Dialogue tool promotes open, honest discussion.
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 their 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 the Eleventh International Conference on AIDS. Since that time, various initiatives using the 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 due to a tendency to have multiple sexual partners. (1) Similarly, two-thirds of the husbands of women respondents were truck drivers. 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, virtues of a good man and a 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 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 extramarital 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 both men's and women's attitudes towards sex, sexuality, 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 extramarital sex (from 18 percent to 36 percent) and for men having sex with their wives (from 12 percent to 23 percent). (2)
"It is more difficult to open a discussion on sex and 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 issues. 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 and 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 at risk for pregnancy and sexually transmitted infections. To determine the intervention's impact, researchers will evaluate whether adolescents' 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.
A Dialogue Between the Sexes: Men, Women and AIDS Prevent/on describes the Dialogue process and is available at: http://www.fhi.org/en/aids/aidscap/aidspubs/women/sexdialog.html.
(1.) Rao A, Nag M, Mishra K, et al. Sexual behavior patterns of truck drivers and their helpers in relation to female sex workers. Indian J Soc Work 1994;55(4):603-17.
(2.) Goyal RS, Kumar CS, Nigam S. Promoting sexual health through dialogue between men and women within social networks. Unpublished paper. Indian Institute of Health Management Research, 1998.