Hesperian Health Guides
Community strategies for STI prevention
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- Chapter 5: Preventing Sexually Transmitted Infections (STIs)
- Start where people are at
- Learn how STIs spread to help prevent them
- Women's equality prevents STIs
- Gender roles and STIs
- Men share responsibility for STI prevention
- Safer sex requires good communication
- Community strategies for STI prevention
Community education and action can help prevent the spread of STIs in many ways. Girls, boys, men, and women around the world are organizing in schools, churches, clubs, workplaces, and neighborhoods. These community groups are finding creative ways to make condoms available, raise awareness about safer sex, empower women to negotiate for safer sex, reach out to youth, and provide access to STI testing and treatment. The following sections share activities and examples of different community strategies.
- 1 Community mapping of sexual health resources and dangers
- 2 Empowerment in all parts of women's lives
- 3 End stigma and harmful beliefs about STIs
- 4 Help adolescents protect themselves from STIs
Community mapping of sexual health resources and dangers
A mapping activity is one way a group can discover and share information about sexual health resources. The map can include places where condoms are distributed, where STI testing is available, and where information about STIs is available. It can also include places to avoid, such as bars or areas where people buy and sell sex. For an example of community mapping, see A map to safe motherhood.
Activity A treasure hunt to find resources for community STI prevention
People may not be aware of all the resources in the community that can help prevent the spread of STIs. You can create a treasure hunt game to help explore resources that exist and then think about what other resources could be made available. You can adapt the activity to focus specifically on resources for vulnerable groups, such as adolescent girls, migrant women, or sex workers. (You can also adapt this activity for other topics in the book.)
- Explain to the group that this is a competition to find as many resources as possible in the community that support STI prevention. The team that identifies the most resources wins.
- Form teams and ask them to imagine the resources or services people need for STI prevention and where they might find those resources in the community. These might include people, groups, organizations, schools, workplaces, markets, pharmacies, and places people gather for transportation or recreation. If possible, encourage the teams to visit places in the community and bring back information to the next meeting.
- Bring the groups together to share what they have found, and then vote for the team with the greatest treasure — the winner!
- Together, discuss the resources that have been discovered and then talk about the gaps. Ask the group: Where is the community well equipped to prevent and treat STIs? Where are there gaps? Are there groups of people that are not well served by the existing resources? Ask the group to think of ideas for new resources to cover those gaps. (This discussion can lead to developing an action plan.)
Empowerment in all parts of women's lives
Some communities are combining STI prevention activities, gender-awareness training, and social or economic support for women because they see how these issues are often woven together in women’s lives. Working on one area alone is not enough to create change.
Sisters for Life makes life healthier for women
The Sisters for Life microfinance project in South Africa helps women start businesses and become more self-sufficient. They also organize to stop gender-based violence and protect themselves from STIs. The women who receive loans are organized into groups of 5, and each group meets every 2 weeks to discuss domestic violence, rape, and the importance of safer sex, including the use of condoms. And they practice with each other ways to discuss these issues with their partners.
After several discussion sessions, each group selects a leader. These leaders meet with elders and other important community members to ask for help organizing workshops and meetings in the village to discuss domestic violence and rape. The women also organize street demonstrations about HIV and STIs, and about rape and crime in the community. These public meetings and events mean women are not left to confront their partners on their own but can speak out with support from the community.
This project has been very successful. Most of the Sisters for Life have built businesses, repaid their loans, and gained self-confidence. The women bring money into their households and no longer feel they have to go along with everything their partners want. The project has especially helped younger women to better negotiate safer sex.
End stigma and harmful beliefs about STIs
Shame and stigma are major obstacles to preventing STIs. When women are made to feel ashamed of their sexuality, it’s harder for them to ask their partners to use condoms or to try new and safer practices. When men who have sex with men are stigmatized, they hide their sexuality and have fewer supports for practicing safer sex. Women who have sex with women also face stigma in the community. Although their sex practices are not usually a high risk for spreading STIs, if they are forced to hide their sexuality they won’t have the opportunity to learn to limit their contact with body fluids by using dental dams and other safer sex practices.
When even more kinds of stigma are layered on women, gay men, and lesbians — such as disability, sex work, using needles to inject drugs, having dark skin, or being from a "lower" class or caste — it is that much harder for the community to prevent STIs.
Help adolescents protect themselves from STIs
HIV and other STIs are a serious and growing problem for young people, especially young women. Many young people turn to their peers to work out their values, plans, and choices. In many communities, especially those affected by HIV, young people may not be able to rely on their families for support.
Programs that provide gathering places for young people can help. Besides providing health information and sex education, they can help young people develop skills such as ways to earn and manage money, use public services, and practice self- defense. They can also help young people learn about their legal rights and what to do when their rights are violated. Youth connected to caring adults may have better access to practical and financial support, school fees, food, and help coping with family illness. They will be less likely to sell sex for money or turn to other risky behaviors.
Straight Talk takes on sexual health in Uganda
Straight Talk started in Uganda in 1993 as a free newspaper written for young men and women aged 15 to 24 years old. Its main goal is to provide information about sex and sexual health, life skills, and child and adolescent rights. The newspaper quickly became very popular, and a second newspaper, Young Talk, was started for adolescents aged 10 to 14 years. Then in 1999, a 30-minute "Straight Talk" radio show started broadcasting. Today it is heard all over the country.
Straight Talk newspapers and radio programs are produced in several local languages as well as English. Straight Talk and Young Talk are also published in Braille.
To encourage young people to participate, Straight Talk formed clubs in many schools and communities. Many young people write to Straight Talk every day, and their questions, comments, life stories, and concerns shape the content in every issue. The newspaper also gives out prizes to encourage letters — a few schools might win soccer balls for sending in the most letters in a week.
In some ways, the newspaper is like a giant advice magazine, with helpful answers to many common questions. Also like a magazine, it is filled with photos of young people, drawings, and useful tips. For example: "Believe in yourself: Thinking too much about what other people think of you changes what you think about yourself."
While young people are at the heart of Straight Talk, parents and teachers are also included because they have the most influence in a young person’s life. Straight Talk also produces the "Parent Talk" radio show and the Teacher Talk newspaper, and holds face-to-face sessions in schools and communities to talk about some of the issues young people face.
School-based programs promote sexual health in Colombia
Young people need to learn about sexual health, but they also need health services that enable them to make healthy choices to prevent STIs and unintended pregnancies. Putting a clinic near or inside a school makes it much easier for students to get the help they need.
In Bogotá, Colombia, a group of public and private schools worked with the nongovernmental organization PROFAMILIA to start school-based programs that teach youth and adults about sexuality, sexual health, and how to prevent pregnancy and STIs. Young people can visit sexual health counselors to ask questions without fear of being judged for their sexuality or their concerns. The program also has regular Health Days when students can have private health exams and also receive birth-control methods if they request them.
At first, some people in the community felt strongly that young people should not be given sexual health information or services. PROFAMILIA met with community members and shared information about the high numbers of pregnancies and STIs among students and other adolescents. This information helped change people’s minds. Parents and teachers want to keep young people safe, so they were willing to support programs to prevent pregnancy and STIs. And the program involves parents and teachers, so everyone learns about sexual health and how to talk with each other about it.
The PROFAMILIA program has also been successful because young people are trained as peer sexual health educators, and they also participate in decision making about the clinics’ programs and services. By creating many partnerships between schools, community groups, health centers, and the government, the program has been able to obtain the funding and resources it needs to continue for a long time.