Market research report on insight and segmentation review for sexual health social

Market research report on insight and segmentation review for sexual health social marketing strategy

For the Department of Health

Ref: Define 1626 / COI 906837

July 2008

Colton House, Princes Avenue, London N3 2DB

T: 020 8346 7171, Fax: 020 8883 4111

VAT No 713 9062 46, Registered in England No. 3316024

Table of Contents

A Introduction to the Research Project ................................................................ 4 i) Background & Research Objectives ......................................................... 6

ii)

B Summary

Findings .............................................................................................19

1. Audience-Generated Insights for Encouraging Positive

Change.......................................................................................19

1.1 Introduction..................................................................................................................... 19

1.2 Overview of Section Content: ‘Hidden rules’ and ‘Myth-interpretations’ ............ 19

1.3 Hidden Rules – Norms and culture ............................................................................ 20

1.3.1 Cognitive Function – ‘whether I have the ability to consider’ ..................... 24

1.3.2 Age – ‘whether I am old enough, too old, too young’ .............................. 24

1.3.3 Non-sex culture – ‘whether I believe sex is acceptable (to do or discuss)’ 27

1.3.4 Gender role – ‘what is expected of me as a male/female’ .......................... 28

1.3.5 Sexuality – ‘what I understand sex to be’ .................................................... 29

1.4 Myth-interpretations and Potential Direction for Solutions .................................. 30

1.4.1 “I am not supposed to be sexual” ................................................................ 31

1.4.2 “Having sex proves something about you”................................................ 38

1.4.3 “Don’t mention condoms” / “Keep condoms quiet” ............................. 41

1.4.4 “You must not disrespect my public reputation by 43

I

1.4.5 “The subject of sexual health is unsuitable in mixed society”................. 47 activity is dirty” ................................................................................. 49

1.4.7 “Don’t mix terms – you can’t say sexual health and sexy ....................... in the same breath”......................................................................................... 55

1.4.8 “Condoms not worth the hassle” .......................................................... 56

1.4.9 “Sexual health is hard to access” .................................................................. 55

1.4.10 “Connect with me” and “Help me to Connect” ....................................... 59

1.5 Where the audience is trying to get to......................................................................... 61

1.5.1 Overarching audience goals........................................................................... 62

1.5.2 Specific

1.6 Messages that start to address inertia .......................................................... 65

1.7 Locating messages: “Islands of Consideration” ........................................................ 66

2 DH: Sexual Health Social Marketing Strategy Research

2. Audience and

2.2 Segmenting by Demographic Group ......................................................................... 68

2.3 Segmenting by Sexual Encounter and Practice ....................................................... 69

2.4 Segmenting

2.4.1 Overview ......................................................................................................... 78

2.4.2 Thoughtless ..................................................................................................... 78

2.4.3 Low Risk .......................................................................................................... 79

2.4.4 ‘Disconnected’ ................................................................................................ 91

2.4.5 ............................................................................................................................ 92

2.5 Mapping

Appendices...........................................................................................................111

1.

Introduction to Social Marketing

2.

Detailed Sample Breakdown

3.

Research Tools: Recruitment Questionnaires, Discussion Guides and

Phase 2 Stimulus

4.

Artworks used as stimulus in Phase 3 and detailed audience responses

5.

Pen portraits of the attitudinal segments

DH: Sexual Health Social Marketing Strategy Research 3

A Introduction i) Background & Research Objectives

Context of this Project

The Department of Health has had some successes in influencing lifestyle related illnesses (such as smoking) but there is a need to improve the performance of its initiatives. As such, the Department is adopting social marketing principles and practices to inform both new and existing programmes of work.

A report

It’s our Health 1 ,

was commissioned from the National Social

Marketing Centre at the National Consumer Council (NCC), to review the role that Social Marketing can play in driving this performance improvement. This report makes a series of recommendations on how to implement the principles of social marketing in the department. Three key components to these recommendations are:

1.

Increasing the degree to which insights into the public’s behaviours are built into strategy, particularly in relation to policy development and cross-programme working

2.

Developing and delivering programmes in conjunction with stakeholders

3.

Setting clear priorities across the Department of Health’s Health

Improvement Directorate to ensure limited resources are applied in the most effective manner.

1

Published in June 2006


An opportunity has arisen to pilot the social marketing approach within the lifestyle related issue of sexual health and teenage pregnancy . COI and

DH are thus working together to develop and evaluate social marketing interventions aimed at improving the sexual health of audiences identified as being at high risk.

The project must use social marketing principles as identified above for design and delivery: build ideas from audience insight ; utilise stakeholders and reflect priorities and evidence of effectiveness .

Eight stages to the project are planned. Three of these stages have already been completed, as follows:

Stage 1 : Audience prioritisation, identifying particular population groups which have high incidence of STI’s, have behaviours which put them at high risk of STI infection/have attitudinal demographic/other characteristics associated with STI risk

Stage 2 : Identification of drivers of risk behaviour amongst target audience groups.

Stage 3 : Audience segmentation sizing behavioural and attitudinal groups, to enable identification of those key drivers that will need to be addressed through the intervention.

This research report relates to Stage 4 of the project, which requires the identification of key insights to inform the development of sexual health/teenage pregnancy social marketing pilot concepts through this qualitative research. Findings need to inform and feed directly into the next steps of:


Stage 5 : Selecting a delivery partner based on their expertise in selected audiences and experience at delivering interventions addressing key behavioural drivers.

Stage 6: Developing pilot interventions and materials, including testing of approaches with selected audiences.

The final stages of the project will include:

Stage 7 : Full implementation of pilot(s).

Stage 8 : Evaluation of the pilot(s)

Summary of Phases 1-3: Target Audience Identification &

Prioritisation

The desk based analysis produced a hypothesised segmentation based on two axes of sexual behaviour (relationship status and number of partners) and factors which drive behaviour (attitudes, self-efficacy/confidence and perceptions of social norms), as follows:

• ‘Low Risk’:

Have positive/protective attitudes, have sufficient self-confidence/selfefficacy to enable them to manage a relationship and articulate their

•

• preferences, and believe in social norms which promote sexual health.

‘Thoughtless’ :

Although they have the capacity/self-efficacy to make positive sexual health decisions, social norms or their attitudes do not support this.

‘Vulnerable’ :


•

Lacking in self-efficacy and not supported by social norms, making it difficult for them to make positive choices about sexual health despite their positive attitudes.

‘Disengaged’:

Having attitudes and social norms which do not support positive sexual health, and lacking in the self-efficacy needed to bring about change.

Taking both the hypothesised behavioural motivations from the desk research (as above) alongside information relating to the incidence of

STIs/teenage pregnancies and presence of risky sexual behaviours, it was recommended at the end of Stage 3 that the pilot activity focuses on those who may be considered specifically Vulnerable and those with high numbers of sexual partners (likely to be in the Thoughtless, Vulnerable and Disengaged segments).

Overall, therefore, the specific task of this Stage 4 research was to generate information that would verify and / or develop the hypothesised segmentation as well as provide target audience insights which could assist in the development of the social marketing pilot concepts (Stages 5 and 6).


In light of the project needs described above, this research was tasked to understand: a) The audience segmentation

• the extent to which the hypothesised segmentation reflects differences in

•

• the target audience and make recommendations for adjustment/refinement or change identify any key markers than can potentially help in targeting/identification b) The audience experience

• the factors driving risky behaviours (unprotected sex – non-use of condoms and/or other methods of contraception) and regretted sexual encounters/experiences the role of alcohol and drugs (determining the extent to which they change behaviour vs are used as a justification or excuse)

•

• the broader context for sexual behaviour (lifestyles, interests, aspirations, cultural influences/perceived social norms and attitudes)

− and within this, the sexual encounter ‘journey’ (where, what and how occurs in the development and negotiation of the encounter

• prior to sex) any gaps between actual and ideal sexual lifestyle patterns and the reasons for any discontinuities; and determine when receptivity to change is highest c) The way forward any opportunities to change risky behaviour (services/interventions/ messages) and why these have potential


• direction on intervention strategies and potential partners put into research for testing to generate guidance for moving forwards to next steps

This report details the findings of the research.


ii) Method and Sample Approach

Summary

A three phase approach was used for the project. In summary:

•

Phase 1: Interviews with Stakeholders to provide a collection of “expert witness” statements to be used as stimulus in Phase 2.

•

•

Phase 2: Creative Conference Workshops with a sample of the target audience to develop insights and intervention strategies and create stimulus for Phase 3.

Phase 3 : A series of interviews and discussions with a further, comprehensive sample of the target audience (interviewed singly, or in friendship pairs and trios) within an Interactive Gallery environment.

2

Phase 1: Stakeholder Interviews

Filmed interviews with five Stakeholders were conducted (approximately 30 minutes each) to provide a collection of “expert witness” statements to be used as stimulus in Phase 2. Respondents representing the areas of service delivery, marketing activity, policy and academic study/teaching.

Content of the interviews was edited to provide a short film for use as stimulus in the Conference Workshops.

The briefing document for the Stakeholder interviews can be found in

Appendix 3.

Phase 2: Creative Conference Workshops

2

See Appendix for further explanation/illustration of the Interactive Gallery approach


Nine Creative Conference Workshops of 2½ hours were undertaken.

Four of the conferences included 18-20 young people of similar age and gender within the broad target audience as follows:

Segment Age

Conference 1 Male

Conference 2 Male

Conference 3 Female

16-19

20-29

16-19

Conference 4 Female 20-29

Other specific criteria for respondents in these workshops included:

•

All to be sexually active

•

•

To include a spread of types (e.g. early experiences through to fledgling relationships for 16-19, through to established relationships for 20-29)

To include a spread of claimed attitudes towards condom use and sexual experience

•

To include those who are relatively extrovert/comfortable in giving views within a group of people they do not kow

A further five workshops, each with 6-8 respondents for 2-2½ hours, were also held as follows, in order to ensure that specific vulnerable groups were heard clearly at this stage of the research, and their contribution and issues were clearly identifiable:

Conference 5 Black African Women

Conference 6 Black African Women

16-19

20-29

Conference 7 Low Attainment Males

Conference 8 Low Attainment Females

16-19

16-19

Conference 9 ‘Borderline’ females (sexually 14-16

DE

DE

DE


inexperienced)

Other specific criteria for respondents in these workshops included:

•

•

•

All to be sexually active

To include a spread of types (e.g. early experiences through to fledgling relationships for 16-19, through to established relationships for 20-29)

To include a spread of claimed attitudes towards condom use and sexual

•

• experience

Low attainment to include: those who have/are likely to achieve less than

5 GCSEs at Grades A* to C

‘Borderline’ to include those who are sexually active but pre-intercourse

(i.e. likely to become fully sexually active very soon)

The purpose of the workshops was to work with the audience to develop insights and intervention strategies. These were captured in creative form

(exhibits and artwork). A selection of these were taken forward (and redeveloped as required), to form the basis of Phase 3, the Interactive

Gallery exhibitions.

Phase 3: Interactive Gallery Exhibitions

In this phase, a series of interviews and discussions were held with a further, comprehensive sample of the target audience (143 respondents). A detailed breakdown of the sample can also be found in Appendix 3.

These respondents were interviewed singly, or in friendship pairs and trios within an Interactive Gallery environment.

The friendship pairs and trios were recruited around a key contact. That is, the key contact was recruited on the basis of their own characteristics, with characteristics of their close friends falling out naturally. The Recruitment


Questionnaire (used for both Phase 2 and 3 target audience recruitment) can be found in Appendix 3.

Respondents were walked through a selection of the artworks generated within Phase 2, and asked to respond to these exhibits. Once all spontaneous ideas had been drawn out, they were also prompted with a wide range of questions in order to explore and interrogate ideas and thoughts articulated by other respondents, in order to collect further insights and to identify concept areas for development.

Data collected in this phase was both verbal and observational – the interplay between the parties being important to understand how the presence of peers changes what the audience can say and how they can selfdirect.

There were separate Male and Female exhibitions. While the interviews focused mainly on the exhibits of the gender of the respondent, they were also shown the exhibits of the opposite gender.

A Note on Data Generation and Analysis

The research generated a signficant raft of both discussion and creative output for analysis and interpretation. An brief explanation is given below of the kinds of processes that were included within both data generation and analysis.

3 The full range of insights, in terms of target audience rules

underpinning attitude, myths which need addressing, and detail around audience differentiation are obviously detailed throughout this report.

3 Copies of the discussion guides for each of the phases can be found in Appendix

3.


As mentioned, in the conferences respondents were tasked to produce artworks which expressed their thoughts and issues around sexual health choices, as well as ‘inventions’ that could help facilitate better sexual health choices. The creative exercise for developing inventions was based on a standard creative technique, ‘Clash’ (clashing properties from one product or category with those from another product or category to come up with a third new category of products or inventions).

The inventions are a key part of the data rather than the output or recommendations given in this report. Diagram 1 below illustrates how the ideas produced by respondents were used to develop insights.

Diagram 1: Illustration of Data Analysis for Insight Mining difficult . Sexual behaviour is ‘illegitimate’.

Anonymity in numbers.

Sex ual healt h is on face wit h my sex ual behaviour. I am me …st ill… and so I allow penetrative sex

Adult sex is without condoms.

Young sex is

Sex w ith condoms is promiscuous sex .

The respondents generated the list of inventions on the left. Understanding the idea behind the invention highlights an audience insight . To give a couple of examples:


Condominos pizza is based on the idea that there would be condoms delivered with pizzas to your door. Mining this invention for its insights, we were able to understand that for some respondents it was important to be able to save face. The ‘I didn’t know it was coming – but I did really…and now I can’t send it back, because that would be discourteous or inconvenient’ was exceptionally relevant to several of our audience segments.’

The ATM card was put forward on the basis of ‘before you get hard use your card’. This was a surprising suggestion given that condoms are free.

The issue for respondents was partly about making them accessible in high streets, but also about condoms being linked with young immature sex and inexperienced sex. The young people behind this idea wanted condoms to

“age up”, and connecting them with credit cards was one route.

Fieldwork and team

Fieldwork covered the following locations: Southampton, Hammersmith,

Edmonton, Barnet, East Sheen, Edgware, Slough, Birmingham, Leeds and

Oldham.

All fieldwork took place between 12 th December 2007 and 30 th January

2008. The research team comprised Joceline Jones, Anna Thomas, David

Proctor, Jon Gower, Patrick Ell, Rowan Chernin, Jill Swindells and John

Miller.

Copies of the recruitment questionnaires can be found in the Appendix.


B Summary & Conclusions

Sexual Health Foundations for the Target Audience

1.

In seeking to understand core drivers and barriers to negative sexual health behaviours, the research is able to confirm much existing knowledge.

2.

There are rules in five main areas which drive target audience behaviour: a.

age (and experience) b.

sexuality and understanding of sexuality c.

entrenched cultural influences around them d.

gender ‘roles’ (which arise from culture, peers and parents) e.

cognitive function (capacity to make decisions – whether innately or whether affected by alcohol or drugs)

These rules build the specific attitudes, confidence levels and social norms that determine behaviour across the audience as a whole. An overview of these rules and the issues they start to raise for sexual health is given I Section 1.3 Hidden Rules –

Norms and Culture, p.24.

Audience Differentiation and Segmentation

3.

There is differentiation within the target audience in terms of how influential each of the different rules is.

4.

The audience divides into attitudinal clusters based on the focus and nature of their specific attitude towards condom usage, their confidence levels in negotiating sexual boundaries and the social myths which


influence their behaviour. Understanding the attitudinal clusters is particularly useful, both in:

•

• gauging the potential warmth of different sections of the audience to marketing activity (communications and interventions) developing content of marketing and communications aimed at these clusters

A full description of the different attitudinal types in terms of how they can be recognised within the target audience population, opportunities for reaching them, and importantly, their specific barriers to better sexual health decisions and possible levers for change is given in Section 2.4, Segmenting the Audience by Attitude, p. 78.

5.

There are other dimensions on which to also consider the audience, for example, thinking in terms of demographic clusters to help with targeting (finding them in the population).

An explanation of these dimensions and how they ‘map’ into the attitudinal segments is given in Section 2, Audience Segmentation p.67.

6.

Overall, it is evident that the research validated and refined the hypothesised segmentation put forward by the earlier Desk Research within Stage 3 of this social marketing project.

Audience Insights for Encouraging Attitude or Behaviour Change

7.

The research method was designed to stretch the target audience’s selfreflection and own creative thinking about possible messages and interventions that would help cause positive shifts in attitudes or behaviour.


8.

Discussion and creative work generated a range of ideas which highlight insights about the audiences’ needs (psychological and educational/informational).

9.

Emerging from this are nine core themes that reflect core barriers for

the audience 4 . These barriers are myths, attitudes or visceral responses

that the target audience are holding in mind (often unconsciously) and are preventing their engagement with positive sexual health behaviour.

These themes are detailed in Section 1.4, Myth-Interpretations and Potential

Direction for Solutions, along with audience driven suggestions for interventions to either work with the theme, or tackle it head on, in order to produce a positive shift in attitudes or behaviour.

Details of the artworks and interventions used as stimulus for discussion (many of which were directly generated by respondents) are also described, along with responses of the target audience, in Appendix 4.

10.

Reflecting the fact that there is attitudinal differentiation within the audience, some myth-interpretations and interventions are more relevant for particular audience groups.

Section 2.4 Segmenting by Attitude, p. 78, includes the specific suggestions for reaching these audiences

In Section 2.5, Mapping Opportunities for Targeting, p. 101, details how the various attitudinal clusters can be considered for targeting marketing activity together as well as likely (audience generated) interventions that can start to address their needs.

* * * * *

4

The nine themes arise when considering the audience as a whole. Each individual theme varies in specific relevance to different parts of the audience.


C Detailed Findings

1. Audience-Generated Insights for Encouraging Positive

1.1 Introduction

In the second phase

5 of the research (Conference Workshops 6 ) respondents

were given two key tasks to complete.

Firstly, they were put into small groups and tasked with generating ‘artworks’ that reflected their key thoughts and issues about sex and safe sexual choices. Moderators listened in to their conversations, gaining insight as the respondents thought through and built their ideas, and probing for further explanation or detail as necessary.

Once artworks were completed, the ‘artists’ shared the thinking behind each piece to the wider group, who were able to comment and ask questions, to challenge or to add their own thoughts.

Following this, respondents were given stimulus materials and facilitation techniques to start generating and illustrating appropriate ‘interventions’ that could be employed to help people like themselves make safer sexual health choices (for example, using condoms, seeking screening, avoiding regretted experiences, etc). Again, the rationale for different ideas was explored in discussion and commented on by the wider group.

5

The first phase was a series of interviews with stakeholders to create stimulus material for phases 2

6 and 3

For detail see Method and Sample, p. 10 and Discussion Guide in Appendix 3


Analysis of the ‘artworks’ and ‘interventions’, together with the associated discussion by the research team, generated a number of core themes and ideas. These were taken forward into the third phase of the research

(Interactive Galleries

7 ) for further exploration with a fresh sample of

respondents.

In this third phase, respondents’ ideas (artworks and interventions) were either represented by one of the original (respondent-generated) artworks, or by a new work (created by the research team) which drew together and expressed a number of specific ideas more clearly.

The short-list of respondent-generated interventions, supplemented with some additional ideas from the client team, was taken forward for further exploration alongside these artworks.

Details of the artworks used in Phase 3 themselves, a summary of their rationale for inclusion, and the responses they generated can be found in

Appendix 4.

1.2 Overview of Section Content: ‘Hidden rules’ and

‘Myth-interpretations’

Respondents reported many different stories and actions that they had taken in respect of their sexual behaviour.

In order to understand these fully, it is necessary to make explicit a number of implicit assumptions that respondents seemed to be continually working from when presented with data or challenges about the way they do, or do not, take care of their own sexual health. These unquestioned principles can

7

detail see Method and Sample, p. 10 and Discussion Guide in Appendix 3


best be termed ‘hidden rules’ (and may well be familiar since they operate across many areas of society). They fall into five main areas:

•

•

Cognitive function – ‘whether I have the ability to consider’

Age – ‘whether I am old enough, too old, too young…’

•

•

•

Non-sex culture – ‘whether I believe sex is acceptable (to do or discuss)’

Gender role – ‘what is expected of me as a male/female’

Sexuality – ‘what I understand sex to be’

These rules are created from:

•

• the ‘groups or societies’ in which the respondents live/work/learn, the media (with its normative frameworks for drama and sexual

•

• attractiveness), parents (who communicate normative frameworks for their children, for each gender and for sexual behaviour in general), church or other moral compasses (who deliver patterns and norms for ideal, living, good living, right living – much of which is directly

• addressed at the area of sexuality and sexual expression), and schools and educational materials (which approach the subject of sexuality to deliver information, rather than to enlighten or empower its students).

Some of these rules conflict with each other. Some may essentially contradict. Many agree in one respect at least: that sexual behaviour is not acceptable for the young and only acceptable for females under certain conditions.

These rules may appear to be being challenged (not least by the notion of

‘gender equality’). However, such challenges are quite weak – especially in the face of high level risk of rejection by parents, peers and partners.

In reality, young people have – by the time they become sexually active - experienced a continuous stream of rigid male and female sexual


stereotyping, underpinned in particular by the concept of heterosexual sexual intercourse.

The ‘hidden rules’ deliver certainty – a deeply-internalised view of how the world works . Even in the act of rebellion (through underage/premarital sex), such norms can be seen to strongly affect the way in which young people initiate sexual activity, protect themselves and plan for sexual encounter.

However, because these norms seem to have been internalised by all within the society (adults and young people alike), they are rarely changed. Such norms may be religious or secular, but they become over time a part of the immediate range of responses to a particular situation – a gut instinct.

Where several norms overlap, it would seem that a process of interpretation has taken place.

In this research project, it was clear that respondents seemed to have analysed the rules differently and come up with a number of varying interpretations or core beliefs about why sexual behaviour and sexual health should remain hidden or distant. We have identified nine of these themes or core beliefs. They were often not correct or true in any real sense, but were made as some ‘sensible conclusion’ for the target audience from the multiple data that is being received.

We might term these beliefs myth-interpretations (misinterpretations based on non-fact in the first instance). Understanding this invisible backdrop of myth-interpretations helps the target audience barriers to better sexual health choices to become challengeable.


