structural factors. One of the primary obstacles is this country's reluctance to openly confront issues regarding sexuality and STDs. Failure to acknowledge and discuss sexuality impedes STD education programs, open communication between parents and their children and between sex partners, balanced messages from mass media, education and counseling activities of clinicians, community activism for STDs, and behavioral research.

Catalyzing Change Through Open Discussion and Promoting Awareness and Balanced Mass Media Messages

A new social norm of healthy sexual behavior should be the basis for long-term prevention of STDs. This is because in one way or another all interventions to prevent STDs are partly dependent on, and must be integrated with, healthy behaviors. In order for societal norms regarding sexual behavior to change, open discussion of and access to information regarding sexual behaviors, their health consequences, and methods for protecting against STDs must occur. Therefore, the committee believes that a significant national campaign to foster social change toward a new norm of healthy sexual behavior in the United States is necessary. An independent entity is needed to promote a social norm of healthy sexual behavior because, based on experience with past initiatives, limitations on government agencies regarding public education programs related to sexuality are particularly problematic.

Lack of awareness regarding STDs and misperception of individual risk and consequences are major barriers to healthy sexual behavior, especially among adolescents and young adults. Lack of open communication and information regarding sexuality and STDs fosters misperceptions and may actually encourage high-risk sexual behaviors. Increased awareness regarding STDs should result in increased individual motivation to prevent STDs and should improve the detection and management of STDs by clinicians. A national campaign to increase public and health care provider awareness of STDs requires active participation of both private and public agencies and organizations to succeed.

Despite their current lack of involvement in promoting healthy sexual behaviors, the mass media can be extremely powerful allies in efforts to prevent STDs by increasing knowledge and changing behavior. Mass media messages that promote healthy sexual behaviors will facilitate needed changes in social norms regarding sexual behaviors because mass media help define these norms. Children and adolescents are particularly exposed and susceptible to explicit and implicit messages in such media. Many adolescents are not receiving appropriate information regarding STDs and sexual behavior from their parents or other sources. Therefore, mass media companies should disseminate information regarding STDs and healthy sexual behaviors, including delaying sexual intercourse and using condoms, with a special focus on reaching adolescents and



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