Monday 11 April 2016

More teenage boys paying for sex: Study

About 2 in 5 polled after visiting STI clinic had used prostitutes; concern over spread of infection
By Theresa Tan, The Sunday Times, 10 Apr 2016

The number of teenage boys who have visited prostitutes is on the rise, a trend that has researchers worried as some do not use condoms consistently, may catch sexually transmitted diseases and go on to infect their girlfriends.

In the first-ever study of Singapore youth who have had sex with prostitutes, it was found that about two in five of the teens surveyed had paid for sex. The interviews were conducted with some 300 heterosexual boys aged between 16 and 19 who went to a government specialist clinic that treats sexually transmitted infections (STIs), between 2009 and 2014.

In earlier cohorts of boys who went to the Department of Sexually Transmitted Infections Control (DSC) Clinic between 2006 and 2009 and were interviewed, only 15 per cent said they had intercourse with prostitutes.

Associate Professor Wong Mee Lian - working with Adjunct Professor Roy Chan and Dr Martin Chio at the clinic - invited new teenage patients at the clinic each year since 2006 to be part of their research.

The doctors wanted to understand their background and behaviour which could put them at risk of contracting an STI, and find ways to reduce infection rates among the young.

Prof Wong, who is with the Saw Swee Hock School of Public Health at the National University of Singapore, said the jump in the proportion of teens who visited prostitutes is significant.

While the findings cannot be generalised to represent the population of teens who are sexually active, she said they do suggest that it has become more common recently for teenage boys to pay for sex.

This is a public health concern as sex workers are a major source of infection - and 30 per cent of the boys she polled between 2009 and 2014 who visited prostitutes said they did not use a condom each time they had paid sex.

The worry is that they could infect their girlfriends or others they sleep with, she said, as they had a median of 4.5 sexual partners, including their girlfriends, by the time they were polled. "Many of those infected with an STI show no symptoms and they could have sex with others without knowing they are infected," she said.

Her study was published in the science and medical journal PLOS One in January. PhD student Junice Ng was the co-author.

Another worrying finding is that of those who had paid for sex, their median age was only 16 and 38 per cent had their first sexual encounter with a sex worker.

Doctors and social workers say two main factors account for why more teens visit prostitutes. The first is the easy access to pornography online. There has also been a proliferation of vice websites advertising sexual services here.

Dr Lin Kai Wei of Nuffield Medical Siglap clinic said his young patients go online to seek sexual services as they find it less daunting than going to the red light districts where others can see what they are up to. "There are all these websites where there are pictures of the girls and their vital statistics. So the boys are tempted," he said.

Singapore Children's Society chief executive Alfred Tan, a father of two, including a 21-year-old son, said the study's findings are worrying, especially as youth are more exposed now to all sorts of vice online.

"We have to start talking about sexuality issues with our children, to let them know what's right and what's wrong, when they are as young as possible," he said.

Study reveals about 2 in 5 boys polled after visiting Singapore clinic for sexually transmitted infections have paid for sex.
Posted by The Straits Times on Saturday, April 9, 2016

Allure of paid sex for teenage boys
Not having a girlfriend and watching porn often are key reasons for turning to prostitutes: Study
By Theresa Tan, The Sunday Times, 10 Apr 2016

Never having had a girlfriend, or one who is sexually active, and watching pornography frequently are the two strongest reasons why teenage boys turn to prostitutes, according to the first study here on teens who pay for sex.

Other reasons that some boys are more likely than others to visit prostitutes include the fact that they started having sex before the age of 16, said Associate Professor Wong Mee Lian of the Saw Swee Hock School of Public Health at the National University of Singapore, who led the study.

They could have reached puberty earlier and tend to have older friends who exposed them to behaviour that included smoking, drinking and sex with prostitutes, she said.

Another factor is that these teens have lower self-esteem.

"These boys want to feel accepted and want to boost their ego. They may not have a girlfriend to boast of, but they can pay to 'conquer' a prostitute," she added.

Her study found that educational background or the type of home the family lived in was not a factor in whether a boy was more likely to go to a prostitute.

