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Wednesday, April 27th, 2011 - 5 comments

What is better – prevention or cure?

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I’m taking into my hands the publication “Reproductive Health and Rights of Adolescents in Central and Eastern Europe and Balkan countries” by ASTRA-Youth – a network of young people, working in the area of sexual and reproductive health and rights. The publication presents very interesting facts on the situation of youth in the Central / Eastern Europe and the Balkans in the field of sexual health and reproductive health and rights. It covers sex education, STIs and HIV/AIDS, abortion, contraception and youth-friendly services in totally 10 countries: Azerbaijan, Armenia, Georgia, Bulgaria, Croatia, Cyprus, Macedonia, Poland, Ukraine and Kazakhstan. Let’s go through it.

Young people in the region remain a very vulnerable group. The most important issues arising from the report are lack of reliable and science-based sexual education; impact of religion; access to youth-friendly services; and lack of adequate state policies. In the present and coming blog posts I’ll touch upon them one by one. Thus, today we’ll talk about lack of reliable and science-based sexual education at educational institutions.

According to the study, in none of these countries young people receive reliable and science-based sexual education at schools or higher education institutions. For example, it is estimated that throughout the course of their primary and secondary school, a young Croatian receives less than 4 hours of sex education per a school year. Great gaps within the sex education programme exist. For example, in Macedonia despite of the fact that the use of condoms is recognised as an important way for protection against STIs, there is no particular part of the textbooks dedicated to the correct use of condoms, and there are no descriptions or illustrations where all the steps of proper condom usage would be described. Up to 87% of vocational school students in Ukraine stated that sex education lessons are important for them, but less than 50% consider such lessons interesting.

It has been long recognized prevention is much better and much more cost-effective than cure. One of the root causes of such challenges as HIV/AIDS/STIs and abortions is undoubtedly low level of awareness. Thus, the Azerbaijan Adolescent Sexual and Reproductive Health Survey 2009 shows that about four fifths of all the interviewed Azerbaijani respondents are aware of STIs and HIV/AIDS. However, more than half of all the interviewed young people (825 out of total 1210) were not aware of any STI’s symptoms. All these prove comprehensive sexual education is the best tool for prevention of such challenges. If you still disagree with me then let’s go more into statistical data.

For every 2 people who get HIV/AIDS treatment, 5 others get infected. At this rate, spending for HIV will raise from $13 billion now to between $19 and $35 billion in just 20 years’ time (Source: Results for Development Institute. Cost and Choices, financing the long term fight against AIDS, 2010).  Globally, the estimated cost of preventing an infection is US $3,923, whereas the estimated cost of lifetime treatment is US $ 4,707. This gives a net saving of US $ 784 for each infection averted (Source: Stover and others, 2006).

For as long as treatment for HIV-AIDS is for life and based on the current costs of HIV treatment, there is no doubt that HIV prevention programmes and services are essential to stop the epidemics in the medium term.

Halving new infections in eastern and southern Africa by 2015 would avert 2.3 million new HIV infections and save US$ 12.5 billion in treatment costs (UNAIDS, Mobilizing prevention as a movement for universal access, December 2009).

Peer education programs have been shown to be highly effective in reducing transmission from and to Sex Workers (SWs). A 1991 analysis carried out among 1,000 SWs in Nairobi found that a program of STD control and condom promotion was able to prevent between 8,000 and 10,000 new cases of HIV infection per year (Moses S, Plummer FA, Ngugi EN, Nagelkerke NJ, Anzala AO, Ndinya-Achola JO. Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS. 1991). Given the modest cost of the program, each averted HIV infection costs between US$8 and US$12, demonstrating extremely high cost-effectiveness. Interventions of this type are competitive with the most cost-effective HIV and non-HIV public health interventions (Cost-Effectiveness of HIV Prevention in Developing Countries, 2002).

Now you decide what is better- prevention or cure?

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The views expressed in this blog-post are solely those of the author.

Comments (5)

bashir ahmad
Wednesday 27th April, 2011, 2:16pm

I really appreciate you for the efforts you did, well i have no much idea about the other countries while if i am talking about Pakistan, the youth do not know about the precaution and prevention about HCV/HIV/STI and Aids till A-level, the age on a young student in A-level is normally 18 years, while we should know about all this in the year of 13 or 14, its because the education about above topics is not included in the education.

Aysel Asgarova
Thursday 28th April, 2011, 3:31am

thanks for providing your feedback, Bashir! totally agree with you! We hear talks about gender violence, STIs, HIV/AIDS, drug abuse,etc. from governmental and international organisations all the time but I guess everyone should understand the prevention of such present-day challenges lies in education at high schools and other educational institutions as its the schools and universities where an outlook and views on life of everyone are formed.

Malika Atasheva
Thursday 28th April, 2011, 6:05am

I really find the statistics about Ukraine young people, majority of which think that it is important to get sexual health education, but at the same time half of them find it not interesting.

It pushed me into thoughts about my own country. I do believe that one day we will have comprehensive SRHR education integrated into school curricula. But I see potential challenges that teachers and teenagers might face: how you educate is important.

It will take some time to create interactive and interesting for young people materials, books, lesson plans. Teachers need to be thoroughly trained and prepared, as well as to be confident and believe in what they are doing.

Also, I though, that the earlier sexual education starts at school the better it is for teenagers to absorb accurate information, before they learn myths and misleading info from the inaccurate resources.

I like your blog, Aysel. Thanks for sharing.

Malika Atasheva
Thursday 28th April, 2011, 6:14am

Sorry, missed one word, and couldn't edit it =)

**I really find interesting to know the statistics about Ukraine young people, majority of which think that it is important to get sexual health education, but at the same time half of them find it not interesting

Nikhil Gurung
Saturday 7th May, 2011, 10:26am

Good Article !!! There's no doubt that Prevention is better than cure. However, we should also equally keep in mind that "Treatment as a part of Prevention" in context of HIV and AIDS while investing towards the epidemic.
When we are talking about early prevention education , we also tend to miss the part of honest and fact based drug education. The already existed curriculum or way of teaching in academic institution only offers that "DRUGS ARE BAD" " SAY NO TO DRUGS" which is not working. Evidence shows that countries Like Ukraine shows that young people have started injecting drugs at the age of 12 years old.Now, you can imagine ??
Prevention effort will work effectively with a meaningful engagement of Key Affected Population such as People living with HIV, SWs , People who use drugs, MSM , TG at all level.
We "youth" should come out of the Traditional Prevention approach and bring the new perspectives on the table.

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Guest Editor

Aysel Asgarova


I was born in Baku, Azerbaijan. I graduated from Azerbaijan University of Languages with major in English Philology and did an MBA degree at Azerbaijan State Economic University with major in Management. I’ve had a number of experiences and worked for both local and foreign companies and international organizations such as Norwegian Microcredit Organisation (HR Officer); The British Council (Programmes Officer) and Azerbaijan University of Languages (Media Specialist). At present I work for UNDP Solid Waste Management Project in the capacity of Project Assistant. Simultaneously, I’m the Founder and Focal Point in Charge of Y-PEER Azerbaijan where I’m dealing with identifying main strategies and policies of the network and overall coordination of its activities. Apart from my native language, I’m fluent in English and Russian. Among my achievements are victory in an e-quiz, held by the British Council together with Oxford Reference Online; victory in the Writing Contest, held by the British Council; and victory in the best project proposal competition, run by World Federation of UN Associations–Youth (WFUNA-Youth) & UN Association- UK as the result of which I was awarded with a trip to Oxford, UK to participate in WFUNA Project Management Training & Oxford University Model UN.

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