Russian roulette - Israeli style

Public's awareness of dangers of STDs still alarmingly lacking, resulting in rapid increase.

Tel Aviv club 88 248 (photo credit: Courtesy)
Tel Aviv club 88 248
(photo credit: Courtesy)
"Intuition." That was the answer given by the curly-haired DJ of one of the many neighborhood bars of Tel Aviv when asked how she knew whether a man was "safe" enough to have unprotected sex with. This situation might seem like an anomalous fluke, but in a passionate city like Tel Aviv, such occurrences are quite common. When prodded further about her understanding of sexually transmitted diseases and their origins, she admitted that her knowledge unfortunately came from personal experience. What is more unfortunate is that she did not seem aware of the contradiction between her intuition and the potentially regretful results of relying on it. Sexually transmitted diseases in Israel seem to fall into two distinct categories. There is AIDS, and then there is every other STD. AIDS was first discovered in Israel in the mid-1980s, and the number of infections rose steadily until the late 90s. Since then, the incidence rate of AIDS in Israel has been remarkably low, with estimates ranging between 4,500 and 5,500 reported cases in the country, and probably another 4,000 unreported cases. The number of cases of AIDS has remained relatively stable for nearly a decade, with slight increases in the last two years. Futhermore, AIDS awareness is relatively high and widely prevalent. Countless organizations and non-profit groups in Israel are focused on increasing awareness of the disease. Many teens, though not all, are educated about the disease in a mandatory 90-minute seminar in sixth or ninth grade. There is also informal sex education in the military that further stresses the dangers of the disease and discusses preventive measures. The other category, consisting of gonorrhea, chlamydia, syphilis and a bevy of other diseases, is almost entirely ignored. Even though these diseases can be treated easily, and are very rarely fatal, they are still serious and can cause major complications. Gonorrhea in men can cause painful inflammation of the prostate gland if left untreated. In women, the most common result of untreated gonorrhea is Pelvic Inflammatory Disease, a serious infection of the uterus that can lead to infertility. These diseases rarely, if ever, receive adequate attention in Israel. Of the remaining patrons at the local bar in Tel Aviv, half had no idea that STDs other than AIDS existed, and not one could name or describe a specific disease. Also, unlike AIDS, the incidence rates of "lesser" STDs are increasing rapidly. A study published in 2003 in the medical journal STI found that the incidence rate of gonorrhea in Israel rose from .74 per 100,000 to 13.8 per 100,000 from 1997 to 2001, (a more than 1,700 percent increase). Dr. Dan Michaeli, former chairman of Clalit Health Fund, reported similar findings in a 2003 article in the Israel Medical Association Journal, stating "Since 1998-99 we are facing a sharp increase in the incidence of gonorrhea in the country as a whole, and in the Tel Aviv area in particular." Instances of chlamydia and syphilis have also increased rapidly in recent years. The numbers dropped slightly between 2003-2005, but since 2005 incidence rates have risen again. The victims of the increased rates of all of these STDs, including AIDS, are mostly heterosexual females. Yet, as many respondents at the local bar pointed out, there is still a widespread misconception that STDs in general are strictly "gay" diseases. But Israel's homosexual community arguably has the highest awareness of STD prevention, and the most consistent rate of safe sexual practices, specifically the use of condoms. At another local bar near the intersection of Dizengoff and Ben-Gurion streets, a veritable Mecca of Tel Aviv hedonism, men interviewed by Metro kept repeating the mantra that condoms "just don't feel good," or are "disgusting," or condom use becomes a minor afterthought when "in the mood." Women echoed these sentiments, adding that contraception and an AIDS test were enough to justify unprotected sex. Again, practically no one seemed to be aware that other STDs even existed. So why the massive ignorance in the heterosexual community, especially considering the fact that putting on a condom takes seconds? Are Israeli young adults so sexually charged that they can't be bothered to perform one small perfunctory act that could protect them from major physical complications? "Rachel," a 30-year-old American immigrant who has been teaching sex education in Israel, both formally and informally, blames the country's school system. She went to public schools in the US, where the concept of using condoms to prevent gonorrhea and other diseases was drilled into her in sex education classes from sixth grade through high school. In her opinion, sex education in Israeli schools seems ad hoc at best and non-existent at worst. Her recent experience with secular public schools in Jerusalem indicated that some schools held annual seminars on the subject, while other schools offered absolutely nothing. Rachel emphasized that school seminars address AIDS but fail to mention other STDs, and the only opportunity that she has to educate teens about the other STDs is when she leads informal sessions by invitation. This base of ignorance seems to carry through to adulthood, as not one respondent at the bars in Tel Aviv mentioned "education" as the source of their knowledge of STDs. Most interviewees cited the media as their main source of information about STDs, and some mentioned "friends" and "family." One anonymous Education Ministry employee informed Metro that two years ago the Ministry augmented its policy on sex education to put more of an emphasis on STDs besides AIDS, but there is no guarantee that the policy changes are actually being implemented in the classrooms. In his opinion, recent cutbacks in funding and in instructional hours mean that there simply aren't enough means to cover everything prescribed by the Ministry, and each school sets its own priorities accordingly. This could partially explain Rachel's varied experiences with public schools in Jerusalem. But, "The problem is much worse in the religious communities," stated Rachel, "because sex and sexuality is taboo, so there