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HIV-positive at 18: Why teenagers risk their sexual health and what parents can do

SINGAPORE — At DTAP Clinic, a private clinic that offers testing for the human immunodeficiency virus (HIV) and sexually transmitted infections (STIs), Dr Ezlyn Izharuddin has supported and treated patients with such diseases from all walks of life and across different ages.

HIV-positive at 18: Why teenagers risk their sexual health and what parents can do

Teenagers are usually more concerned about pregnancy than diseases and do not practise safe sex, a counsellor for youth said.

  • In 2018, four of the new HIV cases reported among Singapore residents were aged 15 to 19. The number went up to nine in 2019
  • Doctors and counsellors said that fear and stigma among teenagers may result in delays in seeking treatment for sexually transmitted infections
  • Teenagers are also usually more concerned about pregnancy than diseases and do not practise safe sex
  • Parents and trusted adults need to have more open conversations about healthy sexuality with the young, counsellors said

 

SINGAPORE — At DTAP Clinic, a private clinic that offers testing for the human immunodeficiency virus (HIV) and sexually transmitted infections (STIs), Dr Ezlyn Izharuddin has supported and treated patients with such diseases from all walks of life and across different ages.

A case that stood out for her was a teenager who tested positive for HIV, which can lead to the acquired immunodeficiency syndrome (Aids) if left untreated.

At 18, the boy, who had multiple sexual partners, was infected through sexual activities. It was detected during a routine health check-up, she said.

Dr Izharuddin’s 18-year-old patient is not a unique case in Singapore.

Between November 2019 and February 2020, social workers and counsellors at Youth Service@Children's Society saw three cases of teenagers with STIs.

The organisation is one of Singapore Children’s Society’s service centres supporting at-risk youth.

The cases were referred by the Youth Court for Beyond Parental Control Statutory Supervision Order, which was renamed Family Guidance Order from July 1. 

A spokesperson from the Singapore Children's Society’s Children and Youth Services said that the three teenagers each had multiple sexual partners whom they had known mostly through Instagram or through friends, and they had not practised safe sex.

In recent years, the Department of Sexually Transmitted Infections Control (DSC) Clinic on Kelantan Lane in Jalan Besar has seen some infected patients who are around 14 years old. The clinic is a public specialist facility that provides diagnosis, treatment and control of STIs.

Common STIs in Singapore are chlamydia, gonorrhoea, syphilis as well as genital warts and genital herpes.

While the highest proportion of STIs here occur among adults between the ages of 20 and 39, based on the most recent STI updates on DSC Clinic’s website, these infections also pose a threat to teenagers.

More than 400 boys and girls aged 10 to 19 were diagnosed with STIs in 2018.

In the same year, the Communicable Diseases Surveillance Singapore report from the Ministry of Health (MOH) showed that four out of 313 new HIV cases reported among Singapore residents were from the group aged 15 to 19.

Last year, the cases rose to nine in the same age group, from 323 new cases among Singapore residents.

Sexual intercourse was the main mode of HIV transmission. In 2019, the mode of transmission for six of the nine cases from the 15-19 age group was via sexual activities among homosexuals or bisexuals.

WHY AREN’T TEENAGERS PRACTISING SAFE SEX?

Speaking to TODAY, health experts said that teenagers face a unique risk for STIs due to behavioural and biological factors.

They highlighted the need for their parents and trusted adults to have more open conversations about healthy sexuality with the children.

For one, social norms and lifestyles have changed, with teenagers having greater exposure to sexual material and easier access to sexual partners through the internet.

The Singapore Children’s Society’s spokesperson said: “The general sensing is that the youth are becoming more liberal in their attitudes towards sex. Hence, more of them may have sexual encounters before adulthood.”

Adjunct Associate Professor Martin Chio Tze-Wei, head of the DSC Clinic, pointed out that while today’s youth may be savvier about safe sex and contraception, it is not translating into action.

Ms Roslinda Mohd Noor and Mr Rahman Katama, counsellors at the DSC Clinic, said that most adolescents they have seen usually do not use condoms at all due to reasons such as peer pressure and a mentality that “it won’t happen to me”.

The Singapore Children’s Society said that spending money to buy condoms is also usually low on teenagers’ priorities due to a few reasons: Limited allowance; the notion that unprotected sex is a sign of love; and perceived decrease in pleasure.

Its spokesperson said: “Besides, the embarrassment to be seen buying or to be questioned for buying condoms when they are underaged may deter them as well.

“Carrying condoms may also be read as them having pre-meditated the sexual activity.

“Having said that, some teens are likely to engage in sexual activity in the heat of the moment whether there is protection or not.”

She goes on to explain that in teenagers, the frontal lobe of the brain — which controls reasoning, decision-making and judgement — is not fully developed.

“There is a tendency to make more impulsive decisions and take risk. Interest in romantic and sexual relationships, as well as strong emotions drive their decision. It is common for youth to have an ‘it will not happen to me’ mindset, thus limiting their ability to assess long-term consequences against short-term pleasure,” she added.

