How can we talk about the taboo and the illegal :

It’s a real privilege for me to have the chance to give a talk, ‘How can we talk about the taboo and the illegal’,  at this year’s IndigNation. http://indignationsg.wordpress.com/

 

Some topics are more challenging than others to talk about in the classroom setting. Topics like,

1. Homosexuality  – How do you de-stigmatise homosexuality, get homosexual students to practise safe sex, when you have the 377A law?

 2. Under-aged sex – How do you get under-aged teens to practise safe sex, or seek medical treatment early, when their beloved partners might be jailed?

 3. STI/HIV destigmatisation – How do you impress upon teens the severity of these illnesses without scare-mongering, and yet de-stigmatise these conditions at the same time?

 4. Condom usage – How do you get teens to practise safe sex without over-stating the effectiveness of condoms, and without “preaching promiscuity”?

 5. Trust and abuse — How do you get teens in a monogamous relationship to consistently use condoms, when love and trust are essential for a healthy relationship?

 

It’s a short 20min talk on this subject of Taboo and Illegal topics, followed by what I hope will be a lively discussion with the audience  =)

( Disclaimer: I am giving this talk in my own personal capacity, and will NOT represent the views of any organization / faith. )

  

 

 

23 August Sunday

Triple bill: Kings and condoms 7 pm @ 72-13 (72-13 Md Sultan Road)

Michael Jackson and The Man In The Mirror: In the wake of Micheal Jackson’s passing, Otto Fong reflects on what he – a gay Asian who studied in America – learnt from African Americans before, during and after Jackson’s reign as the King of Pop.

The same ties that bind: A 20-minute video exploration of the various elements that determine a gay person’s acceptance within the family: family love, prejudice, religion, etc.

How can we talk about the taboo and the illegal: Mathia Lee in her talk discusses the challenges she faced as a Comprehensive Sexuality Education instructor, in bringing into the classroom topics like 1. Homosexuality  2. Underaged sex  3. STI/HIV destigmatisation  4. Condom usage  5. Trust and abuse.

In sum, this forum looks the process of acknowledging a gay person in our midst, and dealing with issues of self-acceptance, family acceptance and education.

HIV is LIKELY to go undetected or misdiagnosed – So how?

Have you ever been tested for HIV when you went to see your GP for a cold or flu?

 

My bet is No, even though the typical, early symptoms of HIV are almost EXACTLY the same as a bad cold/flu –  high fever, aching joints, swollen lymph nodes, bad cough etc.

 

So think about it. If you were never tested for HIV when you went to see your doctor for a flu, what makes you think that HIV infected people will be correctly diagnosed at that early stage? Wouldn’t they be misdiagnosed for a flu?

 

That’s exactly what happens.

 

“In 2006, more than half (58%) of the new cases already had late-stage HIV infection when they were diagnosed. This was similar to the pattern in previous years……

Most of the new cases in 2006 (78%) had their HIV detected when they had HIV testing in the course of some form of medical care. A much smaller proportion were detected as a result of voluntary HIV screening (13%). The rest were detected through contact tracing and other screening. When differentiated by sexual orientation, a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (35% vs 3%).”

– http://www.moh.gov.sg/mohcorp/currentissues.aspx?id=16114

 

Which really means that, whenever you decide to engage in sex with anyone, the best thing you can do for yourself  is to assume that the person is HIV positive, and use a condom — which is 99% effective if you use it CORRECTLY, and 100% of the time.

 

 

In the meantime, these statistics provide a very good argument for automatic, opt-out testing. The government initiative to test all male patients coming into Singapore’s public hospitals, regardless of the illness they came in for, can address this very high rate of misdiagnosis. The number of undiagnosed HIV cases are thought to be about 2x the numbe of diagnosed cases.  The idea of automatic testing is not to ostrocise or to “doom” these HIV victims — the idea is to reduce the spread with early detection, and to get treatment to prolong life.

 

Why is it only restricted to men? Because HIV tests have an inherrant error rate (that’s just the technology limitation), and the HIV infection rates for women are still low enough that it is hard to distiguish the error rate from the real positives, so it is not that helpful as a screening measure for women.

 

While from a public health perspective, automatic HIV testing is an effective detection measure, the social consequence would be the increased stigma attached to being HIV positive.  This is something we cannot ignore, because HIV infected people have a right to be treated with dignity — and that includes the right to keeping their status confidential, their right to treatment, their right to doing all activities that would not result in the further spread of HIV.

 

Moving forward from Obama’s “We reject as false the choice between our safety and our ideals”, we need to make sure we have strategies that both enhance our health safety as a population, and safeguard the rights of HIV infected people, which they fully deserve. This is fully possible if we want to achieve it, and we have to consciously reject as false any assertion that we have to choose between our public health and human rights.

 

So auto-testing would enhance our health safety as a population, and enable the HIV patients to start treatment early to prolong their life and enhance their quality of life. I think Singapore got that right

 

It’s the second part that we need to make sure is in place — and recognise that achieving our ideals of according HIV patients the rights they deserve, need not compromise our health safety at all.

 

What needs to be in place ? This is a non-exhaustive list which would be nice if readers could add on to.

 

The State’s to-do list:

 

1. Affordable treatment .

Affordable not only in the sense that the patients can pay for it, but affordable in the sense that after paying for the treatment, they can still afford to have a normal life — to still be able to pay for their utilities, mortgages, children’s education , even a holiday or two. They should not be enslaved by the cost

 

2. Accessible treatment of high quality

Treatment that is accessible and affordable should not just be the basic, Third-world, scrapping by type of treatment. In should be in line with the country’s philosophy of having First-world, world-class, health care.

