Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

26 August 2011

Safe-Sex Education: Too little, too much?

Though still in the clinical-trial phase of research, an increasing number of studies are pointing to the effectiveness of microbocides and PrEP as possible tools for promoting safe sex (See the Mapping Pathways blog post on the various trials here). These, along with more traditional prevention methods, can possibly be used as additional tools for preventing HIV infection during sexual intercourse. As a result, a question of increasing importance as we go forward is: How will we reach people and educate them about the multitude of safe-sex tools at their disposal in an informative and engaging way?

Dr. Linda-Gail Bekker from the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization, puts it best: “How do you reach hard-to-reach populations? We are going to have to come up with really targeted and specific interventions.” Dr. Bekker feels that in today’s HIV/AIDS landscape, a blanket strategy no longer works for effectively educating people on various prevention strategies. “I think there is a real awakening that we need to tackle this in a slightly more strategic way. It also requires us to be innovative… Clearly if people abstained from sex, or had sex with partners they knew to be uninfected, or used condoms 100% of the time, we wouldn’t have the HIV epidemic. But obviously, spreading billboards all over the world has not cut it. I mean telling a commercial sex worker to abstain is patently daft... Specific populations need targeted input; we have to know our community and provide each risk group with nuanced messages that are relevant to them. Young girls need a certain kind of messaging compared to older women; older men require different messaging compared to younger men; circumcised men need specific messaging compared to uncircumcised men – and so on.”

Dr. Bekker makes a good point. Take, for instance, a large billboard promoting safe sex for World AIDS Day that was seen at a crowded mall in Mumbai (see below). The poster features a lady wearing a demure, white salwar kameez (a traditional Indian dress for women), with a bowl of tossed salad in her hand. The tag reads, “Say no to multiple partners... Be a responsible person.” All in all, the billboard seems more appropriate for promoting healthy eating, than healthy sexual behavior!

At the other extreme is a music video that was meant to raise awareness of safe sex and contraception methods to prevent teen pregnancies in “a fun way”. Created by Marie Stopes International and featuring a comedy music band called “The Midnight Beast,” the song’s lyrics advise teens that: “But something to remember as a rule of thumb, one up the bum and it's no harm done… one up the bum and you won't be a mum.” As one viewer commented, “I take it this video is for a world without AIDS?” Added a stunned HIV/AIDS advocate: “Teaching young people there is ‘no harm done’ during anal intercourse is an inaccurate statement... The risk of transmitting HIV during unprotected anal intercourse is significantly greater than for vaginal intercourse for a number of biological reasons.” You can read more about this controversy and see the music video (which has been watched more than 90,000 times on YouTube) here.

These examples illustrate some of the challenges in promoting safe sex, especially as we go forward in a dramatically changing prevention landscape. That said, there are currently many individuals doing inspiring work. Read about Anne Philpot’s Pleasure Project in India and the UK, which aims to bring the “sexy back to safe sex”; and about Brian Kanyemba’s travels through South Africa, where he educates people about rectal microbocides through a game called “Mapping the Body.” Also be sure to visit “My PrEP Experience, ” a new series on the gay men’s health blog LifeLube that features personal stories and first-hand accounts of people’s experiences with PrEP.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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