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Turning on to safe sex
Reposted courtesy of IRIN PlusNews, 9 July 2002
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Preventing HIV/AIDS in theory seems simple enough. Provide sexually active young people with information on how the disease is spread, and they will naturally adopt safe sex behaviour. But the reality has proved much more complex. Twenty years after the disease was diagnosed, much ignorance surrounding HIV/AIDS still persists.
According to the UN children's agency UNICEF, new studies have established that "the vast majority of young people have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease".
Perhaps even more challenging is the realisation that even among those who have got the message, some have ignored it, or are powerless to negotiate safe sex.
And it is the young who are most at risk. More than half of those newly infected with HIV are between 15 and 24 years, with young women particularly vulnerable. "Adolescents who start having sex early are more likely to have sex with high-risk partners or multiple partners, and are less likely to use condoms," a new UNICEF report warned.
Traditional awareness initiatives have failed to protect the youth. A booklet by the UN's Educational, Scientific and Cultural Organisation (UNESCO) blandly points out: "Several programmes and curriculum innovations have been introduced to promote HIV/AIDS awareness and prevention among young people. Many of these programmes have not yet had the expected results."
For some AIDS researchers, the failure to induce behavioural change lies in the nature of the messages that are being transmitted to the youth. Top-down and fear-inducing lectures on safe sex by national AIDS bodies do not acknowledge that sex is about desire, love, the irrational and the illicit. Cultural contexts, gender roles, and the influence of peers confound a "one size fits all approach" to awareness.
Orthodox public health interventions have "literally bored young people to death", said Mary Crew of the Centre for the Study of AIDS at the University of Pretoria, South Africa. They are judgmental, cautious and "anti-desire", while ignoring the complexities of modern-day South Africa and a "debilitating youth culture of fatalism and bravado".
According to researcher Peter Aggleton, under existing awareness drives, "sex is construed as a behaviour to control, not a passion to be played with safely". They rarely, for example, mention love, which can "legitimate a range of sex practices where risk can be real".
But a more telling indictment of national sex education programmes is that there remains a lack of even a basic understanding of HIV/AIDS in many countries. A UNICEF study found that 74 percent of young women and 62 percent of young men in Mozambique were unaware of a single way to protect themselves from HIV.
"There are more barriers to messages getting out than people realised," UNICEF Executive Secretary Carol Bellamy told IRIN. "While the wall of global silence has been broken, there is a second wall of husband to wife, parent to children, teachers to students." She added: "There are enormous misconceptions, young people lack information on HIV/AIDS. I can't say education [approaches] in the past were wrong, I don't think we've seen enough education."
In South Africa there have been two innovative approaches to that problem. Soul City, a "telling it as it is" television, radio and print initiative set in the community, and loveLife, a fresh and positive media-driven "lifestyle brand". Both, according to Crewe, "open the lid on sexual hypocrisy and get people talking". LoveLife's boss David Harrison believes that the lessons have been learned on not only how safe sex messages should be transmitted, but also what they should contain. "It needs to be targeted, it needs to be focused," he told PlusNews.
The need for a "comprehensive approach" to HIV/AIDS awareness is much more than the typical lone billboard in urban centres. It includes youth advisory services, drop-in centres and youth-friendly clinics.
LoveLife, he explained, taps into youth culture and lifestyle to make safe sex sexy in a "non-didactic" manner. It combines a high-powered media campaign ("for young people, by young people in a language they understand") with adolescent sexual health services, outreach and support programmes that have won the backing of the South African government and some major donors.
While loveLife's approach has stirred some controversy in South Africa, a national survey in 2001 found that 62 percent of young South Africans said they had heard of it and 76 percent of those said it had made them more aware of the risks of unprotected sex. But only 30 percent of sexually experienced youth reported using a condom every time they had a sexual experience in the past year.
Harrison said that while loveLife's approach cannot be directly transplanted to other countries and cultures, it can be "customised". Among the key ingredients would be the need to "tap into aspirations and not fears" of young people. "You need to point out that they have a future," he stressed. Where existing programmes in countries have failed to make an impact, Harrison sees that as an opportunity for a loveLife-style campaign that encourages frank discussion about sex and sexual health based on the realities of young people.
"We now know how to reduce risk," he said. "You need to get to scale very, very quickly. It can't be simply driven through the media, you also need appropriate services for young people."
[This item is delivered to the English Service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations[
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