Under-age-24-your-biggest-health-risks-may-surprise you

2016-11-25

Everyone by now has heard the mantra of how important safe sex is. But a new study shows that it is actually more important than originally thought – that just one or two sexual encounters without a condom is becoming increasingly likely to spread a sexually transmitted disease, including Human Papilloma Virus (HPV), which can lead to cervical cancer, and Pelvic Inflammatory Disease (PID) which can lead to infertility and ectopic pregnancy. Of course, those are just some of the risks of unprotected sex. We’ve long been warned about the dangers of HIV and Hepatitis, Herpes, Genital Warts, Syphilis, Gonorrhea and unplanned pregnancy, which can lead to serious physical, emotional, financial, psychological and societal fallout. With all of these dangers so well known, it seems reasonable that people would be taking more preventive steps to stop these maladies, but in a new report from a Lancet Commission, these risks continue to be major plagues of those aged 10- to 24-years-old, according to World News. John Santelli, MD, MPH, and chair of the Heilbrunn Department of Population and Family Health at Columbia University’s Mailman School of Public Health, said that globally, much more needs to be done to ensure the wellness of young people and prevention of sex-related concerns.

“From a life-course perspective, adolescents stand at the crossroads of the major challenges to global health: HIV/AIDS, intention and unintentional injuries, sexual and reproductive health, and chronic disease. Investments in adolescent health have the potential to alter the future course of global health. Every year of education beyond age 12 is associated with fewer births for adolescent girls and fewer adolescent deaths for boys and girls.”

While developed countries typically see less morbidity and fatality than third-world nations, it is important to note that two-thirds of the world’s youth are growing up in countries without critical access to health care, sexual education, birth control, and disease prevention. This is felt on the global level through the intense need for international charities to address concerns in these countries, but it’s not nearly enough. That’s not to say that those young people in first-world countries aren’t severely affected by poor sexual decision-making and lack of accurate sex education – it remains one of the top two health concerns for young people in Europe and the United States as well.

Of interest, and perhaps of correlation, depression is the other major health risk to young people globally between the ages of ten and twenty-four. Depressed people often have difficulty making decisions, or they may be apathetic about their future and take more risks than those who are not depressed, studies have shown. Regardless of etiology, unsafe sex is the fastest growing risk, rising from 13th place in 1990 to 2nd place in 2013, depression is no longer something that can be universally ignored: it is responsible for the “largest amount of ill health” across the world in 2013. The report stated that more than one of ten people aged ten to twenty-four is depressed globally, meaning that many social indicators such as wealth or culture may play less of a role in depression that once believed. In the United States, suicide remains one of the most common causes of death for young people.

n fact, according to the National Catholic Register, children are now more likely to die from suicide than from motor vehicle accidents, according to the Centers for Disease Control and Prevention. Dr. Marsha Levy-Warren, a clinical psychologist who works with adolescents, says that social media is likely a causative factor, particularly for younger teenagers. Interestingly, even third-world countries have considerable access to the internet in various locales.

“It’s clear to me that the question of suicidal thoughts and behavior in this age group has certainly come up far more frequently in the last decade than it had in the previous decade. If something gets said that’s hurtful or humiliating, it’s not just the kid who said it who knows, it’s the entire school or class. In the past, if you made a misstep, it was a limited number of people who would know about it.”

Nepal Youths Make Sexual Health Services More Accessible

KATHMANDU (IDN) – 21-year old Pabitra Bhattarai is a shy young woman with a soft voice and a ready smile. But, ask her about sexual health services and the shyness vanishes in an instant as she speaks passionately of how youths of her country must have rights to such services.

“Our country runs on the shoulders of young people. So, we can’t risk having a country full of young people with HIV. We must have full access to sexual and reproductive health services (SRHR),” she says, suddenly sounding far more mature than her age.

Yet, rhetoric alone doesn’t define Bhattarai who is already counseling and making aware hundreds of youths – most of them high school students – in SRHR. “I have been to over 20 schools in Bhaktapur, Kirtipur and Lalitpur,” she says.

Youths for youths

On a late October morning, IDN catches up with Bhattarai and two other youths as they set out for a school to a government-run high school. The youths, trained and supported by Marie Stopes International (MSI) – a global organization working on SRHR – are part of a 10-member group called ‘Rocket and Space’ that aims to educate in and give access to SRHR to every youth of their city and region.

The youths try to flag down a taxi in Putali Sadak – a busy marketplace of Kathmandu. But soon they learn that there is a taxi strike in the city and the only vehicle available to them is a newspaper delivery van with no seats. This however fails to dampen their spirits as they readily sit on the floor of the van and start, ready for an hour-long drive to a government-run high school in Baudha neighborhood.

