Young people in the United States receive mixed messages regarding sexuality. Entertainment media frequently portray young, single people engaging in casual sex with no contraception, no consequences, and often no feelings for each other. Media frequently portray uncommitted, casual sex as desirable; characters rarely suffer ill effects from "one night stands." A television prime time analysis reveals that the average adolescent in the United States views 14,000 sexual references, jokes, and innuendos each year.15 However, only one in 85 of these references will mention abstinence, contraception, or marriage, sometimes negatively.16
The SHINE Awards (Sexual Health in Entertainment)—sponsored by Advocates for Youth and the Henry J. Kaiser Family Foundation—annually recognize entertainment industry efforts to provide responsible sexual health messages. In 1982, the National Association of Broadcasters lifted a ban on contraceptive advertising, and polls show that Americans favor contraceptive advertising and portrayals of responsible sexual behavior in the media.16a Yet, most major networks air no commercials or public information campaigns about sexual health.
In 1996, the United States Congress approved America's first national campaign to prevent teen pregnancy, as a part of the Welfare Reform Act, and funded a national "Abstinence Until Marriage" campaign with $250 million to distribute to the states over five years. Many states are using the money for media campaigns targeting teenagers with messages to wait until they are married to have sex. Tour participants encountered no sexuality education or public health experts in the Netherlands, Germany, or France who thought this approach would be effective. Some of the European professionals worried that this strategy—by depriving U.S. teens of necessary information about condoms, contraception, and safer sex behaviors—could drive U.S. teen rates of birth, STD, and HIV higher.
The United States has provided its people with few continuous, long-term national media prevention campaigns about risky sexual behavior. While effective posters, videos, and print materials have been developed for specific groups, these materials have not been widely or consistently distributed except in urban, largely gay areas. Some safer sex media efforts, quietly implemented and targeting gay males and injection drug users, have been effective. Unfortunately, the results are not widely publicized and the programs are seldom replicated.
Over the past 12 years, primarily in response to the AIDS pandemic, the government of the Netherlands has invested heavily in mass media and public education campaigns. These efforts have played a positive and direct role in breaking down societal taboos about discussing protective sexual behavior.18 Officials in the Netherlands believe that mass media campaigns have distinct advantages over other strategies in that they
The Netherlands' mass media campaigns do not operate in isolation, and the development of strategies for impacting sexual health in the Netherlands is quite different from efforts in the United States. First of all, the Dutch government takes a "hands off" approach. In regular cycles, the government provides public funds to the organizations charged with altering sexual health behaviors. The government attaches no strings or restrictions on content or explicitness, instead trusting the agencies to develop effective strategies based on research. Continuing evaluation helps the experts keep abreast of trends in the population's knowledge, attitudes, beliefs, skills, behaviors, and sexual health outcomes. Using this information, agencies develop and implement appropriate campaigns.
In 1988, agencies introduced the first summer holiday campaign. Prior research indicated that 40 percent of Dutch youth ages 15 to 20 had romances while on vacation and that 30 percent of the romances included unprotected sexual intercourse. To increase safer sex during holiday romances, agencies developed packets which contained information, condoms, and brochures in several languages to help Dutch youth negotiate safer sex with potential partners. The campaign's success was measured by increased condom use among Dutch youth.19
The campaigns of 1989-1991 focused on excuses for not using condoms, and the 1992-1994 campaigns worked to achieve changes in social norms, using social learning theory, and the theme, "I'll have safe sex or no sex." The 1995 campaign related to communication skills: "I'll take something off if you put something on." The 1996-1997 campaigns focused on STDs, including HIV/AIDS, with the "STD Top 10" and another communication clip, "Your condom or mine?" The 1998 campaign produced a popular and humorous commercial, the "Too Early—Too Late" campaign, featuring people of all ages and in all walks of life bringing up the topic of condoms either too early, too late, or at just the right time.
While recent campaigns have focused heavily on the prevention of STDs, including HIV, the Dutch have long supported efforts to prevent unintended pregnancies. Seeing abortion as a social failure, the Netherlands has effectively promoted oral contraceptive use since the early 1980s to prevent unintended pregnancy and reduce the need for abortion. To prevent both STDs and unintended pregnancy, strategists developed the "Double Dutch" message, encouraging sexually active people to employ two methods of protection—the pill and the condom.
Dutch efforts have not attempted to deter young people from sexual relationships. Instead, the Dutch focus has been on the positive aspects of a sexual relationship and on sexual responsibility to prevent unintended pregnancies and STDs, including HIV.
In 1997, a government sponsored evaluation determined that safer sex campaigns were effective. Among 1500 Dutch citizens ages 15 to 45, evaluators found:
The Germans have been aggressive in developing and distributing safer sex messages. Under the authority of the Ministry for Health, the Federal Center for Health Education (FCHE) has produced nationwide media campaigns that rely on integrated public and private efforts. Four to six television spots are produced annually and aired through cooperative agreements with television stations which have donated some five million dollars (U.S.) worth of free air time.20 Outdoor billboard and poster campaigns present new educational themes at three-month intervals, and printing and advertising partners provide free printing as well as distribution in some 70,000 locations.
German national efforts have focused on preventing the further spread of HIV/AIDS by educating and motivating people to use protection. Knowledge and behavior changes targeted include:
FCHE developed three elements to decrease public fear and enable HIV-infected persons to reintegrate into society : mass media campaigns, a telephone hotline, and personal communication through intermediaries. The media campaigns feature interpersonal relationships, sexual situations, holiday travel, and leisure time; messages are disseminated through TV and cinema spots, advertisements, and posters. More information is provided through leaflets, brochures, films, and documentaries. The telephone hotline, featured in all media campaigns, provides anonymous, personal counseling by trained staff. FCHE also encourages personal communication through campaigns which extend the mass media messages to the grassroots level through public events, exhibitions, health fairs, and mobile vans.
This integrated, national, multimedia campaign has incorporated process and impact evaluation. In a recent 10-year evaluation, computer-aided telephone interviews of approximately 3600 randomly selected German residents found that:
France's mass media efforts have been less strategic than the Dutch or German campaigns, but they have been more extensive than those of the United States. The Ministry of Health, in public-private partnerships, established its first policies for campaigns in 1986 and produced campaigns through the Regional Center for the Prevention of AIDS (CRIPS) and the Association for AIDS. Because France is predominantly Catholic, efforts have focused entirely on disease prevention, particularly HIV/AIDS rather than on pregnancy prevention. More recent efforts also focus on preventing STDs.
In 1987, French public health officials and the government promoted condom use through national media with the intent to normalize the use of condoms in sexual relationships.23 The French programs also encourage simultaneous dual methods and use posters, billboards, TV and radio commercials, special events, hotlines, pop and disco music, special products, and competitions to get their messages out.24
CRIPS consistently uses a powerful marketing tool—involving the target group—in producing safer sex materials. More than any of the other countries studied, France encourages adolescents to produce the messages targeted to teens. For example, CRIPS sponsored a nationwide poster contest among school students to create ideas for AIDS prevention campaigns. Teens submitted over 5,000 posters, and professional graphic designers worked with the young artists to produce the finished products for national distribution. The poster campaigns also stimulated ideas for commercials, advertisements and instructional aids.25 Most French media campaigns are creative, explicit, and humorous. A few contain partial nudity. The campaigns depict couples that include same sex, racially mixed, young, and old. Heterosexuality and homosexuality are depicted openly and honestly.