There’s a campaign doing the rounds on twitter to #SaveYEAH, referring to an organisation in my field called Youth Empowerment Against HIV/AIDS.
This weekend, Jill Stark wrote about the campaign in The Sunday Age, and the paper also ran an editorial on it, both linking the ‘defunding’ of YEAH to attacks by the Christian right wing of the Liberal-National government on the Safe Schools Coalition Australia.
In fact, as a member of the Ministerial Advisory Committee on BBV and Sexually Transmitted Infections, YEAH CEO Alischa Ross most likely knew in advance that the entire funding stream was being replaced. An ‘Invitation to Apply for Funding H1516G007’ for a new stream was released in November 2015, which included $1.3m for web, app and social media resources targeted people under 30 about sexual health.
Although it knew about the new funding arrangements from November 2015, the #SaveYEAH campaign did not begin until an initial tweet on 14 April 2016. Rather than a ‘defunding’ it seems more likely that YEAH was unsuccessful in applying for funding under the new stream.
The article quotes Anne Mitchell and Michael Carr-Gregg (who is not, to my knowledge, an expert on sexual health promotion) claiming the funding decision is ideological:
They claim YEAH (Youth Empowerment Against HIV/AIDS) is the latest victim of an ideological agenda pushed by conservatives who believe teaching students about sex and sexuality from an early age is dangerous.
“There’s a lot of kowtowing to right-wing activists at the moment and you’d have to say that defunding of YEAH is part of that agenda too,” Anne Mitchell, emeritus professor at La Trobe University and one of Australia’s leading authorities on sexual health and education, said. (source)
This does not stand up to factual scrutiny. The decision to replace YEAH’s face-to-face approach with one based on social media was clearly taken months before George Christensen MP began attacking the Safe Schools Coalition in February 2016.
The Age editorial went further:
The Coalition plans to slash the program’s $450,000 annual budget and instead make information available online.
How sadly ironic. The way modern digital technology has increased pressure on young people especially to engage in unwanted sexual behaviour is an important part of the reason the community needs to have more open discussion about sex and directly confront any misapprehension.
(…)
Given the recent furore over slashing the Safe Schools Coalition – an initiative to stamp out discrimination against LGBTI students – it is hard to escape the conclusion the government is deliberately pandering to the conservative wing of Liberal party in this raid on funds. (source)
Apart from the timing being wrong, spending $900K more funding on sexual health promotion via apps, the web and social media is not consistent with the picture being painted here of a government afraid of talking to young people about sex.
Typical of The Age, it can’t see the contradiction in arguing ‘modern digital technology has increased pressure on young people especially to engage in unwanted sexual behaviour’ while dismissing interventions that engage in the same spaces to address those problems.
For advice on the value of digital technologies in promoting young people’s health, The Age could have asked one Michael Carr-Gregg, who is Managing Director of the Young and Well CRC and developed its Certificate in Young People’s Mental Health and Digital Technology.
We should not fund YEAH
It’s a matter of numbers and reach.
How many young people aged 15-30 are there in Australia?
2,464,966 (ABS estimate 30 June 2013, table 7)
How many new young people enter that cohort every year?
144,617 (ABS estimate 30 June 2013, table 7)
Young people reached by YEAH in 2015
10,000 ‘face-to-face’ (Jill Stark, The Age 23 April 2016)
These figures from their 2015 Annual Report show the cost-effectiveness of this program:
Unless the 62 workshops had 161 participants each, it seems like the 10,000 ‘face-to-face’ contacts — the number quoted in Jill Stark’s article — includes young people reached via Facebook, Instagram, e-newsletters etc. If so, the majority of YEAH’s outreach to young people was via online social media. If not, we paid $456K for YEAH to conduct 62 workshops, at a cost of $7,358 each.
Sidebar: I am absolutely mystified by the claim in YEAH’s annual report that it spoke to ‘50,000’ and ‘82,000’ young people in 2014 to ascertain their views about its participation in the Triple J regional music festival, Groovin’ the Moo.
