The Beauty in the Beast

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Let's Talk About Sex

What can developing countries teach us about sexual health?

For the past few weeks I have felt like I have been living in a time warp... or at least some alternate version of reality.  The argument that seems to have taken over the Republican primary, and the circus of discourse that surrounds it, transports me back to my tiny village in Africa.  I remember very clearly sitting in front of village elders explaining to them why it was important for them to allow me and my colleagues to educate their communities about sexual and reproductive health.  Many of the questions they had centered on the 'dangers of contraception'.  The key difference between sitting with the elders and listening to the rhetoric that has been coming out of the debate is that the elders were willing to ask questions and listen to what the facts were.  They were genuinely concerned about what was best for the people they represented, not what made them feel morally 'comfortable'.  We were able to have a productive conversation about their concerns, and they were willing to accept that times had changed. 

As a result of this conversation we were able to spend the next year training youth leaders in the communities on the ABC's of sexual and reproductive health. 

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Abstinence. Being Faithful. Contraception. 

That may seem like an odd concept to some.  To teach about both abstinence and contraception in the same breath.  To listen to Rick Santorum's version of what would happen if Americans were granted affordable access to contraception you would think that America would become some seedy sex-den previously only available in the red-light district of Amsterdam or an obscure Korean horror movie.

The reality is that none of this actually occurs.  In fact...the exact opposite occurs.  When you begin to educate people about the reality of sex in the world today, people actually start to make informed decisions.  They know the risks, but they also know the benefits.  There is little mystery left...and as such behaviors start to become LESS risky.

The clearest example of this comes from South Africa and Brazil.  Two countries that in the 80's were suffering from a HIV/AIDS epidemic.  The governments of each country took drastically different approaches to the situation and the difference was literally hundreds of thousands of lives.

While the discourse thus far hasn't really touched on the disease aspect of contraception, we can learn a lot about the benefits of education and access to contraception from the spread of HIV/AIDS in developing countries.  HIV/AIDS is associated with many of the 'taboo' subjects that we seem to fear talking about; sex, sexual orientation, and sexual infidelity... the very things that have been described as "counter to how things are supposed to be".  If we look at the approaches that countries are taking to tackle the issue of HIV/AIDS in their countries, we can see what really happens when you have an educated and informed population. 

Look at the data as presented by Gapminder; you can see the progression of HIV/AIDS in both South Africa and Brazil plotted over time.  These countries were both facing an epidemic, and were both on course to have a serious problem.  Then in about 1988 Brazil's numbers stop growing, while South Africa's continue to rise at an alarming rate.  What happened?

There are a few factors that I believe lead to the drastic difference in responses;

  1. In 1988 Brazil passed a new constitution that had a heavy focus on human rights.  It included provisions that directly addressed the issue of HIV/AIDS, including one that defended the right of those already infected to free healthcare.  This was most impactful because it solidified the government's commitment to tackling this issue head on. 
  2. Collaboration between the government, community groups, and key stakeholders.  The ability to join forces was perhaps the most outstanding feature of Brazil's approach.  The involvement of these groups allowed for stigma and discrimination to be reduced; human rights to remain at the forefront; and prevented moral and religious views from impeding prevention campaigns. 
  3. Brazil's culture surrounding sex and sexuality. In Brazil, they didn't bother with the argument about the 'dangers of contraception', they don't fear what might happen in the bedrooms of their citizens if they are given access to contraceptives.  They understand that sex, sexuality, and sexual expression are not in opposition to nature...they ARE human nature.  They accept that sex is an enjoyable act.  Sex is a natural expression and is not one that needs to be shamed in anyway.  By acknowledging this fact the people of Brazil are able to access information about the risks associated with sex; and not only do they have easy access to the information, they have access to contraceptive devices that allow them to have the safest sex possible.

I will not argue that there are no moral arguments to be made here, and the approach in Brazil was not without its controversies.  Religion is an integral component of South American culture, and Brazil is not an exception to this.  However, sexuality and sexual expression are also an integral component of Brazilian culture.  Issues are not considered taboo, and are discussed openly.  This cultural climate allows for an easier implementation of prevention programs.

The Brazilian government vigorously promoted the use of condoms.  State sponsored media campaigns, adverts, and the distribution of approximately 45 million condoms each month.  The messages conveyed by these campaigns are among the most explicit that any government has put forward, causing controversy among some groups.

Yet despite the controversy, the Brazilian government had the fortitude to put the health and wellbeing of its citizens above the concerns of special interest groups. 

It took South Africa about 10 years to begin to implement programs similar to those in Brazil, and the results are evident as infection rates began to level out at approximately the same time.  Today condoms and the pill are widely available, for free, to those that want to use them. 

Prior to this, South Africa took a position not drastically different to those coming out of the Republican primary.  Talking about sexual matters was not considered appropriate.  It was taboo and as such parents did not talk to their children about sex and sexual matters, and in no way was sexual education a part of the curriculum.  When issues were discussed the misinformation that was given out was astounding.

As a result of this policy of fear and misinformation hundreds of thousands of people needlessly contracted HIV/AIDS.  Long held beliefs about sex, and about contraception literally killed people.  It wasn't until the leaders of political organizations, and elders of communities started putting the well being of their people above their moral objections that infection rates began to decline.  De-shrouding sex has saved lives.

While the example of HIV/AIDS in South Africa and Brazil is more dramatic than the discussion of contraception in the United States there are still lessons that can be learned.  The most important being that educating your population and providing access to contraceptive methods leads to an improvement in health and well-being.  Information and frank discussions about sexuality actually leads to more responsible decisions.

The reality is that people enjoy sex.  No one is saying that abstinence is not the ultimate 100% assured way of preventing disease and unwanted pregnancy.  It just seems like an antiquated idea to believe that people are going to only practice the biblical version of what is 'appropriate'.  Rick Santorum and Mitt Romney may wish that things were different; but they aren't. 

People no longer get married when they are 15 years old and as a result more and more people are engaging in premarital sex.  Providing access to contraception does not lead to anything 'abhorrent' or 'abnormal'...in fact, one only need to look to TLC to see that perhaps abstaining well into your 30's is in fact the new abnormal.  If you ask me this first kiss is most definitely not 'normal'.

 

Further Reading:

http://www.nytimes.com/2012/03/01/us/politics/romney-sets-off-furor-on-contraception-bill.html
http://www.avert.org/aids-brazil.htm
http://www.nejm.org/doi/full/10.1056/NEJMp068069
http://cyber.law.harvard.edu/blogs/gems/politicshiv/liebermanpaper.pdf
http://www.princeton.edu/~esl/Gauri-Lieberman_Final.pdf

 

 

Jaime Cundy is a writer and a graduate of the University of Pennsylvania's Masters of Applied Positive Psychology program.

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