people that unwanted pregnancies and STIs do happen to good, faithful, married people, that they happen to people with college degrees and well-paying jobs. We need to tell you that it could happen to you. We all need to know that the only contraceptive method that can protect us effectively is the condom.

That being said, I know how difficult and thorny this can be. Relationships are built on trust, not paranoia. Why would you be in a relationship with someone you can’t even trust to be faithful, and have to insist on a condom years after being married? As national policy makers, what kind of advice can you give to the faithful partner? There is no easy answer. At the end of the day, we are all human, all vulnerable to fall, and we do. After the forgiveness or divorce is through, the last thing we want to deal with is HIV. The only thing we can do, then,  is to equip people with the raw hard facts, rather than give a false sense of assurance, and leave them to decide for themselves.

 

POINT  2

FACT :  Making it a criminal offense of having sex with girls under 16 can harm the under-16 girls having sex.

In the course of conducting these workshops for these students, I have met girls under 16 who love their teenage boyfriends so much, that instead of risking their boyfriends going to jail, they risk their health and lives by sticking objects up their birth canal to do a DIY abortion at home. I have met teenage girls so terrified of authority, they will risk their safety going out with strangers met online while keeping their parents in the dark. I have met girls who come under so much peer pressure to have sex, or who are outright blackmailed – with compromising mobile phone videos and photos for example.

Again, there is no easy answer. The law is there to deter and prosecute malicious sex predators—who tend to be adults. But the law is a weak deterrent for teenage boys whose girlfriends have promised not to tell. Fortunately, it seems that the courts are a lot more lenient to these teenage boys – still, they get probation, simply for having sex.  The law has resulted in under-16s going to the doctors only in the late stage of pregnancies or STIs, when it becomes a lot more complicated to treat. How do we get around this problem? I honestly don’t know.  I tell teenagers that their health should be No.1 priority, and that no doctor can force them to reveal the identity of their boyfriend.

I understand that condoms can fail especially when used incorrectly. So I show teenagers how to use it correctly, and I make sure they practice using it correctly before leaving my workshop. I make sure they know that even if they do not go “all the way”, STIs can still spread through oral sex or heavy petting, and pregnancies can still happen even if their boyfriends “pull out” in time. I understand that even with practice, people can still fail to use condoms properly or fail to use it at all. So I introduce teenagers to the Morning-after-pill, which is the second and last chance at preventing an unwanted pregnancy.

 I understand that we can be pressured into having sex at times, and we can mistake sex for love at times. So I teach teenagers how to negotiate effectively for what they want – whether it is abstinence or sex with condom use. I go through with them what makes a relationship healthy or not, and how to move the relationship towards a healthier direction, or how to get out of it if that cannot be done.

We need go beyond the simplistic view that STIs and unwanted pregnancies are the problems of unruly promiscuous teenagers, and take a closer look at what reality is. We will then see that simply telling them to abstain, will not help the ones who truly need help, and will not help the adults that our teenagers would eventually become.

 

 

Ref:

Profile of women presenting for abortions in Singapore at the National University Hospital
Kuldip Singh*, Y.F. Fong, S.Y. Loh Contraception 66

http://www.geocities.com/mathia_lee_yu_chun/singaporeabortions.pdf

 

Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)
Priya Sen, , Hiok-Hee Tan, Roy KW Chan, Ann Acad Med Singapore

 

 
http://www.geocities.com/mathia_lee_yu_chun/STIepidemiology.pdf

 

 

Preventing HIV/AIDS and STIs : What the State and Church will not tell you

1. Many State-run / funded programmes to decrease STIs and unwanted pregnancies need to follow the ABC (Abstinence, Being faithful, Condom use)  policy. This is largely due to pressure from conservative / religious groups, to reflect an ideal.
2. Abstinence – How practical is this advice? How long can one abstain? Does it apply to just teens, or  30 , 40 year old singles as well? What if you’re gay and cannot marry? If you never marry, will you never have sex too? Fact is, STI rates are highest for the 20 – 40 yr old age group (Teens make up only 10% of STI cases).