It should be noted that the strength with which young people hold to these opinions or myth-interpretations, even when they know them to be illogical or against their own self-interest, indicates (somewhat ironically) their need and strong adherence to a normative framework.

Detailed in the first section below (1.3, Hidden Rules – Norms and Culture, p.24) are the ‘hidden rules’ – broad brush societal attitudes and norms underpinning audience attitudes.

Following this, the nine myth-interpretations are detailed in Section 1.4,

Myth Interpretations and Potential Directions for Solutions, which are central to the research questions of this specific project. Each theme embodies one or a series of ‘facts’ that help to create and maintain attitudinal barriers for the target audience to good, conscious sexual health choices.

Each myth-interpretation is explained in terms of:

•

•

•

What the specific myth or attitude is

Who specifically within the broad target audience it is particularly important for

8

Which kinds of interventions or communications can challenge or accommodate the belief for positive progress

9

1.3 Hidden Rules – Norms and culture

As mentioned above, the ‘hidden rules’ fall into five main areas:

•

Cognitive function – ‘whether I have the ability to consider’

8

This variously refers to different audience segments (demographic or attitudinal) as described in

Section 2, Audience Segmentation, p.68.

9

It should be noted that the interventions or communications suggested are drawn from respondents’ own idea for what they believe can ultimately meet needs. They do not take into account considered evaluation of cost and channels, and some may already be in existence in some shape or form.


•

•

•

•

Age – ‘whether I am old enough, too old, too young…’

Non-sex culture – ‘whether I believe sex is acceptable (to do or discuss)’

Gender role – ‘what is expected of me as a male/female’

Sexuality – ‘what I understand sex to be’

Each of these is discussed below. The detail is unlikely to represent new thinking; however, it important to outline at this stage because: this is the resource from which the audience create their myth-interpretations; and this is what communications, marketing and service activity is working either with or against to address realign wrong thinking.

1.3.1

Cognitive Function

– ‘whether I have the ability to consider’

Rules exist here in that respondents knew that ‘you have to know what you are doing’ (be knowledgeable and in control of that knowledge) to be responsible for making a decision.

Alcohol and drugs are known to reduce this ability generally. As such, they are considered to contribute to the decision to have sex, and the lack of consideration of sexual health (alcohol in particular).

Alcohol is sometimes used as an excuse ... it makes you feel safe when you’re not

... invincible ... but you still know what you’re doing ... like an out of body experience

Female, 16-17, South

Of course, in some cases, other issues arise around cognitive function. There are some within the target who struggle to understand the context in which they are making behaviour choices. While this is sometimes a function of lack of education, in others it is an issue of personal capacity. In either case, decision around having sex per se and considerations of sexual health are obviously both affected.


1.3.2

Age

– ‘whether I am old enough, too old, too young…

Age ‘rules’ are extensive and varied, and provide a complex set of considerations that drive fears and issues.

Many know that the age of consent is sex is 16 and understand this to mean that ‘sex for someone who is under 16 is illegal’, or at least ‘wrong’ in the eyes of the law. This makes accessing sexual health services very difficult for many under 16, particularly if they are unable to disguise their age.

Loss of virginity is considered to be a rite of passage that marks maturity and adulthood (since the act of sex – the ability to perform to pro-create - is adult). Average ages of losing virginity are unknown but are largely assumed to be younger than 16; the main steer obviously taken from the closest social circles.

Varying rates and stage of puberty complicate matters:

•

A young person who is under-developed physiologically (versus their peers) is under pressure to demonstrate that they are mature in some way

•

(which can be sexual activity)

A young person who is well-developed (versus their peers) is under pressure to act their physiological age (which can be through sexual activity)

The same well- or under-development issues do not apply to sexual health services which, as public or commercial entities, ‘must’ operate under the legal structure and recognise chronological age only. For most, it is felt there is no evidence to the contrary, and that physiological legitimacy is possible.

Mature or adult sex is understood to be without condoms. This is sometimes drawn from the premise of mature sex being understood to be within an


emotional relationship (in which condoms are not required because it is

(hopefully) monogamous). However, it is also commonly heard that sex is better without a condom. As this is something you learn ‘though experience’, not using a condom demonstrates experience (and therefore maturity).

Looking at a general developmental timeline, it seems that:

•

•

For the youngest, inexperience and illegitimacy means they are most vulnerable when pressurised and excluded from sexual health help

For those who are age of consent and above but still in education, legitimacy means there is more opportunity for sexual health control but

• other factors (most specifically gender – see below) interfere with interest in sexual health

For who are officially adult have less access than younger groups to information (through schools) and as initiators of the youngest into sex in many cases are recycling more negative behaviours

1.3.3

Non-sex culture

– ‘whether I believe sex is acceptable (to do or discuss)’

Young people understand sex as being largely unacceptable in their culture – whether religious, race or community based (mainstream Western or other).

Specifically:

•

It is not for pleasure (which means it is unacceptable for young people who are not ready to pro-create)

•

•

In some cases, it should not take place at all outside of marriage (or at least outside of a relationship)

It is not talked about (because it is not for pleasure and it is a source of

• embarrassment, involving consideration of genitalia which are ordinarily

(‘necessarily?’) hidden)

There are punitive consequences if caught being sexual (signalled by sexual or sexual health activity) – from severe physical consequences for


some ethnic minorities, through to emotional consequences of disapproval of adults and shame for others

We have strict rules about talking about sex, it is shyness and forbidden to talk about it. If you are underage like 18 you cannot talk about it…if you are not married you cannot talk about it either

Female, African, 20-24, South

I went to a Catholic school so all I got was don’t do it and told when you’re married you do the rhythm method!

Female, 25-29, South

These rules are heard and experienced from a variety of sources within a culture and, critically, parents and other education sources. Indeed, for many respondents, the key risk in sexual activity was from their parents and community finding out they were sexually active or, worse, pregnant.

As condoms are indisputably sexual they cannot be embraced personally in any way without flagging up an intention – that may be rejected (for males) or that should be rejected (for females). Similarly, focus on other forms of contraception, or on sexual health screening are a demonstration of intent.

You have to hide things from parents or you’d get the lecture


Being non-sexual, however, clashes with messages that are being received from elsewhere (media, music, etc) that celebrate sexuality – often in a very gender specific way.


1.3.4 Gender

– ‘what is expected of me as a male/female’

Despite many general equality messages being accessible in society, young people (given their stage of identity development) are particularly focused on what their gender means or brings to the way they are or behave.

There is often both a desire, and pressure, to exhibit oneself as distinctly and appropriately gendered: very ‘female’, or very ‘male’. This is partly due to very gendered and sexualised messages coming from the media (as mentioned above) which offer some role modelling.

There is, of course, a range of other very gender-focused messages that come from a wide range of sources and over a long period of time. In moving from androgyny into sexual beings, many draw from archaic references and signifiers to demonstrate their gender.

Irrespective of where the gender messaging is coming from, gender rules around passivity and activity tend to be reinforced – females being passive and males being active.

In terms of sex and sexual health, females express their gender role by being passive and not asking questions or seeking control. In contrast, males express their gender role by being sexually active and more control focused in regard to sex (rather than sexual health overtly).

Adoption of these simplistic gender roles means contraception and sexual health choices are always ‘not me’ but the consideration of the partner.

Indeed, both genders see condoms as ‘not my problem’ –males think females should request if they need them (because they’re not on the pill).

Females think males should wear them – they are applied to the male anatomy and have an impact on sexual pleasure.


1.3.5

Sexuality

– ‘what I understand sex to be’

The sample was heterosexual (or claimed to be) and heterosexuality was the main subject of discussion.

There was some consideration of homosexual experience but, on the whole, in respondents’ minds these are two separate communities. Positively, however, there appears to be little ‘demonisation’ of homosexuals (as was seen in previous decades) for connection to AIDS/sexual health.

Overall, it was clear that the normative framework of reference is of heterosexual penetrative sex (simple, basic sexual exchange mostly in the missionary position for procreation).

This appears to drive several issues:

•

A very strong focus for young people on pregnancy and pregnancy

•

• avoidance (such that it overwhelmingly dominates versus STIs)

A focus on romance (the basis of a relationship in which sex/procreation is deemed acceptable) – which draws in gender rules

Constraint around consideration of whole body sexual expression and creative thought around safe sex.

Focus on the romantic bond with the partner causes specific difficulties for considering STIs. A romantic bond means high value is placed on the partner. STIs, however, are associated with low value individuals – which leads to a simple disconnect

10 .

Given issues with sexual expression and a lack of discourse of pleasure

(cultural rules largely prohibit – see earlier) condoms are also difficult to

10

Dissociation is compounded by low levels of biological knowledge around STIs.


consider – since they involve consideration of anatomy and pleasure during the sexual act itself.

1.4 Myth-interpretations and Potential Direction for Solutions

Conflicts and confusions within these rules and the issues they generate inevitably makes it difficult for the target audience to find a connection to sexual health.

As mentioned earlier, respondents seemed to have analysed the rules differently and come up with a number of varying interpretations or core beliefs about why sexual behaviour and sexual health should remain hidden or distant: the nine myth-interpretations detailed below.

These myth-interpretations set out the specific intellectual and emotional territory from which the audience receives messages at the moment. It will be essential to challenge this territory: either shifting the ground for the audience (without knocking them off balance) or helping them move easily forwards towards a different, more positive attitude and behaviour

11 .

The nine themes cut across audiences. Many are also interrelated; either setting up others as a corollary or gaining support from associated beliefs. As such, they need to be considered as a ‘package’; interventions that create small shifts in some areas may potentially have value in terms of moving defences and reshaping other areas too.

11

Whether potentially impacting on attitudes or behaviour depends both on the insight itself and the audience: while some can help shift attitude and thus help move norms, others may have a more immediate impact on whether or not the target audience decides to use a condom or get screened.

Which insights are taken forward for specific development, will obviously depend on specific marketing objectives and extent of marketing and targeting opportunities


The myth-interpretations and their suggested interventions fell into two types.

The first type (1.2.1 to 1.2.9) includes those that might be considered social themes as they involve approaching parts of the audience en masse and delivering steps for personal change within a context of social messages.

The second type (1.2.10) includes personal themes as this involves focusing on the individual’s needs and skills in a specifically personal context.

1.4.1 “I am not supposed to be sexual”

This myth-interpretation was perhaps most prevalent amongst the youngest audiences and particularly those for whom the religious and gender norms were strictest. At any stage, however, most females experienced some discomfort with their sexual identity. The youngest and those of Black

African origin experienced the strongest attitudinal barriers as gender rules intersected with religious or age rules:

Vulnerable (young females aged 12 through to 29)

• Black African females

• Black African males

As mentioned earlier

12 , the rules of many cultures 13 demand that the older

members of a community (‘adults’ upwards) should inhibit the sexual behaviour of the young person and safeguard their reputation and that of the family of origin. In some communities, sexuality is considered disruptive or simply wrong, depending on the culture in question. ‘Good’ parents prevent their children from being sexual – according to this myth.

12

Section 1.2, p.20

13

Culture may be based in religion, country of origin or, particular for those of UK origin, their particular socio-economic demographic profile


This is as strong within secular as within religious cultures and is more borne of an old-fashioned morality mindset (rather than a taboo against early pregnancy).

Many young people thus experience silence from those who might set an example or give advice. This silence is unchallenged, but is assumed to be negative and indicating rigid prohibition against young sexual behaviour.

Given this response, and the extent to which it does not address or connect with the vast majority of messages (internal and external) about sexual behaviour, confusion arises. In order to make sense of such disunity between experience in one area and experience in another, a certain amount of psychological manoeuvring has to take place within the young person.

This leads to:

• denial of sexual behaviour and interest (to others)

• dissociation from ‘elders’ to follow the lead of others (such as peers or – often older – men) who set a particular standard

• denial of sexual behaviour and interest (to self)

Clearly, denial and disassociation leave the young person at risk; sexual boundaries cannot be easily defended from a position of oblivious ignorance. Addressing the adults’ incapacity to enter this topic, and in an attempt to help them guide their young people more effectively, respondents helped to generate three core interventions to challenge this norm (and break the cycle):

• Parental DVD

• Information and guidance for the target on emotional intelligence

• Reminders of choices and consequences through top up leaflets, logos or icons (normalising the issue of conscious control of sexual behaviours )


a) Parental DVD

Some groups particularly felt that parents needed help either directly (to become educators on sexual health) or indirectly (through assisting parental acceptance or advocacy of other sources).

A parental DVD was widely suggested, explaining the need for parenting through the emotional and psychological stages of teen sexual development.

Delivery at start of secondary school was felt likely to bring benefits - that is, seen to be from a recognised, ‘close to me’ authority. In-home delivery was thought to be specifically useful for parents with the highest embarrassment or rejection issues (including immigrant parents). Verbal delivery (in target language) would have benefits for a range of audiences, including those parents too busy with other children to come to groups after school, or who were working during the day. It was felt particularly relevant to have something that one parent might be able to show another (further joining up the conflicting messages between home and the outside world).

It would, of course, also be available to parents and older target themselves from sexual health clinics.

To reach immigrant parents specifically, (but with benefit to all those currently averse to engaging with sexually health), indications are the content needs to be delivered in way that:

• relates to wider community/global issues (global population control).

Information also needs to be compartmentalized so that those with boys might not have to go through the issues related to girls, for example, but can focus on their own child only. In this way, it becomes implicitly more ‘me and mine’ and less about broader reproductive education.


• offers specific information about sexual health risks and discusses

‘others’ (that is, not ‘your’ child)

• invites collaboration and conversation, for example by offering credible role model conversations (or even non-conversations incorporating greater tact, positivity and respect)

• uses culturally relevant icons and spokespeople to front message

• specifically discusses the benefits of parents helping young people to preplan protection – and separating this clearly out and away from the suspicion that they will be promoting sexual behaviours through information b) Information and guidance for the target on emotional intelligence

Many respondents recognised the lack of information and guidance on the broader issues of “relationships”. Beyond, the ‘hydraulics’ of sex and the associated physical outcomes (pregnancy, STIs generally), very little else was discussed or passed on in any form. It is of little wonder that the sexual act takes such a central stage in the drama.

Role modelling around language, choices, considerations (things to look out for in terms of what an individual might want and offer emotionally and physically, positively and negatively), was felt extremely difficult to come by.

Where it is found in its shallowest form in teen magazines, TV soaps or song lyrics, it was felt hard to evaluate with reference to oneself.

You need to understand what you can get but more importantly how to handle yourself in the relationship, boys can make you feel xxxx if you don’t do what they want, so it’s important to have self esteem, you learn from your friends and those around you…

Female, BME, 18-19, South


Respondents were not overtly seeking direction on ‘how to manage relationships’; but the distinct lack of context in which Sex Education is passed on appears to directly feed into the perception that sex does not feature as part of mainstream life. Rather, it is a ‘secretive sideline’ with its own rules and culture: where one steps inside and becomes someone else.

Mapping out the physical, sexual and emotional journey of an individual alongside their conscious control of their own sexual health could really help legitimise the fact that they are always a sexual being (with sexual behaviour expressed only when the circumstances are right).

Providing some degree of role modelling – something deeper than ‘boy meets girl’ storylines - is also likely to help the audience find skills to live in this framework.

Examples of specific content that emerged from respondents as likely to be of high value in this context included:

– Considering (a wide range) of better experience through snapshots of positive and negative experiences which illustrate making good and bad decisions

– Right time

– Legitimising non-penetrative sex

– Kudos for consideration and use of contraception and/or sexual health services

– Average age of losing virginity (which is higher than most expect - to challenge perceived norms which have the current tendency to push people into early sexual behaviour)

– Role of sexual health services

– Explanation and contextualisation of ‘frigid’ (in terms of its real definition and how it is misused as a bullying weapon to pressurise into early sex) to help return control to young females


–

The concept of ‘six degrees of separation’ 14 , which does need explaining

in the first instance but is impressively easy to grasp, genuinely interesting to the audience and therefore potentially offers a powerful future-facing reminder

15

In terms of how this information and guidance could be delivered, it was felt there was opportunity for both print and face-to-face channels (e.g. leaflet/booklet and SRE session). c) Reminders of choices and consequences through top up leaflets, logos or icons

It was clear from talking to older respondents (20 years old plus) within the sample that sexual attitudes and behaviour fluctuated in response to external stimuli. Across the sexual development of the individual, for example, certain key facts and even sexually healthy attitudes are easily forgotten. At some points, with some partners, or in some stages of one’s life, certain issues take on greater prominence. At other times, these change in emphasis, become subverted or information is lost and confused.

This morphing and dilution of best practice even amongst the more mature appears all the more important given that the baseline of knowledge and understanding was often very low to start with.

As is well known, and clearly illustrated within this sample, even adult females who have gone through pregnancy and childbirth can still be very poor in terms of awareness of sexual health issues and personal boundary protection.

14

Understanding of how many different people who are physically dissociated from each other can become linked through relationships and sexual activity (however infrequent and of whatever nature)

15

For more detail see Section 2.5, p. 104 and Appendix 4


Additionally, there appears to be both intentional and unintentional exploitation of younger people - older males who are sexually initiating younger females appear particularly instrumental in setting up poor norms

(not using condoms for penetrative sex or oral sex, not discussing sexual history or risk-taking before or after sexual interaction, not going to clinics for screening).

For those in the target group who are still active (from contentedly ‘playing the field’ through to seriously seeking a new long-term partner), the basics therefore need to be repeated and explained in full.

Understanding this, respondents felt that reminders of choices and consequences through ‘top-up’ information for those over 18 would be useful – for example through some kind of a leaflet – to help correct poor practices.

A wider range of sexual health issues (and practices) can potentially be discussed in such a leaflet which, being designed for the older end of the target, should not offend or be accused of promoting sexual activity in the younger target audience. Should they need to access this leaflet, however, it would be possible to be given it.

Leaflets are obviously not of universal interest. Literacy is low across much of the target group and attention in some segments was very low. However, other communications strands targeted at this older group (e.g. logos, icons, etc) have potential for engaging and reminding this group.

The Six degrees of Separation artwork

16 , as touched upon earlier, was an

example of a specific idea that worked well in the research. Once decoded, it operated as a swift and uncontested ‘one strike’ reminder for older and

16

For more detail see Section 2.5, p. 104 and Appendix 4


younger audiences alike. It communicated a multitude of issues connected with the sexual act including risk, behaviour, emotion and consequence

(potential and actual, direct and indirect) in a very engaging and nonjudgmental way.

As such, as a quick and powerful key to a complex situation, it is likely to have impact and to act as a reminder of both ‘pre-‘ and ‘post-encounter’ health decisions.

‘Six degrees of separation’ is a concept that does need explaining in the first instance. However, it is very easy to grasp and for a generation used to compression messaging (via text messaging ‘speak’) it offers a resonant and potentially important aspect to build into early SRE

17 communications too.

1.4.2 “Having sex proves something about you”

This myth or attitudinal barrier was particularly key for:

• Female and male ‘pressurised’ – those who did not feel ready to have sex but were experiencing pressure from peers, partners and others to lose virginity (typically aged 10 to 15)

While the sample of respondents in this project included only a few within this specific age group (females aged 15), many 15+ respondents identified this life-stage and pinpointed this issue as a critical point in their own sexual development.

Notwithstanding the disapproval of their close adults and irrespective of their own lack of understanding of the sexual and relationship territory described above, there is a strong peer-controlled myth about first sex being an

17

Sex and Relationship Education


important milestone or rite of passage. Pressure comes directly or indirectly from peers (for example, through teasing, suggestion or benchmark setting).

Within the general complexity and confusion of teenage development, achieving ‘sexually active’ status is seen as proof that the individual is desirable and that everything ‘works’. Of course, the earlier this first sex occurs, the more likely the individual is to be less confident in establishing personal parameters effectively and to set healthy practice or safe reproductive health for themselves.

While there is wide awareness of a legal benchmark of age 16, many respondents (male and female) reported strong pressure to become sexual from the early stages of puberty. Even where they did not succumb to pressure, there was uncertainty and a lack of clarity about the appropriate time to become ‘sexual’.

Becoming ‘sexual’ is also understood in very simplistic terms (often driven by learning from SRE and its emphasis on reproduction). Thus all references, behaviours and events are set in a framework of adult heterosexual copulation , an “act of adult males and females that results in pregnancy”. To this extent, condoms are a barrier against becoming pregnant because the union is not ‘legitimate enough’ in some important aspect.

There are clearly information and guidance implications that feed into different communications strands to establish a new framework for thinking about the right time , right place, right way for you to encourage individuals to set their own sexual expression boundaries more generally

18 .

Respondent discussion also highlighted the potential for branding and marketing activity around condoms which emphasises ‘right time’ and

18

As noted in 1.4.1 above, page 34


‘special moment’, and could emphasise waiting a little while longer. As a main strand of activity, this is certainly not without difficulties or specific considerations. However late it sets the right age, some groups within UK society (and some young people themselves) will perceive the connection between condoms and age as promoting sexual activity. Although the idea has some merit possibly, most pertinently it might be noted that these condom-age messages would go unnoticed for many groups - and could be detrimental for others - unless delivered in conjunction with empowerment and consciousness-raising work that suggests age as only one of a number of parameters to establish for oneself.

As a complementary activity, there are indications that there might be strong potential to help with rule-setting around ‘right time’ and to anchor condoms as part of a “pre-married” experience/the way forward. As such it would help underpin all other messaging and become important external endorsement of a framework that is being set elsewhere (taught in SRE or delivered through leaflets and services). It could re-emphasise known legal age of first sex (especially important for some younger and low attainment girls who need a clear and acceptable way of rebuffing the onslaught of sexual advances they claim to experience on a daily basis).

There is also potential for connecting a notion of a ‘special’ encounter to the often-expressed regret in: ‘I wish I’d waited’. This was a very common thought from many older females in the research which indicates that it could be honestly and helpfully endorsed by mentors, friends, sexually active peers who are still under age (and even mothers).

Specifically for more liberal parents, existence of this type of brand or product could assist them in taking steps and pre-preparing with their young people, without necessarily encouraging (a ‘this is not for now, but for when you are older’ type of dialogue).


Similarly, it could give licence to young people to be in possession of condoms and “pre-preparing” or actually to take steps to pre-prepare, without fear of being punished.

