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ENHANCING SEXUAL WELLBEING IN SCOTLAND- A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: ANALYSIS OF NON-WRITTEN CONSULTATION EVIDENCE ON THE DRAFT SEXUAL HEALTH AND RELATIONSHIPS STRATEGY

CHAPTER THREE THE MEDIA AND MASS COMMUNICATIONS

Media attitudes to sex and relationships⁴

3.2 Much of the discussions endorsed the view of the draft strategy that the media play a negative role in terms of reinforcing stereotypes about expectations and stigma around sexual health and sexual health services. The role of the media was frequently identified as playing a key role in influencing attitudes to sex and relationships, particularly amongst young people.

3.3 Participants in the Poverty Alliance discussions felt that the references to sex and relationships were dominated by titillation and humour. The effect of the media was often to 'glamorise' issues related to sex and relationships in ways that in the participant's views did not reflect the reality of their experience. In relation to pregnancy and childbirth, participants noted:

"It [the media] portrays pregnancy as if you'll have instant love and knowledge"

"Women always look very glamorous after giving birth on a TV programme or film" (Poverty Alliance group)

3.4 Such portrayals were seen as being very powerful in determining how women in particular should feel about particular aspects of pregnancy and childbirth. These portrayals were not regarded as helpful when contrasted with their 'real life' experiences of pregnancy and childbirth. For men too, the media played a damaging role in relation to sexual expectations.

"You read magazines - the average man has sex so many times a week and you're thinking 'that's a year for me!' That's a joke. Where do they get these figures from? And you end up - it makes you feel somehow lacking - you then become withdrawn or whatever and it makes sex a conquest not a relationship" (Working men group).

3.5 Media portrayals of sex and relationships were seen as lacking realism, with both teen magazines and television 'glamorising' sex and relationships. It was felt that there was little on the emotional content of relationships, or the fact that 'sex is not always great'. Participants also felt that when the issues relating to sexual health are discussed in the media, it is often in a moralistic tone. It was noted that the media could add to the peer pressure that already existed for young people to become sexually active.

The media as a source of information

3.6 Many participants recognised that the media can play a dual role. It can be an important source of information, although this was not always seen as positive, appropriate or correct. Magazines for young people, particularly young women, were seen as providing a great deal of information on sex and relationships, however, not all this information was viewed as helpful or realistic.

3.7 Some participants commented that television soap story lines had the potential to provide opportunities to enable parents or professionals to discuss sexual health issues. Others were more critical and stressed the need for information to be available to follow up issues that may be raised in this way.

"TV soap opera coverage has been very unhelpful. News programmes are leaning towards scandal now too. How can we redress the balance? Can you tell a soap opera to change their approach? Soap opera's can raise issues, but other information needs to be on hand to back it up" (SCF participant).

Views on a media strategy

3.8 Many participants endorsed the view in the draft strategy that there is a need for a comprehensive media strategy, although some felt that the challenge of changing the media's portrayal of sex and relationships would be significant. There was some scepticism about whether this could work, not least because of conflicting messages from other elements of the media and wider society as well as long standing attitudes.

"How do you go about changing embedded values? Scotland is a Calvinist society by tradition, and will take some changing. Attitudes are ingrained" (SCF participant).

3.9 However participants also argued that media campaigns could help parents to talk to their children. There appeared to be a link with the quality of sex education that parents had when they were young and their confidence in discussing issues with their own children. A media campaign could play a part in sex and relationship education for adults. It was also suggested that politicians could assist any campaign.

"There is this 'cycle of embarrassment', where parents do not talk to their children and they in turn do not talk to their own children. It's important to break this if progress is to be made" (Poverty Alliance group).

"A media campaign could help parents too by bringing down barriers. Bringing the subject up so it is there to be dealt with. Young men especially find it very difficult to discuss some issues. The language used, however, will be vital" (SCF participant).

"World Aids day - let's see politicians wearing the ribbon!" (LGBT outreach group).

3.10 Any campaign should promote positive messages and avoid fear and sensationalism. Many comments were made about previous campaigns and the lessons that can be learnt.

"Before the AIDS campaign in the 1980s, people didn't know what it was. TV advertising could prove very effective for sexual health. However, the problem with TV ads is that if you get it wrong, it is wrong on a very wide and visible level. The AIDS campaign using tombstones may have increased awareness, but it also created perception that AIDS equals death, which in turn led to huge stigma being placed on people with the virus. You need to be very sure that the message is right before it goes out" (SCF participant).