is no dialogue." The complete lack of discourse on the subject is further exacerbated by the fact that religious communities turn a blind eye to sexual activity among their teens. She suggested that religious teens might be participating in dangerous sexual behavior without knowing exactly what they were doing and the dangers inherent in it. Rachel's assessment was confirmed by two male bar patrons who were raised in religious communities. "We knew nothing," stated the first, a tall, thin 30-something with dark hair under his kippa. "Nothing was mentioned in schools, and our parents certainly never talked about it." The second man, shorter and not wearing a kippa, added that there were always rumors of somebody who contracted a sexually transmitted disease, but that actual discussions about the topic were unthinkable. But lack of education isn't the only reason for the ignorance. The nation's medical establishment arguably bears part of the blame. Doctors are quick to prescribe contraception, yet rarely mention the importance of safe sexual practices. One redheaded woman revealed that any information she had about STDs came from her American boyfriend, who refused to have unprotected sex with her until she got tested for STDs. "My doctor didn't understand why I was asking to be tested," she stated, "He said that an AIDS test and the pill was enough and that I should stop worrying and focus on getting married. I had to demand that he test me." The reaction of the woman's gynecologist may be extreme, but one young doctor from the Maccabi Health Fund confirmed that there are definite gaps between policy and practice in Israel. As he pointed out, there is currently no official policy for STDs from the Health Ministry, and testing is only done on patients who show symptoms. This can be easy for infections like gonorrhea, but much harder for chlamydia, which has a 50% false positive reading. The Health Ministry told Metro that general STD testing is done for "high-risk" groups, and that there is a free clinic for sex workers in Tel Aviv, but a general policy for the greater population does not exist. Yair Amikam, deputy director-general of information and international relations at the Health Ministry, is aware of the disparity between policy and practice, and believes the problem can be solved with more funding. As he told Metro, the amount of money allocated by the government for the purpose of raising STD awareness is "ridiculous," and forces the ministry to focus almost entirely on AIDS, the deadliest and most frightening STD. Indeed, as other women in the bar confirmed, the medical establishment does not push for regular STD testing, and doctors rarely, if ever, mention anything besides pregnancy and AIDS to their patients. Rachel compared the situation in Israel to that of her university in the US, where the campus health services provided a full bowl of condoms available free to students at all hours of the day, sitting right next to countless pamphlets about STDs. But there could be a third, vaguer, reason lingering below the surface. At a third bar on the north end of Dizengoff, "Karen," another American olah, said she thought the cause of unsafe sexual practice among Israelis was rooted in the "Israeli mentality." "Every time I've been with an Israeli man and I've told him to put on a condom, he would get irritated or angry and come up with all these excuses why he shouldn't use a condom. It's that mentality of macho Israeli invincibility, where they think they know better." Karen offered her own explanation of why Israelis engage in such unsafe sex practices. "It's the same reason why they knowingly drive like crap, or leave their garbage on the beach, or ignore the smoking ban. They all know it's bad, but they just don't care to be bothered by the small stuff because they can always use the excuse that there are bigger issues to worry about in Israel." Many of the bar patrons did admit that some inner voice was telling them that their behavior was putting them at unnecessary risk. Most who admitted to unsafe sexual practices also said they felt some regret over their actions. Yet they continue their unsafe behavior. Maybe Karen is correct in her analysis - that the average Tel Avivian, male or female, will shrug off seemingly minor precautions, ignoring the fact that doing so could cause long-term complications or harm. Neta Yedid, Chief Supervisor for Sex Education and Family Life in the Department of Psychological and Counseling Services of the Ministry of Education, agrees with Keren as well. As she pointed out to Metro, there is a wide gap between behavior and knowledge when it comes to safe sexual practices. She believes that regardless of the policy prescriptions from the Ministries of Health or Education, young Israeli adults will continue to act irresponsibly because they prefer to think of themselves as invincible rather than internalizing the risks. The spread of gonorrhea, syphilis and chlamydia in Israel, particularly in Tel Aviv, will most likely worsen if current trends continue. Even though it is relatively costless to add another five minutes to a 90-minute seminar on AIDS that would discuss other STDs and safe sexual behavior, there is little reason to believe that the education system will make any changes in the near future. There is simply no push from the public to make changes, apart from the few activists like Rachel who are volunteering to compensate for the gaps in education. The medical establishment's attitude to STDs is also unlikely to change unless the public demands it. As long as women fail to demand full STD examinations from physicians, doctors will perpetuate ignorance. While doctors can change this practice easily, there has been no indication that the Health Ministry intends to change its approach anytime soon, or start focusing on preventive medicine when it comes to sexual health. What can change is the prevailing mindset. Instead of gut impulsivity, young Israelis, like the DJ, could take a more rational approach and listen to the red flags of their conscience. Information about STDs and proper condom use is readily available on countless Web sites, and there are plenty of local resources if one is only willing to inquire. Sexually transmitted diseases are not a trivial matter, especially if untreated or ignored, even though many act as if they were.