Mr Rahman of DSC Clinic said that there is also a common misconception that STIs can only be acquired by having sex with sex workers.

“(Teenagers) are also usually more concerned about pregnancy than STIs and so they practise precautions such as the withdrawal method, and having sex during or immediately after menstruation. However, these are unreliable in preventing pregnancy and STIs,” he said.

Ms Roslinda, a senior counsellor at DSC Clinic, said that certain factors such as dropping out of school, alcohol use, involvement in gang activities, absence of a mother figure, poor relationship or absence of a father, televised programmes that portray teen sex as a norm and access to pornography may also contribute to the initiation of sex.

A VULNERABLE GROUP

Living with an STI is hard on anyone but teenaged patients are a particularly vulnerable group.

Adjunct Assoc Prof Chio of DSC Clinic said: “Teenagers may not be equipped emotionally to deal with the situation. They may not be able to tell parents or anyone in school due to fear, stigma and thus, there may be delays in seeking care.

“This may result in a delay in diagnosis and hence, a higher chance of complications arising from the sexually transmitted infection.”

Dr Izharuddin said: “Having been diagnosed at a young age and not yet achieving financial independence would mean this group of vulnerable individuals needs extra care, attention and support.”

She added that most of the younger patients who visit DTAP clinic for STI testing and management do so without their parents.

It would be ideal for teenaged patients to have their parents with them for their follow-up appointments, Dr Izharuddin said, but she acknowledged that many would not be comfortable with it.

While patient confidentiality is assured to the majority of the patients, maintaining confidentiality is not absolute in certain situations whereby safety is a concern for the patient, for example, in cases of suspected abuse, Dr Izharuddin said.

Adjunct Assoc Prof Chio said that for STI cases involving patients under the age of 16, a police report may have to be made — if not done previously — to protect the vulnerable young person in the hope of preventing a future occurrence.  

“They are also referred to a youth counsellor as part of holistic management. We will continue to treat and provide safer sex advice accordingly.

“If there are difficulties with healthcare costs, the social worker will be alerted to assess and provide assistance,” he said.

HOW DO PARENTS HANDLE THE NEWS?

Counsellors and social workers from the Singapore Children’s Society told TODAY that the parents of the three teenagers who tested positive for STI were shocked and angry.

They did not know how to react or respond to their children and sought help from the Youth Court through a Beyond Parental Control complaint.

Not all parents who learn of their teen children’s positive results are shocked.

Ms Roslinda said that some parents are not surprised and had even taken their children to the clinic for testing on their own accord.

As for Dr Izharuddin’s patient, the parents were supportive.

“Their (parent-child) relationship was very good and this is extremely important.

“Regardless of the medical condition, having a chronic one such as an HIV infection can have a big impact on a person’s emotional and mental well-being,” she said.

“Though the parents expressed disappointment, mainly because of the patient’s risk-taking behaviours, they said that they would move on from that to focus on his health.

“Encouragingly, they mentioned that they want to spend more quality time with the patient,” she added.

WHAT PARENTS CAN DO

The Singapore Children’s Society said that young patients’ perception of their parents’ reaction to a STI diagnosis will determine whether they inform them.

Its spokesperson said: “If there is a foundation of open communication at an early stage, they will be more likely to share the news with their parents.

“When parents learn of the diagnosis, they have to manage their own disappointment and shock, and provide their children with the support they need the most at the point.”

Ms Roslinda said that parents and guardians play an important role in educating teens about sexual health

It may not be a comfortable topic to address, but it is necessary to have open conversations about the topic.

The counsellors also pointed out that it is normal for young people to experience sexual urges in adolescence.

However, a strong foundation in healthy sexuality, built on open conversations from a young age, can be a preventive measure against STI, the Singapore Children’s Society said.

“Having open conversations about sexuality early when children are young helps to shape their attitudes towards sex and not let their attitudes be influenced by peers or the media.”

Besides consistent and correct use of barrier methods such as condoms and keeping to monogamous sexual relationships to prevent STIs, Dr Izharuddin also strongly encouraged vaccinations against HPV and Hepatitis B. 

WHAT TEENAGERS CAN DO

Teenagers who suspect that they might have been exposed to STI should seek immediate medical attention, Dr Izharuddin said.

A cure is possible for a variety of STIs and the earlier the diagnosis is made, the higher the chance of cure, she said.

Seeking medical attention will also provide an opportunity for counselling on safe sex and pregnancy prevention.

For those who are worried about their parents’ reactions, Dr Izharuddin advises seeking help in any way.

“If not from parents, then seek formal medical help from doctors as the clinic is a safe space for patients to have frank discussions about health issues. However, telling the parents may relieve the burden,” she advised.

DSC Clinic’s STI/HIV hotline: 1800 252 1324 (from 8am to 5pm)

Related topics

teenagers sexual health HIV sexually transmitted infection parents

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