Angry Doctor

Thursday, May 08, 2008

Them 10

(Edited on May 12, 2008)

Nevermind the gays, now it's those pesky teenagers who are spreading AIDS! Just look at the statistics!

(emphasis mine)

Teens, sex and Aids: Time to face up to today's realities
With teen hiv on the rise, is the abstinence-based approach relevant?
Tan Hui Leng

Amid the heady flush of first love, or lust, can two hot-blooded teenagers abstain from sex when even grown-ups yield to temptation?

More importantly, are we willing to live with the risk of giving them the benefit of the doubt when their lives and future could be at stake?

Risk, in this case, is spelt HIV. Just look at the statistics.

According to the Ministry of Health (MOH), human immunodeficiency virus (HIV) infections have been on the rise annually, registering a record high of 422 diagnosed last year. Those in their 20s and 30s make up the biggest proportion of total patient load.

Does that mean they contracted the virus only in their 20s? Do we know when they started having sex?

According to the Durex Global Sex Survey Report, the mean age at which Singaporeans lose their virginity is 18.4 years old. How many teens under 18 are having sex if the average yardstick is 18.4 years?

Well, teens have been registering single digits in annual HIV statistics. It may not look significant, but each year, the numbers creep up quietly. This is in tandem with the rising trend of sexually-transmitted infections among teens — which has also been steadily increasing in recent years.

It was revealed last week that there were nine teenagers diagnosed with HIV last year, all of whom were between 17 and 19 when detected. This is up from one to four cases each year between 2003 and 2006.

With a higher rate of premarital sex, presumably with multiple partners for some, comes a higher risk of sexual infections.

Despite this, the Ministry of Health is not rolling out its full-fledged HIV prevention programmes for teens.

In Parliament recently, Health Minister Khaw Boon Wan explained the sensitivity in broadcasting the ABC (Abstinence, Be faithful and Condom-use) message nationwide: "Many parents will be upset with such a campaign and we will be accused of promoting promiscuity."

"So, the general broadcast has a small 'c'. On the other hand, the ABC campaign targeted at high-risk groups will have an enlarged 'C' as the main theme."

While this is similar to the argument put forward in the Section 377A debate — let us not upset the majority of the population who are conservative, or rather, heterosexual — it does not hold water when the majority of Singaporean parents could possibly be affected.

Whether they like it or not, there is likely a 50 per cent chance their children are having sex even before they turn 18.

That the importance of condom usage is overshadowed by the message of abstinence is disturbing in the light of the recent HIV statistics.

Mr Khaw said that those in "high-risk" groups would be given a stronger message to use condoms. The recurring question is, who are in "high-risk" groups, particularly if we are talking about teenagers who are exploring their sexuality?

To wait until a youth presents a sexually-transmitted infection before counselling on safer sex kicks in is to hide behind a veil of ignorance.

Promoting abstinence and faithfulness is effective in keeping HIV under control, but more focus is needed on efforts to educate sexually-active teens about sexuality and condom use, said volunteer group Action for Aids. How will the authorities get a chance to help teens when premarital sex is emphasised as a moral wrong?

And do the sexuality and parenting programmes we have equip parents adequately to talk to their children about condom use?

Singapore's rapid development in the last 40 years has fast-tracked a generation that may hold different values from those of their parents. Whether one agrees with what teenagers do in their bedrooms is not the issue — and should not detract from the issue, which is: There is a need to implement an effective solution that will not stigmatise. It starts with acknowledging today's realities.

You can see the statistics mentioned in the article here. As mentioned the 20 - 29 and 30 - 39 group together make up 38% of those diagnosed with HIV in 2007.

What the article doesn't tell us, however, is the fact that men aged 40 and above make up 55% of the total, or that Chinese make up 84%.

Teenagers, or rather those aged 19 and below, make up 2.4% of the total. And if you minus off the one case of perinatal transmission, the figure falls to 2.1%.

Even when we take into account an average latency period of 8 to 10 years and include those in the 20 - 29, 'teenage sex' still only accounts for 15% of the total.

Going by statistics, we should be targeting the campaign at 'dirty Chinese old men' and not teenagers - but why let facts and statistics get in the way of a story, or for that matter a public health campaign, right?

