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The State of Sexual Health at Yale-NUS College

Story | Michael Sagna, Staff Editor

Students’ names have been anonymized to promote authenticity and to protect their privacy. 

Yale-NUS College likes to think of itself as progressive. We pride ourselves on having more forward thinking and student friendly policies than other universities in Singapore. However, some students feel that there is not much information surrounding the sexual healthcare available, and how much it costs.

What are the procedures in place for seeking treatment for sexual health related issues? Could Yale-NUS do more to protect the sexual health of its students? I had the opportunity to interview Student Services to learn about Yale-NUS’s policies on sexual health, largely relating to insurance coverage and survivor support.

The information in this article was compiled from communications with both the University Health Centre (UHC), the Survivor Support Centre, and MYCG & Partners (Yale-NUS and the National University of Singapore’s (NUS) insurance provider). Students also spoke candidly with me about their personal experiences seeking sexual health support from UHC.

Sexually Transmitted Infections (STIs)

In an email interview, Student Services stated that the health insurance “cover[s] only medically necessary treatments for known diagnoses,” but that “this excludes treatment for sexually transmitted diseases.” “This is the norm for most health plans in Singapore and applies even to those purchased by individuals for personal health coverage,” Student Services added.

This means that students are expected to pay for their own testing and treatment for sexually transmitted infections. STI testing at UHC is also chargeable “depending on the tests involved, the prices range from $40-$165,” Student Services stated, going on to mention that a consultation with a doctor is required. Concerning prevention, “Hep[atitis] B and HPV vaccinations are available, subjected to stock availability.”

Likewise, if a student tests positive, they are expected to front the costs of the medication for the infection. When asked about what students are expected to do if they cannot afford treatment or testing, Student Services said that “the College can provide emergency funding via an upfront loan if required, similar to loans given out for other medical issues.”

Simon*, a student at Yale-NUS, gave a statement about his experience after seeking treatment for anal warts at UHC. “A long time ago, I discovered warts on my anus, and finally went to UHC for a check up after a lot of stress and anxiety,” he shares.

“The doctor did a quick rectal examination, and pronounced very judgmentally and ominously ‘Papilloma warts. VENEREAL DISEASE!’ …As he was examining me, a nurse walked in because he didn’t lock the door and screamed ‘doctor!’” 

“[The doctor] wasn’t very helpful with resources or prognosis—he just said he would write a referral… I opted for a direct referral to the skin centre, rather than the polyclinic route which would have been subsidized, because I was already traumatized by this and I didn’t know how long more the treatment would take or if things would get worse.”

“In short, my mental state merely got worse over the next few weeks until I got treated completely at the skin centre.”

Condoms

To promote safe sex, the college provides condoms which can be found in residential college offices, common lounges, laundry rooms, the intercultural engagement space, and the wellness office. “The College encourages students who are sexually active to be safe and healthy,” Student Services stated. “With this in mind, Dean of Students (DoS) provides a limited quantity of male condoms,” which are “intended for emergency use and not intended to be students’ sole source.” Lubricant is not provided.

Isabella Nuñez, Class of ‘21 and President of the G-Spot, stated that the organisation also “has a supply of condoms as well as lube which have been donated by Action for AIDS (AFA). We have periodically provided these at events, in the intercultural engagement space, and sometimes in little goodie bags across campus,” she also explained.

However, Sonia*, a Yale-NUS student from the Class of 2022, described having bad experiences with the condoms provided by the DoS office. “These condoms are notorious for being crappy. Everybody knows you should only use them in an emergency and at your own risk, which is problematic because you expect a condom to do its one job. They have broken not once, but twice on me.”

Despite the fact that she tried to get Plan B on these occasions, Sonia explains “ultimately I was discouraged by the cost and the fact that I would have to go see a doctor. It would also take way too long, feel like an invasion of privacy, and I wouldn’t know how much the whole thing would cost… I did what a lot of people do, which is just pray for your period to come soon.”

Birth Control

Concerning birth control, Student Services explained “UHC provides consultations” and that “fees are kept to minimum.” They provided the example of contraceptive pills, which start at $6.60 a month. While UHC offers Plan B and birth control pills, it does not offer other methods of contraception such as the intrauterine device, the contraceptive injection, the implant, nor the patch.

Priti* recalls going to UHC for Plan B, otherwise known as the morning after pill, a trip she made twice. “The first time was before COVID hit really hard… It was a relatively fast experience. At the pharmacy, the pharmacist was nice about explaining how to use it and actually answered my questions about side effects really patiently too.”

“[The second time] my experience was more eventful because I think I got the same doctor or another one that had access to my records. I say this because she knew that I had come two weeks ago for the same thing and made a remark that Plan B was not an appropriate method of regular birth control and I did feel a little bit judged.”

“In all, I think my UHC experiences were pretty smooth, but I did feel very ashamed that I had put myself in this position to begin with, so any side comments made me want to cry. I think what added to it was that I felt that I was the only person on this earth who had to get Plan B and I had internalized that Plan B was for irresponsible people so I felt terrible about myself.”

