Addressing issues of sexuality and health present particular challenges for health care workers, especially in underdeveloped countries. Cultural discomforts and social taboos leave inquiries ignored, and matters of sexual and maternal health unaddressed.
On April 2nd and 3rd, I attended the 5th Annual Sex::Tech Conference, a two-day event hosted by Isis, Inc. that brings health and technology professionals together with youth, parents and community leaders to advance the sexual health of youth in the U.S. and abroad. The conference presented high-tech educational content (mobile, social media, Internet) developed by professionals, highlighting national and local program successes with a particular emphasis on youth leadership.
A day earlier ISIS and TechSouphosted a Hack-a-thon event, challenging attendees to design an app that would provide researchers and program experts honest, real-time, private data regarding “unmentionable” activities among youth and young adults. Topics included sexual behavior, sadness, and relationship drama. LifeSense won the competition with an app that enables users to record their activities and moods, and see how they compare to other users in their peer group.
Same sex education was also a prominent topic at the conference. Lesbian and gay activism, especially in developing countries, is an understudied area. Dr. Mustanski presented IMPACT research on young same-sex couples in which the couples talk about how they met, how they resolve conflict, keep their relationship happy, and how to talk about safer sex. The research led to the development of a video that you can watch here
Sexuality is openly discussed like any other health issue at the conference, and in the U.S., age-appropriate sex education is often imparted from 5th grade onwards to encourage sexual health among youth. This view has strongly been linked to the cultural traditions of the country. It is commonplace in U.S. for women to garner information about sexuality and health issues through digital media like Web browsing, social networks, mobile phones and traditional media which I discuss below by providing contrasting perceptions of women in developing countries.
Web browsing, utilizing such applications as search engines, online videos and reading materials, is often the starting point for women in the United States seeking health information. There are few or no restrictions on information access.
During the Sex::Tech Conference I learned that many residents in remote communities of the U.S. have Internet access, despite obstacles such as limited or nonexistent road systems, and through the use of Internet-enabled devices organizations are able to establish health interventions in remote places. For example, the Alaska Native Tribal Health Consortium developed ‘IWTK – I want the kit’, a web based at-home STD testing service. They developed a user base through online advertisements targeted at youth and tribal participants and provide a platform for requesting free at-home STD tests. A representative from the IMPACT program presented sample online quizzes that are used to educate participants about HIV/AIDS, women’s sexual health, and transgender health. You can take the quizzes here.
This conference not only highlighted technologies being used in the U.S., but also showcased how England and Singapore leverage the power of new media in STI prevention and sexual and reproductive health. The National Chlamydia Screening Program (England) for one, developed by the National Health Service and SXT Health CIC, is using new media as a way to promote sexual health, facilitate testing and convey the results. Also, Zarina Yousaf from the Health Promotion Board Singapore described the Not So Secret Lives (NSSL) campaign, which seeks to increase awareness among youth about HIV/AIDS Singapore Health Promotion Board leveraging new media, infused with the traditional art of storytelling.
In under developed countries teenagers who have access to the Internet look for resources on the Internet like reading materials and YouTube videos but parents have imposed restrictions on usage of internet and any other browsing they deem unfit for their child. In turn when a child is obligated to ask a question about reproductive and sexual health parents are in a catch 22 situation, they thwart any natural curiosity by the child and toss in the bin. This has been linked to the parent’s preconceptions about sexuality and health the way they were raised.
Social networks have become an integral part of life for many teenagers in the United States. According to the ISIS white paper, TechSex USA, over 66% of youth of color use online social networks, predominantly Facebook, and 73% of all teens (ages 12-17) are on social networking sites. Arai Buendia from ISIS presented one HIV-prevention intervention for Facebook called Just/US. Just/Us commits to the community by bringing resources, sharing pages and information among their fans and new followers. They promise to engage members in meaningful dialogues, share information and resources, and involve fans to create new ideas, responses, and opinions about critical sexual and reproductive health issues. The National Dating Abuse Helpline is also working on social networks as mentioned by Brian Pinero, Acting Director of the in the presentation about next generation services, including blogging and social media technologies such as Facebook, Twitter, Instagram and Flicker. In Sextech 2012 I found most of the teens talked about Facebook, which seems to be the key social network comparatively MySpace, Hi5, Twitter, LinkedIn, etc. One thing that teenagers emphasized in Sextech 2012 is that they need peers of the same age and sex to discuss sexual and reproductive information online in order to feel comfortable. I found this interesting because in many undeveloped countries social networks are rarely used for gathering information about sexual and reproductive health. There has been a slight departure from traditional and conventional thinking in recent times for women to access social networks even in underdeveloped countries, but these programs do not gather information about sexual and reproductive health. Despite the popularity of social network among women in underdeveloped countries it is perceived as an awkward channel for sharing personal and sensitive information. Women fear identity visibility in relation to information gathering about sexual and reproductive health.
