What you need to know
Government health experts in Taiwan want to normalize conversations about sex and relationships in hope of stopping the spread of HIV/AIDS.
People across Taiwan should soon notice an influx of condom vending machines and advertisements promoting safe-sex and home-testing kits for HIV.
The campaign will not be the work of the biggest local condom manufacturer, Fuji Latex, but the Centers for Disease Control (CDC), which believes normalizing conversations about sex is the most important factor in tackling HIV and AIDS across the island-nation.
“Parents do not talk about sex with their children,” says Huang Yen-Fang (黃彥芳) director of the CDC’s Division of Chronic Infectious Disease. “They hope their children will study hard and not have sex. But that is not reality.”
Huang told The News Lens International that despite previous campaigns and sex education classes at school, talking about sex and relationships is still taboo in many Taiwanese households and “the general public is unaware of the risk of HIV/AIDS.”
This, she says, is reflected in the high prevalence of unprotected sex among young people in Taiwan.
The total number of new cases of HIV reported each year in Taiwan, which started to decrease about a decade ago following successful efforts to control the disease among injecting drug users, has crept higher since 2009.
There are now more than 32,800 people in Taiwan with HIV and 14,600 with AIDS, according to the latest numbers from the CDC. That is up from around 30,400 with HIV and 13,200 with AIDS, as of about mid-year last year. Men account for more than 90 percent of all cases. Male-to-male sexual contact (MSM) accounts for 59 percent of disease transmission, injecting drug users 21 percent and heterosexual contact about 18 percent.
Government health surveys have found that while 90 percent of respondents know the main cause of HIV/AIDS transmission is from having unprotected sex, more than half did not use condoms. When asked why they did not use condoms, half said they trusted that their partner did not have the sexually transmitted disease.
Moreover, a survey released last month by the Taiwan AIDS society showed that about 20 percent of young adults in Taiwan had sex with partners other than their girlfriends or boyfriends, about 10 percent have had sex with someone they met that same day, and another 10 percent say they had experienced not recalling the person with whom they have had sex, CNA recently reported.
Teachers too shy or too focused on grades
Sex education is compulsory in high school in Taiwan, and non-government organizations work to provide additional presentations and educational material to schools.
However, groups like the Persons with HIV/AIDS Rights Advocacy Association of Taiwan (PRAATW) have complained schools are not always open to their running of HIV prevention awareness programs with students. When the organization does talk to students, it says that teachers often try to water-down the material to make it less confronting.
Huang confirmed she has heard of teachers “removing” the course from the curriculum, but adds that in some cases this may be because teachers are more concerned with preparing teachers for exams.
“We communicate with the Ministry of Health to solve this problem, but it is not easy to change the situation quickly,” she says.
High school students should not only learn about the risks of HIV and the importance of using condoms but also about respecting one’s partner, she says.
“I have heard they may teach [students about] the physical structure [of the body], but not condom use nor relationships,” she says, adding some teachers do not feel comfortable using the word “condom” when talking to students. “I think the course must be comprehensive. I hope the Ministry of Health can do more.”
Several college-age Taiwanese contacted by The News Lens International said while they were taught about sex education at school, they have never talked about the subject with their parents. This, Huang suggests, is a common trait of conservative or perhaps prudish Taiwanese parents who, keeping with more traditional Chinese culture, will rarely broach the subject.
The lack of education has contributed to the widespread misconception that HIV/AIDS is a disease associated only with drug users and gay men.
HIV prevention advocates are concerned that amid low testing rates among the general population, an increase in the HIV infection rate in other parts of society could go unnoticed. Further, CDC notes that because of the discrimination against HIV/AIDS, people living with the disease may be “unwilling” to seek proper testing and treatment.
Discrimination has also led to the abuse of patients at an institutional level – in a high-profile case earlier this year, the CDC went to Court in a bid to fine the National Defense University NT$1 million (US$32,000) for expelling an HIV-positive student in 2013. From 2013 to 2015, there were 23 reported human rights cases related to HIV discrimination; most complaints related to employment, medical or privacy issues.
Doctors and dentists have also been criticized for being unwilling to treat patients with HIV/AIDS – a dental clinic in Taipei’s Ximending area, which runs a weekly session for HIV patients, can only find one dentist willing to cover the shift each week, PRAA told TNLI in May.
Huang acknowledges that more work is needed to tackle discrimination, and she notes that the Ministry of Health is drafting new guidelines for dentists handling HIV-positive patients.
Getting the conversation started
The CDC hopes to challenge the status quo on several fronts.
First, it is installing hundreds of condom vending machines in busy locations across Taiwan. Huang says this will not only encourage safe sex – 20 percent of young Taiwanese surveyed said they had unprotected sex because condoms were not easily accessible – but also the visibility of the machines will help to “desensitize” people to their usage.
“Not only for the students, but for the teachers too,” she says, adding “teachers can be too shy to say [the word] ‘condom.’”
The CDC has also started promoting relatively cheap HIV home-testing kits with an accompanying online platform and will next year promote that program nationwide.
The home-testing program was launched in September. More than 1,000 people used the test kits within the first month, and at least four people were confirmed HIV-positive. The CDC plans to have more than 100 locations around the island where people can pick up a testing kit – priced at about NT$200 (less than US$7) – including dozens of vending machines. It is also offering online appointments for HIV testing at medical centers.
Huang believes that if testing became widespread among young people, that would go a long way to “reduce the stigma and the discrimination,” and, ultimately, stop the disease from spreading.
“It is like the condom machines; we need to desensitize people,” she says.
Huang points to the success of similar public campaigns to address cervical cancer. As China Post reported last year, 2015 marked the first time cervical cancer did not feature in the list of Taiwan’s 10 most prevalent cancers. A long-running public campaign, encouraging women to have a regular pap smear, was credited with the result.
Editor: Olivia Yang