International Association for Adolescent Health World Congress 1…
After arriving in Kuala Lumpur at 10 and finally getting to bed at 11:30 the first day of the IAAH 9th World Congress began in earnest.
I left the hotel at 7:30, and by 7:32 I was sweating more than I have in my life, without breakfast in my tummy (I thought a sleep in would be better). The conference kicked off (and remained) on time, the whole day. Fantastic. Below are a few highlights from the day, with more to come later.
Safer Sex from A-Z : Teaching Youth the Whole Alphabet
Plenary by Willard Cates Jr.
Willard commented on the issue of HIV and STIs as a youth problem. For those of us working in the youth health field, this comes as no surprise, but it always helps to have a refresher. When we look at adolescents we are dealign with a multitude of factors that increase their link to HIV and STIs.
- Biological Disposition
- Behavioural Disposition
- Social Networks
- Lack of life experience and being at a time in their life where they actively seek sex to see what they like
Add to this the fact that youth sexual health is a political lightning rod and it is a dangerous topic to broach.
And when it is broached, it is often broached in a very polarising way, which Willard likes to describe as the ABC approach. We choose from Abstinence and Being Faithful, or Condoms. This approach divides people greatly, and makes us think about sexual health in terms of ‘prevention from illness’, but there is a real opportunity to start thinking about ‘sexual health’ in terms of wellness and staying well.
To give a bit of a global perspective on the issue, consider the statistics provided:
- 1/4 of women under 19 have an STI in the USA
- There is a massive racial disparity between Caucasian, Latina and Black women, with Caucasian women having the least number of infections
- There is a very high prevalence of STIs soon after sexual debut, so much so that future thinking might see the genital herpes virus not so much as an STI, but as a marker of sexual activity.
- An increase in STI infection in rural youth is occurring
Willard went on to talk about the two ABC arguments.
The Abstinence Group states that abstinence provides 100% protection against STIs. When we look at how it works, this is essentially true, so funding and legislation was provided for that method, however it got to the point where funding and legislation removed condom education from the picture, going so far as to talk negatively about condoms.
So, they have a point, when used perfectly abstinence is great, but it is rarely used perfectly. When used perfectly, the chance of a non HIV+ partner in a relationship with a HIV+ partner contracting the illness is near to 0%, but when used ‘typically’, that chance increases to around 80%. In saying that, there is a lot of research on either side, that suggests comprehensive and abstinence only sexual health education programs do or do not work, some with more bias than others.
Overall, the main problem with abstinence only is adherence.
On the other hand, the Condom argument people argue for aggressive condom distribution tactics, which can be culturally inappropriate. Some programs which encourage 100% condoms use, like sex work parlours in Cambodia, have seen massive reductions in new HIV infections in these environments, so perhaps there is merit in that argument.
Some more stats, for those who are interested:
In a HIV discordant couple (one positive partner, one negative) for those who always use condoms, there is an 0.9% chance of contracting HIV, for those who report sometimes 5.1% and for those who report never – 6.5%.
The main problem with condoms (get ready for a punchline) is also adherence
Now, the main benefit in both condoms and abstinence is they create a delay. And delay is one of the greatest things we can create in health promotion. And as both can be effective, we need to use the right message for the right audience at the right time. No approach should be used alone. We can move towards a holistic view of healthy sex, rather than absence of disease, where we talk about sex as consensual, non-exploitative, honest, protected and pleasurable. And for many of us, pleasure will be the hardest to to talk about.
