Blogs posted for BMJ, Public health issues in Asia

How many cases will it take for policymakers to realize there is a HIV problem in Hong Kong?

Announcing the most recent HIV statistics for Hong Kong, the Department of Health’s Centre for Health Protection reported 154 new cases from January to March this year: in effect, almost every day two more people became infected with a preventable disease that requires lifelong adherence to a drug regimen in order to stay alive.

In my last blog post I talked about how Hong Kong’s schools are failing to teach young people even the most basic facts about safe sex, let alone giving them a forum to safely discuss and learn about sexuality. This shows in the sexual practices of young people: research by local NGO AIDS Concern last year, for example, found that among 121 young people aged 14-21, 40% did not use condoms while having sex.

Another consequence of failing to give young people proper sex and sexuality education is low awareness of the risk of HIV infection and the perpetuation of stigmatizing social attitudes towards lesbian, gay, bisexual and transgender people, and towards people living with HIV. For almost all of the new cases for which there was a confirmed transmission route, unprotected sex accounted for all but one case (which was via injecting drug use).

In a recent conversation with AIDS Concern’s chief executive Andrew Chidgey, he explained that stigma and ignorance continue to make their outreach and education work difficult. “Some people don’t want to get engaged in knowing about HIV. It’s not something they want to be associated with,” he told me. When AIDS Concern staff talk to people who get tested and to people living with HIV, they find that most got infected through unprotected sex. Chidgey attributes this to a number of reasons: people aren’t as aware as they have been in the past about the risks and dangers of unprotected sex; complacency about treatment in the era of antiretroviral therapy; and a lack of information. “The sex education that’s going on is still very limited to reproduction and not about relationships and sex,” he says.

Particularly worrying is that 84 out of the 154 newly reported cases were among men who have sex with men, continuing a trend that has emerged in recent years. The CHPs’ Consultant (Special Preventive Programme) Dr Wong Ka-hing admitted to local media that it has so far been unable to develop an effective strategy to address the spread of HIV among the gay community. The CHP is conducting a study among gay men to try and better understand the prevalence of HIV among the gay community.

I do hope they work closely with local NGOs like AIDS Concern, which clearly have their finger more on the pulse of the LGBT community. The organization is already collaborating with the Chinese University of Hong Kong to research into stigma associated with HIV and discrimination experienced by people living with the virus in Hong Kong. Initial findings using the widely respected People Living with HIV Stigma Index found that half of the 291 survey respondents had “internalized stigmatizing beliefs about their identity as a person living with HIV.” Over a quarter had “experienced insults, avoidance or discrimination from general healthcare workers” at accident and emergency units as well as general out-patient clinics.

Clearly the Centre for Health Protection needs to pass on some basic facts about HIV infection to their colleagues on the frontline of health care delivery in Hong Kong. But if they really want to stop the upward trend of HIV infections over the longer-term, they will need to step out of the health sector and engage with their government colleagues in the Education Bureau. It’s time they pointed out the human cost of continuing to shy away from implementing proper, evidence-based sex and sexuality education in Hong Kong schools.

Public health issues in Asia

Hong Kong needs its own Conchita Wurst

I woke up today to the news that Conchita Wurst had won the 2014 Eurovision song contest, by a mile, and contrary to expectations. I was thrilled, partly because I’m a fan, she’s got a great voice and deserved to win, but mostly because it was such a strong statement from Europe about tolerance, acceptance of diversity, and reason.

Homophobic St Petersburg legislator Vitaly Milonov (the one who sponsored a local law against homosexual propaganda in 2011, which was followed by similar federal law in 2013) tried to mobilise a Russian boycott of the competition, and tried to exclude Tom Neuwirth, in his Conchita persona, from participating.

All to no avail. In fact, the extra publicity was welcomed by Conchita, it raised her public profile and probably helped her win. “I can only say thank you for your attention!” she told Associated Press. “If this is only about me and my person, I can live with it. You know, I have a very thick skin. It’s just strange that a little facial hair causes that much excitement. I also have to add that 80% of the autograph requests that I get are from Russia and eastern Europe — and that’s what is important to me,” she said “Hey, I’m just a singer in a fabulous dress, with great hair and a beard.”

As Conchita’s win, for herself, for her country and for a tolerant Europe, plays out against the backdrop of homophobia in Eastern Europe, elsewhere this year we have seen backwards steps towards institutionalized and legally sanctioned homophobia in Nigeria and Uganda, which were followed almost immediately by crackdowns on the LGBT communities in both countries.

All this might seem very distant from Hong Kong, but homophobia, although a little more low key than in Eastern Europe, is an insidious and dangerous force here too. Although Hong Kong has laws protecting the civil and employment rights of citizens, making it illegal to discriminate against someone on the basis of their gender or race, there is no such protection against sexual orientation discrimination. This is why a fundamentalist Christian international school here can blatantly make the jaw-dropping statement that it will not hire gay teachers.

Other homophobic local Christian groups are also actively lobbying against the introduction of a sexual orientation discrimination ordinance in Hong Kong. One of their insidious tactics is to make spurious links between the issue of discrimination in the public sphere and the issue of same-sex marriage.

After Hong Kong’s Court of Final Appeal ruled that “W”, a transgender woman has the right to marry her male partner, the government rushed to introduce the Marriage (Amendment) Bill that the case prompted. If passed, the bill will restrict the right to be defined as transgender only to those who have undergone full gender reassignment surgery, far from what the court recommended as a ‘compelling model” for Hong Kong: the UK’s Gender Recognition Act, and out of step not just with most Western countries but also with several in Asia Pacific. The stipulation was condemned by the chair of the Equal Opportunities Commission York Chow, as a denial of dignity that has no place in a civilized society.

Respect for basic human rights is enough to justify legal protection and full civil rights for all in Hong Kong, regardless of sexual orientation or gender identity, but there is a public health agenda to this too. The government’s rush to introduce misguided and inhumane marriage legislation, and the lack of progress on bringing in a sexual orientation discrimination law, are, at best, a sign of ignorance within the government.

This ignorance about sexuality and gender starts with the education system, and the parlous state of sex education in Hong Kong’s school system is a public health hazard in its own right. It seems we can’t rely on schools to deliver anything like the basic minimum package of youth sexuality education recommended by the UN. That package is based on evidence that has shown that “comprehensive sexuality education that is scientifically accurate, culturally and age-appropriate, gender-sensitive and life skills-based can provide young people with the knowledge, skills and efficacy to make informed decisions about their sexuality and lifestyle.” These, along with the other pressing human rights issues we are facing in Hong Kong, are issues that we will need to tackle society-wide.

Even if Conchita hadn’t won the Eurovision song contest this year, she would still have achieved one of her main goals, which was to bring the conversation, not just about gender identity, but about tolerance for difference, into family living rooms all across Europe. Maybe we need someone like Conchita here in Hong Kong, to step out of the shadows of the LGBT community and into the public arena, looking fabulous (with or without a beard), standing proud and helping to bring sexual and gender rights and legally protected tolerance for difference under the spotlight and into the public domain where they belong.