Asian cultural taboos hide links between sex and HIV/AIDS

Marwaan Macan-Markar

Modified 29 Jan 2008, 10:21 am

The spectre of HIV/AIDS moving from the margins of society to the mainstream should prod Asians into taking a hard look at taboos that help the pandemic — including how openly they can talk about sex.

But the answer to whether the region actually does this is mixed, say experts promoting the need for more candid discussions in the region on the links between sex and HIV/AIDS.

There are progressive attempts toward this by groups in Thailand and the Philippines. Yet even in these countries — as in most other countries — a "culture of silence'' prevails inside homes.

''Sex now figures prominently in the print as well as broadcast media,'' says Michael Tan, a medical anthropologist at the University of the Philippines and activist on reproductive health issues, including HIV/AIDS.

But while issues like the importance of safe sex — including condom use and concerns over risky sexual behaviour — are discussed in the Philippines, he points out that this is having ''little effect''.

None of these discussions occur at home, where ''parents feel uncomfortable about sex talk'', he notes.

Need for frank language

A parallel situation is found in Thailand, often hailed as an Asian leader in bold measures to break cultural taboos that hinder frank, public discussions on the dangers of unprotected sex in a country seriously affected by HIV/AIDS.

''The Thai school system has responded. The curriculum is moving toward a broader sexual theme,'' says Greg Carl, who works on HIV/AIDS and behaviour change at the Southeast Asia division of the United Nations Children's Fund (UNICEF). ''In Thailand, the curriculum requires that condom use should be demonstrated.''

However, these classes, often taken by the school health teacher, lack a frank and direct language that youth could relate to and gain from.

''The discussions are detached and vague,'' explains Carl. ''The teachers have not been trained to deal with this in a non-prescriptive and non-judgemental manner.''

India's peer programme

India, too, offers a similar dual reality. It has a peer education programme in universities that seeks to address the links between sex and HIV/AIDS.

The programme has been praised by the Joint United Nations Programme on HIV/AIDS (UNAIDS), but that does not mean that it is any easier to hold public discussions touching on sex.

''The peer education programme has been accepted by government policy-makers. This enables youth to talk with their peers on sex and HIV/AIDS,'' says Swarup Sarkar, former head of the UNAIDS South Asia division. ''The media are also talking about it.''

However, these efforts have still not shaken the dominant attitude among Indians of feeling ''shy and shameful to discuss anything related to sex in the public domain", says Shaleen Rakesh of the Naz Foundation, a New Delhi-based trust that deals with sexual health issues.

''Only the youth in urban, metropolitan cities are beginning to feel freer to discuss these issues amongst themselves. But even this is not true universally.'They still feel embarrassed and hesitant because the environment is constantly policing them and judging them on these matters," he adds.

Women and youth at risk

The need for such discussions in both the public and private realm has gained greater urgency in light of a UN report on HIV/AIDS released Tuesday, which reveals that 435,000 people died from the disease in Asia and the Pacific last year.

Likewise, those who stand to gain most from candid discussions are the region's youth — also the ones at great risk of bearing the brunt of the pandemic, adds the Report on the global HIV/AIDS Epidemic released by UNAIDS.

At the end of 2001, there were 1.1 million young people between the ages 15 to 24 in South Asia and 740,000 in East Asia and the Pacific living with HIV/AIDS. Some 62 percent of them were women in South Asia. In East Asia and the Pacific, women made up 49 percent of those living with HIV/AIDS.

The preponderance of women sufferers in the Asia-Pacific reflects the global trend, which shows that 7.3 million young women and 4.5 million young men had HIV/AIDS at the end of last year.

In all, Asia-Pacific was home to more than 6.6 million people living with HIV/AIDS at the end of 2001. That makes it the region with the most number of people with HIV/AIDS after sub-Saharan Africa, which has 28.5 million people with HIV/AIDS.

India has some 3.97 million people living with HIV, which makes it the country with the most number of people with HIV in the world after South Africa, and Thailand has 670,000 people with HIV/AIDS.

Misconceptions about transmission

These numbers may increase in the future given what a companion report to the UNAIDS publication reveals -- ''that the vast majority of young people have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease''.

This report, also released by UNICEF on Tuesday, points out that in four Southeast Asian countries — Cambodia, Vietnam, Indonesia and the Philippines — between 58-95 percent of girls aged 15 to 19 have at least one major misconception of how HIV can be transmitted.

Thus, UNICEF argues, there is no substitute to an open, frank exchange of information about sex and HIV to protect young people.

''Adolescents must learn the facts before they become sexually active, and the information needs to be regularly reinforced and built on, both in the classroom and beyond,'' it states in the report Young People and HIV/AIDS: Opportunity in Crisis .

At the heart of any education efforts should be the ABCs of Prevention,'' where young people must be encouraged to ''abstain from sex (or) delay the first sexual experience, be faithful to one partner (and) consistently use a latex condom properly'', the report adds.

Many Asian countries are heading down this road, but experts agree that the region still has many miles to travel to achieve what the youth need — a regular, frank flow of information.

Parents also need to be part of this process, says Filipino academic Tan. ''We need to educate parents so they can feel comfortable to handle the issues.'' — IPS