Monday Article #32: Sexually Transmitted Infections to Sexual Education

How often do you hear the word ‘sex’ in peers’ discussions? Almost none – it IS a taboo word in Malaysia. Not only it is rarely discussed, the quality of the mandatory sexual education (SE) delivered in Malaysia was questioned especially after the 2021 incident. This occurred in April where a teacher received a public backlash for making a rape joke while explaining sexual harrasment. This article aims to abstractly introduce sexually transmitted infections (STIs) and sexual education in Malaysia while addressing the relation of sexual education to STIs.


What is Sexually transmitted infections (STIs)? Sexually transmitted infections (STIs), commonly known as sexually transmitted diseases (STDs), are generally acquired by sexual intercourse such as oral, vaginal and anal sexual intercourse. All of which, involve the exchanging of blood, semen, vaginal or other bodily fluids that would pass the bacteria, viruses or parasites from one to another. To note, STIs may also be acquired through genital contact with infected partners. Common STIs are chlamydia, genital warts, herpes and HIV. Very often, these infections are symptomless, but symptoms may include itching, swelling or redness around the vagina or penis, unusual discharge from the vagina or penis, or even pain in the lower abdomen.


Fortunately, treatments are made easily available from local clinics. For instance, chlamydia and gonorrhoea can be treated by antibiotics and scabies can be treated with prescribed medical lotions. However, in the case of viral infections that can’t be cured such as HIV and genital herpes, treatments are used to relieve or suppress symptoms. Importantly, if these conditions were left untreated, pelvic inflammatory disease (PID) and infertility may culminate. Untreated STIs will also increase your chances of getting HIV.


How do we prevent ourselves from getting STIs then?

Abstinence is definitely the most effective amongst all for any sexual intercourse is not involved. Otherwise, ensuring the safety of sexual intercourse is very important, that is, condom usage and frequent STI testing will be inevitable. Furthermore, vaccines can be found extremely useful in preventing STI like Human papilomavirus (HPV).


STI in Malaysia

A 2012 Global School-bsed Student Health Survey that was carried out by MOH found that of all the students in Form 1-5, 50.4% of students had their first sexual intercourse before 14 years old. Among these 50.4%, only 32.2% used condom on their most recent sexual intercourse. This result reveals our adolescents’ early exposure to sex without protection agaisnst unwanted pregnancy, as well as STIs. Unsurprisingly, a positive trend in STI cases has been continually observed in Malaysia, especially for chlamydia, genital warts and herpes. In fact, according to the health indicators released by the Ministry of Health (MoH) in 2021, the reported cases of syphilis, gonorrhoea and AIDs cases sat at a high number of approxiamtely 3.5K, 2.4K and 1K, respectively. In that year itself, the incident rate of AIDs has gone up to 3.19 per 100,000 population. These shocking numbers continue to stress that the current sexual education provided should be looked into to ensure quality sexual education, which can be referred as comprehensive sexual education (CSE).



Data from: https://www.statista.com/statistics/999241/sexually-transmitted-disease-cases-malaysia/#:~:text=Number%20of%20sexually%20transmitted%20disease%20cases%20Malaysia%202020%2C%20by%20disease&text=In%202020%2C%20approximately%203.5%20thousand,for%20AIDS%20in%20that%20year.


Sexual Education (SE)

Sexual education – or sex education – is “used interchangeably to denote an age-appropriate and culturally relevant approach to teaching about sex and relationships with scientifically accurate, realistic and non-judgmental information.” One study from the United States demonstrated that sexual education interventions can prevent or reduce the risk of adolescent pregnancy, HIV and STIs among children, further reinforcing the association of sexual education to STI reduction.


Sexual Education in Malaysia

In Malaysia, sexual education has been integrated into secondary schools since 1989 and primary schools since 1994. It is taught as part of various subjects, including science, language, Islamic education and moral education. Since the changes and updates made in 2006, this curriculum has retained its name as ‘Reproductive Health and Social Education’ (PEERS). Various topics on sexual and reproductive health issues are taught throughout Year 1 to Form 5 in PEERs. PEERs is geared towards abstinence-only education that discourages the act of sexual intercouse by instilling fear of unplanned pregnancies and STIs rather than focusing on delivering comprehensive sexual education that better adolescents’ decision making capabilities in sex.


Further, in a 2011 study by the National University of Malaysia (UKM) found that 90% of their respondents reflected that sex education was not taught in Malaysian schools and all the relevant information provided were vary vague. Another study found that PEERs are highly focused on human anatomy and general biological functions, instead of human relationship, negotiation skills and biological topics like masturbation. We can thereby conclude from these findings that despite having sexual education integrated in taught subjects, there remains a huge gap in its content and delivery.


What can we do then?

To close the gap, several key players should be the main focus, that is, teachers and parents. Both parties need to be empowered to teach and talk about sex, with the support of set policies. Compulsory training needs to be provided to all Health Education teachers. Aside from the knowledge they already equipped, they need to learn the “what” and “how”of sexual education. how to identify their own biases and not assert them on students when they teach. They should also learn to be able to guide students on how to overcome their internal resistance, debunking myths and to encourage them to broach and discuss “sensitive” topics. While the teachers play a key role in delivering the formal teaching of sexual education, parents’ attiude and support are incredibly vital. Only with parents’ approval and support, the teachers will be less reluctant to deliver the content and their children will be more open to discussion. Nonetheless, a more robust monitoring and evaluation system need to be developed to ensure effective implementation of sexual education at school from district to national levels. To read more about the challenges faced by teachers and potential actionables moving forward, go to https://www.malaysiakini.com/letters/572815


In conclusion, in order to deliver a complete and effective CSE to our adolescents, the stigma around ‘sex’ needs to be broken by collective efforts from policies, teachers and parents for the consequently resolution of the many challenges faced.

 

REFERENCE(s):


http://www.myhealth.gov.my/en/sexual-transmitted-disease/


https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/HEALTH%20INDICATOR/Petunjuk_Kesihatan_2021.pdf


https://www.malaysiakini.com/letters/572815


https://core.ac.uk/download/pdf/81122559.pdf


https://arrow.org.my/publication/comprehensive-sexuality-education-for-malaysian-adolescents-how-far-have-we-come/


 

Article by: Lim Tze Yee


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