3.11 Participants emphasised that campaigns should link in with information resources, helplines and so on. As well as a broad-brush campaign, there will need to be targeted approaches to address specific needs. Imaginative suggestions were made to reach a range of audiences.

"Adverts or messages could be put on things like soft drink cans. A positive message is needed, not scare tactics" (SCF participant).

"A series of adverts, using consistent characters, could be used to build up knowledge over time - like the coffee adverts" (SCF participant).

"An internet site should also accompany an ad campaign, particularly for young people and others who might feel uncomfortable phoning for advice" (SCF participant).

"Society is portrayed as driven by sex. Young people are being fed this, and need some cool programmes to encourage people to take a different tack, show the choices to be made and show people have the ability not to conform to stereotype" (SCF participant).

3.12 Whilst there were views that advertising can work, participants emphasised that there is a need to be consistent and to know your audience.

"How are you going to target the men you want? We're all quite a variety of ages, different lifestyles etc. The media campaign will presumably be on TV. Workplaces are a good solid place but you'd have to pick your time and know your culture. It's also got to cross that taboo that you can't talk about emotional or relationship things" (Working men group).

3.13 A comprehensive media strategy would be welcome, however it will face many challenges and ingrained attitudes. It could play an important role in breaking the 'cycle of embarrassment', by educating adults, assisting parents in talking to their children and give young people opportunities and confidence to raise issues with their parents or peers. It would also assist health and social care professionals to discuss sexual health issues. Any campaign should be positive, not based on fear or sensationalism and should recognise that there are a number of different audiences that may respond best to targeted messages. However there are divergent views about the content of such a campaign.

Equity, respect and diversity

3.14 Whilst there was a common view that fear doesn't work as a media strategy, there were differing views as to what the content of such a campaign should be, what positive messages should be conveyed and how the values of equity, respect and diversity should be interpreted.

3.15 Participants in the Poverty Alliance groups felt that a more positive approach would include more 'straight talking' regarding the 'facts' regarding sexual health and relationships. Others stress the need for messages about self-esteem and self-worth. Some other participants felt it should emphasise parental responsibilities. Others said it should not preach to people or promote abstinence. Some were concerned about how a campaign would deal with issues of sexuality.

"There is a danger of sexualising young people at a very young age in a negative and potentially damaging way. The document states a desire to eradicate heterosexism, but being heterosexual is the norm. We do not want to cause pain to any section of society, but don't want to see people lured out of heterosexuality, if that is what they are. We still have to say to young people who do have homosexual feelings that it's OK to feel that way" (SCF participant).

3.16 Others cited examples of media campaigns from other countries that had addressed some taboo issues.

"There's an example from Denmark of posters in bus shelters. They help to create a good climate. There's an image of a man walking in a park, with his wife and child, with another man sitting on his own on a nearby bench. The other half of the image shows the man at night in the park chatting up the guy on the bench" (LGBT outreach group).

3.17 Several participants said they would like to see a positive campaign about same sex relationships.

"Any campaign should eradicate homophobia rather than promoting homosexuality. It would be better for the media campaign to focus on tackling homophobia in a similar way as the 'See me, I'm a person' ads tackle ignorance and discrimination based on mental health grounds" (SCF participant).

3.18 The sex workers that were interviewed suggested that public media campaigns that are done around promoting safer sexual behaviour also need to target men that buy sex and their attitudes towards sex workers.

"Clients will actively seek unprotected sex from sex workers. Those men know that the woman is a sex worker and yet are still of a mind to try and persuade them and on occasions be prepared to pay more money! On occasions they are prepared to use aggressive language and abuse and to rape in order to get unprotected sex" (Sex worker interview).

3.19 Participants felt that media campaigns should not just be targeted at young people and that there are wider links with equalities issues, such as physical and learning disabilities and older people.

"Some people in our communities first of all have to be accepted by others as being equal sexual beings, [for example] people with physical and learning disabilities. It has to be recognised that they should have the same choices about sexual relationships" (SCF participant).

3.20 Much of the draft strategy seems to have been interpreted as being targeted at young people and many of the discussions focused on them. However, some participants highlighted that since older people are also sexually active, they may also be at risk, yet have not been exposed to campaigns around safer sex or use of condoms.