Is this an argument for funding YEAH to reach more people? No. The problem isn’t a lack of resources, it’s that their service model is misguided to begin with. The problem is partly how the organisation was historically focussed and partly the failure of its CEO, Alischa Ross, to step down from hands-on management of the organisation when she was no longer a young person.
First, the history of YEAH. As HIV/AIDS infection rates increased in the early 2000s, a number of different ‘moral entrepreneurs’ saw their opportunity. In November 2007 the ABC reported:
MARK COLVIN: In the last few years especially, it appears the issue of AIDS has gradually dropped down the agenda, both for politicians and the community.
Infection rates in Australia are rising and there are concerns that the young generation is ignorant or complacent about the dangers of HIV.
Youth affairs reporter, Michael Turtle.
MICHARL TURTLE: This year, it’s estimated about a thousand Australians will be diagnosed with HIV for the first time. That’s an increase of about 30 per cent from the year 2000, when 763 people were found to have been infected.
After almost two decades of containment, HIV has begun to get the better of the community again. (source)
Ross framed YEAH as a pre-emptive response to a forthcoming epidemic of HIV/AIDS among young people:
MICHARL TURTLE: Alischa Ross is the CEO of the group Youth Empowerment Against HIV/AIDS.
She also sees the prevention of the virus as a priority for all ages and all sexualities. And she’s warning that it may not be long before it becomes a big problem amongst the new generation.
ALISCHA ROSS: We know that Sexually Transmitted Infections amongst the young people are spreading like wildfire. This is the same behaviour that results in spread of HIV, so it is a matter of time until we see HIV spreading amongst young sexually-active teenagers.
MICHARL TURTLE: Ms Ross is calling for a renewed focus from governments on education and awareness. She thinks HIV needs to be talked about more in schools and in the community.
ALISCHA ROSS: If we’re talking about this as a preventable disease, which it is, and we’re meaning prevention in true sense of the word, which is to stop something from happening in the first place, then I don’t think our response to prevention, when it comes to young people, should mean that we wait to see a problem emerge. (source)
By that point — 26 years into the AIDS crisis — it was pretty clear that Australia was not going to see what’s known as a generalised epidemic where more than 1% of the heterosexual population are living with HIV. Instead we have what’s known as concentrated epidemics — predominantly among gay men; due to prompt and proactive work by sex workers and people who inject drugs, HIV prevalence in those two groups in Australia is incredibly low compared to other countries.
In that interview, Ross argues we should respond to something of which there was zero evidence — a mainstream HIV epidemic ‘in the new generation’. The heterosexual focus here is subtle, but distinctive: if you are targeting gay men, it’s pretty inefficient to go through ‘schools and the community’.
In this early phase of YEAH’s development one particular phrase got a workout:
Through the development of YEAH (Youth Empowerment Against HIV/AIDS) Alischa’s focus has been educating young people from across diverse communities, advocating the message, ‘HIV/AIDS is an issues that affects everyone‘. (source)
Alischa Ross had no educational training and this is apparent from the incredibly dense ‘student fact sheets‘ and teaching materials YEAH was promoting at the time. I remember being concerned that the information provided was confused:
A retrovirus moves in the reverse direction to the natural cycle of the body’s own cells enabling this type of virus to bypass check points that would usually prevent the integration of foreign materials entering human cells.
The body relies upon these check points in the cell cycle to regulate disease control. HIV’s ability to bypass this allows it to integrate into the body’s own system and take over white cells by inserting its own genetic material into the body’s T cells and the new DNA re-programs the cell to destroy the immune system. (source)
In the late 2000s the Australian Government launched an ‘STIs are spreading fast’ campaign and YEAH obtained funding to promote STI awareness among young people. This led to a shift in its messaging to emphasise a sense of crisis around STI. In a presentation to the 2012 CSRH conference, Ross and Felix Scholtz argued:
In the past 3 years Australia has seen a 20% increase in the rate of STIs diagnosed amongst people aged 15–29 years. With more than three quarters of nationally reported STIs occurring amongst young people we must find new ways to effectively communicate and articulate in a meaningful way with young people, many of whom have limited or inaccurate knowledge of sexual health risks and how to prevent poor sexual health outcomes.