In fact, to further lend credibility to her argument, our reporter makes the observation that "[w]ith a higher rate of premarital sex, presumably with multiple partners for some, comes a higher risk of sexual infections", as if extramarital sex with multiple partners did not come with high risks too.

angry doc welcomes a campaign that doesn't dodge the issue that people are having sex with multiple partners without barrier protection - admitting that this is in fact the case and that it is the major cause of HIV transmission in Singapore is probably the first step in solving the problem.

angry doc also sees the point of having a campaign that targets teenagers; even though not all teenagers are the same, we know enough about their mindset and behaviour as a group to know that we must tailor the message in a way that will reach them and engage them in a way that will not look like talking down to them. (However, angry doc feels that past health messages aimed at looking 'cool' and 'hip' to teenagers have always looked rather forced and lame...)

One problem with a targeted campaign, however, is that it can - as exemplified by this article - create a false impression that the group being targeted forms the bulk of the problem. As angry doc has shown above, this is clearly not the case here.

Another problem with a targeted campaign is that it can lead to stigmatisation of a group, especially when the 'grouping' is based on the observation of a correlation, but does not in fact represent causation.

The truth is the boxes that we put people in when we present HIV/AIDS statistic - age, race, marital status, sexual orientation - are not really useful in telling us how or why people caught the infection; they are merely used because they are 'visible' and therefore convenient labels we can use to try to put some semblence of order in all those numbers. These divisions should be used only to help us plan and tailor our educational programmes when trying to reach different segments of our population, but not to give the impression that it is one group or another that is responsible for our HIV/AIDS problem.



  • Thanks for pointing out the latest statistics, Angry Doc.

    During the blogger forum I discussed with one of the organizers about the possibility that the bulk of the incidence rise could be due to older adults; that is, the publicity programme is not targeting the relevant age group.

    The reply is that teenagers and 20+ youth, being younger and better educated, are more receptive of a public health campaign than older adults who may be set in their ways.

    At that time I felt that this sounds like a reasonable long-term approach. Although it seemed really strange that the 20+ group could be increasingly engaging in risky sexual behaviour despite knowing better.

    Like you said, the latest data demonstrates that the bulk of the increase is actually in the over-40 groups.

    By Blogger Lim Leng Hiong, At May 09, 2008 3:39 pm  

  • Have u read the book "The Logic of Life - Uncovering the New Economics of Everything"?
    I'm barely into Chapter2.. havenot decided whether the author is right or wrong, but the author has smthg to say about the topic u just wrote about (in the USA) in Chapter1.

    By Blogger pretzel, At May 09, 2008 10:20 pm  

  • No I haven't. I was at the bookstore today and was wondering whether to get "The Undercover Economist", but I got Robert Winston's "The Human Mind" instead. Maybe the next time then.

    I did read "Freakonomics", and although I didn't look up the studies mentioned in the book I think the author's point that human beings are basically creatures of incentives makes a lot of it made sense. I believe "The Logic of Life" makes pretty much the same argument?

    Coincidentally, I was having a conversation with a colleague this afternoon about whether medicine - besides being a science - is also an "art".

    Some doctors like to call the 'people skills' part of medicine an art, but I tend to see it more of a science because to me, motivating desirable behaviour and discouraging undesirable behaviour are really about applying incentives and disincentives to the patient, and we can to an extent observe, describe, predict, and modify human behaviour.

    Art, on the other hand conveys to me something not really rational or predictable, and knowledge which cannot be imparted systematically. I'm not sure we should mystify medicine that way.

    By Blogger angry doc, At May 09, 2008 11:07 pm  

  • yeah, so far in chapter 1, it's about "humans as creatures of incentives". But not sure if there's any twist in his interpretation (i'm barely into chap2)

    Don't think the Dr can treat Medicine as a "science" esp those who are at the frontline interacting with patients everyday. Maybe it's really a "SCIENCE" applicable to those medical professionals doing hardcore medical research?

    ART.. "knowledge which cannot be imparted systematically"
    -- don't really agree this pt... the professors and experts in the Arts & Social Science Faculty are doing a gd job imparting their knowledge, and teaching the young minds how to look deeper beneath the surface.. :)

    By Blogger pretzel, At May 11, 2008 8:32 pm  

  • I stay in Berlin, you can see that they have so much condom advertisement everywhere...

    By Anonymous Jeslyn Wong, At May 26, 2008 1:47 pm  

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