"There has already been a lot of talk about young people. Relationships can break up at any age, and older people can find themselves sexually active with different partners. The risk of catching STIs is not confined to the young, so a strategy must genuinely aim at all, from cradle to grave" (SCF participant).

"There have been a number of cases identified of HIV infection amongst older people, including a man in his eighties. It is not just a young person's condition" (Consultant clinician interview).

Emphasis on barrier contraception

3.22 This recommendation will face a number of challenges. Whilst many participants did identify a real need for education on safer sex, it was felt that any campaign should not just focus on the use of barrier contraception or condoms. A small minority of participants suggested that the campaign should promote abstinence.

"It's not just about education in the use of condoms. We need to educate them in what sex really means - the consequences" (African men group).

"Condoms don't stop it! The best way to do it is to say 'no sex until you're married'. We need to attack the media" (African men group).

"There is merit in using a 'just say no' style message, which could be used to point out that things like unwanted pregnancy or STIs could and might happen to you" (SCF participant)

"Any condom campaign needs to include the message that using them comes with certain responsibilities" (SCF participant)

3.23 One suggestion was that condoms should be advertised on TV.

"They can advertise everything else on the TV - how can they not advertise condoms? It's safe, it' s simple and it might stop teenage pregnancies as well" (Sex worker interview).

3.24 Others also suggested that reliance on condoms for protection may be misplaced as they can burst or fail and that, in any case, they will not always be used because of the particular circumstances.

"Condoms - kids look at them for protection from pregnancy - no one tells you they break!" (African women group).

"It's down to alcohol. It's OK having the condoms, it's OK having the sex education, but if you're on the bevies and you're with someone you want to be with, then you'll do the deed. Then you'll say 'what have I done?'" (Working men group).

3.25 Some participants wanted to see more appropriate information being provided and see it as important that this information is more widely available and accessible although not in a way that is stigmatising. Provision of information is discussed more fully in Chapter 6.

"Factual information regarding STIs, such as Chlamydia, should be available in bars where young people are, and also at places such as under 18 discos" (Poverty Alliance group).

"There needs to be something to highlight that diseases such as syphilis etc are not things of the past" (SCF participant).

"Information needs to be discreet and people be able to access information that they are interested in without having to identify themselves as being within a particular category e.g. gay man, lesbian etc" (SCF participant).

3.26 Some existing examples were cited although there were also calls to include the views of those at whom the campaign is targeted and not to overlook the needs of visually impaired young people.

"HEBS have a great poster campaign running on barrier contraception. Posters are up in pub toilets. It seems to be doing really well. The posters are visually shocking, which makes them thought provoking, clever, eye-catching and effectively targeted at teenagers" (SCF participant).

3.27 In terms of avoiding pregnancy many young men and young women do not like using condoms. Access to condoms may be an issue and this is discussed more fully in Chapter 6. Some young male participants interviewed by Children in Scotland said that their own personal experience is that some young women want to become pregnant. They also acknowledged that young men do not always take responsibility for using contraception or for the consequences of not using it. Failure to use condoms is also related to stigma and contradictory pressures on young women, under pressure to be sexually active whilst also facing stigma if they are.

"You get a lot of guys who call you names" (Young mothers group).

"You're either a virgin or a whore - you can't win. Until you leave school and then everyone just does their own thing" (Young mothers group).

3.28 There is still stigma attached to carrying condoms, especially for young women.

"Young women say that their parents would react really badly if they found condoms in their bag. Young men also make assumptions about the sexual activity of a girl who carries condoms" (SCF participant).

"Sex carries status for young men, which makes it OK for them to carry condoms. We need to make it OK for young women too" (SCF participant).

3.29 There are some fears that focusing on condoms will encourage young people to think it's OK to have sex, as long as you use a condom. Some participants stressed the need for a greater understanding of the context of the sexual encounter to be promoted with condom use.

"Condoms do protect, but their use will mean different things to, say, a 13 year old and a 17 year old. The whole picture is needed - what will happen if you do go and have sex?" (SCF participant).

3.30 For some older people contraception is not an issue, due to age or the fact of sterilisation or a vasectomy.

"I went through being married with a partner and 3 children for 20 plus years to being single effectively - it does change your lifestyle. I'd had a vasectomy. I wasn't going to be having any more children so protection for sex wasn't an issue - there was no risk [of pregnancy]" (Working men group).

3.31 Amongst older people, since condoms will not be used as contraception it will be difficult to encourage people to use them to protect against STIs. Indeed, there may be erectile problems, which make it difficult to use condoms.