Traditional Media, like TV & Radio:
In the U.S. teens want to have education through TV and Radio programs. TV and radio are popular among teens, and educational programming on TV and radio holds great potential to reach teen viewers and listeners.Highlighted in Sextech were programs such as Teen Mom, 16 and Pregnant and Jerry Springer for their popularity with teenagers and interest in developing discussions of sexual health. This prospect stands in stark contrast to ideas for education in developing countries because social discomforts inhibit the effectiveness or popularity of such programming. In developing countries many women feel they are being watched and their privacy is breached when they are watching anything related to sexual and reproductive health. If in the company of other, especially male or older members of the family, it may be common for a woman to pretend she has not seen or heard the content. These women are embarrassed about any discussion of sexuality and reproductive health publicly.
I was amazed to hear that American teens are using different applications and new features on their smartphones. Even those who do not have smart phones are either Web browsing or using video and game features on entry-level phones. National Dating Abuse Helpline provides good evidence that youth use multiple communications channels. Brian Pinero, Acting Director of theNational Dating Abuse Helpline mentioned that the goal of the program is cross-channel engagement, providing the opportunity for service at every potential interaction. The helpline makes services available 24 hours a day for teens and young adults, including peer advocate-led support services to victims of abuse via online chat, phone, and text. With collaboration and cross-channel engagement in mind, Pinero also values the resources of Planned Parenthood of Orange and San Bernardino Counties (PPOSBC), including the hotlines that provide information direct to youth across media platforms.
Evelyn Gonzalez–Figueroa also spoke about Planned Parenthood of Orange and San Bernardino Counties, and highlighted the text, chat and phone hotlines of PPOSBC offers. The forums facilitate anonymous question and answer exchanges, creating a safe pathway for youth to readily connect to local resources and services.
Mobile phones are the most commonly used devices in mHealth interventions, boasting great practicality and utility. As discussed by Ernesto Dominguez of the Cascade AIDS Project, almost everybody has a mobile phone these days and young people are more open to communicating about sexual health via mobile media because it promotes a greater sense of anonymity than other social media and it’s easy. Dominguez mentioned some examples of mobile phone use in his interactive workshop “101 ways to use Technology for sex education,” including automated health reminders via text message and personalized responses to questions via hotlines. Through this he tried to teach participants how to select and use new media platforms for health promotion. It is plausible that the mobile phone could be used as a convenient device if one has no Internet access or is restricted by cultural norms. Mobile phones could also be a great way for women to ask questions of their peers without being seen in public. William Evans from the University of Nevada emphasized the value of two-way text messaging services, such as TextToday, for crisis management. It is an effective method for communication among youth seeking help with acute emotional issues or resource needs. Soyon Im of the HIV Vaccine Trials Network added to this discussion through her presentation of the challenges of moving data from Web-based platforms to mobile-based platforms and how to best manage processes.
I was most struck by how openly sexuality and sexual health were discussed at the conference. It was also interesting to hear how young women are using social media and other new technologies to gain information about sexual and reproductive health and put the information to use. In underdeveloped countries sexual health and reproductive health are considered taboo subjects for women. Many women feel shy bringing up this subject even with other female members including their mothers. Any issue related to sexuality is either discussed with a peer or learned about through reading materials. Their attitudes, beliefs and behavior about sexuality are linked to prior perceptions that a person has grown up with which are firmly rooted in their cultural belief systems. Women in developing and underdeveloped countries often do not feel comfortable using information technology for garnering knowledge about issues related to reproductive health. We must recognize and act one the need to broad educational modalities for sexual and reproductive health, and provide comfortable avenues for women to discuss issues of sexual and reproductive health.