This project investigates the effectiveness of people aged 17–29 trained in HIV/STI peer-education, to deliver sexual health promotion activities at a national regional music festival to determine if there is an evidence base for scaling-up youth-led sexual health promotion.
Using peer education and social marketing activities, the project facilitated the promotion of positive sexual health messages to 85,000 young people in five regional centres. Using qualitative analysis of the perceptions and experiences of participants, it’s argued that methods involving young people are more likely to be effective in directly impacting young people’s behaviour.
The analysis contributes to understanding best practices to empower young people to take control of their sexual health. The findings support increased investment in policy and peer-based programs that put young people’s leadership at the centre of national responses to youth sexual health. (source
The abstract uses relative percentages (‘a 20% increase’) and proportions (‘three quarters’) to suggest a sense of crisis around STIs in young people.
However, diagnosing more STIs doesn’t automatically indicate an increase in transmission of STIs: it can mean more people getting tested, either seeking it out because of awareness or being proactively offered testing by doctors. It can also mean the same base rate of infection multiplied by an increased rate of sexual encounters and partner change (or concurrency). My point here is that it’s an incredibly crude figure and careful analysis and further research are required before drawing conclusions from it.
Secondly, there’s an implicit claim that STI diagnoses among young people are disproportionate. This in fact reflects patterns of sexual and romantic partnerships in Australian culture: many people see their twenties as a time for exploration and form longer-term partnerships in later life.
There are other problems here. Like the way a funded project is presented as a research initiative (‘investigates the effectiveness of’). Or the weasel words used around its absurd estimation of its claimed reach (‘facilitated the promotion of … messages to 85,000 young people’). Or the mismatch of constructivist research methods and data type (‘qualitative analysis of the perceptions and experiences of participants’) to assess a probabilistic question (‘likely to be effective in directly impacting young people’s behaviour’).
But most of all it conflates policy participation with service delivery. I agree with its call for ‘increased investment in policy and peer-based programs that put young people’s leadership at the centre of national responses to youth sexual health’. And that’s why I don’t support the #SaveYEAH campaign — because YEAH, as an organisation, is not configured in a way that reflects best practice in youth leadership and engagement.
Achieving effective representation of young people doesn’t require a model where young people deliver all the services. It requires an engagement structure and practices that reaches a diverse array of young people, listens to them on an ongoing basis (this rules out focus groups and online surveys), and then translates their feedback into influence on policy-making and service delivery by other agencies, so that young people have better experiences of more sensitive and relevant education, clinical service provision, etc.
Effective policy advocacy achieves a multiplier effect: by targeting policy and the establishment of best practices, it influences a wider array of services and actors who in turn influence the daily lives of a much, much wider audience than direct service provision can ever hope to reach.
Even if you ‘promote messages’ about sexual health to young people, if they can’t get condoms, or see a trans-friendly psychologist, or get sexual health care which includes a rectal swab, then the message isn’t helping anyone.
Of course, YEAH would argue that it does this advocacy work as well. But when its CEO Alischa Ross turns up at a policy forum instead of an actual young person and gets called out for speaking for Youth Empowerment Against HIV/AIDS (Inc) instead of empowering actual young people to participate in making policy, that doesn’t work.
Ross was born in 1980 and in a 2009 book chapter she wrote:
There is a norm among youth-led organisations of CEOs ‘stepping up and stepping back’, or in the case of Oaktree Foundation, requiring their CEO to resign at age 26. Organisations that don’t take this approach need to be transparent about their adherence to best practices in youth participation, engagement and leadership. That is a governance issue, because it profoundly affects the organisation’s credibility in funding and advocacy. YEAH needs to have a good hard think about those issues as it casts around for new funding.