"The older you get- if you're trying to put a condom on - you're more worried about losing it than trying to get that on you. So you think 'I'll not bother- I'll just get right in there'" (Working men group).

3.32 There is also a strong reluctance to use condoms especially amongst men and a sense they are not at risk. This can be because they assume they are in relationship where there is mutual fidelity or because they are convinced that 'it'll never happen to them'.

"The thing about [HIV/STIs] is that to my mind you're only going to catch that if you're sleeping around! If I'm with my partner and there's only the two of you together then you cannae catch it" (Working men group).

"It goes through your mind [that you may be at risk], but you always say to yourself, 'it'll never happen to me'" (Working men group).

"Men are blasé about it [Chlamydia] because it doesn't affect them anyway [yet] it's mostly men that spread stuff. They're like 'but it doesn't feel as good with a condom on'. That's rubbish! If it doesn't feel as good then it's obviously not getting done right" (Sex worker interview).

"You want to hear some of the excuses! One of them said 'I'm an Irish Catholic!' so I said 'what are you doing here then?'. He said 'we don't believe in contraception.' So I said, 'I don't believe in diseases'! They'll say 'I'm clean' and I'll say 'darling, you might be - I know I am but I could be lying! You've known me 2 minutes - why the hell would you want to? Some of them will offer you an extra tenner, but I'll say, 'I want to see my grandkids - I want to see my kids grow up'" (Sex worker interview).

3.33 These illustrate some of the social and cultural taboos that will have to addressed in any campaign which seeks to promote the wider use of condoms to protect against STIs. Some participants would welcome a more positive campaign.

"We need to normalise condom use and eroticise the alternatives to penetrative sex. Gay men have done this quite successfully" (LGBT outreach group).

"Adverts could also educate people on how to put condoms on, aimed at both genders. The positive reasons for using them could be played up. Advocate that it is ok to use them!" (SCF participant).

3.34 Some believed that shock tactics are necessary, whilst others say such an approach would not work and that developing self esteem and communication skills are key to safer sex.

"Some bluntness is needed. Tell people of Scotland they are 'a bunch of ignorant gits!' and that we need to change. Don't let PC restrictions stop the real message coming through" (SCF participant).

"When it comes to safe sex, I think shock tactics are the thing that help the most, because they're the things that people pay most attention to" (Sex worker interview).

"You can't use shock tactics, or statistics. Neither of them work. Messages find their way in visually and audibly. Any message needs to include themes of self-worth and self-esteem" (SCF participant).

"Strategies for safer sexual practices are ultimately the most effective at preventing STIs. Merely saying 'use a condom' won't work if people don't have the strategies to talk to their partner about safer sex" (SCF participant).

"This is not just about sex. A media campaign needs to talk about stable relationships as well. Society has changed and a condom-only campaign would be too limited. A healthy lifestyle needs to be promoted. This will cost millions of pounds, but would be worth it because campaigns are where most people get their information" (SCF participant).

3.35 However, a further issue is the need to acknowledge some of the taboo issues, such as the need to use condoms for oral and anal sex and to make stronger condoms available more widely.

3.36 Some sex workers act as peer educators in this respect, both for clients and other sex workers.

"I tell them [other sex workers] 'it's imperative you use a condom for oral sex because you can get this, this and this - same as sex without'. They feel under pressure or don't know any different. They're not told - they think it's normal because maybe in their own life when they go out clubbing or whatever, it's quite normal to do that - but it isn't!" (Sex worker interview).

3.37 Of clients that will pay more for unprotected sex, one sex worker interviewed said "they must think they're invincible".

3.38 Unquestioned assumptions and labels can be a real obstacle in attempts to promote safer sex.

"There's a tendency to assume that all gay men have anal sex and that only gay men have anal sex" (LGBT outreach group).

3.38 For a media campaign to be effective, it is clear that it would need to be linked to other elements of the strategy, including tackling the reluctance and stigma around condom use. Participants comments illustrates that it will have to tackle a number of sexual taboos, challenge homophobia, confront sexism particularly in attitudes towards young women and challenge sexual behaviours and assumptions amongst older people and men who pay for sex. It should also signpost people to more information and resources, including information on where to access cheap or free condoms including different types of condoms. Further recommendations made in the draft strategy in relation to making condoms more widely available are discussed in Chapter 6.

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