When Clara* had her first unwanted pregnancy at 16, she didn't know a condom would have worked, so she hadn't asked her boyfriend to use one. By the time she had her second unwanted pregnancy, just two years later, a social worker had already taught her about condoms. But that time Clara had been too afraid to ask her boyfriend to put one on.
In the bustling Chinese city of Hong Kong, sex is shrouded in stigma and shame. Sexual education, while offered in some secondary schools, focuses on abstinence and morality. Because of the city's semi-independence from China, there's a religious presence there that isn't to be found in mainland China. This likely has contributed to the paucity of sex-related information available to young people. And now, the city has a problem on its hands: Youth STI infection rates are rising at an alarming rate, according to a new study.
The government has never completed comprehensive studies on teen STI infections. A recent report from Center for Health Protection paints broad strokes across demographics, plainly admitting that "comprehensive data concerning sexually transmitted infections (STI) is not available in Hong Kong," and that its few findings are "likely the tip of an iceberg." But a team of scientists at the University of Hong Kong (HKU) is finally about to complete a comprehensive study of STI infections, after years of battling apparent disinterest in sexual health in the city's academic community. "In Hong Kong, research is heavily focused on HIV/AIDS and not STIs," says Julia Sun, a research assistant on the team, who for years has advocated for sexual health and awareness.
The findings—which will be released in a report by the end of the year—are surprising. Out of a random sample size of about 900 people of all ages, STIs—gonorrhea, chlamydia, and syphilis—were most prevalent in women under 30. "We would normally think the rate in women would be lower," Sun says. "Generally, males have riskier sexual behavior, both in heterosexual and homosexual relationships."
Another finding from the HKU study: Both men and women under 30 had a higher rate of STIs than those over 30. For Sun, this likely comes from Hong Kong's rejection of basic sexual education in its school system. "Although Christianity is not the most popular religion—Buddhism is—its members hold a lot of social resources and have an influential social status," Sun says. "Especially in education and social welfare, in which a lot of the institutions have a Christian background."
Sun joined the team at the Department of Family Medicine and Primary Care to help raise grant money for a project she started called Sticky Rice Love. It's an internet forum for teens to turn to for reliable sex advice from youth-friendly counselors. Based on her experiences advocating for sexual health, Sun has come to believe that women in Hong Kong have higher rates of STIs because they're too afraid to ask men to use condoms.
"Females in Hong Kong feel it's hard to execute safe sex in heterosexual relationships because, according to other research, they have lower bargaining power," Sun says. "Asking male partners to use a condom is not a norm in our culture."
After starting the Sticky Rice Love project, Sun teamed up with a grassroots NGO called AIDS Concern to introduce a simple, Western-style sexual education program in secondary schools. In light of local schools' high academic burdens and extreme focus on exams, they designed the program to be short—only four courses. Sticky Rice Love and AIDS Concern approached 400 schools to implement the program. Three agreed to it.
"In Hong Kong, sexual education is still a taboo—schools have a conservative way to deliver the message of sexual health," says Jim Hoe, a program manager at AIDS Concern. "Even the nature of our organization is a concern—they think if we come to the school, it means the students are sexually active and quite naughty."
AIDS Concern also conducted its own independent research on teen STI infections from 2013 to 2015 and found similar results to the new HKU report. In 2013, out of a smaller sample size of 129 heterosexual youth, 11.6 percent had contracted either gonorrhea or chlamydia. The same year, johns tested by AIDS Concern had an infection rate of 2.6 percent. Men who engaged in sex with other men who were also randomly tested by AIDS Concern that year had an infection rate of 3.9 percent. "STI infection was higher in the youth community than in other communities," Hoe said. "We didn't expect it to be four times higher than among sex workers' clients."
Last year, when AIDS Concern conducted a new study, raising the sample size to nearly 300 heterosexual youth, the infection rate spiked to 14.4 percent. "Young people don't have accurate knowledge [about sex]," Hoe says. "And the main reasons teens don't use condoms is because the male partner said 'no' or there was trust in the male partner."
Hong Kong's government feels it's meeting the meter mark when it comes to sexual education. "Knowledge on STIs has all along been incorporated into sex education... With [the] growing volume of information, sex information is everywhere," a spokesperson for the government's Department of Health said by email.
Hoe says that schools often turn to two independent NGOs called Mother's Choice and the Family Planning Association for sexual education. Some staff from other grassroots NGOs, who asked to remain anonymous, suggested that both these organizations approach sexual education conservatively—and do little to stem teens' rising STI infection rates.
Michelle Chak, a spokesperson for the Family Planning Association, says the organization was invited to give 213 sexual health talks at schools in 2014—she defended their practices as in fact being helpful for the first-line prevention of STIs. Mother's Choice did not respond to VICE's request for comment on the issue of teen STIs.
"The government is very concerned about AIDS—and unlike with STIs, they release this data quarterly," says Bowie Lam, who runs a local NGO called Teen's Key, which offers sexual advice and support for young women. A request to interview government officials regarding STI intervention and sexual education was denied. However, the Department of Health did offer to send further information on "life skill-based HIV education."
Teen's Key also began approaching secondary schools this year to introduce sexual education; of the ten they approach, two agreed. "Schools say we're too open," Lam says. "We have to bargain with them because they want abstinence and they're frightened of safe sex education."
Lam says the situation is becoming so desperate that HKGolden, a local online pop culture forum, is proliferating with posts from teens trying to get simple advice about sex. But unlike Sticky Rice Love, it's rampant with unverified comments. One girl posted that she was afraid of contracting STIs after sex without a condom, and she was told by users to wash her vagina with Coca-Cola and hot water.
In Sun's view, Hong Kong's approach to sexual education is an ironic tragedy. The city is semi-autonomous from mainland China—which for decades suffered under Mao Zedong's family planning policies—yet is more conservative when it comes to talking about sex, she says. "The sexual education in urban mainland China is more comprehensive, and they're now starting in primary schools—while we can't even start in secondary school."
*Name changed to protect source's identity