Information may be their only defence / by Martha Leslie-Harwit and André Meheus

'' Information may be their only defence " by Martha Leslie-Harwit and Andre Meheus Or Martha Leslie-Harwit served as an intern in WHO 's Programme for Sexually Transmitted Diseases and Or Andre Meheus is Chief of this unit Sexually transmitted disease (STD) and unwanted preg-nancy are major health prob- lems for sexually active young people aged between 15 and 24. WHO has had an STD prevention programme since its inception in 1948. To the list of STDs has now been added infection with Human Immunodeficiency Virus (HIV) which may lead to Acquired Immu- nodeficiency Syndrome (AIDS). The major strategy we have to limit the extent of the HIV epidemic is health education directed towards behavioural change. And even be- fore AIDS began to be a major public health problem, the increas- Unwanted pregnancy and venereal dis- eases are major health problems for youngsters all over the world. Photo WHO!T. Urban 16 ing rates of viral STD such as geni- tal herpes or genital papilloma (warts) underscored the importance of preventing infection through health education. Young people in virtually every culture are sexually active. The me- dian age at first intercourse is 14 to 15 years in Africa , and 16 to 20 years in Europe and North Ameri- ca. Frequency and complications of STD are highest in sexually active young people . Access to reliable , modern contraceptive methods also is a major problem for them in most regions of the world. Except in parts of Western Europe , sex edu- cation programmes and the avail- ability of contraceptives to young people have been slow to develop. The causes range from ideological beliefs that sexuality should not begin prior to stable, long-term, monogamous relationships , to lack of adequate funding for education programmes. The need to educate all people about STD is urgent , given that treatment is available for many and early treatment is often necessary to prevent blindness and infertility. It is even more urgent because of the STDs that are not treatable. This is particularly true for young people , who are just beginning to explore their sexuality and have not yet been permanently harmed. Information may be their only defence. In planning a health education programme for young people , the timing of the communication, both as regards the life stage of the young person as well as the particu- lar hour, day , and date , is impor- tant. Different information sources have particular strengths and weak- nesses; content and timing have to be modified appropriately. The mass media are effective in putting the message across to large populations , including that hard-to- reach group of adolescent school dropouts whose often destructive behaviours may put them at partic- ularly high risk of unwanted preg- nancy , and of STD. But these presentations must be carefully planned. Messages must be fairly simple and direct. Complex and frightening messages risk being only partially .understood , and people withdraw rather than listen to them. Repetitious material tends to bore readers or listeners. Ideally the information should be present- ed clearly, simply , and specifically, but with sufficient variability be- tween presentations so that the au- dience remains interested. For young people it is most effective if they can identify with the speaker, WORLD HEALTH, July 1988 and a dialogue format enhances their sense of involvement. Clear recommendations of health-pre- serving behaviour tend to elicit the greatest degree of acceptance and action. Credibility can be further increased by involving well-known and respected hero figures-includ- ing rock music stars. France has found that media campaigns which are most effective in reaching those at high risk of STD present their information through comics strips, posters and advertising cartoons. In the Nether- lands, popular guides called " Looklet" on sexuality are avail- able to all young people, and reas- suringly discuss specific self-protec- tive behaviours , stressing mutual responsibility and respect for one's partner. The Swiss have created several brochures on AIDS, from plain leaflets to cartoons or illus- trated magazines. The United States has set up a "hotline " tele- phone service to provide informa- tion on STD and AIDS. Several de- veloping countries have their own information programmes , making use of radio announcements and television spots . UNICEF has spon- sored the production of a short ani- mated film to teach street chil- dren-many of whom are forced into prostitution by economic need- how to avoid AIDS. The mass media can provide an initial introduction to the subject to the greatest possible audience . The next most successful method to continue rapid learning is the small discussion group composed of young people themselves and a group leader. Such groups offer an opportunity to share views in an in- formed , concerned and responsible setting ; they also encourage and endorse self-esteem. The role of the group leader is to facilitate dis- cussion, and to provide clear, cor- rect information as subjects arise. Comprehensive programmes for STD and family life education have a high success rate. The low rates of adolescent pregnancy and preva- lence of STD in Sweden and the Netherlands attest to the value of such long-term programmes. Even less comprehensive programmes do succeed in teaching important in- formation to adolescents, although it may be hard to determine whe- ther behaviour is also changed. Courses most likely to succeed in W ORLD HEALTH, July 1988 In virtually every culture today, young people are sexually active. All too few have access to counselling, information and education about the risks and how to avoid them. Photo W HO!T. Urban causing behavioural change are those which , besides providing basic scien- tific information on reproduction, also discuss at length the social contexts of sexuality. Information is not presented in isolation, but is made directly relevant to each young person as a decision-maker aware of the consequences of the choices available. These courses in- volve the young person in thinking about his or her life situations, and in making informed choices. Preventing the problems of sexu- ally transmitted disease and un- wanted pregnancy is an important goal , and several creative health education efforts are under way to meet this need. WHO itself has re- cently convened a group of experts to discuss what national and inter- national initiatives can help to pre- vent STD and AIDS in young people, and how to improve those programmes. • 17