 

3. Enforced, laws (not guidelines) preventing discrimination at the workplace

HIV CANNOT spread through working together (unless you’re in the unprotected-sex trade/ having unprotected sex with your colleagues). In the same way that the government took concrete action against the discrimination of pregnant women, similar action has to be taken against workplace discrimination.

 

4. Laws protecting confidentiality

Patients have the right to confidentiality. When this confidentiality is breached, patients should be able to sue the violating parties. In bringing on these lawsuits, patients should have provisions to protect their confidentiality during the legal proceedings, similar to how rape victims are protected during legal proceedings

 

5. Laws protecting against discrimination

Patients should be able to sue organisations that practice discrimination, similar to the way we can, if we are discriminated based on race / religion etc unnecessarily. This is slightly different from workplace discrimination –which has to be enforced more strongly because it is their means of livelihood. Here, we want to enforced their rights to be treated without discrimination by country clubs, associations, schools,  media portrayals etc

 

6. Family members of HIV patients have to be protected under the same laws, as those above.

 

7.  Have a long-term public education programme against discrimination against people living with HIV

Public education should go beyond stopping the spread of HIV, but should to decrease discrimination amongst those affected. In campaigns for safer sex, other groups of people should not be discriminated against, eg. homosexuals , women (notice how ads always portray women as the agents of infection? women are forced into either categories of being a slut or being a virtuous wife — another false dichotomy). Governmet bodies need not be the ones running these programmes ; they can provide funding to diverse groups who can conduct these campaigns from all the different perspectives

 

 

 

We, the Peoples, to-do list

 

1. Make friends with people with HIV — we will then learn that they are as human, as good, and as bad as we are

 

2. Learn more about what living with HIV is like

 

3. Speak up whenever discriminatory words/acts are observed

 

4. If you are in the position of power eg. as a policy maker, as a HR manager, as a journalist — exercise your power responsibily

 

5. Spread the message

 

 

AWARE’s Comprehensive Sex Ed Programme

Please see latest (7 May o9) post “AWARE’s Comprehensive Sexuality Education (CSE) : Re Homosexuality, anal sex, pre-marital sex“

 

 http://mathialee.wordpress.com/2009/05/06/awares-comprehensive-sexuality-education-cse-re-homosexuality/

 

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Here’s AWARE’s letter in response to the Sunday Times teenage sex article that ST did not publish:

[Correction: Sunday Times published it on today's edition of Sunday Times(21 Dec 08). Ommited lines are marked in bold here ]

      It is with great empathy that we at AWARE have read your special report” the young and sex”, dated Dec.14, 2008.  When an incident such as this one, of the pre-teen girl who invited a 16-year-old boy to have sexual intercourse, hits nearer home, we begin to question why. Instead of looking for a scapegoat and where to place blame, AWARE believes that educating the youth about sex, sexuality and self esteem issues related to Body Image, must be a significant component of every child’s education. To this end, AWARE has introduced Comprehensive Sexuality Education (CSE) workshops for teens and for teachers in schools.  Sexual curiosity is the result of a natural biological hormonal response in the young and technology in their hands has merely enabled them to become more public and explicit.  How can we deal with this? Through education and open communication alone.  Some answers to your question: “Why are they starting so young” may be:

1.    Some teens engage in sexual activity to feel a sense of self-worth and love. Solution: help teens build a sense of self-worth through healthy means.  Our CSE program discusses the effects of basing our self-esteem on sex. Our Body Image program discusses how our self-worth allows us to stay healthy and safe, and explores the false assumptions and the unhealthy ways of achieving self-worth.

2.    Some teens engage in sexual activity out of a sense of curiosity.            Solution: short of monitoring teens 24/7, what we need is to equip them with accurate, responsible and complete information to make wise choices, and to make healthy choices about sex. Our CSE program has been proven to do that. We educate youth on the consequences of each choice. Our CSE teaches them to stay healthy and responsible, should they choose to engage. It also teaches them condom usage, as user ignorance is the biggest reason for failure. 

3.    Some teens engage in sexual activity because they don’t know how to communicate and negotiate for alternatives. Solution: equip and empower them with the skills to say “NO”. Our CSE does that.

Prosecution might be a deterrent for malicious adult sex predators, not teens. Education is what the young need. Fear of prosecution only prevents youth from seeking advice and information from reliable authorities, or seeking help when pregnancy / Sexually transmitted infections (STI) occur. We hear of DIY abortions done by under-14s to prevent their boyfriends from being jailed, hence endangering their own lives. 

Lack of open communication about sex from adults, be they parents or teachers drives children to rely on peers or media/internet for information, which may often be less than reliable.

Sex education needs to go beyond preaching abstinence as the only form of sex education.  This is not the reality as statistics show.  Education should provide life – long skills. Being comfortable with ones sexuality and practicing safe sex needs to be taught to teens so that it is bridged into adulthood as well.    

We believe that we should tackle this issue at the prevention stage – by empowering teens and adults to NOT get into a situation where they have to consider abortion, adoption, single parenthood etc. It does not help to criticize the young after they have had abortions, kept their child or developed AIDS.

AWARE will further its education program, by conducting talks and workshops for teachers on how to design programs and conduct Comprehensive Sex Education. We are looking to bring these talks to parents as well.

Dr..Roopa Dewan Public education; Mathia Lee- CSE AWARE;

 

 

 

 

A Lifelong approach to Sexuality Education is needed

I refer to the letters “Abstinence is the safest choice” by Goh Syh Leh and “Demonstration is a point of embarrassment” by Jonathan Loke (Oct 23) (Attached below).

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 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. 

I felt the need to do something, and so I joined AWARE as a trainer for its Comprehensive Sexuality Education Program, where teenage girls are provided with both the information and skills needed to keep themselves safe from STIs and unwanted pregnancies.

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.

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.

 

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.

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.