They have been invited by the principal of the school, Bhattarai reveals, to speak with the students in 11th and 12th grade about sexual health and hygiene. “They think we can do it better (than them),” she says with a tinge of pride in her voice.

“No taboo” education

An hour later, the three youths tumble out of the van and enter a fortress-like building of the government-run school. Sitting in two semi-dark rooms of the 3 stories building are about a hundred adolescent boys and girls. While her male colleagu Suraj meets the boys, Bhattarai and her female colleague Deepali Pradhan head for the girls room.

The school authorities have specially requested the volunteers to tell the girl students about menstrual hygiene, Pradhan informs. So, for next 45 minutes, the young women explain to their audience the process of menstruation: they start a conversation by asking the students what changes when they have their first periods.

The students typically look at each other and smile nervously. The youth workers encourage them to speak, saying, “Look, I am just like you, I am like your elder sister”. Slowly, a girl stands up and says “sprouting of breasts”. Bhattarai asks everyone to clap for student. With that, the ice begins to melt.

For the next 45 minutes, Bhattarai and Pradhan touch upon all aspects of menstruation: the expected physical changes, the cramps, the menstrual cycle and how to count it and the importance of maintaining hygiene during this cycle. “Their family members and their teachers feel embarrassed to talk about these things. And the girls also feel shy to ask. But when we talk, they listen. They think, we are their friends,” Pradhan says.

In the boys’ room, Suraj Khadka, the young Rocket and Space member, talks about adolescence, physical attraction to the opposite sex, masturbation, condoms and the importance of safe sex.

Batting for the Disabled

Dan Bahadur is 19 years old and physically challenged. Since May this year, he has been educating fellow youths with disability in his city on SRHR.

There are 3 million people with disability in Nepal today, says Bahadur, and nearly half of them young. Not long ago, they were socially ostracized, he says: “People looked down upon the disabled. They were seen as people who brought bad luck to others.” Today, however, there are special facilities for people with disability, including quota in educational institutions and government jobs.

Yet, when it comes to sexual health, the disabled people, especially youths are normally forgotten. Bahadur wants to change that, but so far, the goal has remained a big challenge. “People laugh at me when I talk of SRHR. Some think it is weird and even ask me, “do disabled people have normal sexual needs?”

There are, however, a lot of people who give him support. Many of them are from people with disability themselves, including players from the national Wheelchair Basketball Association – an institution promoting and campaigning for sportspersons with disability. Bahadur has met several players, made them aware of their SRHR rights, including contraception, abortion, counseling on sexual health and hygiene.

Nilima Raut, MSI’s Youth project manager explains, “The main slogan of the UN of Sustainable Development Goals itself is ‘Leaving No One Behind’ and in reaching out to disabled youths we are making an effort to achieve that.”

Talking Sex in a conservative society

Here are, however, challenges galore as Nepali society is largely conservative where premarital sex is a taboo. Vinuka Basnet, a 20-year old college student says that her parents were shocked when they came to know she was working as a sexual health worker. ‘They were embarrassed and afraid that now everyone would point at me and say “she talks of sex”. It took a long time for her to pursue her parents, she recalls.

Suraj Khadka says that since the school syllabus does not include sex education, students do not see his lessons as important enough. “They laugh and ask me questions that are irrelevant.” He, however, has a solution: “Let them laugh, but encourage them to ask what’s relevant to them.”

Others like Dan Bahadur often find communicating sexual health in their local language very challenging: “Take ‘nightfall’ for example. There are no synonyms for that in Nepali. Disabled youths who have spinal injury will have nightfall, but cannot feel it as they are paralyzed down the waste. It’s important for them, as well as for those who care for them to know this, so they can maintain cleanliness. But when I try to explain this, I am at loss of words,”

Youth-friendly tools

But, since success of the youth SRHR educators depends on their communication with their fellow youths, they have formulated innovative ways to overcome the communication barriers.

Vinuka Basnet shows off some of the tools that include coloured pictures of male and female anatomy and reproductive organs, posters, brightly colored T-shirts and bracelets with slogans such as “No condom, no sex” and “I am a rock star”.

They carry these tools with them at every meeting. While the posters and the pictures are used to educate the youths, the shorts and the bracelets are distributed among the attendees for positive and enthusiastic response.

Meeting the Unmet needs

Nepal legalized abortion in 2002 to achieve the MDG 5, the Millennium Development Goal 5 (to decrease maternal mortality by 134/10,000 by 2015). During the MDGs era (2000-2015), the country made significant progress and the mortality rate decreased from 581/10,1000 live births to 281/10,000 live births (National Demographic heath survey, 2011).

