Sexual reality. The gap between family planning services and clients' needs.
IPPF's AIDS Prevention Unit (APU) conducted HIV prevention training workshops for key staff of family planning associations (FPAs) in West Africa. The experience of these workshops and the findings of a 1992 needs assessment among selected FPAs have articulated the nature of the gap between clients' needs and social norms and providers' values in relation to sexual behavior. This chapter of the book entitled Learning about Sexuality: A Practical Beginning examines how sexual options to minimize the risk of HIV infection (condom use, abstinence, fidelity within marriage, and nonpenetrative sex) correspond with the realities of the attitudes and sexual lives of different client groups. It also addresses how effective these options are in preventing HIV/AIDS. Another discussion revolves around the extent providers help clients determine the best HIV prevention strategy for themselves. The book also covers whether providers help clients overcome gender inequalities that place them at risk of HIV infection or reinforce gender stereotypes. Significant obstacles among the work of the APU include providers' long-standing attitudes, biases, and perception; consideration of counseling and education as if the clients can freely decide what to do about sex; providers' concern for social and moral well-being of clients; and conflict between contraceptive targets and the mandate to provide clients with the information needed to make informed choices about reproductive and sexual health. The book provides four steps to address these obstacles and to change the behavior of both FPA staff and clients in order to close the gap between their goals and perception: structured sessions on gender issues in FPA staff training and actively challenge gender discrimination and attitudes that result in sexual ill health; structured activities on religion, traditional sexual culture, and sexual health in FPA staff training; pilot projects that test the feasibility of FPAs using a participatory community development approach in sexual health; and network with groups that have resources to address some underlying determinants of sexual health.