   More importantly, this is useless advice for married persons. The implied message is of course NOT that celibacy is the ideal state, not when the government is actively trying to get the birth rate up. The implied message is against Premarital Sex.
   
   The implied message is that, somehow Sex is OK when one is married, that somehow Married Sex a person from all STIs and Unwanted pregnancies. IS THAT TRUE????

3. Not really. That’s why the 2^nd message is BE FAITHFUL

   Telling a person that BEING FAITHFUL protects him/her from STIs and Unwanted Pregnancies is the equivalent of telling a person that BEING HONEST protects him/her from being a victim of theft.

   In Singapore, 2/3 of HIV positive females are FAITHFUL wives who got HIV from their husband. In other parts of Asia, 25% of HIV patients are women, and 90% of the women get it from their husbands.

   The ‘Be Faithful’ message gives people a false sense of security. Being faithful is a MORAL obligation we have to our partners, but is NOT a protective measure for ourselves.

   The Be Faithful message is also unhelpful for preventing unwanted pregnancies.

 Just because you are married and faithful does not mean you won’t get accidental pregnancies. Just because you are married and faithful does not mean you can afford to keep all the accidental babies.

10, 000 out of the 14,000 abortions performed in Singapore EACH YEAR are on MARRIED women.

In this day and age, in this country, where contraceptives are so easily and cheaply (Pills from polyclinic at $5 a month!) available, why do 10,000 of our women even put themselves in the position where they have to consider an abortion!  Is there something wrong with our EDUCATION? ( think about this : each year, there are 26,000 babies born in singapore, of which 13,000  are female babies. And 14,000 women go through abortions each year)

Why don’t our women know how to prevent pregnancies they don’t want? Why do they risk their health and bodies?

1. Condom use : probably the most useful and practical advice

   Condoms are the ONLY method of preventing STIs and HIV

   Pills are cheap and prevent pregnancies, but cannot prevent STIs

   What are some issues with condom use and promotion?
   - public backlash against overt promotion . Many schools are afraid to dish out this advice, lest parents accuse them of promoting Sex
   - How to use condoms properly? Hardly ever taught. BIGGEST cause of condom failure is user ignorance , ie. People use it wrongly.
   - Condom use is ranked last in the ABC message : Implicit message that Good girls (A grade!) don’t have sex. Not so good girls (B grade!) have sex, but at least they are faithful. If you really cannot make it or cannot control yourself as a good girl or even as a Not-so-good-girl, at least, please use a condom.

   The result is that no one wants to admit that they fall into the ‘C – grade’. It reinforces the misconception that if you buy condoms, you’re a slut who is asking for sex!

As a result, people put themselves into the position of having sex without a condom . How so? Because they give themselves this excuse :  because “we didn’t mean to have sex. We didn’t plan for it. Only sluts and desperate people plan to have sex. Only sluts and desperate people will carry condom. For us, it was a moment of passion. So no chance to get the condom”

1. Emergency Contraception / Plan B / Morning-After pill (Go google for more info)
   A pill you take within 72 hours of sex to prevent pregnancy. High dose of hormones, not healthy to be used regularly. Use only when your main mode of contraception failed. Available at GPs.

   Can prevent you from having to go for an abortion.

   Can prevent you from getting pregnant AFTER you have sex.

Does NOT prevent STI, if you kenna already, it cannot help you.

Emergency Contraception is NOT ACTIVELY PROMOTED publically à Is it responsible of sex educators (government, mainstream educators, civil groups, religious groups) not to promote the use of EC because of protests from conservative groups???

 

6.       Vaccinations against HPV
HPV causes 90% of cervical cancer cases, and is an INCURABLE STI. The vaccine costs $700. There are no subsidies for this vaccine.

Reason given: it does not cover all strains of HPV, only 70% of the strains.

Currently, regular PAP smears are the main method of preventing cervical cancer. But this is fire-fighting. Because Pap smears detect ABNORMALITIES , which you need to undergo a surgery to remove. Pap smears detect the cancer AFTER you develop the cancer. Vaccines PREVENT the cancer. However, with or without vaccine, please go for PAP smears (VERY CHEAP) because cervical cancer in the early stage is 90% curable, at late stage it becomes incurable.