1.4.3 “Don’t mention condoms” / “Keep condoms quiet”

A fact which is commonly believed is that condoms are an explicitly sexual item and one that is only present because a sexual act is about to, or has taken place (unless for practical jokes of a very different nature, such as water bombs). As such, they are a form of ‘evidence’ which indicate transgression or intended transgression of cultural rules.

Given the cultural issues described in the two sections above, it is unsurprising that many young people lack the confidence and/or desire to openly carry or be seen in support of condoms. For some, even the word is too openly sexual. To do so is to openly express sexual interest or intent, with concomitant risk of being knocked-back or ridiculed for thinking too much of oneself.

At this stage in the teens’ lives, sexual stereotypes are powerful confidence boosters as well as being social crutches to hang on to. Clothes, makeup, hair, music are all chosen or rejected with one eye on ‘what others – especially others of the opposite sex – will say’. Condoms are viewed as irrefutably a ‘male’ sexual item by females, and carriage by a male indicates sex to be his goal.

The gender stereotypes that form much of the young courtship and attraction game are further impounded by parental gender rules (that ‘nice girls don’t have sex’) which serve to distance condoms from females even further. Both genders are led to the conclusion that mentioning condoms is the


same thing as an invitation to have sex. For females who want to appear ‘nice’, this is an invitation which should then be turned down. For teens who do have sex, condoms are de facto unlikely to have been mentioned – by either male or female.

This myth-interpretation or attitudinal barrier was particularly key for:

• Females (aged 12 to 17)

• Black Afro-Caribbean females

• All males who wish to have protected sex

To shift or help break this rule about condoms, it was felt that they needed to be presented as:

• Ubiquitous (without indicating personal or individual attachment)

• And, in a different context and time to the act of sex itself (for example, in the context of pre-planning, flirting, conversation and possibilities/choice rather than an inevitable course of action towards sex)

On the latter point, tone is critical – playful, comedic and comfortable

(versus connected to sex or lewdness) is most appropriate. This would help the target develop skills, language and ideas for how to factor condoms into conversation at any stage of the sexual journey.

Respondents specifically suggested making condoms present as part of a piñata/party decorations in pubs and clubs or through t-shirts worn by staff or others. The focus would not be on condoms themselves and would avoid overtly alluding to sex or the item. Instead the focus would be on slogans about:

• how they might be discussed or reframed as a pre-sex conversation, for example, raising the subject of sexual health and the concept of a


comedy ‘threesome’ : male, female and condom (‘you, me and the Jimmy

Hat’)

• offering simple and appealing expressions to adopt that easily emphasise boundaries and self-control (i.e. ‘no glove, no love’ )

This type of messaging at the point of ‘pull’ (for sex itself or simply for attention as a sexually desirable being) would help keep the focus on right choices at this time. In the right context and execution, such activity can also contribute to normalisation and even some aspiration - with the ideal being to build both.

1.4.4 “You must not disrespect my public reputation by suggesting

I have sex”

For those most concerned about the cultural need to maintain a reputation of innocence, not being perceived as a sexual being was critical.

This myth-interpretation or attitudinal barrier was particularly key for:

• Females (aged 12 – 17)

• Black African males in public

• Black African females in their community

Shifting culture through other interventions would help reduce this issue long-term for some groups, but this is obviously a far more difficult task for those respondents embedded in a religious or national identity which creates a closed community (for example for the Black African respondents in this sample).

Short-term - for each of the audiences mentioned above - there is a high degree of sensitivity to activity and communications that do not accommodate the opportunity to be innocent. Within all social marketing


options in this area, the need to be able to dissociate from an overt (and visible) personal connection or selection of condoms must be in-built.

The suggested intervention in this case was to deliver condoms into the hands of potential users such that the user could not possibly have predicted or chosen to be involved in the topic (although in truth, they had actively and consciously chosen this ‘surprise’ method accessing condoms).

A good example was where condoms would be discretely over-packaged (i.e. not easily recognised as condoms) and could thus be connected in some multi-pack way with other non-sexual items such as food, chewing gum, tights, shaving foam and so on or could be easily placed in a package of general health items.

The main principle of this intervention is ‘face-saving’; packaging idioms would be borrowed from other products. It would allow for a safer purchase and an easier conversation at the checkout. The lack sexual imagery or traditionally ‘pornographic’ sexual cues associated with condom packaging are not – for example – highly present in chewing gum or hair gel.

Such giveaways or packages could be tailored to include specific individual characteristics through photography, tightly targeting the audience and at the same time, able to message implicitly about value and acceptance by others in the targeted group.

Such imagery could also include messages which could raise the subject of condoms from a male-only preserve to a partnership item – photos of male and female holding hands (i.e. together in the subject of health) could move to change the current dynamic.

In terms of where this type of giveaway or package might be available/accessed, the ideal was outlets like McDonald’s with some sort of


watershed built in (post 9pm deemed essential but viable) to protect the very young. For the Black African respondents specifically, this type of outlet was highly valuable because it is accessible by all, including people outside their own national community. It is therefore genuinely ‘global’, particularly anonymous, and easily found if you happen to travel to a different area or town.

Retailers like Boots or supermarkets were also suggested as an option for non-food associated multi-packs.

While this type of intervention helps get condoms into the hands of those who have the strongest barriers to acquisition, it also starts to create consideration beyond and between the current ‘islands of consideration’ for the wider range of condom users

19 . It clearly positions them as everyday,

health and beauty items to be purchased when thinking about personal maintenance rather than simply when thinking about sex.

1.4.5 “The subject of sexual health is unsuitable in mixed society”

The extent to which gender rules (for example, that ‘nice girls don’t have sex’, and that condoms are a male sexual item as they are worn by the male) are, as already mentioned, deeply entrenched. It is consequently very difficult to step beyond these gender rules without losing a critical element of sexual attractiveness to the opposite sex, or drawing one’s own identity and belonging into jeopardy.

Carrying a condom amounts to breaking gender rank in at least two ways for females: it means they are moving into male territory by handling a male item. They are not acting passively or receptively, and thus call their own femaleness into question; they are also seen as setting themselves at an unfair

19

For more detail, See Section 1.7, Locating Messages - Islands of Consideration, see page 66


advantage against their female friends by using condoms (i.e. ‘the offer of sex’) as means of gaining headway with the opposite sex (to find a boyfriend).

Males do not perceive the situation in the same way: it is important to note that they do not believe the young woman is less female for suggesting the use of condoms. However, the females strongly report this as being an unsuitable action ‘for a girl’.

This myth or attitudinal barrier was particularly key for:

• Females aged 12 – 17 (but especially low-empowered, borderline, very young females)

The intervention suggested to help counter this barrier to condom use is similar to the solution suggested above (Section 1.4.3, “Keeping Condoms

Quiet”) for making condoms higher profile as well as less automatically attached to a sexual act.

Ultimately, the task is also about normalising carriage for any gender – a task that several of the issues and interventions point towards – by removing the aspect of personal agency in the question of ‘condom or no condom?’

Respondents’ specific ideas included insisting on condoms as an entry ticket into parties, clubs and events for young people. They could also be supplied as part of a more general ‘girly kit’ or goody bag. Benefits felt likely to be delivered by such activity included:

• (with appropriate branding, endorsement of and/or messaging within such an idea or goody bag), the carriage decision is firmly placed into the hands of an authority figure and removes choice

• (with removal of personal choice), fears of ostracism and bullying opportunities are removed. Respondents reported feeling worried that


they would be attacked for being ‘big-headed enough to think I could pull’ or being ‘sexually desperate enough to be looking for it’

• (by drawing carriage and use back onto the ‘safe side’), condoms normalised as ‘sensible kit’ and regained from ‘the wild side’

• (with universal condom carriage) reinforcing or introducing female solidarity

• enforced carriage normalisation at point ‘on the pull’ (even if event specific) also helps facilitate use

Yes, to know that everyone must [have one] would make me more likely to carry them.

My boyfriends don’t know where to put them


Condom give-aways are also an opportunity for product immersion: the introduction to consumers of the benefits of variant condoms and (possibly) other associated products that facilitate good or better sex. Concern about being connected to condoms, for all the reasons given so far, currently prevent any kind of browsing or product exploration for the overwhelming majority of respondents – a habit which extends beyond age eighteen.

Some respondents also mooted the idea of a National Condom Day for similar effect, to get condoms into the hands of ‘everyone’ but dissociated from sex.

1.4.6 “Sexual activity is dirty”

The insights described so far above (all generated from the risk of breaking cultural and gender rules) indicate the high levels of shame and embarrassment which the target audience experience around sexual expression. Without a means of discussing and dispersing the anxiety this brings, anger and self-attack are natural psychological moves.


This attitudinal barrier was particularly key for:


• Black African women

• Strongly religious groups

Many within these targets felt defiled from sexual contact. Feelings were compounded where sex was actually associated with a sexual health problem.

If your seen at their [dedicated service] people think you have an infection ... it’s better to be secret

Male trio, Gambian, 20-24, Mids

Younger girls feel disgraced about going to the clinic…but at the end of the day you choose when you have sex, but no one should judge you for it. You shouldn’t be made to feel mad about going

Female, 16, South

Locations and nature of young sex (out-of-doors, in a hurry or in a temporarily ‘stolen’ space) can contribute to sex seeming shameful, and sometimes literally ‘dirty’ if the space itself is less than hygienic and there is no opportunity to ‘clean up’ afterwards.

Intervention activity was suggested to address these perceptions of selfdisgust and to assist in a closer alignment of sexual health alongside sexual beauty and whole body health .

It was felt that better (strong linkage) could be made through using signifiers or services that draw these three components together. Examples given included:


• a mobile bus which would conduct sexual health services alongside other and other health and/or beauty functions

• sexual health testing at mainstream, health and beauty hybrid shopping destinations (e.g. Chlamydia testing at Boots or Superdrug)

• vouchers/partnership/sponsorship with self-expression/ethical/ value brands and celebrities (A-list musicians, Aleysha)

• similarly to above

20 , multi-packing

condoms and other ‘clean body’ items (both low value – like chewing gum, or high value – like beauty treatments)

As well as helping to bring condoms into day-to-day life (to help in normalisation), interventions in these areas show potential to hit specific

‘planning to go out’ times. They help to place condoms in the pockets and handbags of the target audience at an immediately useful time.

1.2.7 “Don’t mix terms – you can’t say sexual health and sexy in the same breath”

Sexual stereotypes and cultural norms around what sexiness is - as well as what it definitely is not (e.g. STIs) - mean that it is difficult to find a way in which sexual health can sit easily alongside sexiness .

This theme was a particular barrier to condom use for:


• Caribbean males

In response to this, specific communications themes springing directly from the artworks

21 arose as potentially powerful hooks for focusing on reality

20

Section 1.4.4, “You must not disrespect my public reputation by suggesting I have sex”. P.45

21

See Appendix 4 for detailed response to all artworks and intervention ideas


and for allowing the two concepts ( sexual health and sexiness ) to be considered together.

Because the messages are necessarily challenging and require self-reflection, more private posters on toilet doors, walls and mirrors were suggested as ideal. In the toilets there is also the benefit, of course, of a temporarily

‘captive’, hygiene or genital-focused - and if in specific venues, sex-focused - audience.

Sex is promoted a lot pictures everywhere yet sexual health isn’t. They don’t weigh up.

Male pair, 19-24, North

Placing these messages at point of ‘on the pull’ helps focus on the reality of unprotected sex and draws forward the spectre of a (potentially) regretted experience. If alongside condom distribution mechanisms, then condoms can potentially, and very simply, become the ‘hero’ of the situation.

The specific communications themes included: a) ‘Bootylicious’

22

The idea researched was developed as a female communication but it was felt there could easily be a male version too. This idea was felt to:

• quickly tap into the schism between ‘elevated’ sexual presentation and ‘more realistic’ physicality of the human body, and to profit (in terms of attention span and engagement levels) from the gap between the two

22

See Appendix 4 and Section 2.5, p.101 for more information on ‘Bootylicious’ artwork


• reaffirm and clarify the nature of what is likely to happen in a physical encounter

• (and particularly in conjunction with consequences for boys) deliver reasons to act in line with latest role modelling

Importantly, the visual must be more than balanced by the message.

Otherwise, the ubiquitous nature of such images causes some switch-off for female audiences.

All this stuff about booty girls, well I just think you’ve got to ignore it, it’s not who I am…it don’t bother me… Not influenced by that. I’m quiet, people more likely to listen to that will be influenced by that kind of thing in a bad way…

Female, BME, 18-19, South b)

‘Six Degrees of Separation’ 23

As mentioned earlier, this idea was felt to deliver a non-judgmental overview of sexual territory and allow for a degree of ‘self diagnosis’ of sexual health risks taken.

A key benefit was the power of the visual (once introduced and understood) to incorporate a wide range of risks and concerns (pregnancy, STIs, homosexuality, multiple partners, long and short term fidelity, uncertainty regarding partner and own sexual history) in a way that was engaging, quickly personalised and inescapably true – without recourse to graphic sexual images or shock tactics.

23

See Appendix 4, and Section 2.5, p.101 for more information on ‘Chained’ artwork


Taking an aerial view of their personal sexual situation had a number of outcomes and benefits for respondents:

• It removed, without scare tactics, the security blanket of ‘my partner looks fine so we don’t need condoms’

• It raised the prospect of undesirable connections (which of your same sex friends can you link back to?). This was a powerful question across the sample, but even more so for the higher risk males who tended to ‘hunt’ in packs of similarly high risk friends.

• It curtailed the ‘romance factor’ – the desire, for girls in particular, to count only those encounters in their sexual history that led to “proper relationships” and to ignore the risks of lesser flings (of their own or their partner’s) c) ‘Chained’

24

The idea researched was developed as a male message but it was felt there could easily be a female version too.

It was specifically felt to:

• remind that – even if no ‘Happy Family’ is created – there is a significant change in the life of someone who becomes a young parent

• make explicit the visceral fear of young males that they might become trapped or contained (and that - at the worst extreme - that this could be to someone who they, and their friends, would definitely not ordinarily choose as a partner). This fear was described in Phase One of the research by a group of young northern males. However, it was recognised and endorsed by males of all ages and backgrounds, encouraged by many reports of personal experience (young females trying to get pregnant) or semi-personal experience (close friends becoming unwilling young dads)

24

See Appendix, page xx, for detailed description of responses to ‘Six Degrees of Separation’ artwork


• remind that avoiding this particular type of life-long commitment is worth a short-term commitment to condoms

• invert a currently high-value experience (pulling on a lads’ night out) and translating it into the plug being pulled on the sexual chase games they have enjoyed up until that point.

‘This plays in the back of your mind. It happened to us both - got pissed up, shagged a girl’ [and got her pregnant]

Male pair, 25-30, South

Cos I don’t wanna have no baby at the age of 16’

Male, Black African, 16-17, North

1.4.8 “Condoms are not worth the hassle”

This myth-interpretation created a particularly strong barrier against positive sexual health practice for:

• Young men (especially Caribbean)

• All females

Issues around effort are certainly increased by any of the themes described above. These all underpin the difficulties in carrying and using condoms, in terms of social rejection or punishment.

However, the most common reason for condoms being too much hassle is their perceived ability to physically spoil or diminish sexual pleasure and to prevent it happening in the first place. This learning appears to start early.

I got a little brother, he’s getting home from school and saying ‘most of the girls in my class don’t like using condoms’. He’s in year 9.

Male pair, 19-24, North


This belief is quickly propagated and spread between both males and females. While it is taken as read that the idea has come from those with experience, a root cause (unrecognised by the audience) appears to lie in a lack of skill to manage condoms effectively in a sexual situation. This applies both to the literally physical application and to the inter-personal negotiation process of using one and getting rid of it afterwards.

Taking the prototypical sexual encounter from school-based SRE classes which focus on procreation, young people inevitably draw sexual behaviour stereoptypes from biological functionality. Pregnancy possibilities place disproportionate attention onto the female sexual partner. Attention to sexual health becomes cursory and more of an aside than the main conversation about reproductive control. Within the raft of options for fertility management, condoms appear a long way down the list. They are considered ‘primitive’ because they are highly physical and clearly visible.

There is little learning about the potential value of condoms to increase sensation. There has, to date, been little information to young respondents on the associated consumer benefits (increasing longevity of erection, providing extra stimulation, improving or varying foreplay, and differing flavours for use in oral sex, and so on). Condoms are firmly not associated with oral sex in particular – despite the high awareness of flavoured condoms. This leaves an important gap in knowledge about STI transmission but also a disconnection to the value of different flavours. It is a natural conclusion from the above points that condom variations are meaningless and cannot meet a real consumer need. This again reinforces a disconnect between the possibilities for condoms and pleasurable sex.


The core intervention suggested by respondents to address this particular issue included compulsory practice with condoms . This would begin early in the classroom in PHSE with information about: a) benefits to being able to handle a condom easily and well b) protocol in disposal

This may be somewhat hard to deliver without a committed empowerment campaign for young people in the arena of sexual activity – and supported by a variety of sources. A first step, however, would be to ensure that the target audience at least gets involved in putting a condom on the practise phallus in classes.

Respondents reported that currently this exercise is delivered in mixed group classes of about 30, and is voluntary – neither factor is conducive to young males or females gaining proper practice and useful familiarity with condoms.

A more developed programme, however, could take account of other needs and potential strategies:

For example, young Caribbean males in high risk segments reported a sexual identity strongly built around ‘game’ and being sexually provocative and flirtatious. For some currently, and for others when pushed towards the concept, the idea of being good at putting on condoms was welcomed. This could become a useful weapon in the ‘game’ of achieving sex or of demonstrating sexual experience and prowess.

For a wide range of males, seeding information about the benefits of condom knowledge and use (for example, around prolonged performance in the sexual act and in masturbation) may be effective. This, combined with greater instruction about best how to remove and dispose of condoms, is


likely to significantly raise the interest and contribution of males towards more widespread condom use.

Get a load of condoms, blow them up, whack one on in the privacy of your own home, that’s how you learn.

Male, 25-30, South

One of the reason this intervention may well be successful is that it is working with gender rules - by creating specific male-condom connections - rather than trying to subvert them by asking females to put condoms on males or to carry.

Ultimately, raising the profile of condoms to a part of the ‘pleasure kit’ was felt likely to encourage condoms onto the shopping list. These would become an item wanted for their own sake, rather than an item that should be carried to meet textbook requirements. Issues over the evidentiary nature of condoms (easily found, hard to dispose of) still persist however.

1.4.9 “Sexual health is hard to access”

This theme created a key barrier against condom carriage and conscious sexual health protection for:

• Young people (aged 12-15)

• Those from strongly religious backgrounds

• Newer immigrants

Younger people in particular found it physically as well as emotionally difficult to access sexual health services and products.


For many of the reasons described earlier, there is a general desire not to be seen as sexual beings. However, for many it is also related to awareness and the ability to safely locate the services they need.

Sexual health services and sources of advice and contraceptives are not widely known. Sometimes, they are considered to be accessible only to those of ‘legal’ age (16+). Those who are younger than this can feel there is no place of authority for them – they fear they may be reported or refused.

Even for older end of the audience, simply looking for sexual health services can be too revealing. Certainly, asking friends or family means revealing either existing behaviour or sexual intent. It also indicates sexual health concerns – which can be too private to discuss and will almost certainly become fodder for gossip.

Across the different target clusters, there were calls for more clearly visible signposting of where to find sexual health services. However, due to general embarrassment about use, a level of disguise and anonymity was ideal.

For younger people in particular, not needing to access the internet (and thus provide a trail of evidence) was important. Not needing to give personal data in order to access information, avoiding having to speak to an adult and explain oneself before accessing service provider – these were all perceived as real benefit that could increase connection.

The level of ignorance about where and how such services might operate cannot be underestimated. Even displaying information through GP surgeries was felt to be to be prohibitive because it would require too much visible and easily interpretable activity on their part (to make an appointment at a GP surgery – or to be off-school and in the surgery by ‘accident’ at the appropriate time). It was suggested that clearly visible posters or stickers

(similar to the Neighbourhood Watch signs) in windows of mainstream


public places (or even on lamp posts on the high street) should highlight service location in a simple but cryptic manner. The same stickers would be present in all conurbations – so that young people could take advantage of their non-local services easily, and more safely.

These stickers could act as:

• a simple reminder of the need to consider sexual health; if close to the point of purchase for many sexual health items then this message would be timely and potentially facilitating

• a reassuring and constant reminder – even when not engaged in sexual activity – of sexual health, risks and best practice; to help broaden the times when sexual health is considered and assist with a pre-planning mentality

• a source of help that can signpost services that can be quickly accessed in emergency

• potentially encouraging discussion of a difficult issue, and in some way creating a sense of ‘ad sophisticates’ – old enough to know what it means. Cryptic/coded information was felt to be appropriate to a certain level to ensure that smaller children and non-target are not involved.

• a constant reminder to consider and purchase (and ‘slow burn’ reminder for use) - potentially most powerful when close to point of preparing to go out (e.g. Saturday shopping for girls)

For the service itself, drop-in centres, in better-disguised multi-purpose venues, were often considered ideal: for both screening and more general access to information and contraception.

In the spirit of this, the idea of mainstream public testing, for example through whole body health buses being available appealed. It was felt that such a service could:


• allow for an appropriate mix of anonymity and expertise through wrapping up a range of ‘nurse’ activity: anaemia testing, mole checking, vaccinations, menstruation issues/questions, eye tests, smoking cessation, etc

• offer both drop-ins and appointments, with the latter based on time slots with optional appointment lengths, and therefore the chance of multipletest appointments

• be both informative and timely - close to the point of purchase for many sexual health items as well as a potential source of free condoms for both men and women. (However, compulsory ‘goody bag’ rules need to apply to permit acceptance with a range of items and/or information included)

• as a reassuring reminder – even when not engaged in sexual activity – of sexual health, risks and best practice; to help broaden the times when sexual health is considered and assist with a pre-planning mentality

• act as a source of help that can signpost services that can be quickly accessed in emergency

• encourage discussion around both sexual health and other health concerns

A concept like a whole body health service was felt likely to bring sexual health into day-to-day life and in line with other acceptable health issues over time.

The same principle was also felt likely to improve provision at GPs surgeries

(for example through multi-purpose health clinics). In this location, however, there were persisting issues around visibility (due to recording of events, or knowing/being recognised by staff) for some.

