Pawana Wienrawee and Carol Livingstone, respectively technical adviser for PATH (Programme for Appropriate Technology in Health) and Bangkok-based journalist.
A Vietnamese poster.
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You have to start from the ground [children and youth] with education, so that youth will grow fruitfully and be protected from Aids. If not the tree will die. Youth delegate to the fourth International Congress on Aids in Asia and the Pacific, Manila (Philippines), October 1997. |
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HIV/Aids in South and East Asia The five hardest hit countries… *adults refers to the 15-49 age group Source: UNAIDS, 1998. |
While the
region increasingly taps the media’s potential to spread the message on Aids prevention,
traditional taboos continue to hamper the educational programmes
MTV Asia
is currently broadcasting an excellent HIV-prevention campaign. Savvy and modern,
MTV’s commercial efforts reach affluent youth in major cities. The music lovers who
see MTV’s HIV education spots have the means to afford condoms and protect themselves.
These young people include many of the future leaders of Asia’s next generation.
But the majority of youth in the Mekong region –young agricultural workers in rural
areas, newly arrived factory workers in big cities, day labourers on construction
sites and others–don’t have access to MTV’s message. Much of the HIV and Aids education
aimed at youth takes place in schools, but it usually only begins after the sixth
grade. A large number of young people have already left school by this age. In Cambodia,
for instance, only 40 per cent of children continue their education after their sixth
year.
Throughout the region, traditions still act as a sizeable obstacle to effective
HIV/Aids prevention programmes. Sexual education is not considered a part of the
natural process of growing up. Parents still greatly influence their children’s choice
of marriage partners. In countries like Cambodia and Myanmar, arranged marriage is
often practiced. Pre-marital sex for “good” women is considered scandalous. Couples
often do not date, and thus, sexual negotiation doesn’t begin until well into the
marital relationship, if ever.
Scare
tactics
As in many countries,
teachers and students in the region often have trouble discussing sexual issues in
the classroom. Teacher trainers, who help teachers learn to discuss sex with their
students, often find that these adults have never touched a condom before and are
frequently embarrassed while giving the lessons. Most grew up in an environment in
which sex was never discussed. Often, the task of conducting sessions on condom education
is left up to NGOs. Partly because of the traditional difficulty of talking openly
about sexual issues, many of the education programmes have focused on scare tactics:
if you have sex or inject drugs you will get Aids and die. Youth can often list what
is considered appropriate and inappropriate behaviour, but this knowledge doesn’t
always change how they act. Traditional taboos have filtered into the formal and
non-formal health education systems, and affect how governments and societies at
large perceive sexuality and HIV. For instance, condoms were illegal in Myanmar until
1992. In some countries, a woman carrying one would be considered a prostitute by
many members of her community, including the police.
Effective youth education programmes need to equip young people with the skills
and knowledge to effectively negotiate their sexual behaviour. Such programmes must
start out by listening to the students, finding out about the reality of their sexual
lives, and helping them to deal with these situations. The reality is that throughout
Southeast Asia there have been fairly profound changes in sexual morals and social
behaviour: for instance, young couples are now more likely to hold hands than 20
years ago. Partner selection in countries such as Thailand is now often left to the
young themselves. Advertisements show a life in which an acknowledgment of sexuality
is the social norm.
Still, many traditional attitudes towards sexuality prevail and some have a particularly
high cost. Because female virginity is highly prized in some countries, it is considered
acceptable for young men to visit prostitutes. The sex trade has been a major cause
of the spread of Aids in the region. In Thailand, there are now more men infected
with HIV than women, but the ratio is expected to be even by 2005. Forty-four per
cent of the prostitutes in the northern region of Thailand are thought to be HIV-positive.
In Cambodia, that figure is over 60 per cent in some areas.
Dealing
with prostitution
In Cambodia, they
start at 13, or even younger. Many sex customers delude themselves by thinking that
they are less likely to contract HIV from the young. By UN standards, 80 per cent
of the sex workers in Cambodia are youth. In other countries, many young hill tribe
women have ended up in the sex industry. And this trade continues to grow.
Many governments have tried to deal realistically with the prostitution issue. For
example, Cambodia and Thailand have supplied condoms in brothels. This is an important
measure, when you consider that the young, less well-off men who drop out of school
before being taught about HIV-prevention and reproductive health, are among those
who may feel they can’t afford a condom. But not all condoms are free. Poverty, especially
among youth, plays a major role in the spread of the virus. What appears to be a
cheap price for a condom to an office worker in Bangkok, may be prohibitively expensive
to a bicycle tire repairman in a village. As many African programmes have shown,
money for education and prevention in all forms, from all sectors, is a key factor
in fighting the spread of the virus.
Because so many young people in Southeast Asia are beyond the reach of traditional
HIV/Aids education programmes, many of the most successful ones have involved peer
group talks. These might take place in the workplace, informally at someone’s home,
during youth festivals, vocational training programmes or via other community activities.
Peer-to-peer education involves not just discussing Aids and the peer pressures
involving sex, but includes talking about everything, helping young people gain life
skills to negotiate all the issues in their lives.
The local media that may reach the majority of the less-educated population make
an important contribution to forming people’s attitudes to HIV. Soap operas have
been a successful medium for spreading the HIV message in Viet Nam. A non-governmental
organization in Cambodia sponsored a boat tour along the Mekong to produce a video
about an HIV-positive Cambodian soldier returning home. Because it was well-made
and captured the audience’s interest, the video was an extremely effective education
tool and was seen by over 100,000 in the space of three months.
To counter given the many negative representations of Aids victims in Thailand,
a group of NGOs has commissioned a series of portraits of young people with HIV.
Professional photographers, many of whom have worked with fashion magazines, have
donated their services to help young people see that these individuals are as beautiful,
and as full of life, as everyone else.
The epidemic, which disproportionately affects young people, must be seen as a socio-economic
and a development problem by governments and society at large. Unless there is a
rapid and effective response, it is foreseeable that Aids will curb the economic
growth of the region in the years to come. It is imperative that development plans
incorporate an HIV/Aids perspective, and all the more so when dealing specifically
with programmes targeting the region’s youth.