Mariah*, an alumni from the Class of 2020, also described feeling uncomfortable at comments made by a doctor at UHC after consulting a doctor for strong period pains. “The female doctor asked me about my sexual history, and when I told her that I am not sexually active she praised me for being a good girl. She said quite dismissively [that] I should not engage in sexual activities like many of my peers who got various kinds of sexual transmitted diseases.”

Sonia had a similar experience of unsolicited comments being made when seeking treatment for a urinary tract infection. “It was an old man doctor who asked me if I do dirty activities like have sex. And he was like, looking at my vagina. I was like ‘what do you mean dirty activities?’”

When asked about abortions, Student Services stated that “Abortions are not available in UHC and not covered under the NUS Student Insurance. Prices vary hence it is best for students to call the respective hospitals or clinics to enquire.”

Funding and Finances

When asked about funding for different types of birth control, including those explained on posters around campus (pictured above), Student Services stated that “[students] may approach Carol Pillai, Associate Director of Student Services, for emergency funding for emergency contraception.”

Despite the fact that Yale-NUS only offers funding in the form of loans for treatment for STIs, the procedure is slightly different when it comes to emergency treatment in the forms of morning after pills, abortions, and Post-Exposiure Prophylaxis (a drug which can lower the chances of HIV infection after exposure). If students require funding for these, “this would be deemed as emergency funding under the context of survival support. Thus, it would not be in the form of a loan.”

Survivor Support

Yale-NUS’s approach to survivor support is organized through designated staff members. Student Services explains that “Survivor Support Advisors (SSA) can serve as an initial point of contact for survivors of sexual assault or misconduct on campus. An SSA serves as a consistent presence to mitigate the harm caused in survivors being asked to retell their story when navigating internal processes to support their healing.”

“SSAs are trained in trauma-informed protocol and support provided is individualized to the survivor’s needs. This can include emotional support, regular check-ins, guidance on resources and options available, requesting AD notes, emergency funding, accompaniment to the police or hospital, and general logistical adjustments.” Student Services also added that survivors may visit the Sexual Assault Care Centre (SACC)—an external organization which provides resources and services related to sexual assault.

“[Survivor support funding] is not in the form of a loan. Survivors have the agency to visit the SACC at any time without informing the College. We have a confidential billing process with SACC which allows us to fully cover the fees for the survivor without SACC having to disclose any details to us.”

Criticisms

In response to the information in this article, the G-Spot, a student organization which aims to raise awareness about gender and sexuality issues, identified three main gaps in Yale-NUS’s sexual health policies.  

“Firstly, that information on what exactly is covered can be hard to come by—we often rely upon dated info or word-of-mouth to assess potential prices and insurance coverage. Secondly, we lack health experts on campus (such as a nurse) who could clarify these policies for us and refer us to the correct place. Thirdly, sexual health measures beyond condoms are not financially accessible to many students—and, in the vein of broader questions of financial accessibility on campus, measures of mitigating this economic inequality (such as Emergency Funding) are sometimes inconsistent and students may not feel welcome to pursue them,” Isabella Nuñez, President of the G-Spot, stated.

“I recognize that our health insurance policies and the practices at UHC are difficult to change, since they are NUS-wide systems, but there are also several actions which can be taken at the level of Yale-NUS to improve the health, safety, and comfort of our students,” Nuñez added. 

Kingfishers for Consent (KFC), a consent and accountability advocacy group on campus,  also emphasized its view that “these are conversations that should happen openly without any stigma or shame associated with them. In addition to the workshops we do to hold conversations of this kind, this semester we’ve introduced a ‘Kingfishers for Consent Lunch Tag.’ On Fridays from 12:00 to 12:30 you can find KFC members to chat about anything consent or sexual wellness related in an open and friendly way!”

Responses

The Octant reached out to UHC for comment on the accounts of Yale-NUS students. Dr. Lee Chian Chau, Deputy Director of UHC, stated that “Sexual health-related issues are often highly sensitive, and our doctors are trained to be cautious in medical consultations and diagnoses on such matters. We will remind our doctors to be more sensitive when seeing patients on sexual health-related issues, and to exercise more care and empathy in their patient communications.” He also added that “Patients who have any feedback on our doctors or UHC service can contact us at uhc_health@nus.edu.sg.”

Dave Stanfield, Dean of Students at Yale-NUS, also provided a statement in response to the experiences of students at the college .

“Every year, DoS reviews the practices we have in place and takes further action where needed to promote sexual health and wellness at Yale-NUS. Regarding insurance coverage, we plan to more explicitly highlight to newly admitted students the coverage limitations of the student medical insurance plan with respect to STI testing and treatment.”

“We will continue to work closely with KFC to consider other ways to promote sexual health through the committee and support them in their design and distribution of an informative poster on STI and HIV testing and treatment, forms of birth control, how to put on a condom, etc. DoS is also considering a new web page dedicated to sexual health with relevant insurance information, including a list of clinics with affordable places in Singapore for STI and pregnancy testing.”

It remains to be seen, however, how both the University Health Centre and the Dean of Students will fulfil their promises to students in the coming years.

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