In terms of insights based on personal interventions, two modes of approach emerged through the Interactive Galleries:


• the first is the desire to have sexual health advice delivered in a way that feels relevant and empowering (‘connect with me’)

• the second is the desire for assistance in recognising how one’s own experiences fit within the experiences of others and show particular steps for enabling change (‘help me to connect’)

In both cases, workshops of some form were felt to offer the ideal teaching arena. Many young people, males and females, felt they needed time to consider their experience in a collaborative process. Indeed, several reported that they had moved forwards in terms knowledge and self-definition even within the research process itself, which had been designed to be extremely collaborative and non-judgmental.

Large-scale group discussions were felt to be less conducive than small groups, with some gender separation being seen as essential to allow free discussion and to avoid distraction and impression management.

There are some things you’d rather talk about with just girls, but some mixed sessions would be good too as it might help open up the subject and get us talking more to the opposite sex


Make people take part in workshops, go into the Uni and make them listen…like the London lecture when we started University.


While this is something that could potentially be built into social marketing interventions, particularly for those outside the education sector, there is also clearly a role for this type of approach in SRE too.

Sexual health should be compulsory in schools ... unless the parents wish to exclude them ... just like religious education ...



Specific components sought for the ‘ideal’ workshop to ‘connect with me’ included:

• Have people ‘my age’ facilitating or leading in some way

• Have experiences of others my age on film; to give a feedback loop on experiences in the short term (in terms of positive and negative physical and emotional consequences)

• Use stories of older people to show me why this is important and how decisions and behaviour patterns might pan out over the longer term

• Have language, experiences and perspectives that resonate, such as those encapsulated, for example in the artworks ‘Weighing it up’ and

‘Hammered’

25

• In tone, be very neutral, and very open and brave

• Offer a perspective that makes sense, such as that in the artwork ‘Six

Degrees of Separation’

• Include goody bags with vouchers and novelty that allow content to be taken into the outside/non-sexual world

• Ideally, use non-teachers who can credibly use the words and language that illustrate that they have ‘been there too’

Perhaps 17s+ would be good, people who know a bit about it, because you need to think about it more. With 14 year olds you need to lay the facts on the table, this is slightly different, more thoughtful


The schools are just doing one lesson a year, that is no good….and I don’t want a talk to a teacher about my sex business, they should pin 2 condoms on the homework paper, if you’re not having sex then there’s no problem, but if you are then great, I don’t want to be put on the spot by a teacher.

Female, African, 20-24, South

In Holland they start very young with love and relationships, when they’re 7, after that making babies and how not to when they’re a bit older like 8/9 and play about with condoms then so they all know from the beginning and it’s all very normal to them ... the other stuff then comes later when they’re ready for it

25

See Appendix 4 for detailed responses to artworks



Other components to meet needs for helping ‘me to connect’ included:

• Accommodating the participants’ own experience as legitimate in some way

• Illustrating what the opposite gender are going through now and show their vulnerability

• Using skits and drama to build self-connection and empower with skills

• Helping parents to cope with this transition (for example, through a parent workshop, parent leaflet or DVD)

• Showing the complexity of issues and challenges facing young people through artworks ‘like these’ (the style and relevance of the artworks chosen for the Gallery was held up by several as helping to move the issues forward in an accessible way)

1.5 Where the audience is trying to get to

1.5.1 Overarching audience goals

Throughout the research process, respondents seemed to be struggling to square their own interpretations and beliefs (discussed above in these insight themes) with the very attractive proposition that change might be possible.

Instead of feeling shame, guilt, fear and denial over their emerging sexuality, respondents began to consider, through the experience of their sexual identity being aired, that there could be a more positive vision of the future.

The desired future appeared slightly differently for respondents – depending on how strongly or weakly attached they were to the above negative beliefs.

However, in general, all were trying to get to resolution. This was expressed as either:


•

•

•

Normalising sex – respondents wanted to be acknowledged as being part of a society where sex was a natural and mainstream part of everyday life (rather than confined to a secret corner). This would include making sexual references a more visible part of life.

Curtailing sex – in some way, some respondents felt sex had become too big and too prevalent. They wanted to see less of it and for younger individuals not to be rushed into exposure to the subject. This would include making sexual references a much more hidden and considered part of sexual life , with the proviso that it should be only expressed at the ‘right time, right place’.

Celebrating sex – for those respondents for whom the research process had been particularly cathartic, the idea that the sexual discourse had been too damagingly repressive for too long led to a more militant mindset. This would include making sexual health references in particular a strongly visible and centre-stage part of everyday life.

In order to achieve these goals, particular interventions were suggested that reflected a mix of messaging and facilitation . The latter was suggested as possibly including information, condom provision, more service provision and a clear move to fit these into the target audiences salient consideration spots, regardless of historic reasons or prejudices not to.

In thinking about this ‘brave new world’, where sex is normalised, not pushed and where sexual health is paramount, key questions may need to be addressed. Currently, these are related to the immediate issues of accessing sexual health screening and advice; and, they are pertinent in understanding the level of ignorance and the nature of concern expressed by the target audience around the subject of sexual health practice.


In designing any communications aimed at this target audience, these questions and others of a similar level need to be addressed and new ones anticipated as time goes on.

Q) Where is the clinic/resource? (this has been discussed in detail earlier)

•

•

•

•

How can I find out where it is (without asking an adult/leaving a trace?)

Is there another one that’s not local and how do I get to it?

Is it in a safe area – given that its on someone else’s ‘turf’?

Will it be massively signposted as I walk in so that everyone knows where I’m going from the minute I get off the bus?

Q) What will I get involved in?

•

•

What’s the set-up inside? What will I need to tell them?

How will they ask me? (In public at the reception/or in

•

•

•

• private, face to face, on a form?)

Do I have to give my real name/age?

What’s the waiting room like?

Who are the staff (will I know any of them?)

Who are the other patients? (will I know any of them?)

Q) What do I need to be tested for?

•

•

•

•

What is the risk?

When will I get the results?

How can I get the results?

How can I judge beforehand if I’m likely to have something

•

•

• or not?

What is the likelihood of having something awful?

Will I be able to be cured? If not, what happens to me?

What would you say to those people you’ve slept with?

Would you have to tell them? How would you tell them?


For condoms, young people specifically ask for help with the issue of accessibility, application and introduction - especially for females (as per clinic questions):

Q) How do I get them at the relevant time?

•

•

Where could I hide them?

How could I buy them one by one when I need them?

Q) What could I say?

•

•

•

Various suggestions like ‘Have you got one?’ would be used once commitment was raised

Would we be protected against every sexually transmitted infection?

What if I’ve already got one? Is there any point in changing behaviour? Could you get multiple infections?

Q) Would I introduce one newly into an established relationship?

•

•

How would that work?

What’s the risk? Is it insulting? What’s the conversation?

•

•

•

What about other contraception – do you use both?

What if they refuse?

How does it make sense with the emotional commitment we’ve made (esp. low-risk and established relationships)

•

What benefits – if any – are there? Sell them to me in terms of sex – not sexual health!

1.6 Messages that start to address inertia

Once the ‘hidden rules’ are broken, and myth-interpretations can start to be re-evaluated, young people move naturally to a more logical and thus more self-protective mode of behaviour.


They begin to consider screening and condoms in equal measure across the board. From what they say, it would appear that both have a place in the repertoire and should be promoted equally.

Given that there are multiple opportunities for sexual encounters, increasing the percentage of protected acts at the same time as increasing numbers of individuals screened suggests an exponential gain in sexual health scores.

Across all audiences, the following points need to be expressed clearly in order to take control of the debate and to avoid it slipping backwards into the swamp of ‘hidden rules’ and ‘myth-interpretation’.

A. Sexual health is about pregnancy AND about STIs . Both are an issue and we are focusing on the physical connection between two (or more) young people, rather than the cultural norms in which the dialogue has historically been set.

B. STIs are a risk for everyone and anyone . This is not about value judgments on individuals – viruses are indiscriminate.

C. You are sexually active . You are already a sexual being – even if you have not had intercourse. Take more action – earlier - to keep yourself safe.

3.4 Locating messages - Islands of Consideration

It was clear throughout the sample that the current customer journey of condom consideration comprises remote and disconnected ‘islands’ – in terms of when and why condoms might be considered. These points of consideration also vary in terms of how high consciousness or specific the consideration of condoms is.


It is clear that within current ways of thinking, these points represent those moments when the target audience is perhaps most receptive to sexual health messaging.

The points include:

•

Planning to go out/evening preparation : where specific consciousness around condoms tends to be low, but there is a focus on wanting to be desirable for the opposite sex. Given this mindset, raising the question of ‘in what terms they are making themselves desirable?’ versus ‘in what ways are they not?’ could bring forward the possibility of regretted experience (for example due to fear/anxiety over pregnancy or STI, or shame for being considered ‘a slag’ by self or others) to prompt reconsideration or conviction about condom use. Therefore, messaging supporting avoidance of regretted experience will help keep focus on ‘right behaviour’ (using condoms or saying no). Product intervention here, or while ‘on the pull’ below, is likely to facilitate better choices further.

•

‘On the pull’ (for sex or attention): again, where specific consciousness around condoms tends to be low, but there is a focus on wanting to be desirable for the opposite sex and in many cases the opportunity for sex is close. Therefore there is again the opportunity to raise the possibility of regretted experience as a trigger for thought. However, alcohol can also feature here as the ‘get out clause’, indicating that it might feature specifically some way in messaging at this point too.

Every time I’m in the pub and see a woman I never think about a condom! Might have a dance buy her a drink, just thinking about pressing

Male pair, BME/Caucasian, 25-30, North


•

Point of coitus : the point of the sexual encounter itself is often when the issue of whether or not to use a condom becomes real but it is, of course, too late to ensure – the focus is just on the sexual act itself.

•

The morning after a sexual encounter : this is a point of consideration when doubts or regret feature about the experience or partner – or become sown by others. While the focus in on hindsight, to some extent it is preparation too. The audience is right for being confronted with risk and regret alongside inspiration for a better plan next time (and possibly the idea of testing).

Sundays – through TV, top up/hangover/corner shop shopping, fast food and takeaways - offer salient points of contact as specific channels or points of reference in messaging.

The scarcity and distance of the islands, however, also indicates the extent to which condoms are not part of normal life. A clear role for communications and interventions is to help these ‘islands of consideration’ join up and make condoms connect with everyday life: so that sexual health becomes a higher awareness subject throughout the daily routine.


2. Audience Segmentation

2.1 Introduction and Overview of Segmentation Structure

The hypothesised segmentation generated by the in-house client team considered the target audience from the viewpoint of identifying highest risk sexual behaviour.

In doing so, several dimensions (demographics, number and nature of sexual encounter, attitudes to condoms and to own sexual confidence) were drawn together. The role of this research was to test and to refine the hypothesised segments.

Diagram 2 below shows the total number of dimensions (11). These are grouped into three strands (demographics, sexual encounter and attitude) – the first two being specific risk clusters standing out from the population at large. The third strand based on attitude, covers the whole audience

Diagram 2: Hypothesised Segmentations and Classifications

26

26

The One Night Stand segment is a new cluster that arises specifically from findings of the research and is described in Section 2.3, page 76


Each of the dimensions has been drawn out as important for considering or mapping the audience within the extensive desk research conducted by

COI

27 . Each dimension potentially has a purpose in helping targeting:

•

Demographic group allows for channel/media/reach planning but also

• highlights other factors that might need to be considered (e.g. specific norms in relation to age, culture or SEG

28 )

Nature of sexual encounter practice through time allows specific high-risk behaviours to be considered and specific acts/events to be overtly mentioned or catered for through communications/interventions work.

If possible, sexual encounter data may perhaps be tracked alongside demographic and other data – however, accuracy levels might be challenging

•

Attitudes towards sexual health behaviours highlight the beliefs of respondents (their motivations and rationale for behaviour, which needs to be understood and factored into marketing work in order to dismantle social discourse and prompt change)

The research was tasked with understanding whether the dimensions are useful ways to segment the audience and how, if at all, they map together.

In terms of delivering a single framework through which to view the issue, it is our recommendation that the attitudinal strand can obviously incorporate all other strands within it, and make reference to where and how they may create difference and texture. (Some demographic groups, for example, are more prevalent in certain attitude clusters than others: some attitudinal groups are more closely related to specific behaviours than others).

27

This was drawn from a combination of data sources including NatSocCen data

28

Socio-economic group


Viewing the audience through the lens of their attitude allows a complete coverage of the target audience - more than the current high risk demographic groups does - and a relatively stable set of clusters (compared to the inherent fluctuations of a strand of clusters based on relationship duration). The data seems naturally to fall best in this strand, and it is in this way that we recommend considering the target group.

Before moving into the extremely high level of detail that the research has delivered on the attitudinal clusters , it is useful to confirm the data under the other strands (made up of specific, high risk demographic and behavioural clusters) and to see how these might shed light on some particular aspects of the task.

For simplicity, we cross-reference each with attitudinal clusters only: it is correct to say, though, that a triple cross-reference (overlaying attitude and behaviour on the demographics, for example) is conceivably possible - although the data begins to splinter and to lose the shape it has gained through clustering.

2.2 Segmenting by Demographic Group

As mentioned a demographic approach allows targeting/placement of activity and communications.

Within this sample, the three specific risk groups of Black Caribbean, Black

African and DE Teens had been pinpointed as being of particular interest because of their correlation in populations with poorer sexual and social health.

They present in key areas of the particular attitudinal types

29 as follows:

29

Detail of each of the attitudinal segments can be found in Section 24, p.78


Demographic

Group

Attitudinal segments present within Group

Black Caribbean Black African

Single Focus

(Drunk)

Single Focus

(Sober)

Single Focus

(Drunk)

Single Focus

(Sober)

DE Teens

Single Focus

(Drunk)

Single Focus

(Sober)

Danger

(Males)

Disconnected

(Females)

Unguided

Considering each of the demographic audiences, the strongest religious and cultural norms were seen amongst the Black African audience, and to a lesser extent amongst the Caribbean audience. In particular, the rigidity with which young people (of both genders) are controlled was seen strongly amongst Black Africans. Sexual activity before marriage is not supported.

Threats to ‘send back home’ any young person – and in particular any female

– who is found to be ‘loose’ were openly reported by the teens themselves.

For males, especially those who were newer to the country, the relative freedom meant a stronger impulse to seek more dangerous and ‘edgy’ encounters.

Amongst the highly urban Caribbean target audience, the same norms are still applied although there is a much greater store set on the female being

‘good’. Many of the males reported a strong implicit and explicit permission to be cheeky, flirtatious, ‘naughty’ – and this contributed to high-levels of sexual partners at a fairly young age. There was a sense that having multiple liaisons indicated status and control; multiple mobile phones were the way to leverage control over the females.

This is by no means necessarily a behaviour that is connected to an indigenous Caribbean culture or nature ; it is certainly a widespread function of


where and how young urban populations are living and conducting their

‘business’.

DE teens on the whole are stereotyped by lack of formal education. This does not mean that they are unable to understand the issues once properly explained. What it does relate to is a lack of adherence to, or need for, public formal structures throughout their lives. DE teens reported being allowed out more and later than some other target groups. They were somewhat older in attitude and more vocal than some of the other demographic groups. They talked about boyfriends and girlfriends from an early age; and perhaps tended to start having sex earlier – and though this was by no means across the board.

In looking at the DE teens population, the important norm which appears to be missing or severely diminished is that young people should not have sex . It seems to be pretty much accepted that this is what they will do, eventually.

Some young DE teens reported their adult/older boyfriend sleeping over at their house, or them sharing a bed with him at his parents house. The inevitable consequence seems to be that at least a proportion become young mothers and fathers early. This fact is absorbed into the general structure of the community rather than generating horror and further shame.

The lack of strong disapproval might in some ways be interpreted as empowering. Many of the rest of the female sample seemed far more cowed and furtive when discussing sex and underage pregnancy than these teens.

However, the DE teen females are exposed to older predatory males from a very young age; although they may feel empowered at 17 through being able to openly be sexually active, the research indicated that several respondents felt early exploitation had set them on an unnecessary and unpleasant path for much of their young adulthood (bringing up children when in their late teens, multiple relationship breakdown, lack of sexual confidence in a very real sense).


In terms of all three demographic groups, words are potentially a huge issue.

For some of the DE teens in particular, reading and attention span for new concepts was short. For newer immigrants, English is obviously a potential issue. However, for all groups of this target age, it should be remembered that urban speak, compression messages, emoticons, text speak and infosnax are standard and familiar. These are much more likely to be used in an area which is private, secretive and away from the adult world. Formal vocabulary and sentence structure is likely to seem out of place. The challenge is to find a bridge that allows them to access mainstream sexual health services and to engage in dialogue beyond their youth culture.

2.3 Segmenting by Sexual Encounter and Practice

As mentioned, segmenting by Sexual Encounter and Practice is useful to reset the parameters around sexual pairings and to consider in communications and interventions the territory beyond the ‘heterosexual pair bond for life’ that so strongly flavours traditional sexual discourse.

The specific Sexual Encounter or relationship types were seen and explored in greater depth within the research – with some adjustment around detail.

A new additional category was also identified, however, where high risk behaviour was almost more prevalent than amongst some of the other clusters identified: One Night Stands.

A summary of each of the Sexual Encounter Practise types is given below.

2.3.1 High Numbers of Sexual Partners

Those with High Numbers of sexual partners within our sample tended to be either having multiple simultaneous relationships or frequent sexual exchanges outside of a relationship. More rarely, it was shown as several


shorter consecutive relationship all of which included sex. At the younger end of the spectrum, ‘high numbers’ were relative for age, and ‘relationship’ was being defined in terms of days: this is perhaps quite a volatile definition, dependent on truthful reporting of sensitive behaviour, and a certain fluidity in assessing the material is appropriate.

Overall, the category appeared more male than female: this is in line with gender norms and may therefore include a significant amount of underreporting on the part of the females. On the other hand, the comparative freedom that the young males in the sample were allowed, compared to their female peers, may support this picture.

Attitudes

30 which were connected with high numbers of sexual partners

included:

•

•

Single Focus (Drunk)

Single Focus (sober)

•

•

•

Danger Seekers

Disconnected (Males)

Disconnected (Females)

It may appear obvious that alcohol and a willingness to have sex might lead to an overall increase in numbers of sexual partners. What is perhaps more interesting is the repeated nature of such encounters, in particular, because each encounter encompasses the same planning points, a similar pattern for engagement and a similar morning after opportunity to reflect. Continuing to ‘make the same mistake’ each weekend indicates the low level of awareness, of perceived danger from such encounters, and the high reward gained from the event itself. This may represent one of the most hardened targets to reach.

30

See Section 2.4, page 78 for detail on the attitudinal types


Those in Established Relationships were generally hypothesised to be ‘low risk’.

The research indicated that this is a false conclusion, since many attitudinal types (if ‘established relationship’ is understood as meaning a one-pair relationship persisting beyond more than a few weeks) were found within this category, as well as instances of risky and regretted behaviour.

In particular, the issue of female control – even within longer-term encounters – is raised. Currently there are pockets of females (especially younger, but also of other communities) for whom male attention is inherently validating. They are willing to endure sex which is not particularly desired in order to maintain the relationship, for example.

Specifically, this category represented a wider range of attitudinal types

31

than any other Sexual Encounter Practice type:

•

•

•

•

•

•

•


Danger Seekers

Disconnected (Males)

Disconnected (Females)

Denials

Disempowered

Unguided

Risky and regretted sexual behaviour in Established Relationships arose differently depending on the attitudinal type of at least one of the parties:

•

For some, additional sexual encounters were taking place outside of the established relationship (e.g. Danger Seekers)

31

See Section 2.4, page 78 for detail on the attitudinal types


•

•

For others, where a sexual relationship was not a part of the established relationship, unprotected sexual encounters were taking place under certain conditions:

− Alcoholic influence: for Single Focus (Drunk)

− Where, after some time in a non-sexual relationship, there was pressure or suggestion for sex from their partner: for Denials,

Disempowered and sometimes Unguided

And lastly, for some, an unprotected sexual relationship may have begun immediately and continued: for Disconnected males and females, and many

Unguided

Those in Fledgling Relationships were generally hypothesised to be open to risky behaviour due to pressure early in a relationship to have sex, and lack of knowledge or skill to ensure safe choices.

Certainly, the attitude clusters found primarily in this segment reflect these characteristics. Where any intent for an ongoing relationship was established

32 , pressure or suggestion for sex from a partner easily led to

unsafe decisions for some:

•

Denials

•

•

Disempowered

Unguided

Alcohol could also be the catalyst for the initial unsafe encounter in a

Fledgling Relationship, for:

•


32

May be from an expression of interest at the initial encounter, liaison over a few days as well as longer periods of time


1.3.4 One Night Stands

While ‘one night stands’ are a feature of behaviour in the High Number of sexual partners category, they also happened on a less frequent basis within a range of attitudinal segments:

•


•

•

•

Single Focus (Sober)

Danger Seekers

Unguided

Although infrequent (even one-off) events, unsafe sexual choices (and sometimes regrets) were the norm where the sexual encounter was a one night stand.

The reasons for unsafe choices in the one night stand scenario stemmed largely from the nature of the ‘relationship’ with the partner.

In some cases, the partner would be someone they did not have any previous relationship with and were therefore on totally unknown ground at the point of negotiation. Without knowing that person, and therefore whether or how offence might be caused, or unwanted or unintended messages about one’s own sexual identity given away, confidence and skill in negotiation was lost and it became easier to ‘put their head in the sand’ to avoid humiliation or offence.

In other cases, the partner would be someone they knew well, but did not have any previous sexual relationship with, or a relationship of a different type (e.g. good friendship). As such, they were on new ground at the point of negotiation and, in addition to the issues around confidence and skill described above, there were specific potential emotional consequences too

(in terms of damage to the existing relationship). Clearly in reality, damage to the existing relationship is also possible should there be an unintended


physical consequence from the encounter, but latent consequences were not as top of mind as those which were immediate.

For the ‘low risk’, in addition to the above considerations around partner, unsafe choices in the one night stand scenario also stemmed from change in normal circumstances: different location, different build up, etc.

2.4 Segmenting by Attitude

1.4.1 Overview

Findings from this research

33 indicate that the broad brush desk study 34

resulted in a fairly robust attitudinal segmentation

35 . However, beneath the

broad strokes, there are some significant refinements and developments to take into account.

