Barbara Walters chats with Forward Syria
Swaying between art and seduction
Discussing monetary policy with the man in charge
Where the earth screams in horror
02/12/2011 - Issue 48
Let's talk about the birds and the bees and STDs
by Jennifer Mackenzie
Awareness campaigns are underway to prevent and manage sexually transmitted diseases, which remain misunderstood and underestimated due to pervasive social taboos.
When Do Raeda Jarah was invited by UNRWA to give a training session on adolescent development and health issues, including HIV and other sexually transmitted diseases (STDs), to several classes of male and female students, she was startled by their reactions to the medical diagrams.
“They didn’t know anything about their bodies - neither the boys nor the girls,” she said. Director of Halbouni Health Counseling Centre, one of the Syrian Family Planning Association’s clinics in Damascus, Dr Jarah, has made protecting Syrian’s reproductive health her vocation. “We must correct our wrong beliefs,” she said, citing clients who believe that HIV can be contracted from toothbrushes, swimming pools or toilet seats.
This lack of knowledge exists in spite of a high school curriculum that includes a section on reproductive health, which has been recently updated, and government awareness campaigns to educate Syrians about the dangers of STDs. But the issue of sexuality as a taboo topic in society remains a formidable barrier to these goals.
“Some teachers are ashamed,” said Doctor Jarah, “so they don’t explain in a proper way.” For instance, the clinic’s health counselor, Amal Dulati, reported that her daughter “was waiting for this lesson, but the teacher cancelled it. She [the teacher] said, you can read it at home, alone.”
However, discussing such subjects at home is also difficult. “In families, we don’t talk about these things,” Dulati said. “Families don’t provide information - they believe it’s very shameful to talk about.” And while she tries to encourage women to, “give the right information to their kids, many mothers don’t know anything, either.”
This lack of awareness is far more dangerous for more marginalized groups; intravenous drug users, men having sex with other men, and prostitutes, who are up to 100 times more likely to contract HIV. “We have to work more with marginalized groups - we must focus all our efforts on them,” said Doctor Hussam Eddin Baradee, the national coordinator of a new partnership with Global Fund to create a five-year National Strategic Framework on HIV/AIDS. As these groups are illegal, he explained, “We cannot go to them directly.”
Strategies to detect STDs
Since Syria began testing for HIV in 1987, there have been 302 positive cases among Syrian citizens, according to the Ministry of Health. Recently, efforts have been made to encourage incidence reporting, and since then, 50 new cases were recorded in just two months.
Premarital STD screening is mandatory, and the ministry also hopes to ban marriage between the carriers of certain diseases in order to eradicate them.
Doctor Baradee is optimistic about the new strategies, but added, “They’re not enough, we don’t have a study of high risk groups,” which also includes sailors, truck drivers, and youth living outside their family homes.
Another Syrian doctor concurred. “You can’t deal with a problem if you don’t know how big it is. You don’t have formal studies, so you can’t estimate how many cases you have hidden. In general, STDs are well-controlled in Syria, and not that common, but they’re increasing - syphilis, pelvic inflammatory disease, gonorrhea and chlamydia. Our main focus is on HIV and hepatitis, but I think chlamydia and syphilis are equally important.”
He also pointed out that, “in big cities like Aleppo and Damascus, the health system is sufficient, but in rural areas it’s not, and it’s low on informative and preventative measures.”
For some groups, awareness alone may not be enough. According to one study, most sex workers know how STDs are transmitted, but, as one social worker put it, “if he pays more, she cancels the condom.”
In the gay community, by contrast, awareness of STDs is “nearly nonexistent,” declared one member. “Everyone sleeps with everyone, and doesn’t use protection. They’re not looking for information unless they get something - then they do research and say, Oh, so that’s what it’s called.”
Equally, the subject can be tricky for married couples. “It’s very difficult for women to talk to their husbands about using condoms if their husbands travel,” said Doctor Jarah. “If a wife wants to use condoms, it’s like accusing her husband of being unfaithful to her, so it can cause problems in the relationship.”
Still, the staff at the Halbouni Center are excited by the progress of their three-year-old pilot program in holistic healthcare, supported by the EU and implemented by the Syrian Family Planning Association with the technical assistance of the Italian Association for Women in Development.
“It’s not immediate - it takes time,” said Doctor Jarah. “After being trained by international experts, the Halbouni staff are providing this training to other clinics,” she continued, so that they can bring their model to other cities like Deir ez-Zur and Aleppo.
Zahra Lazkane, the youth counselor, is also proud of her young volunteers. “I train ten people, and then they’re responsible for another ten.” Perhaps her experience offers an analogy for society. Before, she found the isolation of one health issue from another daunting, but, she says, “when we started this project, it’s more comfortable to work with a group.”.