Prof Wong and PhD student Junice Ng studied 300 heterosexual boys aged between 16 and 19 who visited the Department of Sexually Transmitted Infections Control (DSC) Clinic between 2009 and 2014. The government clinic focuses on the treatment of sexually transmitted infections (STI).

The researchers noticed that more young patients at the DSC clinic said that they have had sex with a prostitute in recent years.

So, they decided to find out more.

Their research, published in the science and medical journal PLOS One in January, found that 39 per cent of the boys polled said they had sex with prostitutes - a figure that Prof Wong described as high.

According to the study, of the boys who visited prostitutes:

• The median age was 16.

• It was the first sexual experience for 38 per cent of them.

• They had a median number of 4.5 sexual partners, including girlfriends or casual friends they slept with, by the time they were interviewed by Prof Wong's team.

• 30 per cent did not use a condom consistently, that is, each time they had sex with a prostitute.

• 42 per cent were diagnosed with an STI, but none was infected with the Human Immunodeficiency Virus (HIV) that causes Aids.

• Those who did not use condoms consistently were a lot more likely to be diagnosed with an STI.

Prof Wong said the teens' multiple partners and inconsistent condom use are a concern. They could be infected with an STI and pass it on to their girlfriends or others they have sex with.

Doctors and social workers said peer influence and pressure, plus curiosity about sex or a desire to be seen as sexually experienced, are also reasons why the teens turn to paid sex. Prof Wong said: "The boys say their friends dare or urge them to go to a sex worker to initiate them into manhood."

Those interviewed said national service is one stage in life where many young men get introduced to paid sex by their more sexually experienced mates. Take, for example, full-time national serviceman Raymond (not his real name), who had his first sexual encounter with a prostitute last year when he was 18.

"My army mates talk openly about their sexual experiences and visiting prostitutes. And if you have nothing to share, they tease you," the 19-year-old said. "I was a bit embarrassed (about being a virgin) and I wanted to fit in." His army mates took him to Geylang and his sex jaunts continued until he was diagnosed with gonorrhoea recently.

Doctors and social workers interviewed are concerned by the high proportion of teens who went to prostitutes. They believe this is because of the proliferation of online sex sites and forums.

Besides Singapore, some boys also visited prostitutes in neighbouring Johor Baru, Batam and Bangkok, the study found.

Adrian (not his real name), a 21-year-old, has had sex with prostitutes while holidaying in Bangkok. His friends took him to a Geylang brothel and paid for his first sexual encounter when he was 14 or 15.

He has friends who go to Johor Baru regularly to "have fun, as everything from food to prostitutes" is cheaper there.

Adrian, who is waiting to enter polytechnic and says he has stopped visiting prostitutes, added: "The holidays are to chill and to drink, not specifically to have sex. But when it's all boys going on holiday, sex somehow becomes part of the package."

Sexuality education 'helps cut infection rate'
By Theresa Tan, The Sunday Times, 10 Apr 2016

The number of teenagers diagnosed with a sexually transmitted infection (STI) has plunged, as more young people know how to protect themselves against such diseases.

In 2014, there were 391 youngsters aged between 10 and 19 who were diagnosed with an STI.

This is fewer than half the 887 diagnosed in 2008 when the number of teen infections was at its peak.

The data for last year is not available yet, said the Department of Sexually Transmitted Infections Control (DSC) Clinic, which collates the number of infections in Singapore.

The DSC Clinic is run by the National Skin Centre's Department of STI Control and is a specialist clinic for STIs.

Its spokesman attributed the fall to youth being more aware of how to protect themselves from being infected. This is due to sexuality education programmes in schools.

Doctors and social workers say teens are also more aware of using condoms.

The Health Promotion Board and Education Ministry came up with an STI and Human Immunodeficiency Virus (HIV) prevention programme called eTeens.

While the key message is that abstinence before marriage is the best course of action, "it provides accurate information on STI, HIV and protection from a health perspective to enable them to make informed and sensible decisions", the DSC Clinic spokesman said.