At a very top-level, labelling is adjusted: the ‘Disinterested’ segment is better labelled Disconnected – for reasons that will be explained in Section 2.4.4, p.93 below. [It should be noted ,however, that these labels are still working title and need further development.]

As Diagram 3 below indicates, the four original segments are now comprised of distinct sub-segments. These have already been mentioned above but the detail is now set out.

These sub-segments share an overarching theme in terms of what drives their behaviour generally

36 , but are different in terms of other specific

attitudes and/or behaviour (for example, how audiences defend their

33

B oth target audience phases of the research (Conferences and Galleries)

34

See Background for more detail

35

Four umbrella segments, initially labeled: Thoughtless, Low Risk, Disinterested, and Vulnerable

36

Overarching theme being comprised of personal attitude towards condoms, self confidence and social norms


behaviour, the extent to which they recognise their own behaviour, and so on) .

Diagram 3: Summary of Revisions to Hypothesised Segments:

Denials Disempowered Unguided

Each of the umbrella segments and its sub-segments are discussed below:

2.4.2 Thoughtless

Within the Thoughtless attitudinal cluster, the most important ‘hidden rules’ are those related to gender. The influencing discourse revolves around male and female behaviour in relation to sexual activity/passivity. Thus:

•

• boys (should) have many sexual partners and achieving sexual conquests are what matters girls (should) do not engage in sex

On the whole, the Thoughtless category has a high level of knowledge, broadly accurate, about safe sexual practice and risks; for the mostly males within this category it is acceptable to read about and discuss sex and sexual practices.

There is then a deliberate choice to waive these considerations.


The ‘safe sex’ focus, it should be said, is very much along the lines of contraception

(preventing pregnancy) rather than any real consideration of STIs. These tend to be off the radar, as ‘unpleasant’, ‘unlikely to happen to me’ or ‘known’ to be of little consequence.

At the point of sexual encounter, this cluster show quite a singular focus in their aim to achieve sex. In this respect, they have been given the current name

Thoughtless (without thoughts). Through intention, or through alcohol/drugs, they are un-connecting with the needs of others and choosing to unhook from the risks to themselves. [There is no inherent sense intended that they are necessarily more malicious or more blameworthy than other groups in their actions.]

The sub-segments within this category, described in detail below, include: a) Single Focus (Drunk) b) Single Focus (Sober) c) Danger Seekers a) Thoughtless: Single Focus (Drunk)

The single focus drunk are those for whom alcohol has created the filter through which sex is desired or – in some cases – allowed. This latter is especially true for girls and raises the problem that before they are drunk enough to think about sex, they are not actively able to pre-plan around STIs or pregnancy. Once they are drunk enough to have sex, they are unable to plan about condoms or teen pregnancy.


The demographics of the segment are broad. It includes both males and females and stretches across SEG, culture (with the exception of most Muslims

37 ), and

all types of usual sexual commitment and practice.

As indicated earlier, there is a high incidence of ‘one night stands’, ‘fledgling relationship’ and ‘high number of partners’ within this cluster. Alcohol clearly fuels encounters but does not necessarily help them to flourish post-intercourse.

In terms of behavioural drivers/triggers for this segment, by definition of being drunk, all experienced lowered cognitive function during the event. This was possibly due to genuine drunkenness. However, inebriation was sometimes admittedly simulated in order to access sexual behaviour and dispense with

‘responsible’ considerations and choices.

I was pissed – either state of mind or drunk

Female, 18-19, North

Alcohol is sometimes used as an excuse ... it makes you feel safe when you’re not ... invincible ... but you still know what you’re doing ... like an out of body experience


Pre-event preparation (in terms of consideration/purchase/carriage of condoms) was absent from the alcohol planning steps – which can be, as we have seen in other research, fairly elaborate for the youngest target. Such sexual

‘planning’ seems currently to be positioned at odds with the excitement of the unknown.

For females, condoms were not considered during sex either because of the level of skill and cognition required. Engaging with condoms essential means

37

Who do not feature by virtue of the alcoholic element


admission of intent which, while very much there, is perceived as taboo for females.

For males, inebriation was felt to legitimise both sexual activity (for both males and females) and non-attention to condoms: natural desire is fuelled, passions are aroused speedily, condoms are an irrelevance

Because there are harder drugs, they have less control. As soon as a girl opens her legs you’re not going to think, condom

Male, BME, 20-24, South

There are a variety of locations in which to potentially reach the Thoughtless

Single Focus (Drunk) segment:

•

Outside (pre- and during event)

•

•

•

In pubs and clubs (pre- and during event)

In home (pre- and during event)

Travelling (pre-event event)

In terms of developing suitable interventions, the core thought behind reconsideration for

females

is: a girl can be very drunk (i.e. drunk enough to allow sex to ‘happen’ without having to take responsibility for consenting to or wanting sex) and still ask for condoms.

Working within their current hidden rules, centred very firmly around gender , there is likely to be potential for interventions that help individuals carry and use without being associating with carriage and choice, for example:

•

‘Compulsory condom’ entry requirements to venues

•

•

•

Condom machines in private toilet cubicles

‘Condomshhhsshhshs!’ – introducing a way of asking for condoms while drunk, i.e. that avoids revealing rational brain engagement with the act of sex

Evoking group collective protection – ‘carrying a condom (for someone who might need it) shows she cares (for her friends)’


Alt ernatively, interventions promoting carriage ma y be able to work against current rules and grow conviction in, and normalisation of, carriage:

•

‘Because we’re worth it’ style communications (particularly via the private

• media of toilet doors)

National Condom Day

In terms of suitable int erventions for

males

, the core thought behind reconsideration is: a boy can have drunken ‘safe’ sex in order to protect his wild nights out.

Working within their current norms, there is likely to be potential in emphasising the risk and dangers presented by females in general to drunken men, and the solidarity/fun of males, for example:

•

Involve pre-planning in a big night out with the lads (including ‘condoms’

• because you have no idea what could happen, or with who!)

‘Chained’

38 message has much power for this group (i.e. making the wrong

girl pregnant and living with the – life long - consequences) a nd indicates risk

•

• and uncertainty to self

− Private media such as toilet cubicle posters is felt to be ideal for highest

− cut through

Or for this message (or other appropriate messages) club mirrors were felt to offer a potential reminder to self

Alternatively, interventions advocat ing collective responsibility may have impact on chang ing their current framework, for example:

Messaging about looking after male friends

Provision of more accessible and more visible mechanic for delivery (that does not overtly communicate ‘sex’ to female but allows m ale to be protected)

38

See Appendix 4 for further detail


•

Connection to post-coital ‘island of consideration’

39 to deliver more effective

messages about pre-planning/behaviour change b) Thoughtless: Single Focus (Sober)

The boys were tending more towards the Single focus (Sober) cluster. For this group, the motivation was about more about notches on the bedpost. Thus, c onnecting with their status aspirations is one way to reach them.

These males are seen to be very much in control of the sexual encounter. They do not really like condoms – so avoid using them or discussing the m. The aim at a ll times is ‘bareback’.

However, if faced with a choice between no sex or sex with condoms, they will use protection. They claim that girls have only got to speak up and the issue will b e solved.

The problem is that women need to speak up a little and tell us to use condoms, the re’d be no arguments.

Male pair, 25-30, South

There were indications that the low engagement of this segment with condoms is howev er reinforced by Caribbean females. As they tend to flee the situation at a n overt discussion of sex (which raising the subject of condoms necessitates) there is good reason to avoid the topic as they perceive it lowers their chances of sex.

The demographic profile of this sub-cluster is narrower, being male only in this samp le, and tending towards mid-age teens (seeming to peak at 15/16). Nonreligious Black Caribbean and some Black African respondents featured strongly

39

For further detail see Section 1.7, p.66


within this segment of the sample, as did other teen males from the DE socioeconomic group.

As indicatd earlier, there was a high incidence of ‘high number of partners’ and

‘one night stands’ within the sub-cluster. Quantity of conquests, rather than q uality of relationship, are driving behaviour.

In terms of motivational drivers/triggers , the Thoughtless: Single Focus

(Sober) enjoy a high male status as a result o f playing the sexual ‘game’. This group is sexually experienced and aims to control the sexual encounter as much as possible. There is keen awareness of gender rules and these tend to be played to advantage.

Their body’s a tool and they run the show.

Male p air, BME/Caucasian, 25-30, North

Interest in condoms was very low. Not liked, they were still used where cultural rules dic tated they are essential (e.g. where unwan ted pregnancy would be a d isaster) and where another option for avoiding pregnancy was not likely to be being used by the female.

Any alternative to pregnancy tended to be considered favourably. This is not a very ‘paternal’ group at p resent. Many within this category felt sufficiently e mpowered that they would persuade/have already persuaded their partner to take emergency contraception or have an abortion in the event of ‘an accident’.

If they were unlikely to see the female again, the issue was considered irrelevant

(it became the female’s problem).

To the extent that you phone up the bird the next day saying ‘Why didn’t you make me use a condom? Get the Mor ning After pill’.



But now [since I got a girl pregnant] I’m taking more precautions, I don’t come in her.


Taking t hese scenarios into account, for this group of males, there would seem at first glance to be no major consequence to not using a condom.

S hock tactics are an obvious route through to these individuals in the first instance. However, many of the total sample expressed an interest in stronger messages that then faded as the messages became digested. Othe r routes may h ave more impact.

There are a variety of locations in which to potentially reach the Thoughtless

Single Focus (Sober) segment:

•

•

Sporting activitie s

Male socialising (e.g. pubs, clubs)

•

•

•

Schools

Sports shops

High street/public areas

In terms o f developing suitable interventions, the core thought behind reconsideration fo r this largely

male segment

is: a ‘cool player’ gains advantage from using condoms.

Working within their current framework/way of thinking, there is likely to be potential for interventions which give a higher status to the male who is ‘in control’ of con doms, for example through:

•

•

Compulsory condom practice in schools which would allow all to be confident about how to apply and remove

‘Could you do it one-handed?’ challenge; setting up considerations of being skilled (and therefore ‘cool’) in condom a pplication


•

High appeal condom wallets (e.g. ‘bling’ or appropriately branded/designed), which can be an excuse to carry and a way of impressing others

The core idea could be strengthened and suppor ted by complementary messaging, such as attaching lower status to males who are ‘out of control’.

Ho wever, it would be important not to attach the lower status to the same a ctivities as those given above, as this would create a reason for some who lack efficacy to distance themselves and simply choose not to be involved with condoms.

Low status could, however, be attached to lack of control through indicating the consequences of non-condom usage (such as in the ‘Chained’ message

40 ).

“…She pulled out the Johnny and put it on me and she had already put the holes in it so when I bussed in her I take it off I can see it leaking out the sides. A couple of weeks later she told me she was pregnant”


Interven tions which help join up their current ‘islands of consideration’

41 could

help cha nge their current framework for cons idering condoms, for example:

•

•

•

Bringing advice and information to the individual via ‘high street’ indicators

(telling them where to go) or delivering this within the high street itself

Interventions which wrap together sexual health with whole body health (for example, something similar to the ‘Dick Doc’ idea generated by respondents

42 , but are again brought to the individual as opposed to relying

on the individual to be proactive and seek it out

Bringing clear messages around negative consequences to individuals. One idea that started to make negative consequences relevant and salient was ‘Six

40

See Appendix 4 for detailed response to Artworks

41

See Section 1.7, p. 66

42

See Appendix 4 for det ailed response to Artworks and Interventions


Degrees of Separation’

43 which links one boy with lots of other ‘single focus

(sober)’ males. c) T houghtless: Danger Seekers

The demographic p rofile of this sub-cluster appears very narrow. In this sample, re spondents were male Black Africans (mostly of Ghanaian origin) with strong religious beliefs. However, within t his, they represented a range of age and s ocio-economic groups.

As indicated earlier, there was a high incidence of ‘high number of partners’ and

‘established relationships’ within the sub-cluster. While these are seemingly at odds with each other, th e group was distinctive in terms of engaging in sexual a ctivity that was ‘extra-curricular’ to the established relationship.

For these males, the key influencing rules are slightly more well-developed than for the other ‘Thoughtless’ sub-clusters. Gender is still very important, but here culture also plays a part. Indeed, cultural rules are such that pr e-marital sex is considered a sin, and it is not only believed that girls ‘should’ not have sex, it is also believed that they do not (or will not) enjoy it.

It is not unsurprising then that much sexual practice and female sexual enjoyment is illicit and on the edge of mainstream activity.

I am a good boy when I do my prayers 5 times a day ... 25 minutes a day if I don’t go to the mosque, but longer if I do ... for the rest of the day I can be a bad boy


In term s of drivers/triggers to sexual health behaviour choices for Danger

Seekers, birth control is important and condoms are likely to be considered s ince

43

See Appendix 4 and Section 2.5, page 101 for more detail


female p artners were less likely to be on t he contraceptive pill. However, birth c ontrol is firmly secondary to male sexual pleasure which is the primary motivation. Those in this sub-cluster claimed to wear a condom if the circumstances (or partner) really demanded, but where possible, these males would aim to persuade their partner not to. Failing that, they would find a way to reduce the impact of the condom.

Instances were repeatedly reported (by the females) of the males in this demographic removing condoms mid-intercourse without agreement and with no discussion. In these cases, they ha d conceded to wearing a condom in order to initiate sex, but once activity had begun, they had allowed consideration of their own pleasure to override any concerns about pregnancy or STI risks.

Respondents within this sub-cluster had very high levels of self-confidence within their established relationship. They were allowed to set the rules and exercised a high level of control over what happened (sexually and otherwis e).

They also held a strong belief that sexual activity outside of the established relationship was necessary for pleasure, but also (in some way) for protection of their established relationship partner. By utilising prostitutes or others fo r e xperimentation, the (relative) virtue and reputation of the official partner is protected – especially where experiences such as anal sex might be discussed amongst the men. This is important if the partner is to remain a long term one, and if their own public reputation (how they treat their partner) is to be protected.

Overall, there was low interest in condoms. They are considered where deemed essential to making sex happen but they are generally considered unnecessary within their own lifestyle. In legitimate (i.e. married) relationships, condoms do n ot have a place; pregnancy is avoided through other means (withdrawal, anal sex, paid-for sex with others) and pleasure reduction is considered damaging to the relationship.


For sex outside of the relationship, again there is no real reason to use.

Pregnancy can be avoided in other ways as above. Fear about AIDS has a blunting effecting on concern about STIs; the negative consequence is p otentially so huge that it is easier to dismiss or deny any personal relevance.

Given the lack of reason to use, condoms are simply an extra cost (in terms of money and pleasure).

Some girls came to me and wanted £20 for sex and if you have no condom it’s an extra £1- I think they were prostitutes. I’d rather use a condom than not, but if none, I’d rather do sex than not


In term s of where to potentially reach the Thoughtless: Danger Seekers , as discussed, they appear highly present in the Black African traditional commun ity. However, given the need to k eep sex hidden, any messaging around p re-marital sex and unsafe sex is likely to offend if targeted at the community itself and is likely to be strongly rejected.

Therefore, while it is a challenge, it is perhaps better to address this group through non-community messaging. Perhaps considering whole body health (of which sexual health is a part) rather than explicitly sexual health, is also likely to be important for this group to help with acceptability and ‘relevance to me’.

In terms of developing suitable interventions, the core thought behind reconsideration for this largely

male segment

could be: pressure from my community is putting me at risk. This is obviously very sensitive, since it invo lves questioning and reframing cultural rules and norms.

Working within their current framework/way of thinking, there was some suggestion for interventions which leverage the fear of AIDS and the acknowledge sin and underground sex mentality, as f ollows:


•

•

•

Messaging based around the idea of “Sin a little (i.e. have illicit sex with a condom on), live a lot”

Condoms given away free, but importantly pre-packaged in ‘face-saving’

manner, at non-sex outlets 44

Sexual health information given in ‘global’ way to males (rather than ‘my community’) – however, avoiding ‘homosexual message’ which will cause open

• offence/hostility

Using sex workers to promot e ‘pleasure enhancing’ condoms to clients

Cle arly, such interventions are difficult since the whole territory is extremely com plex.

A lternatively, interventions to help change their current framework involved changing dynamics around condoms, for example:

•

•

•

Workin g with the partners

45 to help increase female empowerment and insist

on condoms

Messages aimed at making condoms part of real ‘committed sex’

Messages aimed at making condoms a key part o f pleasure enhancement

2.4

.3 Low Risk

to g ender). Specifically, family values lead females to have an established, and selfprotective sexual health strategy and good relationship in relatively stable pairbond relationship structures.

The demographic profile of this sub-cluster was very broad. Including both males and females, respondents in this sample reflected a wide range of socioeconomic groups. There was some prevalence of specific cultures and religions with positive values around relationships within this particular sample (for

44

See 1.4.4 “You must not disrespect my public reputation by suggesting I have sex”, p. 45

45

The female partners audience is covered in more detail in Section 2.4.5 Vulnerable, p. 96


example, Catholic, Orthodox Turkish/Cypriot/Greek) but this was not exclusive or definitive. Others were present in this category though adherence to strong family values.

This group had a high level of cross-over with the ‘established relationship’ cluster.

In terms of drivers/triggers to sexual health behaviour choices for this ‘low risk’ group, they are currently confident about their ‘safe’ status. However, they are less confident and committed to talking about sexual health with partners.

G ender stereotypes are strongly present and they are often a feature of their family.

Condoms tend not to part of the sexual health repertoire, or even considered, for a variety of reasons:

•

Th ey are considered unnecessary in a strong, monogamous partnership

•

•

They are considered unnecessary if sex is taking place between ‘nice’ girls and boys who tend not (or are assumed not) to have multiple sexual partners

Condoms are not required for birth control because fear of pregnanc y is taken sufficiently seriously to warrant taking the contraceptive pill for girls

(although this can be hidden from parents and not raised as a topic for debate wi th partners)

This group had a forward planning mentality generally, having considered the issue s of unwanted pregnancy seriously. However, they would not consider carrying condoms as, given these are ‘unnecessary’ in their own circumstances, th is would be a sign of seeking illicit and additional sexual activity.

In terms of where to potentially reach the ‘Low Risk’ segment, this group appears largely pro-school and thus this would be a good channel from Year 11 onwards. Within this sample, older respondents were also often w orking – and


so offer opportunities to be reached via the workplace. Presence of specific cultures indicates that some could also be reached through community networks or groups.

While existence of this group was validated by this research, this segment is out of the sample range and hence not discussed in detail within this report.

H owever, our analysis indicates that this sub-cluster may be possible contenders for helping others with pre-planning and pre-considered carriage. As such, they may be a target for group responsibility messages aimed at the ‘Single Focus

(D runk)’. For impact within the Low Risk group, however, communications would need to be very ‘single gendered’ and not to involve personal carriage of condoms.

2.4.4 ‘Disconnected’

[Note: this category was relabelled within the research as Disconnected – as o pposed to the original ‘Disinterested’. This was felt to better reflect their particular attitudes and issues, which are described below.]

The Disconnected males and females seem to have low levels of education – simple biology and in particular facts about STI transmission and pregnancy means that this group are disconnected either from t heir actions or the c onsequences. They place higher levels of importance on social acceptance and fashion because these are the priorities and the currency in their world. Being part of the social collective is a key route to this group

I didn’t carry condoms on me when I was out in the park at night when I was 14 and started having sex ... I had nowhere to put them ... no bag, no jacket, skimpy clothes – I was more concerned about looking cool and getting it, than using a condom

Female, 25-30, Mids


The Dis connected group is felt to be fairly homogenous in terms of attitude and key them es across males and females, and so they are considered here as a single group.

W ithin this category, the key influencing discourse is cultural . Specifically, values and beliefs of family and those around them have strongly set norms of low or no consequences to either unwanted pregnancy or STIs. These norms sit alongside a high ig norance of facts around sexual health per se.

I’ve had a STI and had it sorted, you know you can get it sorted, so why bother?

Male Pair, BME/Caucasian, 25-30, North

Oral sex and condoms, can you catch things? Never heard that . What about the ta ste? Strange.


Gender also has a key role in terms of this group considering males and females to have distinct and separate roles in relation to taking responsibility for contraception and contraception choices.

T he demographic profile of this sub-segment appears fairly broad. While respondents in this sample were generally of lower socio-economic group (DE), both males and females were represented across the age range researched (16-

29).

As indicated earlier, there was a high incidence of ‘DE teens’, previous ‘high number of partners’ and current ‘established relationships’ within this cluster.

In te rms of drivers/triggers to sexual health behaviour choices for respondents in the Disconnected segment, confidence varied widely and tended to relate directly to level of sexual experience.


It would seem that information and understanding is gathered through direct p ersonal or close experience, rather than through structured lines of education.

For females, conversations about condoms are halted because condoms are in the male domain - they are applie d to a male organ, they are the male re sponsibility. Conversely, for males, the same conversation is considered to be in the female domain, since it is females who get pregnant.

B oth genders ‘unhook’ from their own responsibility in the subject. Similarly they unhook from risk to themselves.

This group feel they have limited reasons to worry about their own sexual health, since they know that their partner is ‘fine’. This view is driven largely by lo w awareness of sexual health issues and STIs. They focus more on pregnancy and the relationship itself than the mechanics of sexual health.

I’m not a fan of condoms but if a girl asked me, have you got any, yeah, but at the same time I pull out I’d say you know why I’ve been down the clinic and I’ve been checked out and I’m clean. So if you ain’t got nothing and you know you’re clean, hey, we don’t need this.


There is a sense that the subject matter is boring – because not related strongly to perso nal interests, people in general, comedy, or any of the values they hold.

Condom s in particular are res isted as ‘not for me’. This is on the basis that they are unnecessary (no consequences attached to their non-use) or old-fashioned a nd primitive (that is, they ‘get in the way of proper sex’).

In terms of where to potentially reach the Disconnected segment, school is likely to be a key channel at the younger age (up to 14). For the teenagers in this


segment, parks, youth centres, shopping malls, McDonald’s and buses/bus stops are all places that are frequented.

Pubs play a key role in the social life of the older end of the segment but also feature to a lesser extent for younger individuals in the audience (from 14 upwards, especially for females). Older respondents are also often working.

