Efforts to help  sexual partners  talk to each  other about  reproductive  health matters  are limited. Few   have been evaluated.


However, FHI has developed and is evaluating  a tool  to help men  and women communicate openly with each  other about sex and other issues  affecting  sexual health.


Called DIALOGUE, this communication tool to facilitate  group discussions was  first presented  in 1996 by FHI’s AIDS Control and Prevention Project(AIDSCAP).


Women’s Initiative  at a satellite  meeting of  of the Eleventh  International Conference on AIDS. Since that  time, various initiatives using  DIALOGUE process have been  conducted  in Asia, Africa, and Latin America and the Caribbean.


In 1997, for example, the  Indian  Institute of Health  Management  Research (IIHMR), with financial assistance  from FHI, tested  Dialogue  among  some  400 married  men and women(about 200 each)from  one rural  and one urban  area of  Jaipur District , India.



Two –thirds  of the  men  were   truck drivers, who are  considered  at high risk for  HIV infection owing to a tendency  to have  multiple  sexual w partners.



Similarly , tw0-thirds  of the husbands of women  respondents  were truck dtivers. Researchers  trained  to guide  and record  the Dialogue process conducted  60 focus  group discussions,12 of which  involved  men and women  talking to  each other.



Main discussion points  included: the roles and responsibilities of men in the family , gender equity, vitues of a good man  and good woman, knowledge  of symptoms, causes  and prevention of  sexually transmitted infections(STIs) and HIV/AIDs, use of  condoms, promiscuous sexual behavior of men , and safer sexual practices.





Interviews with the approximately  400 men  and women  prior  to the Dialogue sessions showed that spousal communication about sexual matters barely  existed .




Discussions were  largely limited  to husbands expressing  their desire for  or satisfaction  with sex. About 60 percent  of respondents  reported  discussing STIs  with their Spouses, but most women  had simply suggested  that their husbands  be careful  to avoid infection.




Nearly  half  of  the 128 truck drivers  and a quarter  of the 81 percent men  from other professions admitted having sex  with multiple partners. This practice  put their wives  at risk  of STI/HIV infection. But only 18 percent of the men  reported  regularly using  condoms while  having extra-marital sex, and only 12 percent  reported  doing  so while  having sex  with their wives.



In contrast, interviews conducted  after  the Dialogue  sessions with a selected  group of  couples  representing  about  one-fourth of the  total participants showed  marked changes  in boh men’s and women’s  attitudes towards  sex, sexually , and sexual health .



Some 70  percent  of the 92 respondents reported  being more  comfortable  sharing  such issues  with Spouses  during Dialogue  discussions.



More importantly, condom use  doubled  for men having  extra-marital  sex( from  18 percent  to 38 percent) and  for men   having sex  with their wives (from12 percent to 23 percent).



‘’It I more difficult to  open discussion on sex related matters  in the presence  of near  and dear ones,’ says Dr.  R.S. Goyal, Principal  Coordinator  for the project  and a  professor  at IIHMR.



‘’People  find it difficult  to talk about  such issuies. But once  the ice is broken , dialogue  is more  intense and effective. In this case,  Dialogue  helped  to create  an enabling  environment  for a free  and open discussion of sex related  issues, and  its most  important  achievement was  as much  as a 100 percent  increase  in the use  of condoms.’’




Evaluation  of this communication  tool will  continue in India. In a study  in Rajasthan , Dialogue  will be used  among 400 of 1,600 adolescents’ likely to  be a risks for pregnancy  and sexual ly  transmitted infections.




To determine  the intervention’s impact , researchers  will evaluatev whether  adolecents’ knowledge  about reproductive  and sexual  matters  has improved , an environment  for the free  and open discussion of sex  and related issues  has been created , and whether  practices  that protect  reproductive  and sexual   health  have been adopted.

(Culled  from the Network)











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