[It is important] to involve all women in this work. [We need to] establish links with women in the health sector who are not usually identified as "feminist" or "activist." - Maria Margarita Diaz, Brazil

We must bring men into the movement as allies. - Dr. Debrework Zewdie, Ethiopia

Preventing and treating RTIs, whether they are sexually transmitted or result from poor medical care or harmful practices, requires simultaneous work on the most intimate of personal relationships and the most public of health infrastructures. Prevention and control of RTIs demands analysis, investment, and change at every level --

• from personal interactions to public policy;

• in cultural, economic, social, and political life; and

• at the household, community, state, national, and international levels.

PERSONAL AND ORGANIZATIONAL PARTNERSHIPS

Alliances of different groups will be essential to address power imbalances that block the development of comprehensive programs of RTI prevention. Indeed, the strength of such alliances was a characteristic of the meeting itself, as participants from countries throughout the world discovered similarities and diversities within the group, shared information and ideas, and decided on global priorities. Alliances among women are key mobilizing tools to challenge existing power structures and identify alternatives and priorities.

Participants agreed that women should work together within and between Southern countries and between the South and the North to gain support for changing their own sexual relationships, utilizing and transforming health services, and influencing policy. Cooperative action will increase women's understanding of themselves and of each other -- on a personal as well as on a political level -- as people working for change in a variety of ways and settings. "[We need to] understand the differences [between us] so we can use them best to come together" (Dr. Judith Wasserheit, United States).

Men are key players in women's personal and public lives -- whether nurturing or exploiting, cooperating or obstructing, concerned or indifferent. Participants agreed strongly that building a successful movement for the prevention and control of RTIs requires solidarity and alliances with men at all levels to change male behavior. Strong efforts are needed to reach men as well as women in education and treatment. Programs that serve women should better understand women's personal relationships -- most frequently as sexual partners with men -- in order to build women's confidence to negotiate their sexual relationships and protection from unwanted sex, unwanted pregnancies, and STDs.

We need to forge alliances with adolescents to develop appropriate and effective programs. Their reproductive and sexual health is too often defined in terms of teenage pregnancy and AIDS. We should be looking to young people -- to the next generation -- for solutions to sexual and health dilemmas, rather than simply defining adolescents as being "at risk." Young people can challenge unequal power relationships early in their development and should be encouraged to create new definitions of male-female interactions based on more egalitarian and mutually supportive norms. Program managers should solicit their opinions in the design and management of RTI programs for them. Alliances between student groups or out-of-school teenagers and adults concerned with RTIs would recognize Common problems as well as differences.

In addition, women's health advocates need to create linkages with political leaders, churches, associations of doctors and nurses or midwives, schools, social workers, community activists, and family planning organizations, among others, to mobilize support for a new vision of gender relations that incorporates the sexual and reproductive health and rights of people. In particular, activists, policy makers, and service providers need networks to bring them together, and a forum for exchanging view points and planning strategies.

In particular, activists, policy makers, and service providers need networks to bring them together, and a forum for exchanging view points and planning strategies.

FUNDING PRIORITIES AND NORTH SOUTH COOPERATION

Where is the collaboration? Where is the North-South dialogue? Where is the money? People are suffering! - Dr. Lilian Wambua, Cameroun

Participants made a number of recommendations about the contributions that funding agencies can make. For example:

• Funding agencies interested in health care and family planning should redefine their mission to include issues such as sexuality and RTIs; broaden their measures of program development; and include groups currently excluded, such as the young and the unmarried.

• Family planning policies should be based on a sexual and reproductive health and rights approach, not on population control.

• The realities of gender and power relations, RTIs, sexuality, and violence should become an explicit part of the policy dialogue.

• Donor agencies need to listen closely to what feminists and women's health advocates have to say in each country, rather than making assumptions about what women need.

• Donors should funnel money to nongovernment organizations and community groups so that they can design their own programs and simultaneously work toward influencing government policies and programs.

• A sustained commitment to change, including long term financial support, is essential.

• Donors should provide timely access to information on the availability of funds and the procedures for obtaining them.

• Donors should allow considerable flexibility in the use of their funds so that recipient organizations can define their own priorities and experiment more freely with innovations in program design, implementation, and evaluation.

• Funding is needed for educational efforts, for training of trainers and providers, and for the development and improvement of simple RTI diagnostic technologies and barrier methods of protection, as well as for program design, services, and evaluation.

• Donors should support intracountry and international meetings to promote the collaboration of women's health activists, research scientists, and service providers.

• Information on research findings, on international policies, and on emerging donor priorities must be quickly disseminated to interested organizations.

In working toward a vision of a more egalitarian world based on mutual respect and recognition of commonalties and diversities, participants urged that health, including sexual and reproductive health, be perceived and treated as a basic human right. This recognition is central to the prevention and control of RTIs.


Our advocacy [as women] must include [our] self-interest. - Madhu Kishwar, India

[We need to] think realistically, but we need to think big. - Dr. Judith Wasserheit, United States

Participants urged that health, including sexual and reproductive health, be perceived and treated as a basic human right.

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