In terms of developing suitab le interventions, the core thought behind re consideration for the Disconnected

segment

(male and female) could be:

Everyone is connected through the people that they’ve slept with. focusing on sexual health (and using condoms until they establish a permanent relationship) is the only way to keep themselves healthy. If condoms and STI prevention are the accepted behavioural norm , they w ould follow

Working within their current framework/way of thinking, interventions would facilitate carriage and normalise female carriage by indicating that ‘doing what everyone else does is easiest way to get things right’, for example through:

•

Girl kits to carry them – free with lip-gloss/magazines

•

Boy kits to carry them – free with shaving foam/magazines

•

•

Normalising ‘good pairing’ (i.e. making relationships that use condoms the positive norm through high visibility statements allowing for social proof

(T shirts in clubs)

Free condoms at all ‘points of pulling’ (e.g. bowls of condoms on bars ) olve increasing

•

The six degrees of separation

46 message (delivered privately such as on a

toilet door poster)

46

See Appendix 4 and Section 2.4 fo r more detail


The Vulnerable cluster contains largely female sub-clusters:

S ub-cluster 1 – Denials: T hese are girls who “never ever, ever even think” about sex – and certainly “don’t need” to think about the consequences. These are obviously potentially a high risk group but would seem by d efinition to be hard to reach.

Sub-cluster 2 – Disempowered: Their level of sexual vocabulary is very limited and sexual self-concept highly restricted, to the extent that many experience themselve s as victims. The Black African women that we met were key examples o f this type.

When I got to Granada with my nan, I stayed with a big woman who had a low moral standard, …she and her kids were setting me up with other people and a politic ian …The politician had his way with me.

Female, BME, 20-24, South

He took the condom off. While we were having sex. I didn’t even know. I said ‘what did you do that for?’

Female single, Ghanaian, 1825, South

Sub-clus ter 3 – Unguided: These presented as both girls of 13 and 14 years old and as 2 5 and 26 year olds

47 .

T his sub-cluster were girls who had had limited guidance through their lives from adults. They have been initiated into sex by older individuals – often those with unscrupulous motives, an d they leave their teens with at least one child and

47

the latter were labelled COMFY - Children of Multiple Fathers Young (being both a product of this themselves, and repeating the cycle having had children young - often in their teens – and with multiple fathers)


very little information or sexual empowerment. They are a hard audience to reach because they appear to have been through sex and all it has to offer. The question perhaps is how to reach them as beginners?

For Vulnerables as a cluster, the key influencing discourse is again gender, with girls believing they should not be engaging in sex. For this group, raising acceptance of sexual practice is likely to raise interest in and focus on sexual h ealth practice.

•

Denials tended to be from the higher socio-economic groups (BC1), and within this sample often had some element of a European religion in their background.

•

Unguided tended to be from the lower socio-economic groups (DE). Older females within this sub-segment tended to have children from multiple fathers but still to be engaging in sexual activity - sometimes with previous partners, sometimes w ith newer males. Drunken sex and nights out were seem as an escape from the house and the children.

•

Disempowered tended to include Black African females specifically, aged 15 upwards.

A s indicated earlier, there was a high incid ence of ‘fledgling relationships’ within the Vulnerable cluster; this was more because the males they partnered with were not willing to make the relationship formal than it was because the females were unwilling to commit.

In terms of drivers/triggers to sexual health behaviour choices for respondents amongst the Vulnerables, this group experience low levels of protection from their peers, parents or othe rs, and are thus easily guided by males (often older th an themselves). They are very likely to express regret over sexual experiences.


I was in the room with his friends and I felt uncomfortable. So I said ‘Can we go into your room?’, and when we got in there he said ‘Are you sure you want to do this?’ I was like ‘What??!’ But I did anyway. I thought I couldn’t get out of it.

Female, 16-17, North

Overall, confidence was low and related to both low self-esteem and l ow connection to the idea of themselves as sexual beings. Indeed, for Denials in p articular, first sex is lied about and experience of STIs under-reported. Across the Vulnerable segment(??), respondents carried a strong belief that they should not be having sex, and feared personal disapproval from others.

Girls are crazy. She’s like ‘Don’t look at me’ and crossing her arms like this…

Male, BME, 16-17, Mids

If you think about what we don’t know and don’t think about we’re all still pre tty naive!

F emale, 25-30, Mids

Given th eir mi ndset, contraceptive options present a dilemma for this segment.

While u nwanted pregnancy is a negative consequence (since it is proof they are sexually active and therefore shameful), to access or use contraception is also

‘proof’ that they are actively seeking sex. Carrying condoms in particular is high risk, since it infers that they are not only accepting of sex, but they are actively seeking it.

You have to be free at the clinic at certain times, like once a week. If you don’t want you r parents to find out then you have to do it secretly. I think people should talk about it more. Kids learn about it at the age of 10 now though



Furthermore, they place a very strong focus on the achievement of sexual pleasure for the male as they believe that if this is assured, then the relationship will be good.

A s they have a strong belief that condoms really compromise pleasure for males

(there is a much better feeling from sex without a condom), they feel pressured to deal with the pregnancy risk in some other way (for example, through use of the contraceptive pill, morning after pill). Given the issues of shame outlined above, this means they often engaged in sex, or go along with unplanned events, by blocking out the event and its consequences altogether.

Condoms are a lot more important now with all the STI’s ... even if you’re on the pill or whatever you should still use condoms ... even in a relationship as you never know ... but you don’t ... it’s like you don’t trust someone.


In terms of where to potentially reach the Vulnerable segments, education establishments (school and college) carry credibility but need to consider gender separation. Highly female-oriented retail and fashion, cosmetics and hairdressing also offer opportunities as relatively safe, gender separated spaces in which to consider information. Outside their own ‘community’ can also be important as within the community involves too much visibility.

In terms of developing suitable interventions, the core thought behind reconsideration for the Vulnerable

segments

could be: girls are already sexual beings and they should have the same rights to sexual health as boys/men. Men don’t always know what they are doing – and often they are too scared to ask. Women can control things.

W orking within their current framework/way of thinking, interventions increasing understanding and sense of risk around negative consequences of non-condom usage are likely to raise conviction, for example through:

•

Feedback on negative consequences of not using


•

•

Normalising condom carriage and usage to very high level – high streets and shops (seeing ‘everywhere’ communicates acceptance and use by

‘everyone’)

Making sexu al health connected to whole body health (hair and nails), for

• example through an intervention like the Beauty Bus

48

Interventions that can help change their current framework involve advocating change, for example:

‘Because we’re w orth it’ communications (delivered through private media

•

• like toilet doors, or more female-specific channels like shampoo, makeup, underwear, makeup)

Workshops

49 and self

-esteem raising

Promotion of Femidoms as iconic ‘fe male empowerment’ statement – not necessarily for me to use, but there’s a need in the world behind certain bedroom doors

A s a summary of how these audiences fit together, Diagram 4 below illustrate the extent to which the attitudes

50 featured within the different

demographic groups and sexual encounter

types 51 . A full circle indicates a more

significant presence and a half circle a less significant presence.

52

48

See Appendix 4 for detailed response to artworks

49

See Section 1.4.10, ‘connect with me’, p. 59

50

Note: the attitudes shown here represent the evolved /validated segmentation described in Section

2.4, p.78 rather than the original hypothesis

51

Note: the sexual encounter types include an additional new category to those hypothesised, One

Night Stands, detailed in Section 2.3, p. 73

52

This mapping, and the indication of prevalence is based on this sample only. While this is a large qualitative sample, the numbers interviewed are not statistically relevant and therefore some caution is required in inferring accuracy around sizing to the total population.


Diagram 4: Indicated Presence of Attitudinal Segments in Risk Clusters

2.5 Mapping Opportunities for Targeting

In summary, there are four broad attitudinal clusters. There are a further number of sub-clusters which deliver extra attitudinal detail. In addition, there are a few key demographic groups and behaviours which need also to be kept front of mind.

In thinking about how to structure a map that will encapsulate, group and hold these clusters, it is perhaps most useful to consider the segments against two specific axes:

•

Axis 1 - Control over the rules of the sexual encounter. To what extent can the clusters be spread out or grouped along a line related to their levels of control over the sexual encounter? Control is clearly important as it indicates the level of existing empowerment of individuals within the target audience to act on new information or ideas that are given to


• them. Where control is low, more help is required to both mobilise and support action of the individual in changing their behaviour and in increasing control.

Axis 2 - Extent of commitment to a one partner/pair relationship. How do the clusters and sub-clusters fall along the line of commitment to single pair bond?. Commitment levels in terms of whether one sees oneself as attached to another for any length of time (or aspiring to this) make a significant difference in terms of the frame of reference of the individual and whether they recognise themselves in messages and information.

Diagram 5 below aims to illustrate this, showing how each of the clusters

(whether divided by attitude

53 ,demographic groups

or sexual encounter

types 54 tend

to fall.

55

Diagram 5: Map of Sexual Health Segments and Clusters

53



54



55

This mapping, and the indication of positioning is based on this sample only. While this is a large qualitative sample, the numbers interviewed are not statistically relevant and therefore some caution is required in inferring accuracy around sizing to the total population.


Looking at this map, it is possible to see four homogeneous centres for activity, drawing together as targets for action several clusters who have similar needs or motivations. Following on from that, it is also possible to prioritise these groupings and (even to summarise the sorts of interventions that would address shared issues - see diagram 6 for additional details). Insights and understanding from the different groupings highlight:

• which audiences (by demographic, sexual practise or attitude) are likely to need most sustained effort to engage them in the first place, and then to create a positive shift in attitudes and/or behaviour?

• which audiences might be a ‘quick win’ and show positive changes with less effort?

Quadrant 1: top left-hand corner

The first grouping, in the top left-hand quadrant, might be terms ‘Sexual

Health by Choice’ because it is larger pulling together groups whose mindset and sexual health behaviour are fairly hardened through experience and who make more conscious choices in terms of condom wearing.

These (usually, though not exclusively) males are intent on their own way.

They are fairly skilled in terms of seduction experience and hold the upper hand when it comes to deciding how the encounter happens. In fact, the level of confidence they display is only addressed by a similar degree of upfront and direct communications and interventions; anything less is unlikely to cut through or to be given enough respect for a hearing.

Given the right tone, it is possible that this audience will take on board a message of self-protection – self-interest is a key driver. Parental help and information may be necessary (see below) in terms of the parental DVD, but this is largely in terms of allowing parents to provide a support – rather than a permission - for positive sexual health choices.


Diagram 6 below shows how intervention types for the groupings can be pulled together, addressing the similarities across clusters (whether divided by attitude

56 ,demographic groups

or sexual encounter types

57 ).

58

Diagram 6: Map of Sexual Health Segments and Clusters with Intervention Summaries

Fledglin

Car. F

As can be seen, the types of interventions

59 that work with this grouping are:

‘Mainstreaming’ the Six degrees of Separation icon – as discussed earlier, this icon compresses such a complex message into such a highlypersonalised mechanic that the more self-absorbed among these clusters

56



57



58

This mapping, and the indication of positioning is based on this sample only. While this is a large qualitative sample, the numbers interviewed are not statistically relevant and therefore some caution is required in inferring accuracy around sizing to the total population.

59

More more information on the artworks and interventions mentioned here see both Section 1.4 Myth-

Interpretations and Potential Direction for Solutions and Appendix 4


found it very compelling. At first glance, it represented them and their multiple sexual conquests – a fact that they were proud of and which gives them personal status. At second glance, they begin to understand the seriousness of the risks they are running, without the need for strong shock tactics. This places the icon in a position of respect – it is worth listening to because it is giving the facts straight, in a non-preaching way.

‘Mainstreaming’ the icon – putting it as some kind of signifier to remind these clusters at all times of their sexual health choices was a popular consideration: these males perceive themselves to be sexual beings and enjoy that element of their identity. They are often on the pull – flirting and using every opportunity to engage. Helping them to keep their sexual health at the forefront of their minds at every point when they are thinking about their sexual options, is considered a sensible step.

In a similarly direct fashion, the intervention of mobile screening buses for whole body health are perceived to address their needs. As a grouping, these is little fear about the judgments or disapproval of others – if sexual health choices entail a visit to the clinic, this group are more than happy for the clinic to come to them and to visit anonymously within that setting. The first step, obviously, is to encourage the idea that sexual health screening is needed – or even to avoid that issue altogether, by making the bus stop at locations, or offer useful items such as variety condoms, that work with mass inertia and self-interest to generate footfall.

As mentioned already, the parental DVD – which all young people agreed should be given out to parents of secondary school age – was thought to be of use to the younger of this target in particular. They may be slower in receiving and understanding the rational for positive sexual health choices, since they are – from very young – quite single-minded in their behaviour.

Messages via parents and peers would be the quickest route through to them, although parental influence is likely to diminish to a merely supporting role once behaviour is set.


The Condom Challenge – addresses the underlying need of these clusters to be seen as sexual experts or above the rest in terms of skill. Their reputation is part of their attraction and ensures a virtual circle of success in seducing. The condom challenge works on the principle that putting on a condom in the best – least disruptive way – indicates a highly experienced lover. The challenge could be included on mobile health buses or in schools/events/clubs and so on. It plays firmly into the court of fun, flirtation and competition – key elements of the psychology of these clusters.

Quadrant 2: top right-hand corner

Moving across the complete cluster mapping diagram, the grouping in the top right quadrant of Diagram 6 can possibly be termed ‘Sexual Health – a

Lower Relevance Issue’ (because there is a somewhat higher tendency towards stable pair-bonding and thus lower risk behaviours). Membership of this group may fluctuate – this will be an age and a stage within many respondents lives and will thus need continued repetition of activity; even though those within it are low risk at the current time, they are in a frame of mind where messages may be easiest to hear and will almost undoubtedly move into another category at some point in the future. They may be addressed by the sorts of interventions typified as follows:

Parent DVD – the parent DVD is a supportive message source for this group, for whom cultural norms and what family says are important. As such, all parents need to be delivering the same message about sexual health choices to avoid undermining the activity.

Mainstream Six degrees icon – the group is more stable at this particular time in their lives. They are able to perhaps take in more information than other clusters. In their role as advisors to other clusters, they will need to be armed with information about sexual health, location of clinics, best practice


and so on. However, since they are in relationship at this time, messages which target risk clusters may be too clearly ‘not me’ to cut through.

Mainstreaming the Six Degrees icon as discussed above offers a way for sexual health to become part of all behaviour. Such information will be sought out when the groups ebb and flow in the relationships market of their teen years.

Compulsory Condoms at Clubs – working in a similar way to the point above, the grouping is in a frame of mind where they can receive messages – and possibly condoms for others in their group to use – but would not naturally enter this behaviour change process unless forced to. Condoms are currently strongly viewed as representing ‘younger, inexperienced sex’ – something that the established relationship is at odds with. To that end, variety condoms as Pleasure enhancers may be more acceptable because sexual experimentation and the other person’s needs are receiving more time and attention.

Quadrant 3: bottom right-hand corner

Working clockwise around the map, the grouping towards the bottom right quadrant is possibly well-characterised as ‘Sexual Health – Not My Choice’.

These are (usually, though not exclusively) females – they may contain some of the youngest males initiated by older females.

For them, the control of the sexual experience is in the hands of the other partner. In addition, they are highly desirous of a relationship or pair-bond; the combination of low control and high commitment means that they are vulnerable to exploitation and manipulation.

As a first step, workshops are suggested as a way of addressing the empowerment needs and self-definition that the clusters struggle with.

Sexual stereotyping and imagery mean that many of these women run risks


with their sexual health and with their whole body health (eating and exercise) in order to be seen as desirable. Workshops on a small scale model, and with a peer-led flavour speak directly to their needs in this respect. Teen video messaging may also have the same effect.

Compulsory Condoms at Clubs has been discussed already. As an addition to what has already been said, the importance of the compulsion to carry cannot be underestimated. In order for these clusters to even begin discussing the issue, they must be guilt-free and secure in their gender role

(passive recipient), rather than sexual aggressor with condom.

Mainstream Six degrees icon – already discussed. In particular, low confidence amongst this group in general, plus the need to maintain a reputation of innocence, mean that asking for information and advice as to the location of sexual health facilities is a step too far. Such information needs to be mainstreamed and easily accessible, and to be similar across towns – wherever the target audience chooses to access services (to preserve anonymity), the event should be as easy as possible.

Parent DVD – as discussed.

Toilet doors – Bootylicious - working to address body confidence issues and to raise self-esteem in the context of sexual health choices. The bootylicious artworks operated by role-modelling positive behaviour whilst clearly signalling femininity and remaining within the gender rules for the group. By hosting such adverts in private spaces, where these females are away from the crowd and may be able to consider their own health interests and needs, toilet doors are considered to be an optimum medium for the message.


Quadrant 4: bottom left-hand corner

Finally, the clusters drawn together in the bottom left quadrant of the map perhaps share a certain impenetrability in terms of targeting and getting the message through. This is largely because for all these clusters, cognitive function – the ability to take messaging on board, to process and adjust behaviour accordingly – is diminished. In the case of Single Focus (Drunk) this is perhaps most clearly demonstrated: alcohol reduces the ability to control the sexual encounter and to think about condoms. At another level, it increases the sexual desire whilst removing the ability to evaluate the partner on criteria that might be used to see a committed pair-bond. (in fact, the presence of alcohol is seen as a clear justification and excuse not to have to think about such ‘whole-partner’ evaluation, but just to seek physical gratification).

The One-Night Stand are included in this grouping, partly because some one-night events may be fuelled by alcohol. However, some were reportedly the result of emotional instability, ‘on the rebound’, and included sexual intercourse with friends or familiars – rather than complete strangers. In this case, cognitive function is either lowered through high emotions and a desperation to seek comfort, or through struggling to comprehend the sequence of events that see sexual passion enter relationships where previously the topic has been completely off-bounds.

For all these clusters, ‘Sexual Health?’ is the last thing they can think about.

Interventions that can gain a foothold in these situations are few and perhaps need to acknowledge the challenge they face.

Free condoms – increasing the presence of free condoms wherever and whenever young people gather is one intervention that hits at the heart of the spontaneity of this type of sexual encounter. The difficulty is doing this without being seen to be promoting sexual activity amongst youngsters. Due


to the very covert and secretive levels of unprotected young sex, any visible evidence in the form of used condoms will raise the issue and will appear to be indicating a significant rise in numbers of encounters.

No love, no glove messages – lowered cognitive function in sexual encounter means that messages need to be compressed and simple, repeatable by both parties (i.e. not gender specific and not sexually overt), and instantly comprehended. The above is a slogan that is already in current teen use, but there may be others more suitable. Placing such messages close to private spaces, and ideally close also to condom machines and venues, effectively increases the opportunity to carry to the greatest extent. It stops short of placing the condom in the hands of the partners, but is at least able to find a space within the alcohol fuelled, unexpectedness of teen sexual encounters of this type.

Chained – This artwork has been discussed extensively. It is essentially a sledgehammer message; wholly appropriate if the goal is to target the most challenging sexual health risk situations, where the audience is not really listening. However, it is a potent blend of emotion, aggression and truth; as such, it may have a significant positive impact for some but there may be consequences, particularly for females who have become young mothers to an unwilling young father. At the very least, the execution as developed was intended to provoke and extract data from respondents. It should be used as a guideline to create a more even-handed campaign that would be rigorously tested in research to establish its merits.

* * * * *


Appendix


Appendix 1. Introduction to Social Marketing

Introduction

The term social marketing was first coined in the 1970s and refers to the application of marketing to the solution of social and health problems.

However, over the years there has been a growing perception that it is being confused with generic marketing especially recently with the advent of on-line tools such as “social media” and “behavioural targeting”.

Social marketing, like generic marketing, is not a theory in itself. Rather, it is a framework or structure that draws from many other bodies of knowledge such as psychology, sociology, anthropology and communications theory to understand how to influence people’s behaviour. Like generic marketing, social marketing offers a logical planning process involving consumer-oriented research, marketing analysis, market segmentation, objective setting and the identification of strategies and tactics. It is based on the voluntary exchange of costs and benefits between two or more parties. However, social marketing is more difficult than generic marketing. It involves changing intractable behaviours, in complex economic, social and political climates with often very limited resources.

Furthermore, while, for generic marketing the ultimate goal is to meet shareholder objectives, for the social marketer the bottom line is to meet society’s desire to improve its people’s quality of life. This is a much more ambitious - and more blurred - bottom line.

What is meant by Social Marketing?

Social marketing is the systematic application of marketing concepts and techniques to achieve specific behavioural goals relevant to a social good.

Most definitions of social marketing include three key elements:

•

it is a systematic process that can be phased to address short, medium and long-term issues

•

it uses a range of marketing concepts and techniques (a marketing mix)

•

its aim (which in the case of health related social marketing is improving health and reducing health inequalities) has clearly identified and targeted specific behavioural goals.

Social marketing takes lessons from commercial marketing and social sector marketing and applies them to the social and health sectors. It puts a detailed knowledge of consumer behaviour at the very heart of the development of behaviour change interventions, campaigns or programmes.


In the health sector its foundation is the recognition that simply giving people information and urging them to be healthy is not enough. We need to understand why people act as they do and therefore how best to support them in their life choices. As well as merely giving information, it means supporting and encouraging people, fostering in individuals and communities the desire for good health that they already have.

This core idea – starting from where people are and focusing on what help they need to make changes in behaviour – means moving our approach to behaviour change interventions from focusing only on awareness raising strategies to a social marketing approach.

A social marketing approach does not replace other measures. It is not a separate programme of work, it is part of the toolkit that can be used in a strategic way to inform the mix of intervention options, including regulatory action through legislation. It can help shape policy and its implementation, to promote and encourage positive behaviours and influence the provision of services. The behavioural analysis may indeed result in a need to focus on

‘upstream’ targets such as professionals and stakeholders to re-orientate health services and service provision.

And with its focus on establishing unambiguous behavioural goals, social marketing can improve effectiveness measurement and allocation of public funds.


Appendix 2. Detailed Breakdown of Sample Structure

Creative Conferences

• 9 Creative Conference Workshop sessions overall including:

• Four Creative Conference Workshop with c.18-20 respondents, 3 hours each, as follows:

Conference 1

Conference 2

Conference 3

Male

Male

Female

Female

16-19

20-29

16-19

20-29 Conference 4

• And five Creative Conference Workshop with c.18-20 respondents, 2½ hours each, as follows:

Conference 5

Conference 6

Black African Women 16-19

Black African Women 20-29

Conference 7

Conference 8

Low Attainment Males

Conference 9 ‘Borderline’ females

(sexually inexperienced)

Interactive Galleries

16-19

Low Attainment Females 16-19

14-16

DE

DE

DE

• Overall sample of:

– 35 trios (22 amongst high sexual partners and 13 amongst vulnerable)

– 20 depth interviews (12 amongst high sexual partners and 8 amongst vulnerable)

– 10 paired depths (6 amongst high sexual partners and 4 amongst vulnerable)

• Definitions


– Early sexual experience/sexually inexperienced: Had sex for first time during the last 12 months or not yet had sexual intercourse.

