The whispering about "female problems" must stop. -Billie Miller, Barbados

We need to deconstruct masculinity. It is always linked to violence, control, and dominance....it is the next generation that counts. -Lori Heise, United States

We cannot begin to backpedal because men say they are threatened or they are hurting. We have been hurting for a while. We need to find new ways to communicate [with] and involve men. -Billie Miller Barbados


PUBLIC INFORMATION AND EDUCATION

Public education is a vehicle for disseminating information, building skills, communicating across social boundaries, and reconstructing social attitudes. Information alone typically does not change behavior. Education however can provide the skills to implement behavioral change if it is based on an understanding of the cultural characteristics of the community.

Women have been victimized by men's ignorance and irresponsibility and by their own ignorance of the existence and consequences of RTIs. At the same time key actors in the health field typically have little understanding of RTIs and their impact on women's lives. Health and education professionals and service providers are not trained to address RTIs or sexuality. The messages they disseminate are often ineffective inappropriate or inaccurate. As a result women and men who suffer from RTIs often have no medical information or are misinformed. Information that is culturally appropriate, medically correct, and supportive of mutual understanding and respect could greatly enhance relationships between women and men.

Participants identified the goals of public education on RTIs as preventing and controlling the spread of infections and transforming social relationships that put women at special risk because of their partners behavior. The prime objectives of a public education program should be:

The goals [...are] preventing and controlling the spread of infections and transforming social relationships that put women at special risk.


MESSAGES AND METHODS

Public education campaigns must emphasize the prevention and treatment of RTIs. They should stem from the needs of the people they are intended to reach -- information gaps, misinformation, things that people want to know about sexuality and RTIs-and must be linked to the realities of men's and women's lives. What common practices are likely to cause infection -- unsafe abortion? genital mutilation or unsafe birthing practices? multiple sexual partnerships? specific sexual practices? How can these risk factors be addressed ?

Participants agreed that messages need to include sexuality issues along with positive and nonstereotyped portrayals of gender roles. Current public health and family planning messages, including those conveyed in AIDS campaigns, need to be evaluated for their accuracy and mode of presentation, to ensure that they do not blame victims (such as women and prostitutes) and perpetuate norms of male entitlement. Women should be portrayed as human beings with full dignity and rights, and as partners with men in all aspects of personal and public life, rather than as sexual objects or personal property.

Modes of communication should be adapted to local and national conditions. Using appropriate, commonly used local idioms and symbols is important. Communications planners should not make assumptions about the meanings of symbols, colors, or words, or use words and symbols that have in the past communicated false beliefs or negative gender roles. Messages should be short, clear, consistent, and pretested, with special consideration for the needs of nonliterate women. Scare tactics without information are not helpful.

To be most effective, messages should have the following three components: reinforcement, a multiplying effect, and sustainability. Repetition of the message is critical to reinforcing it.

Participants agreed that messages need to include sexuality issues along with positive and nonstereo typed portrayals of gender roles.

A variety of methods can be used to promote public education. Programs need to recognize the characteristics of different groups that need information, design appropriate messages for each group, and use all possible avenues for reaching people. These avenues include existing sexuality or family-life education programs; family-planning education and AIDS programs; mass media, including magazines, newspapers, radio and television, and commercial films; schools; community-based workers and groups; and popular national and local public personalities. Types of presentation include participatory games, drama, role-playing, folklore and songs, stories, and other traditional educational methods, as well as commercial channels of information and entertainment. Support groups and peer education and training have proved to be useful venues for giving health, sexuality, and contraceptive information in many settings. The content of RTI campaigns can be interwoven in each of these approaches.


RESEARCH AND TRAINING

Baseline data on the prevalence of different types of RTIs among males and females, and follow-up data to monitor change, are essential for designing, implementing, and modifying effective information, education, and communication campaigns. Everywhere, research is needed on communities' knowledge, attitudes, and practices relating to sexuality and RTIs. Language and symbols must be interpreted before messages and strategies can be designed. Media experts, technical people familiar with RTI types and prevalence, and local and national women's groups all need to collaborate in the formulation of materials.

Participants agreed that emphasis must be given to operations research; that is, research by people directly involved in education and services; rather than to "academic" research without direct application. Appropriate message development and testing are especially crucial in countries with heterogeneous populations. Evaluation of materials and messages is also critical. RTI programs could learn what works and what does not in public health and family planning campaigns (e.g., condom advertisements), as well as in other public information programs or advertising campaigns. Full participation of women's health activists who are not only familiar with local beliefs and practices but are also sensitive to gender role portrayals is essential, as are focus groups and other work with boys and men.

Everywhere, research is needed on communities' knowledge, attitudes, and practices relating to sexuality and RTIs.

For effective communication, training of educators should be multidisciplinary and include the topics of sexuality, gender relationships, and communications skills, and information on both the biomedical and the behavioral aspects of RTIs. Educators may be health and family-planning providers, schoolteachers, social workers, and other professional workers. They may be local political leaders, youths, midwives, housewives, parents, or popular local figures, men as well as women. On an informal basis, training and education can be conducted in community institutions such as churches, women's groups, sports clubs, literacy programs, and work or recreational settings.

Trainers need to be carefully selected, and they should not impose messages; rather, they should facilitate the exchange of information and draw out the implications of this knowledge and attitude base. "Men must be involved because they share the responsibility of reproductive health, and both men and women do not understand their own and each other's bodies" (Dr. Rani Bang, India). Educators need to be supervised and their training reinforced with periodic retraining and evaluation of their technical and social skills.

Conference participants emphasized that women's health advocates and representatives of other community groups must be involved in program development to ensure that educational messages and materials are specific to the needs of the community as the community defines them. Education should be decentralized, participatory, and continuously evaluated, with close contact between policy-makers and communities. A multidisciplinary approach to integrating RTI information into the curricula of all schools and other formal educational programs, training centers, literacy programs, and other informal avenues of education could be instituted through government policy. Nongovernmental organizations involved in health and education can also play an important role in educational efforts, by integrating RTI education into their activities on a national and local level, and by collaborating with government programs.

In view of the discussion of sexuality and gender reported earlier, it is clear that gender sensitivity in policy development, research, training, and program implementation is a top priority. Notions of masculinity and femininity need to be redefined, and gender images in the media scrutinized, so that political pressure can force the removal of exploitative and negative images of women. This, of course, is a broad agenda, which moves well beyond the boundaries of what is typically considered the rubric of an educational program on RTIs or STDs. Participants strongly asserted, however, that these broader issues of sex discrimination and female subordination must be confronted directly if educational campaigns are to successfully challenge behaviors and beliefs that perpetuate disease transmission.

If we don't understand the way we are discriminated against sexually , then how can we have the possibility of empowerment? We mustn't b e afraid to put these things on the table. . . .We face discrimination, and RTIs are part of that. -Amparo Claro, Chile

Sometimes the passion is our own. Advocacy is not going to work until people concerned about the issue create themselves into a constituency that can be used to make change. -Andaiye, Barbados

Men must be involved because they share the responsibility of reproductive health, and both men and women do not understand their own and each other's bodies.


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