Commentary Sexual Health

Rates of HIV and Teen Pregnancy Highlight Sexual Health Education Gap Among Jamaica’s Youth

Gwen Emmons

HIV won’t disappear overnight. Unintended pregnancy won’t magically cease. But by working with and through young people to gradually change Jamaicans’ access to sexual and reproductive health information and services, JFPA is ensuring that the next generation of Jamaicans will be knowledgeable and empowered to demand and the care they deserve.

Until just six years ago, sex education was virtually invisible in some of Jamaica’s secondary schools. Even after the Ministry of Education incorporated sexuality and sexual health information into the curricula of the nation’s schools in 2006, young people still weren’t getting all the facts they needed make informed and healthy choices.

The long-held taboos in Jamaican culture that prevent people from talking openly about sex die hard. Teachers who were raised in an era when issues of sex and sexuality were met with silence find it challenging to overcome years of socialization to deliver the material in the new curriculum to students. They get tongue-tied when talking about certain aspects of sexuality or intentionally leave out information that they believe may encourage young people to become sexually active.

The teachers aren’t alone in their views. There are others who share their concerns throughout the country. Parents, community members, church leaders, and even teens themselves lack access not only to basic sexuality information, but also guidance about how to talk about it. These cultural obstacles mean that many Jamaican youth recieve  incomplete or inaccurate information about sex, putting them at risk for unintended pregnancy and sexually transmitted infections, including HIV.

The increased risk of HIV among Jamaica’s youth was a particularly compelling reason for local officials to decide to incorporate sexuality education programming into secondary school curricula. Recent data show that 1.7 percent of Jamaicans between 15-49 years old are living with HIV and the region is second only to sub-Saharan Africa in the rate of HIV infections. Early initiation of sexual activity, unprotected sex, sexual abuse, multiple partners, and transactional sex with older men leave Jamaica’s teen women more than three times as likely to contract HIV than teen men. Lack of knownledge of the basics of transmission, or how to keep themselves safe, presents a huge barrier to protecting adolescents.

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“If we do not teach our kids about sex, we will be receiving kids who are HIV-positive or pregnant, and we are putting them into the grave if we do not educate them properly,” Easton Williams, head of the Planning Institute of Jamaica’s Social Policy, Planning, and Research division noted at a recent  World Population Day symposium.

Realizing that a holistic and accurate sex education program relies on more than just the school system, NGOs have stepped in to fill the gap. The Jamaica Family Planning Association (JFPA) is one organization working to empower young people–and the institutions that serve them–to access sexual and reproductive health services. “Youth is a priority area of work at JFPA,” says St. Rachel Ustanny, JFPA Executive Director.  “[Our work] builds young people’s capacity to access sexual and reproductive health services and make informed decisions. We promote access to services as a human right.”

The belief that having access to sexual health services is a human right, and not just information about the biology of reproduction, guides JFPA’s Youth Advocacy Movement (YAM). YAM meets young people where they are – in schools – and offers safe, peer-directed spaces where adolescents can receive additional sexuality education from people their own age and ask questions they might be too timid to ask their teachers during class. Since many teens look to peers for information on sexuality and sexual health, several NGOs across Jamaica rely on peer-driven programs like YAM to share sexual health information.

“Establishing the YAM in schools is an attempt to increase youth access to sexual and reproductive health information. By carrying out its work within schools, rather that requiring students visit the JFPA clinic, the young people are better able to have successful meetings and educate their peers,” Ustanny says.  

The YAM curriculum complements what is taught in Jamaica’s Health and Family Life Education program. It uses dynamic methods to convey information, including computer games, round-table discussions, and film. JFPA peer health educators connect young people to resources within their schools and in their communities, including giving referrals to JFPA clinics in St. Ann’s Bay, Montego Bay, and Kingston. YAM also seeks to rally support for youth sexual and reproductive health services among Jamaicans of all ages.

Students who attend YAM meetings share information with their peers and communities, extending JFPA’s reach beyond the three schools in which they work. They are also encouraged to bring the information home to their families. This dissemination process beings valuable feedback to JFPA on which resources and services young people in Jamaica need, which allows them to tailor their programs and services to best meet the needs of youth and make the case to government officials for more funding.

“It’s important to develop broad-based support among young people to advocate for their sexual and reproductive rights,” Ustanny notes. “Without this support, the advocacy work is patronizing and will result in decisions that are not congruent to the needs of young people.”  

Comprehensive sex education advocates like Ustanny scored a major victory when the Ministry of Health mandated that sex education be taught in primary and secondary schools. But it’s clear that the Jamaican government isn’t doing all they can to transform that mandate into a reality for Jamaican students. Only a few teacher training institutions offer HFLE curriculum training, so many new teachers graduate from their training programs without knowing the most effective ways to engage their students on this subject matter. And while the Ministry of Health has been offering workshops to train teachers in HFLE, it’s unclear how many teachers are taking advantage of these workshops–or how effective they are in helping teachers overcome cultural taboos on talking about sex.

The Ministry of Health has also restricted some funding avenues for sexual health services, making it challenging for NGOs to expand their work. JFPA used to provide free vaccines in their clinics, thanks to government funding. However, JFPA is now considered a private facility by the Ministry of Health and is no longer eligible for the free vaccine distribution program. Furthermore, limited funding opportunities across the country mean that NGOs like JFPA must make difficult choices about their programs. JFPA can only host the YAM in a few schools because funding is so tight, limiting the reach of a valuable, high impact program. Panelists at the recent symposium also noted that pregnant teenage women still lack the supports they need to complete high school–surely an issue the government could champion, if they were willing to devote additional resources to it.

The high level of bureaucracy in Jamaica’s government makes it nearly impossible for activists and NGOs to reach key officials–effectively isolating decision makers from those who are working on the ground. Ustanny reports that she must wait nearly nine months –or more–before Ministers will schedule meetings with JFPA. Her letter to the Ministry of Health about the vaccine distribution program, for example, has gone unanswered for 11 months now.  The follow up process eats up NGOs’ time and resources, Ustanny says, but the meetings are one of few avenues NGOs have for making their case to the government. This inaccessibility raises serious questions about how committed government officials are about implementing change on behalf of Jamaica’s students. But since the Jamaican government is the gatekeeper to funding opportunities, policy changes, and the like, NGOs are reluctant to publicly critique these practices.

More alarmingly, though, the very cultural taboos that challenge Jamaica’s sex education program are ingrained in the Jamaican government, coloring policy decisions and putting adolescents at risk. Jamaica has the highest adolescent fertility rate among English-speaking Caribbean nations, at 112 per 1,000 women ages 15 to 19 – and over 1 percent of Jamaica’s teens have HIV, according to Advocates for Youth.  Yet the government remains entrenched in a years-long debate about permitting schools to distribute condoms. Instead, school administrators must refer students to off-campus resources, an extra step and an added burden for teens trying to make informed decisions about their sexual health.

These challenges reaffirm Ustanny’s commitment to adolescent sexual health. And through the YAM program, she’s helping to inform a new generation of Jamaicans – future educators, parents, and government officials–who can talk freely about sexual and reproductive health. HIV won’t disappear overnight. Unintended pregnancy won’t magically cease. But by working with and through young people to gradually change Jamaicans’ access to sexual and reproductive health information and services, JFPA is ensuring that the next generation of Jamaicans will be knowledgeable and empowered to demand and the care they deserve.

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