– Low educational attainment.

– Fledgling relationship : Have begun a new sexual relationship within the last 6 months.

– Established relationship: In a sexual relationship which began over 6 months ago.

• 1. High numbers of sexual partners (Hi)

• All women to have 2+ partners in the last year, 4+ for men a) Main Sample Structure

ABC1 16-17 18-19 20-24 25-29

Male -

Female Vulnerable

Hi

1 x trio

-

Disengaged

Hi

1 x depth

-

Vulnerable

Hi

1 x trio

Disengaged

Hi

1 x pair

Hi

1 x depth

Vulnerable

Hi

1 x trio

Hi

1 x trio

Disengaged

Hi

1 x pair

Thoughtless

Hi

1 x pair

Vulnerable

Hi

1 x trio

C2DE 16-17

Male -

Female Vulnerable

Hi

1 x depth

1 x pair

-

Disengaged

Hi

1 x trio

18-19

-

Vulnerable

Hi

1 x depth

Disengaged

Hi

1 x trio

20-24

1 x trio

Vulnerable

Hi

1 x depth

Hi

1 x depth

1 x pair

Disengaged

Hi

1 x trio

25-29

Thoughtless

Hi

1 x trio

Vulnerable

Hi

1 x trio

b) Black Caribbean Men

C2DE 16-17

Male Thoughtless

Hi

1 x depth

Disengaged

Hi

1 x trio

18-19

Thoughtless

Hi

1 x trio

Disengaged

Hi

1 x depth

20-24

Thoughtless

Hi

1 x trio

Disengaged

Hi

1 x depth

1 x pair

25-29

Thoughtless

Hi

1 x trio

c) Black Caribbean Women *

C2DE 16-17

1 x trio

18-19

1 x depth

1 x pair

20-24

1 x trio

25-29

1 x trio

* Black Caribbean women to be recruited on the basis of being in a relationship with a black

Caribbean man who demographically and attitudinally fits into a priority audience above.

Disengaged

Hi

1 x depth

Disengaged

Hi

1 x trio

Disengaged

Hi

1 x depth

Disengaged

Hi

1 x trio

Disengaged

Hi

1 x trio


2. Vulnerable

C2DE a) Vulnerable: Spread SEG on 20+, 16-19 year olds (C2)DE

16-17 18-19 20-24

Male

Female

Early sexual experience

1 x pair


1 x depth


1 x depth


1 x trio

Fledgling relationships

1 x trio

Fledgling

Relationships

1 x depth

Established

Relationships

1 x trio b) Vulnerable Black African Women

C2DE

Female

16-17


1 x trio

18-19


1 x trio

20-24

Fledgling

Relationships

1 x trio

Established

Relationships

1 x depth

1 x pair

C2DE

Male c) Black African Men, aged 16-29

16-17


1 x trio

1 x depth

18-19


1 x trio

20-24

Fledgling

Relationships

1 x depth

1 x pair

Established

Relationships

1 x trio

25-29 relationships

1 x trio

Fledgling

Relationships

1 x depth

1 x pair

25-29

Fledgling

Relationships

1 x trio

25-29

Fledgling

Relationships

1 x trio

Established

Relationships

1 x trio

Established

Relationships

1 x trio

Established

Relationships

1 x depth


Appendix 3. Research Tools

3.1 Recruitment: Stakeholder Interviews (Phase 1)

Note: No formal Recruitment Questionnaire was used for Stakeholders in Phase

1. The recruitment process involved the client team identifying a range of potential respondents (representing different perspectives and levels of contact with the target audience) who were contacted independently by Define and asked to take part if available.


3.2 Discussion Guide: Stakeholder Interviews (Phase 1)

Similarly, no formal discussion guide was used. Respondents were asked to ‘talk to camera’ about their knowledge and experiences of the target audience, and any information they felt may be pertinent to put in front of them to stimulate debate in the Conferences Workshops (Phase 2). The Briefing Document below was used to introduce the process to stakeholders:

Sexual Health Social Marketing (COI for DH and DCFS)

Brief for Stakeholder Interviews

Need:

We are making six short films which will be used as stimulus in research conferences. The delegates will be members of the public, recruited for because they represent the audiences who may be targeted in some ‘social marketing’ pilots that the Department of Health are developing to improve sexual health and reduce rates of teenage pregnancy..

The films need to stimulate ideas, thoughts and feelings about the risks that people take when having sex and potential interventions that might be delivered to reduce this risk taking.

Tone:

Overall, we would like a mix of tone – informal and formal. We would steer away from stigmatising anyone who behaves in a risky way . However, we would like you to be free to say what you think and feel, therefore, please be as open and direct as you can and we will edit! Humour is welcome as are anecdotes or illustrative stories about people and events.

Look:

The films will need to be mixed in background and ‘feel’. Backdrop will ideally include – the medical/official (computer desk/office/lab), the outdoors (greenery and trees),


the mainstream (shops or cars in the distance), the informal (relaxed sofa or easy chairs), the social (coffee shop or similar with food and drinks), the private (if we can get it, a film near the washbasins of a loo/inside someone’s kitchen)

Content:

As far as possible, we would like a range of views, opinions, ideas and perspectives. The locations have been chosen to prompt thoughts from each of these perspectives into behaviour.

We will discus your interview beforehand so that you feel comfortable with what you are saying and so that we can prompt you for things you want to say – this is not a memory test!

However, just so that you have a chance to get prepared, for each of the interviews, we would like you to talk around the following themes:

Mainstream thinking: What are the current perceptions and beliefs about who has ‘poor’ sexual behaviour.

− Everyone, others, media

Social circles: Where does the problem start with people putting themselves at risk through their behaviour – risk of STIs, risk of Teenage Pregnancy, or more generally at risk of having sexual experiences that are regretted? Who is most at risk? Who is least at risk?

What drives risky behaviour : Why do people have unprotected sex? What are the key attitudes motivating behaviour?

Spreading the word: What are the consequences of good Sexual Health practices? What are the repercussions of poor practice?

− Friends, lovers, work, family

Self-connection: Where does the conversation begin?

− Self-relationship, symptoms, worry, protection

Making it better: What do you think we could do to reduce risk taking and to decrease the level of regretted behaviour? (NB focus to be outside of communications

e.g. How could we get “safer sex kit” into people’s hands a priority and easier for people?

t the right time? How could we make sexual health maintenance a higher


3.3 Recruitment Questionnaire: Target Audience (Phases 2 and 3)

COI RECRUITMENT QUESTIONNAIRE: SH SMS

CONTACT DETAILS

Interviewer:

__________________________________________________________________________________

Respondent

__________________________________________________________________________________

Address:

___________________________________________________________________________________

__

________________________________________________Post Code:

________________________________

Tel._________________________(Hm) ___________________________

(Wk)______________________(Mobile)

Please note method of recruitment: (tel/f2f/snowballing/list) ………………………………………..

UNDER 16’S PLEASE ENSURE THAT WE HAVE PERMISSION FROM THE CHILD’S

PARENTS/CARERS – CONSENT LETTER MUST BE RETURNED

PRIOR TO INTERVIEW

INTRODUCTION

Good morning/afternoon/evening. My name is (…) from Define Research and Insight. We are an independent market research company. We are looking for young people (aged between 16 and 29 years old) to take part in an informal market research discussion to find out what they think about relationships, sex, sexual health and contraceptives amongst other things!

I need to ask you a few simple questions first to see if you are right for our study – this will only take a few minutes. Please do answer all the questions honestly, we don’t mind what your responses are as long as you say what you feel. This questionnaire is totally confidential and details of who you are won’t be passed on to anyone else.

If you are right for our study we would like you to come along to _____________ to take part in a research workshop. This would take about three hours and would be with around 20 other girls/women

OR boys/men. There won’t be any girls/women OR boys/men there. If you have any friends that fit our criteria, we would be happy for them to come along too.

Our researchers will give you various bits of information and ask you some more questions about what you think. You’ll also be asked to do some creative work - a bit of painting and cutting and sticking! But again, any discussion will be completely confidential. We’ll be giving you each £40-50 as a thank you for taking part.

Please ensure that the respondent understands that anything they say in the discussion will not be used with their name attached and their name will not be passed on to anyone other than the researchers working on the project.


MAIN QUESTIONNAIRE

LOW ATTAINMENT AND EARLY EXPERIENCES QUOTAS ONLY, OTHERS BEGIN AT

Q.4

Q1. Are you going to either school/college at the moment?

Yes – at school/college 1

No – left school/college 2

Q2. Did you get/do you expect to get , any qualifications from school/college at age 16? If so, what sort of qualifications did you get / do you expect ?

None 1 Go to 2a

Up to 5 GCSEs

More than 5 GCSEs

Up to 5 GNVQ or NVQ Level 1 or 2

More than 5 GNVQ or NVQ Level 1 or 2

2

3

4

5

Go to 2a

CLOSE

Go to 2b

CLOSE

BTEC or OCR National Level 1 or 2

BTEC or OCR National Level 3

NVQ Level 3

6

7

8

Go to 2b

CLOSE

CLOSE

A Levels /AS Levels

Other

9

10

CLOSE

CHECK WITH OFFICE

RESPONDENTS MUST HAVE ACHIEVED A MAXIMUM OF 5 GCSES OR EQUIVALENT.

ACROSS SAMPLE ENSURE A SPREAD OF CODES 1-4/6

Q2a. And what grades did you/do you expect to get?

Mostly A* to C

A mix from A through to G

Mostly C’s and below

1

2

3

CLOSE

ENSURE A MIX OF CODES 2 AND 3 BUT AN OVERALL BIAS TO 3

Q2b. And what assessment did you/do you expect to get?

Pass 1

CLOSE

Q3. Have you been/are you going to college? For what type of qualification?

Not at college

NVQ Level 1 or 2

1

2

BTEC or OCR National Level 1 or 2

BTEC or OCR National Level 3

NVQ Level 3

A Level / AS level

HNC / HND / DipHE

Foundation Course

Degree or Post graduate qualification

3

4

5

6

7

8

9

CLOSE

CLOSE

CLOSE

CLOSE

CLOSE

CLOSE

ALL

Please explain to the respondent that as part of this questionnaire you are going to ask them some personal questions that you would like them to answer as honestly as possible. Ensure that they


understand that anything they tell you will not be repeated to their parents/carers or to anyone else that knows them and that anything they say in the group discussion/paired interview will not be used with their name attached and their name will not be passed on to anyone other than the researchers working on the project.

Please stress that if they feel at all uncomfortable answering any of the questions either now or during the interview they are free to stop.

Q4. Do you have a current boyfriend/girlfriend and how long have you been seeing each other as boyfriend and girlfriend?

No - not had a boyfriend/girlfriend yet 1

No - had a boyfriend/girlfriend but not for a while (more than 6 months)

No – but had one recently (less than 6 months ago)

Yes – less than 6 months

2

3

4 Fledgling Relationship

Yes – more than 6 months 5 Established Relationship

• MAIN CONFERENCE GROUPS: ENSURE A SPREAD OF CODES 2-5, MAX 4

RESPONDENTS TO CODE 5, NONE TO CODE 1

• BLACK AFRICAN FEMALE GROUPS: AIM FOR A SPREAD OF CODES 2-5, MAX 2

RESPONDENTS TO CODE 1

• LOW ATTAINMENT GROUPS: ENSURE A SPREAD OF CODES 2-5, MAX 2

RESPONDENTS TO CODE 5, NONE TO CODE 1

• BORDERLINE FEMALE GROUP: ALL TO CODE 4 OR 5

ALL RESPONDENTS

Q5. Can you tell me how many ‘official’ boyfriends/girlfriends you have had in the last five years?

None 1

One 2

2-5 3

6+ 4

RECRUITER: ENSURE A SPREAD OF CODES, THOSE WHO CODE 1 MUST STILL BE

SEXUALLY ACTIVE (SEE Q6 BELOW)

Q6. And – a little bit of a personal question - how many people you have either slept with, or not slept with but been physically intimate with , in the last five years? IF RESPONDENT DOES NOT WISH

TO ANSWER ASK Q6a INSTEAD. IF VERY UNCOMFORTABLE WITH SUBJECT

MATTER, DO NOT RECRUIT

A) Slept with B) Physically intimate with but not slept with

None

1-2

1

2

1

2

CLOSE

4

5

RECRUITER NOTE: SLEPT WITH = HAD SEX WITH, PHYSICALLY INTIMATE =

SEXUAL BEHAVIOURS BUT NOT INTERCOURSE

• MAIN CONFERENCE GROUPS: ENSURE A SPREAD OF CODES, AT LEAST SEVEN

RESPONDENTS TO CODE 3-4 AT (A), AT LEAST FIVE RESPONDENTS TO CODE 5

OR MORE AT (A)

• BLACK AFRICAN FEMALE GROUPS: NONE TO CODE 1 AT (A), MAXIMUM 5 AT

CODE 2, SPREAD OF OTHERS


• LOW ATTAINMENT GROUPS: NONE TO CODE 1 AT (A), MAX FOUR

RESPONDENTS TO CODE 2 AT (A)

• BORDERLINE FEMALE GROUP: TO CODE 1 AT (A) AND ANY CODE AT (B)

Q6a. Pen Portraits (USE SHOW CARDS)

Read out statements/show cards and ask them which they feel nearest to personally. You can adapt them, such as change the gender if this helps for a particular recruit. There will obviously be parts of the descriptions that do not match but this is to help with illustration only.

1 Kelly/Danny has had a couple of boyfriends/girlfriends, but nothing that serious. Her/his longest relationship has been 3 weeks. She/he hasn’t had sex yet, but imagines that she/he will do soon. Some of her/his close friends are having sex.

Michael/Zoe has been going out with his/her boyfriend/girlfriend for a while now. They are very close and he/she thinks they will have sex soon.

Kate/Ross has had a couple of boyfriends/girlfriends, but nothing that serious. She/he hasn’t had sex yet, and doesn’t think he/she will for a few years yet.

Neil/Ayesha has a steady boyfriend/girlfriend. When they started having sex together they weren’t in another sexual relationship and their relationship has always been exclusive.

2

3

4

Michelle/Paul are in a steady relationship. Their relationship is exclusive, but when they started seeing each other there was some overlap and Michelle/Paul were finishing with their previous relationship when starting their new one.

Carl/Melissa are in a sexual relationship, but Carl/Melissa have had sex with someone else.

Duane/Lara aren’t in a steady relationship, but they have had sex with each other and with a few different people in the last year.

5

6

7

• MAIN CONFERENCE GROUPS: ENSURE A SPREAD OF CODES 4-7, NONE TO

CODE 1-3, MAX SEVEN FOR CODE 4, OTHERS MIX OF CODES 5-7

• BLACK AFRICAN FEMALE GROUPS: NONE TO CODE 1-3, AIM FOR A SPREAD OF

OTHER CODES

• LOW ATTAINMENT GROUPS: NONE TO CODE 3, MAX TWO RESPONDENTS TO

CODE 1 OR 2, MAX 3 FOR CODE 4

• BORDERLINE FEMALE GROUP: ALL TO CODE 1 OR 2, NONE TO CODE 3-7

ALL EXCEPT BORDERLINE FEMALES

Q7. RECRUITER NOTE: THIS QUESTION COMPRISES THREE PARTS (i, ii and iii). THE

ANSWERS READ DOWN THE COLUMN. PLEASE SCORE EACH QUESTION AND

THEN CODE APPROPRIATELY V, T OR D. i) Do you use a condom all of the time?

Yes A

No B ii) Do you find it easy to discuss sex with a partner?

Yes

No

A

B iii) Have you had a sexual experience that you regretted afterwards?

Yes B

No A

ABB = V

ABA = V

AAB = T

BAA = T

BAB = T

BAA = D

BBB = D


AIM FOR A SPREAD OF LISTED CODES. DO NOT RECRUIT THOSE WHO CODE

OTHER COMBINATIONS

NO MORE THAN 4 PER CONFERENCE WORKSHOP AND 2 PER SMALLER WORKSHOP

TO CODE A ON (i)

MAIN CONFERENCE GROUPS ONLY

Q8. Which of the following apply to you (can code more than one)?

I know my opinions and like to speak my mind

Sometimes I get a bit embarrassed about what people might think of what I’ve got to say so I’d rather let someone else do the talking

A

B

I think I’m quite creative

I think I’m quite good at things like art and drama

I don’t like doing art and drama and things like that very much

I like thinking of good ideas

I would be ok about discussing personal topics in a small group with people I don’t know

I’m not very good at thinking of ideas myself but if someone gives me a headstart I’m good at adding things to make it even better

I’m not really an ideas person but if someone tells me what to do, I’ll have a go

I quite enjoy meeting new people, you can have a laugh

A

A

A

A

A

B

I’m really shy with people I don’t know

It takes me quite a long time to decide what I think of new people, so I keep quiet for quite a long time

• ALL TO CODE AT LEAST TWO ‘A’S

B

A

B

B

QUOTAS

CHECK INTERVIEW SPECIFICATION FOR REQUIREMENTS

ETHNICITY: (please circle)

White

Black African

Black Caribbean

Mixed Race

Asian

Other ……………………………………………………..

GENDER: (please circle)

Male 1

Female 2

AGE: ……..…………………………………………..WRITE IN

SEG : OCCUPATION/WORKING STATUS OF H.O.H

…………………………………………………………

(Please circle as appropriate)

B

1

2

3

4

5

6


3.4 Discussion Guide: Conference Workshops (Phase 2)

SEXUAL HEALTH/TEENAGE PREGNANCY SMS CREATIVE

CONFERENCES

Prepared by Define - 05 December 2007

Total running time: 180 minutes

Genders separate

Age 16-19

Age 20-29

Identify key insights to inform the development of sexual health/teenage pregnancy social marketing pilot concepts for testing

Time: 00-10

1. Welcome and Wall of RISK:

Summary

Recruitment questionnaire and pre-task letter to encourage them to bring photo with them.

Each respondent would be asked to bring a picture (or photograph of an object) that most strongly relates to risk . As they enter the conference, they will be welcomed, name ticked off a list, and directed to the wall of risk.

They will be asked to stick their picture to the wall with a short explanation underneath – in the breaks, they will be encouraged to use this wall of risk as further stimulus for their work.

Set up

Table at door of hall with list of delegates names

Stickers for them to be allocated to groups post briefing – cat, dog, mouse, snake, monkey, tiger

Blue tack for their own picture

Sticky labels and pens for writing underneath their picture


MDF painted black and hung up on the wall

Other pre-placed risk-related stimulus and some quotes about risk printed and laminated on wall

Some pictures of risk (as if from previous sessions) already on there to model behaviour

Moderator 1:

Once you have done that, put your photo on the wall and written what it’s about and why it represents risk to you, then do please take a seat. There’s a notebook and pen, plus some info on each seat – that’s for you! Loos, if you need them, are

…. We will be starting the main session in five minutes.

Time: 10-14

2. Conference Introduction

Summary

For the start of the Conference sessions, all respondents start out in the same room. There is a short briefing, stakeholder films and Q&A, then split out into

Creative Workshop groups to make art.

Set up:

⇒ Chairs laid out in conference style in main room

⇒ Projector and screen set up at front of room

⇒ Pens and notebooks for taking notes plus small sheet with some topline stats on sexual health ‘FAQs’ for each delegate, plus the MRS

Guidelines printed out – ready on chairs

At some point issues of confidentiality, anonymity, rationale for recording AND how any issues around THEIR personal feelings/safety can be cared for during the proceedings if they feel exposed/vulnerable/upset for any reason ?

Moderator 2:

“Welcome everyone. My name is x and I am from Define Research. Thank you for coming along today and for agreeing to help us get some ideas about sexual health and sex.


“In a minute, you’ll be watching six short films. No, there’s nothing naughty in them! They are about sexual health from different perspectives – but that doesn’t mean you can fall asleep! These films should give you some ideas and thoughts that you will need to use in the next half of the workshop – when you make your art works.

“Now just to be clear. You’re here today as people who have shown a high degree of openness and willingness to talk about sexual matters. You’re recruited because you are less shy than other people and because you scored highly on creative ability.

“So we want you to carry on being like that. We really hope that you’re not suddenly going to go all quiet and not say anything – we want to hear your thoughts and opinions throughout the next few hours so that we can understand your point of view and help the people who have asked us to set up this conference today.

“On your chairs is some information about sexual health and pregnancy. The films we are just about to watch give you more. And because this project is run under the Code of Conduct of the Market Research Society, all your responses and all your involvement in this is confidential and anonymous. Your name isn’t used in any of the work we produce and you won’t be identified or re-contacted as a result of this piece by us, so don’t be afraid to really say what you think. Or to tell it like it really is – we’re not judging people. Please be aware that other people in your group will be revealing personal stuff about themselves too. Please try and stay open-minded (we know that’s hard if you feel a bit embarrassed!) but we’re all adults in here and hopefully today will be a positive experience for everyone.

“Once you’ve watched the films and asked any questions that you may have, we’ll split up into small groups – based on the animal sticker you’ve been given. You’ll each go into a different space – and start working with your group.

“In those groups, you are going to be making artworks and discussing sex, sexual behaviour – your own or anyone else’s – and thinking about how best to show a particular aspect of the experience.

“Now, IMPORTANT POINT. The artworks are NOT advertising! We don’t want you to make adverts – we want you to use your skills and the materials you have to show an experience. It might be the moment when you’re having sex and you think about condoms (how could you represent that?) Or the feeling when you are sitting in the loo somewhere waiting for the two blue lines on the pregnancy stick or whatever…we’ll give you the titles for the art works later on when you split into groups. But we don’t want you to come up with adverts saying

‘don’t have sex’ or ‘you should have used a condom!’

“The best artworks are going to be put into a research project – about sexual health and unplanned pregnancy. So they need to be things that really capture a


feeling, a mood or an experience that will make other people talk about sex and how to improve sexual health.