The most common STIs diagnosed among teenagers are gonorrhoea and chlamydia infection. And almost twice as many girls, compared with boys, were diagnosed as having an STI, the spokesman said.

One reason is that teenage girls are biologically more susceptible to infections like chlamydia.

Dr Tan Kok Kuan of the private clinic Dr Tan & Partners said that young girls are also more likely to have older and more sexually active partners, and this increases their chances of catching an STI.

Doctors interviewed say teens who get tested for an STI usually have at least a few sexual partners.

For girls, their partners are boyfriends or even casual friends. For boys, besides girlfriends, they also could be having sex with a prostitute.

For example, Dr Tan said he recently saw a 17-year-old boy who caught chlamydia from a prostitute in Geylang. It was the student's first sexual encounter.

Social workers and doctors interviewed also shared another observation: More teens they see these days have multiple sexual partners. Some even change a few partners in just a year.

"I find that teens' attitudes towards sex these days are a lot more blase. Some are even having sex with casual friends whom they are not in a relationship with," said Dr Tan. "It's like meeting up to have sex these days is almost as casual as meeting up for a game of tennis."

Rethink what we teach teens about sex

The study highlighted in last Sunday's report ("More teenage boys paying for sex: Study") sheds light on a situation that many of us working in the field of youth sexual health have known for some time: That it is not uncommon for young men in post-secondary education and national service to be pressured by peers to have sexual experiences with female sex workers.

According to the statistics reported, although there was an almost twofold percentage increase in the number of boys visiting sex workers, there has not been a corresponding increase in the number of teens diagnosed with sexually transmitted infections (STIs) ("Sexuality education 'helps cut infection rate' "; last Sunday).

Hence, we shouldn't isolate sex workers as a "major source of infection", or attribute this trend to vice websites and online pornography.

Instead, as a responsible community, we need to discuss other issues uncovered by the findings: Our society's definition of masculinity in relation to a young man's sexual behaviour with the opposite sex, the adequacy of sexuality and sexual health education for teens, and the effectiveness of these efforts.

We understand that the Health Promotion Board has a range of online resources which help parents engage their children on these issues.

Additionally, we are aware that the Department of Sexually Transmitted Infections Control Clinic provides well-utilised, community-focused sexual health screening and treatment services.

Yet, we note the significant absence of appropriate sexuality and sexual health education in mainstream schools. Many of our counselling clients report that, in their experience, such programmes at school are often awkward at best, or inaccurate and judgmental at worst.

In our work with lesbian, gay, bisexual, transgender and questioning youngsters, we help raise their awareness of how STIs are transmitted, instead of stigmatising the people they choose to have sex with, including sex workers or casual partners.

Often, a powerful message that stays with them is the sense of ownership about how they choose to have safer sex, rather than with whom.

Perhaps it is time for all of us to reconsider not just why we need to talk about sex with our teens, but also when to do it and how it should be done.

Leow Yangfa
Executive Director
ST Forum, 17 Apr 2016

Proper condom use protects everyone

As a sex worker community organisation, Project X regularly interacts with brothel-based and street-based sex workers in Singapore ("More teenage boys paying for sex: Study"; April 10).

We find that one of the biggest concerns sex workers have is clients demanding unsafe sexual practices.

Clients do so by exploiting a sex worker's financial vulnerabilities by offering more money, or by using violence or the threat of violence.

In fact, many sex workers note that they often have to spend time educating their customers about sexually transmitted infections and HIV.

Many unlicensed sex workers in Singapore fear carrying condoms because there is the threat of being arrested.

It is a common police practice to stop people in red-light districts and search their bags. If condoms and/or lubricants are found, they can be charged with soliciting (for Singaporeans) or be deported from the country (in the case of foreigners).

As a result, many unlicensed sex workers - Singaporeans and foreigners alike - refuse to take our condoms when we distribute them in our outreach programmes.

This is also a public health concern.

Rather than making scapegoats of sex workers, it is important for all of us to remember that there are two sides to the story, and that both are equally important in the fight to ensure the health and safety of everyone.

Vanessa Ho Xi Huei (Ms)
Project Director
Project X
ST Forum, 24 Apr 2016

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