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Sex education in China leaves young vulnerable to infection

Despite the introduction of sex education into Chinas curriculum more than 25 years ago, it is still
inadequate. Talha Burki reports.
According to ocial statistics, there are
13 million abortions in China every year.
Many experts suspect the real figure
could be twice, or even three times,
as high. That would mean abortions
far outnumber livebirths. Aside from
reecting on Chinas one-child policy,
the end of which was nally announced
in October, 2015, the abortion rate is
a useful proxy for public awareness of
matters related to sexual health. Older
generations of Chinese people tend
to hold deeply conservative views on
sex, and homosexuality remains taboo
(there is no place for same-sex relations
within the Confucian value system).
But among younger generations, there
has been a sharp increase in sexual
activity. A 2012 survey noted that 70%
of Chinese people had had premarital
sex, up from 15% in 1989. The rippling
effects of ignorance and stigma can
be discerned in increasing burdens
of sexually transmitted infections.
After almost disappearing after World
War 2, syphilis has resurgedby some
estimates, an estimated 9% of men
who have sex with men (MSM) are
infected with the bacterium.
Only 60% of teenagers have basic
knowledge of HIV/AIDS, explains
Xiaomi Li, of Lingnan Partner
Community Support Centre in
Guangzhou, Guangdong province,
which provides sexual health services in
southern China. 30% of teenagers have
no idea that HIV wont be transferred
by mosquito, Xiaomi added. Roughly
90% of new HIV infections are caused
by unsafe sexual contact. Sex education
was formally introduced into the school
curriculum in 1988. Nonetheless, the
current policies, as practised, are widely
considered to be inadequate. Teenagers
mostly obtain information about sex
from the internet or friends. But even
the most able can struggle to interpret
this information. Do not believe in
26

good students, warns Xiaomi. Those

with excellent or good scores, leaders
in classes or leagues who are dened
as good students, are not different
from other students when it comes
to attitude towards sex, the frequency
of sexual behaviour, and unprotected
sexual behaviour.
In July, 2015, the National Health and
Family Planning Commission (NHFPC)
and the Ministry of Education issued a
much delayed circular on establishing
an HIV/AIDS reporting system in
schools. The document noted that
health education on preventing HIV/
AIDS is insufficient in some schools;
students are not fully aware of selfprotection. It stipulated that by the
end of high school, children should
have spent 10 h learning about HIV/
AIDS. Provinces should combine health
education on HIV/AIDS prevention with
sex health education...with focuses
on sexual morality and responsibility,
prevention, and rejecting unsafe sex,
wrote the authors.
Still, planning and implementation
are entirely dierent matters. Teachers
are commonly untrained in sex
education. Moreover, this is not a
subject that will appear on the university
entrance exam towards which virtually
every moment of Chinese school-life
is devoted. And communities can
be resistant. Last year, Peng Xiaohui,
who gives talks on sex education, was
attacked by a woman who reportedly
stated she wanted to defend our race,
and build a good environment for
children to grow up in.
UNAIDS Catherine Sozi talks of a
disconnect between the young Chinese,
computer-literate, and keen users
of social media, and a government
shackled to old-fashioned public
health campaigns involving posters
and suchlike. Technology has still not
caught up with the young people who

need to be targeted, she told The Lancet

Infectious Diseases. The current services
for young people are insufficient allround; sex education is one aspect
of that, but there are also things like
youth-friendly services and peer-led
community outreach.
With Chinas HIV/AIDS epidemic concentrated in populations such as MSM,
who represent about a quarter of new
infections, directing interventions at
specic audiences could pay dividends.
We need targeted information, age
appropriate, and delivered with userfriendly technologywe have to have
differentiated messages, concluded
Sozi. Still, there is cause for optimism.
We do believe that situation is
improving, said Xiaolo. Some government departments who work on the
front line have already found out the
serious impact of teenagers lack of
sexual education, and they are willing
to support social forces to carry out
this work. The Ministry of Health
and the NHFPC are piloting projects
that offer counselling to women
who attend for abortions. This has
enormous potential. A study involving
almost 80 000 Chinese women who
had abortions in 2013 found that 37%
were undergoing their second abortion,
and 29% were undergoing their third.
This is partly explained by demand
for the procedureclinics might not
have time to devote to counselling.
But there is also a peculiar conict of
interest. Public hospitals charge their
patients. So reducing the number of
abortions would reduce their income.
Among its other advantages, reducing
co-payments, something the Chinese
Government plans to do, or even
shifting to a single-payer health-care
system could have unexpected benets
for the nations sexual health.

Talha Burki
www.thelancet.com/infection Vol 16 January 2016