Teen Sexual Health

It is necessary to have an understanding of the difference between risk and vulnerability and the impact of both in healthy sexuality.

Vulnerabilities Model:

Four areas have been defined as having an influence on the vulnerability people experience in their sexual health: Individual, Interpersonal, Cultural, and Structural.

Individual: This area focuses on the person and how they behave, the decisions they make, etc. However, we must remember to look at each person's mind-set and circumstances, not just their behaviour. This is because our social environment affects how we behave and our overall health.

Interpersonal: Human relationships are based on complex dynamics that include power. How social power - and all its uses and abuses - is negotiated between people can have a direct affect on their health.

Cultural: Our social experiences are governed, in large part, by our culture and its worldview, habits, practices, rules of conduct, and shared stories (myths). These cultural factors are most often hidden to those living within the culture and are easily taken for granted.

Structural: Over history, societies have created large systems for managing themselves, including legal, economic, political, and educational systems. These systems are ingrained with the values and beliefs of a society - both past and present. The values and beliefs on which these systems are based can lead to situations in which certain groups of people are marginalized and made more vulnerable.

Vulnerabilities Model

The risk and vulnerability of people is examined using HIV as an example

Risk refers to behaviours (things we have control over such as using condoms with our partner) or situations (things we do not have control over such as condom use during forced sex) in which there is a possibility of becoming infected with HIV. Risk is a "cut and dry" concept; is objective and not subjective; and is not attached to who you are as a person but what activities you are engaged in. The concept of "risk" refers to "risk of HIV infection".

Vulnerability is a more subjective concept. It takes risk a step further and examines how and why some groups of people are exposed to much higher levels of risk in their lives. Vulnerability is a measure of how much control people have over their sexual health and the risks they are exposed to. The concept of "vulnerability" refers to the likelihood of being exposed to a situation or behaviour in which there is a risk of HIV transmission.

Impact is the effect of HIV/AIDS on the physical, mental, and social well being of individuals, and on the social, economic, and political life of communities.

Example: The Difference Between Risk and Vulnerability in Two Women
If we look at two women, one a married woman living in a middle-class suburb with her monogamous partner and the other a commercial sex worker living in a poverty-stricken neighbourhood, we see that the sex-trade worker is much more vulnerable to HIV infection. A number of factors influence her higher vulnerability, including a greater number of sex partners and having limited control over the way in which sexual activity happens and if condoms are used. However, if both women were exposed to HIV-infected semen during sex, they would both face the risk of becoming infected.

Determinants of Health: What Makes Canadians Healthy or Unhealthy?

This deceptively simple story speaks to the complex set of factors or conditions that determine the level of health of every Canadian.

"Why is Jason in the hospital?

Because he has a bad infection in his leg.

But why does he have an infection?

Because he has a cut on his leg and it got infected.

But why does he have a cut on his leg?

Because he was playing in the junkyard next to his apartment building and there was some sharp, jagged steel there that he fell on.

But why was he playing in a junkyard?

Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.

But why does he live in that neighbourhood?

Because his parents can't afford a nicer place to live.

But why can't his parents afford a nicer place to live?

Because his Dad is unemployed and his Mom is sick.

But why is his Dad unemployed?

Because he doesn't have much education and he can't find a job.

But why ...?"

- from Toward a Healthy Future: Second Report on the Health of Canadians

In the late 1990s, Health Canada moved towards a new model for understanding and promoting health, known as the Population Health Framework. The Population Health Model differs from traditional medical and health care thinking in two ways. First it addresses a wide range of factors that influence health, while traditional models tend to focus on specific risks and clinical factors relating to specific diseases. Second, it looks at the entire population - as well as subgroups within the population - instead of working with one person at a time. The Population Health Framework is being used to develop broad strategies for creating environments that support the health of the entire population, as well as that of groups with in a population who experience much poorer health. Through research it was discovered that the things we have traditionally thought were most important to health - such as access to health services and education - have relatively small impact on disease and death within populations, while social, environmental, and economic factors play a much larger role. These factors are known as the determinants of health.

Health Canada lists the following twelve determinants of health for Canadians:

• Income and Social Status
• Social Support Networks
• Education and Literacy
• Employment/Working Conditions
• Social Environments
• Physical Environments
• Personal Health Practices and Coping Skills
• Healthy Child Development
• Biology and Genetic Endowment
• Health Services
• Gender
• Culture

For more information visit the Public Health Agency of Canada (formerly Health Canada), at:
http://www.phac-aspc.gc.ca/ph-sp/phdd/determinants/index.html#key_determinants

Case A:
Rahul is a 17-year-old guy from an Indo-Canadian family. His parents are very proud of him and his accomplishments in academics and sports. They always talk about how they will be able to find such a fine wife for their handsome and talented son when the time comes. Rahul always smiles at this while inside he cringes. He knows he doesn't want a wife. He's not attracted to the girls at school; he's much more interested in the other guys. He also knows that his parents will be livid if he says anything about this: his role as a good son is to marry a good girl and have children. His parents often talk about the bad morals that exist in Canadian society, citing the tolerance of homosexuals as just one example. The only time he's been with a guy was one night at a rave. He had taken some drugs with his friends and his inhibitions were down. He doesn't remember much about this experience, including whether or not they used a condom.

Case B:
Kristy, 14 years old, recently moved to a new area of the Lower Mainland with her family. This means she had to go to a new school this year, leaving all her friends behind. At first, she was a bit lonely at school but that changed since she began hanging out with the popular guys in grade 12. Her new friends have been inviting her to parties and giving her rides. This new crowd tends to attend more parties with alcohol and drugs than Kristy's old group of friends. Her parents have commented that her interests seem to have changed quite a bit: she is no longer so involved in school clubs and community groups. One night at the end of a party, one of the guys asks her to give him a blow job in exchange for a ride home. Kristy is confused about what to do. She doesn't really want to give him a blow job, nor does she want to risk losing her new group of friends.

Case C:
Shannon is 15 years old. She has lived in Canada for her entire life. Though Shannon has grown up with Chinese parents, she feels more Canadian in many ways. Shannon feels very open with her friends, but she doesn't feel like she can be herself at home with her parents. She thinks of herself as educated in sexual health, but she has honestly only once talked to her mother about sex. Growing up, she felt like there was a language barrier between her and her parents. She didn't know how to ask them questions about sex or body parts. In fact, she never knew the word for vagina in Cantonese. Her mother called it "down there." "Vagina" was not a word that anyone in Shannon's home would use. Shannon recently started seeing an older guy. They often go to his apartment and make out. Shannon never lets it get too far: she's scared of what people would think of her if she did. He never explicitly asks her if she wants to do something; he just tries it and waits for her to say no.