Angry Doctor

Monday, May 12, 2008

What we don't know about sex

(edited at 11:25 PM)

Unsurprisingly, the call for a safe sex campaign targeted at teenagers has drawn opposition from the public.

Joanna Koh-Hoe believes "that safe(r) sex is not actually safe", and that "the increased rate of teenage sexually-transmitted infections (STIs) and pregnancies is contributed by the teens who have bought into the safe sex message and think that premarital sex is okay so long as they use a condom".

Alphonsus Tan questions the statistics quoted in the news article. He too believes that "[t]he knowledge imparted to youth that condoms are 99 per cent safe, protecting them from pregnancy and sexually- transmitted diseases, will... let them know that they are not so vulnerable. Armed with that knowledge, they would be more willing to engage into sexual activities". "Educating them about condoms only empowers them to do the deed," he concludes.

Bryan Goh wonders if "by encouraging safe sex and the use of contraceptives... are we actually advocating the wrong (read: 'relaxed') idea about sexual activity?".

So what works? Abstinence campaign, or safe-sex campaign? Does a combination work better, or does mixing the two send a 'mixed signal' to teenagers and actually encourage them to have sex?

Well, it depends on what one means by "work", angry doc supposes. Different people and groups have different definitions of what a successful sex education campaign is. Some want teenagers to abstain from sex until they are married, some want teenagers to delay the age when they start having sex, and some just want fewer cases of sexually-transmitted infections and unwanted pregnancies, never mind how many teenagers are having sex.

We can look at studies from other countries, but as far as Singapore itself is concerned, angry doc is not sure we have enough data to answer the question of "what works?".

Surveys on sexual status and activities rely on self-reporting, and can therefore be inaccurate. Statistics on sexually-transmitted infections (and HIV/AIDS) on the other hand are probably more reliable, since these diseases are notifiable.

To be helpful to policy planners, the STIs and HIV/AIDS statistics must be viewed as a function of the number of teenagers in the country, as a function of the percentage of teenagers who are having sex, and as a function of the percentage of teenagers who practise safe sex.

More importantly, to assess the success on any intervention programme or campaign in influencing the sexual behaviour of teenagers, we need to have data for the period before and the period after the intervention. Right now, we can't even be sure if the rise in HIV/AIDS amongst teenagers is occurring in the context of more teenagers having sex but practising safe sex, or fewer teenagers having sex but practising unsafe sex, or merely as a result of the same number of teenagers having the same kind of sex on the background of a population increase!

Unless we have the data, we can never know if a "safe sex" campaign will actually encourage teenagers to have sex, or if "abstinence only" campaigns for Singapore will work.

angry doc would like to suggest that the ministry conduct a study to obtain the baseline data so we can have a frame of reference, except he is worried that asking teenagers whether they are having sex will in itself encourage them to have sex...



  • There are findings that "[abstinence education] can place some teenagers at higher risk of unintended pregnancy and STDs, because up to 60 percent of teenagers who pledge virginity until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional sex education."

    By Blogger lbandit, At May 14, 2008 12:44 pm  

  • Thus, the conclusion is we need to strengthen abstinence education. Just a pledge is not enough, much more support is needed.

    The findings also suggest that 40% didn't engage in pre-marital sex, verses presumably 0% of those who use contraceptives, and the former are 100% safe in contrast to the latter.

    And, I think the main point of Angry Doctor is the need of local studies. Were the findings you mentioned been done within the local context?

    By Blogger dclh, At May 16, 2008 3:53 pm  

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