Friday, August 3, 2007

News Flash: Talking About Sex is Fun

I'm still trying to figure out what I think about loveLife, the ubiquitous sex education and teen-empowerment organization whose goal is to reduce HIV transmission among young people in South Africa. LoveLife's Y-Centers were frequent destinations for myself and my fellow journalists in July--all organized by the Kaiser Family Foundation for our traveling AIDS Seminar.

Clearly, Kaiser made a point of taking us to all these loveLife groups because the foundation is a major supporter--to the tune of more than $150 million about $80 million over the years. Some of us joked that we were going to know loveLife's slogans better than the kids did by the end of our trip.

More seriously, questions have been raised in the international press as to whether loveLife's approach has any effect on HIV rates. We also heard from parents who said their initial impression of loveLife was that it was a place where their kids went to find sex rather than to refrain from sex.

And it's absolutely true that loveLife's pamphlets and workbooks are pretty frank. One exchange between cartoon characters Miriam and Maxwell has Max telling Miriam that he has to have sex with her or his "balls will turn blue." Miriam replies, "Good. Then I can hang them on the tree this year for Christmas ornaments." That sort of no-holds-barred exchange probably goes a long way towards explaining why the Global Fund no longer supports loveLife.

Of course, anyone who has been around teenagers or remembers being a teenager knows that this is the way teens talk--the myth about blue balls, for one, having been around for generations.

Denying sexuality hardly seems to be the answer. Later in our trip, we heard anecdotal reports that anal sex rates are on the increase in South Africa because of the number of abstinence programs that promote virginity before marriage as well as the growing popularity of hymen examinations for young brides. Talk about unintended consequences. Unprotected anal sex is a much more efficient transmitter of HIV than unprotected vaginal sex. (See also this new report by Kristen Underhill and colleagues in the British Medical Journal, which concludes that abstinence-only programs have no effect on pregnancy or HIV rates in rich countries.)

Another challenge when trying to figure out how effective loveLife's programs are is the fact that official UNAIDS statistics are broken out by fairly large age groups. Teens are covered in the 15-to-24 year-old bracket. By not breaking out the lower end of the age group--15 to 17 or 18--you're not getting a good picture of whether prevention messages targeted at teens are working and then failing as they grow older.

I keep coming back to the energy and enthusiasm of the teenagers we met at the loveLife programs that we visited and the commitment of their peer educators--dubbed "groundbreakers" in the loveLife lexicon. There was certainly a sense of possibilities, of optimism for the future, of a life to live for and a reason to avoid becoming infected with HIV.

That positive spirit was quite a contrast with that of so many of the adults we met on other portions of our trip. I'm not a trained psychologist or anything but it certainly seemed to me there was a lot of depression amongst the adults we met. The end of apartheid did not magically erase the legacy of racism, extreme poverty, missed opportunities and mistrust. There is still so much left to do.

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