Yet, latest statistics show that Nepal (27.5%) still has a very high unmet need for contraception in the Asia region. In terms of unmet need indicator, at least 14% and 12% of married or in-union women of reproductive age, in Southern Asia and South-Eastern Asia want to delay or avoid a pregnancy and are not able to do. Also, almost half the population is unaware that abortion is legal in the country.

This is where the youth health volunteers are making a big contribution, taking SRHR to the most vulnerable and needy sections of the society: migrant workers, slum dwellers and young women whose husbands have gone abroad to work as migrant workers.

23-year old Kavita Chulagani is a young mother whose husband works in the Middle East as a driver. Kavita uses vaginal implants as a contraceptive, which she received for free at a clinic run by the Meryl Stopes clinic. It would have been very difficult for me to access this,” says the young mother who lives in a slum in the city outskirts, “but the youth workers directed me to this place. Now I am telling women of my neighborhood to come here too,” she says.

According to Raut, there has been over 100% increase in the demand for SRHR services since the youth project started. “There are still a lot of people to reach, but the increasing demand gives us hope,” she concludes. [IDN-InDepthNews – 24 November 2016]

Photo: Youths of Rocket and Space group in Kathmandu brainstorm on how to make their presentations on Sexual and Reproductive Rights more effective. Credit: Stella Paul | IDN-INPS

I’m Married…Do I Still Need to Get an HIV Test?

2016-11-15

’m willing to bet most married people don’t use condoms. As a woman I encountered while tabling at a health fair the other day might put it, “Isn’t that the whole point Marriage is about trust. Unplanned pregnancies and getting HIV shouldn’t be an issue once you’re married.” And maybe she has a point. So why can’t I help but cringe during my work day as a sexual health hotline specialist every time a caller tells me, “I’m married so I haven’t been tested in years.”?

Maybe it’s because as a married woman who has worked in the sexual and reproductive health field for almost 8 years I know that a wedding ring isn’t nearly as effective at protecting you against HIV/STIs as a condom, but before I climb onto my sex educator soapbox, I think it’s important to mention that I don’t use condoms with my husband either. However, I think what bothers me when women dismiss regular testing as a part of their sexual healthcare is the implication that getting tested must mean you don’t trust your partner or that someone has to be cheating.

Most days when I talk to women about missed periods, yeast infections and even fertility awareness as they ask for help pinpointing their ovulation so they can discover who the father of their child is (the hardest calls are the ones where I honestly can’t confirm between the two men because the sexual encounters were too close together) I’m just happy to get a woman to see a gynecologist. With more and more people being unable to afford insurance and access routine healthcare, it’s not out of the ordinary for women to tell me that the only time they see and OB/GYN is when they’re pregnant. What bothers me most about the idea that HIV/STI testing is unnecessary in a committed relationship is the idea that those things are the only reason to see a medical professional.

I still get tested regularly, and it’s not because I don’t trust my husband, it’s more so because while I’m getting my annual exam to make sure I’m free from fibroids, ovarian cysts and bacterial vaginosis, I figure why the hell not? With 14 million new HPV infections occurring each year, there’s more to maintaining your sexual health than making sure your boyfriend hasn’t “burnt” you. So please, save the “I’m married. STIs don’t happen to me” excuse for someone who thinks that moral superiority actually means anything to cervical cancer. STIs don’t just happen to promiscuous commitment-phobes, they happen to women who have been asymptomatic for years who although may be faithful to their current partner, haven’t had a pap smear in years so they don’t know they’re infected with HPV. They happen to women who don’t realize the “change in their bodily odor” is not due to age but a persistent case of bacterial vaginosis that the never bothered to get diagnosed all because they were too busy being a wife instead of a patient. And yes, they happen to women who thought that marriage was supposed to mean trust, but their husbands missed the message and have now infected them with HIV after years of infidelity.

Much like a pre-nup, if your partner has the best intentions for you and nothing to hide, an HIV/STI test shouldn’t make or break your marriage. Anyone that loves you should want you to take whatever steps you think are necessary to protect yourself without being offended. But most importantly, married or not, your love for your partner should never take priority over your respect for yourself. This is coming from a woman who STILL hasn’t managed to schedule a wellness visit for herself despite making sure hubby got his cholesterol check and my toddler got her flu shot. I get it, as a wife and mother it becomes all too easy to put yourself last and convince yourself that it’s OK because you’re “living the dream”. But don’t get it twisted: Sexual health isn’t something that ceases because homeboy decided to make an “honest woman out of you” and you shouldn’t use the comfort of marriage and kids to stop prioritizing your health as a woman.

Toya Sharee is a community health educator and parenting education coordinator who has a  passion for helping  young women build their self-esteem and make well-informed choices about their sexual health.  She also advocates for women’s reproductive rights and blogs about  everything from beauty to love and relationships. Follow her on Twitter @TheTrueTSharee or visit her blog, Bullets and Blessings.

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