“We’ll come back together at the end and each team will present their ideas back to the whole group – show what you made and explain how you got there. We’ll film that bit so you’ll get a chance to have your say and explain your thoughts.

“Maybe you want to choose a spokesperson for that bit or maybe all three in the team want to speak.

“This workshop today is really important and you have a very big role to play.

“But for now, just sit back and relax and watch the films. After that, we’ll take questions, have a loo break and then go do some painting!

Time: 14-35

3. Films and Q & A

6x films

Moderator 3: Now, can I take questions? Does anyone have anything they’d like to ask?

Q and A session

Plant questions: these will be planted in the audience – either with clients who are present or youth workers who are very comfortable with sexual conversation – answers will be given by the research team. It is important that the tone is light and easy – very informal – anything can be talked about and this is a low risk situation.

Q1. Can you tell who has an STI?

A. One in nine – so highly likely, even if no symptoms, that some STIs in this room.

Incidentally, in recent research by the Terence Higgins Trust one in ten men thought Chlamydia was a flower.

Q2. What’s the worst thing that you can catch during sex?

A. A bus??? No, seriously – it depends on your attitude. HIV is pretty worrying since it can develop into AIDS and that’s fairly serious. Many of the other STIs – if treated – can be controlled or cured completely. The ideal would be not to catch much of anything during sex – it can be quite a major hassle sorting it out afterwards.

Q3. Is unprotected sex always bad?


A . Everyone in this room is the product of unprotected sex – so we shouldn’t be complaining too loudly! I guess the point is that unprotected sex that leads to negative consequences is the issue.

Sex should be fun – no one is saying ‘don’t have sex’! No one is saying ‘don’t have sex before marriage’. No one is saying ‘you are only allowed to have one person who finds you cute’! The question is – how can it be safer?

Q4. What does it mean to be safer?

A. We could probably all say in one go – “Use contraceptives – use a condom”. That’s certainly part of it, but the fact of the matter is that people don’t for all sorts of reasons. You’re drunk, you’re lazy, you don’t have any, you don’t want to bring it up. It might also be about deciding whether you really want to have sex or not that time, or with that person …

Time: 35-100

4. Workshop Instructions:

Moderator 1:

“We’ll now be getting into small groups – you were given a sticker at the beginning = cat, dog, mouse, snake, monkey, tiger. You now have to find the two others in your group and then you’ll be directed to where you’re going to work next.

“There are 3 researchers managing this session and we’ll wandering between the groups. In your space, you’ll find a set of instructions. Feel free to come and look at the wall of risk for ideas and we’ll come round and chat to you throughout the exercise. Good luck!

Set-up in each smaller space:

⇒ Series of cards (see below for content)

⇒ Three chairs in each area

⇒ Variety of art materials, sexual health stats and information

⇒ White board for capturing brainstorm and ideas

CARD 1

Please introduce yourselves to the other members of your team. You should start with

⇒ first name,

⇒ age,

⇒ star sign,

⇒ job/what studying,


⇒ how many times you have moved house in your life

CARD 2

Please take five minutes to discuss the films and briefing you have just had.

Include

First thoughts

⇒ What’s most relevant to your own experience?

⇒ What you disagreed with?

⇒ How you think other – less confident – people would react to the subject of sexual health, STIs and unplanned pregnancy?

⇒ Which bits they would like?

⇒ Which bits would make them most uncomfortable/worried?

CARD 3

“You are making art for an Exhibition called ‘How it really, really is”. You have to make a piece of artwork that really captures one aspect of the issues you’ve heard in the films or from your own experience. This issue should be one that you know affects the choices people make at different points in their sexual behaviour.

The artwork should be an expression of the attitudes and behaviours of people like you towards things like deciding to have sex, risking your sexual health, STIs and unplanned pregnancy.

“Use any of the information and stimulus – as well as the Wall of Risk you made earlier – to help you decide what your artwork is going to be.

“While you’re working, the interviewers may come round and ask you questions individually or as a group.

“Don’t forget you’ll be presenting back to the rest of the group so keep a note of your thoughts along the way!”

CARD 4:

Possible titles for your art

A MOMENT IN TIME: When’s the moment in the whole course of events leading to penetrative sex when someone could change their mind and use a condom?

NO CHOICE: The times when you take the biggest risks with sex and how and why that seems right

BACK OF MIND: Times when ‘being good’ is the last thing on your mind

LOOKING GOOD: Ways of making it easy to keep healthy sexually


STOP RIGHT THERE: Anything that you could do to get condoms and contraception in there at the right time in the easiest way

MORNING AFTER: Feelings about the sexual risks you’re taking or you have taken

SAFE SEX VS UNSAFE SEX: What’s the big difference?

VULNERABLE: A time when you weren’t sure or were worried about having sex

GETTING WHAT YOU WANT: How you can avoid having sex that you later regret.

MALES AND FEMALES: The different ideas they have about sex

ASKING ABOUT CONDOMS: How you would feel telling someone that you wanted to use a condom

UNDER THE INFLUENCE: The influence alcohol or drugs has on condom usage

CARD 5:

Photographs with labels - e.g.

I have three STIs – but no symptoms

We could never talk to our boyfriends about contraception – way too embarrassing!

If I mention condoms, I think she’ll think ‘Stop!’

I caught an STI from oral sex

I got pregnant at 14 and again at 15 – but I’m not messing up MY life!

I’d want to use a condom but what if I lose my boner?!

CARD 6

Articles/Email threads including suggestions for interventions?

These might reflect specific current ideas for intervention (for example community condom branding, opportunities for ‘amnesty’ in a services setting, sexual health toolkits for those most at risk).

Time: 35-100

5. Discussion Guide for Moderators Roving through the groups:


Summary

Working from and discussing these cards, respondents are asked to build their artwork to encapsulate a feeling or a moment in sexual interaction that is key to sexual healthy behaviours.

During this time, we will be roving amongst the groups, asking questions and giving direction. Each moderator may ask the whole group as they work or you may pick out one or two to ask individually. Ensure the dialogue is respondentcentred. That means giving open questions and a non-judgmental attitude: some of what they may say at ‘first-layer’ can be to test us so that they see if ‘secondlayer’ information will be acceptable. Moderators will work to stay ON THE

SIDE OF THE ‘UNDER DOG’ in the dialogue – even if that means putting the opposing point of view to what they are initially giving us.

E.g.

M: Tell me about condoms…

R: People should always use condoms – they’re dirty if they don’t

M: Are they actually dirty though? Is that a bit harsh??? Could there be situations where it’s not easy to get it perfect all the time?

Throughout, keep gaining information about the respondent, their own behaviour as well as what they are creating and why.

Specifically, the requirements for the project are to verify the segmentation as it stands currently. That means the notes in the attached appendix are critical for the moderating task on both this and the Gallery section.

Moderator:

Understand for each key audience:

The attitudes and other factors driving risky behaviours (particularly, but not exclusively non condom usage)

⇒ Tell me about condoms

⇒ Tell me about contraception in general

⇒ What do you currently use

⇒ What’s working for you

⇒ What’s a hassle

⇒ What doesn’t work

⇒ What’s way out there - really risky sexual behaviour? What’s textbook - really sexual healthy behaviour?

⇒ What emotions decide which way you have sex – on the spectrum of ‘way out there to textbook’?

⇒ What else determines it? How does that decision get made? By whom? At what point?


⇒ What else in life is like this? Why? What is very unique to sex?

The role of alcohol and drugs (determining the extent to which they change behaviour vs are used as a justification or excuse)

⇒ What about drink?

⇒ Drugs?

⇒ Do you ever not know what you’re doing?

⇒ Do you know anyone who uses them as a total excuse?

⇒ What about just taking the edge off the decision? Why is that helpful sometimes? What does being drunk let you do that you can’t do being sober?

⇒ How does it change the sexual behaviour range?


The broader context for sexual behaviour (lifestyles, interests, aspirations, cultural influences/perceived social norms and attitudes)

⇒ Tell me about you… Tell me about you…

⇒ What do you do how do you spend your spare time?

⇒ What do you like music-wise? Radio/music stations?

⇒ Where do you shop for clothes? If you had more money, where would you like to shop for clothes? Where NOT?

⇒ Going out? Pubs, clubs? Where would you like to go, but don’t yet?/Would not go?

⇒ Who do admire/who are role models/who would you most like to meet/be/NOT?

⇒ How did you meet your sexual partner(s)?

⇒ Are you seeing people at the moment?

⇒ Whose the worst person you ever went out with/slept with? Why?

⇒ NB. Moderator – some of this will come through observation of group work and wider conversation. Some will need direct questioning. Note language, moral frameworks, background detail, references to sexual networks. Watch for quieter respondents and use group questions to access their responses.

And within this, the sexual encounter ‘journey’ (where, what and how occurs in the development and negotiation of the encounter prior to sex)

⇒ What’s the usual line-up for sexual behaviour – how does the story go?

⇒ At what point do you sort out sexual health? Before/after/during?

⇒ How – tell me exactly how and what you do, think about, bear in mind, put to one side?

⇒ What would make a difference? What could make a difference?

⇒ What about getting round the emotional factors?


⇒ What about getting round the practical factors?

⇒ What would NOT work? Why?

⇒ What would be the worst thing they could do to get people to got on side with the sexual health thing?

⇒ What would be the best?

⇒ What would they do in Holland? In America? In Africa? In India? In China?

In Spain?


Any gaps between actual and ideal sexual lifestyle patterns and the reasons for any discontinuities; and determine key influencers and times and places when receptivity to change is highest

⇒ Moderator to probe sensitively – without judgment – at each opportunity

Moderators: choose the three most productive groups to follow on with brainstorming if time is short. Write on white board. Explore any opportunities to change risky behaviour (services/interventions/ messages) and why these have potential – Use stimulus table to generate ideas

⇒ Anything you’ve ever seen in any context that’s about making things EASY?

⇒ Think about Labour saving devices? Convenience foods? Quick top up Oyster cards? Season tickets? ATMs? Washing machines? Driving? Bar snacks bowls?

⇒ Think of an activity from the past that’s been made easier through invention or information…e.g. Pizza delivery PLUS Automated call-up services =

911CONDOMS?!!!

⇒ What companies or brands are connected with making things easy?

⇒ What do they do that makes a difference?

⇒ How does the invention/company make things easier? What specifically happened? How could you apply that to sexual health?

⇒ What companies could you see being connected with a sexual health campaign?

⇒ Cartoon characters/famous people eg. Jordan, Homer Simpson, key characters from soaps ??? etc. Etc.

⇒ What companies would not be associated? Why? Thinking about those that

COULD NOT – what could they do if they HAD to be associated with a campaign? What’s the wildest stretch of the imagination that you could think of to make them fit in?

NB moderators to remind respondent teams that they have to present back to group. Indicate that they will want to select someone to speak, that they will have to present the artwork and that they will have to explain why they chose this theme, what they know about sex that makes them think this will stimulate discussion, and what their picture represents.


If appropriate, respondents ideas for intervention should also be presented at this point.

Time: 100-180

6. Main group discussion

Summary

To get all respondents back into large group again – to present ideas and film rationale, to get groups (of six people each) to talk about and discuss thought processes, pros and cons.

Show art pieces one by one to whole group, then split into three teams of six and have mini discussion around two artworks each. Rotate after five minutes to cover the next two and then the final two.

Moderator 2:

Right you’ve all been working in small groups and now its time to come back into the main group and to talk through ideas. Each team will have a chance to present your artwork and to tell everyone what your group thought. Remember that we are all really working together and that this is not a competition. Today is about finding ways to stimulate discussion and to get other people talking about sex and sexual health. So we’ll have a look at the art and then maybe line them all up and talk about them in groups….

Set-up

⇒ Film camera

Moderators in mini group of six respondents (i.e. two trios stuck together):

⇒ Prompt for reactions – recognitions – dispute – weaknesses and strengths of pieces produced

⇒ NB not in artistic terms, but in terms of their provocativeness, accuracy, emotiveness, sheer insight and honesty!

⇒ Establish which ones seem to open up the debate and which seem to close things down

Moderator 3:


Summary

Close and thank

Set up

⇒ Incentives

⇒ Signature sheets


3.3 Discussion Guide: Interactive Galleries (Phase 3)

DISCUSSION GUIDE: SEXUAL DEPTH INTERVIEWS – GIRLS

GALLERY v4

8 gallery installations

1)

Weigh it up:

consequences considering the balance between sexual health behaviours and negative

2) behaviours

3) networks are understood and motivating

4)

5)

6)

7)

8)

Plus for specific focus when moving through the boy’s gallery:

7)

Slagshag:

hijacking current terminology to establish levels of sexual and social attitudes and

Six Degrees of Separation:

Beauty Parlour:

Bootylicious:

Solidarity:

Montage:

A piece of me

exploring the extent to which sexual transmission and establishing the relationship between sexual health and whole body health

Reclaim the words:

exploring current roots of ‘empowerment’ in healthy sexual behaviour

Female sexual imagery exploring possible support networks and messages for sexual health short video clips of some of the work created at conference by the females

: looking at the presentation of the female body as a sexual instrument

Introduction

•

Moderator

-

Moderator to introduce self, explain the process of market research to respondents and the format of the interview/discussion

•

Inform

-

Explain topic of discussion is around an art gallery and particular pieces of art that they will be taken around and asked some questions about. Explain the need for recording and

f

.

1) Weigh it up: considering the balance between sexual health behaviours and negative

To allow us to understand respondent’s verbal toolkit for discussing sexual health, normalising emotional discussion and warm up.

Leave space for spontaneous responses and mirror respondents initial comments back to them


Then ask

•

Who drew this?

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−

−

Where were they?

What do you think they are drawing about? Why are they?

Anything in here which is relevant to you/could be in a picture you might draw?

What/why?

− What’s definitely not in your version?

Looking at the picture –on the top – compared to the bottom

• What can you see? Why are these on one side of the line or the other?

• What’s this art trying to balance out?

• Does this make sense? Could you imagine someone thinking about the subject like this?

• What subject are they thinking about?

• Would they be thinking out loud about it? With whom? Or to themselves?

• What about with a partner? Could you use talk to a boy about these kinds of things? What about sexual health? What about getting pregnant?

• What words could you use? Any words that would cause you a problem? Any words that would be too embarrassing to say with a boy?

• What about with friends? Mother? Teachers etc? what’s that experience like of talking to them about these things?

Show Comments Card G1: “It’s obviously easier to use a condom when you are having sex so that you don’t get all the negatives of worrying am I pregnant or did I catch something…but then when you are having sex, you sometimes forget”

• What do you think about what this person is saying? Do you have any sympathy for them?

• Why is there a difference between what you know you should do and what we sometimes do in real life?

• What about having to hide things from people? How does that have an effect?

• Where does this fit into life generally? What else does it make you think about?

• What other groups in society have to hide things from people – how do they cope with that?

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Gay Pride? Bare-knuckle fighters?? Where do they get help and support and information?

How could you make those kinds of things relate to sexual health and sex for girls?

• STIs, condoms, pregnancy, safe sex: do you ever talk about these things? Who with? When?

What do you say?

• How do you talk about sex and sexual health with your partner? Sexual health in particular: is either set of words more sexual health than sex? Or more sex than sexual health?

• How do you discuss putting on condoms, starting to have sex, getting STI tested, asking about STIs, etc, etc

• How do other people that you know discuss sex and sexual health?

• People need to talk more about sexual health and feel comfortable doing that: how do you think that could happen? How do you think we could help? What actual things could you do to help people know what words are suitable and help them feel comfortable talking?


Probe fully on any suggested Interventions/Initiatives or new ideas – list.

Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

2)

Slagshag:

hijacking current terminology to establish levels of sexual and social attitudes and behaviours

• What’s going on in this picture? Why is the word slag in there? What does it mean? What is it saying about him? What is it saying about her? Which one of them is using the word?

Or is it someone else? Her friends? You?

• Probe fully.

• The person who did this, meant the slagshag was when a condom isn’t used – some people also call that bareback. What’s good about ‘bareback’, is it a better way of having sex? Is it more important than having ‘healthy sex’? What does ‘healthy sex’ mean?

Show comments card G2: “If you have sex without a condom then you’ll end up dirty. It’ll get into your blood. You are going to catch something and you’ll be the slag giving it to everyone else. Slagshagging is letting him put it in without getting him to put one on!”

• What do you think about that? Which bits work most powerfully for you? Probe component parts of statement

• Any you don’t agree with?

• What do you think of this idea of slagshagging? Is it something quite common? Is it something lots of people do? What’s OK about it? What’s not OK? Would you want to be thought of as slagshag girl?

• Why? Why not?

• What difference would it make to you and how you think about yourself now? In the future?

When you are married or you have kids? I was a slagshag when I was younger?

• Is this like anything else in life? What? How important is it generally? Can it be counterbalanced, how? What’s the ideal, how would you prefer to be seen?

• What if a boy was a slagshag boy? Could he be? How? How would that make you feel about him? Would it make you think differently about sleeping with him? Really? How would it be easier to say yes or no to using a condom with him? Or sleeping with him at all?

• Can a boy be a slagshag boy ? Can a boy be a ‘ slag’ ? Or a ‘ slut’ ? What would you call a boy sleeps with lots of girls but won’t use condoms? Would that be negative or not really? What about stud , is that a male slag? How positive or negative is it?

Other girls we have interviewed across this project have come up with quite a few


words or terms that they think apply to male ‘slags’

: G igolo? Male whore?

What do you know about this term? How would it make boys feel to be called this? What about other people? Someone who does sleep with a lot of girls - do you think he would care about any of these? Who might?

• What about cruiserboy ? Cottager ? What do you know about these terms? In what way do they/can they apply to male slags? Does it matter that gay men who are sleep with lots of other men are also called ’sluts’, cruiserboys or cottagers? In the gay community, a male slag is also someone who’s ‘very rent’ - how do you think boys would react to being called this? How would you feel about it? What do you think boys would least like to be called, why? What about someone you know who does sleep around a lot, what label do you think they would be most concerned about? Why? Do you think terms like these would make you/them/others rethink some of their choices/behaviour?

• How do you think people could talk about consequences or negative things like this in order to encourage people to take more sexual healthy choices? Does it make the subject sound depressing? What else could they do? Have a walk of shame for the worst male slag and female slag?

• Is that you? Who is it? How do you know?

• What about the boys? They say they would really do whatever the girl told them they had to do – they just want sex. Is that likely to be true? If you knew that, what would you say to them? Do you prefer it without condoms? Why? Probe fully – convenience, not having to talk about it, not having to negotiate, sensation… How could you change things if you had to? What would you say – who would be a good spokesperson for this?

Who else? What else?


Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

•

3. Six Degrees of Separation: exploring the extent to which sexual transmission and networks are understood and motivating

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•

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What’s going on in this art? What do you think about it?

Any thoughts about that as an idea – if you had to draw your own sexual map, would you be able to do it? How do you calculate your risk?

What’s good about this idea? What’s bad about it? Imagine that you had to draw up your sexual map – say there’s a website and you have to put your information in – how would that make you feel? Would you want to be able to see what other people are connected to you?

How close say, someone that you really don’t like is to you?

Thinking about sexual health – would there be anyone you k enough about them? Or your partners? Or your social circle? now that you would think you would really rather NOT be connected to? Could you make the connection? Do you know


•

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So why would you NOT want to be connected to this person – what are they doing that makes you worried? DO you never do that? What else are they doing? What do you do instead? Why are your choices different?

If that was you at A and you were starting to think of the links, where would you get to before you thought maybe I should get tested?

What makes you choose different things to other people? When do you choose similar things?

Alcohol? Drugs (which – probe cocaine and ecstasy)? Links? Bad boys? Bareback?

Forgetting? Etc, etc

What could be done to get this girl to take better sexual health choices? Frighten her? Shame her? Make it free? Make it more accessible?

If you ended up with an STI, how would you feel? Why? Who would you tell/what w ould you do?

Which STIs would you be more worried about, why those? Probe if necessary on Chlamydia and risk of infertility – is this something they likely is it/is it a real risk?

think about? Do they care about this? How


Wo uld this be a good topic s for a ‘workshop’ session or learning/training ession? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do dividually/very small groups/friends? Who would run it – young people in or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

4) Beauty Parlour: establishing the relationship between sexual health and wh ole body health

•

•

Who do you think did this one? W hy? What else would you say they are like?

• What is the image? And this one? What are they trying to say?

Why are they talking about nails and hair and massage and makeup etc?

• Why would that be good to have them altogether? Where would this be? Wha t would it be like? Who would pay for it? Who could sponsor it? What else would be there (relationship counselling, dieting, stopping smo else? Who would it be for? All women? – you and your mother going to t same place? Just 18-30s. Or young teens? king?) What he

• Show card G3: “They ‘d have it all under one roof and then you could go in an noone kno ws whether you are there for a blow dry or a blow job class ”

• What do they mean a blowjob class? Could you imagine that happening?

Would that be useful? What do you need to learn in order to be sexually healthy? Where do you learn it? What is the effect iveness of that teaching?

• This kind of service could be anywhere (in a house, shop, mobile/bus) – where would it be best?


• What else could be done to help young people be more sexually healthy an make choices about sex that they don’t regret? What was your worst sexu al d choice? Anything worse than that? REASSURE ON CONFIDENTIALITY .

Why do you think you were in that position? What could have been done what do you wish you ha

– d known – that would have changed that situation for you? Where is the best support and advice coming from in terms of tone? In terms of accurate information? In terms of practical usefulness?

• What could be other ways to go about getting tested? Applying online and sending by post? Going to the pharmacy? Going to the GP?

• What if there was a clinic at the GP that wasn’t just about sex, but you could go to it to sort out anything to do with sex? What could/should go with it to make it easy to go to?

Pro be fully on any suggested Interventions/Initiatives or ne w ideas – list.

Wo uld this be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it n eed to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people o r adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

5)


exploring current roots of ‘empowerment’ in healthy sexual behaviou r

• Who do you think did this? What’s it about?

•

•

Is this something that happens often?

What do you know about this scenario? Have you ever been in it? Anyone you know been in it?

•

Show card G4: “They call you a slag so you feel bad about yourself for having sex. So you don’t tell anyone…and you d and then you find the boys can f on’t get the information you need, orce you into doing worser things because once you’ve got a name for yourself it’s like, what’s the point?”

•

Calling women slags to insult them is never going to stop – realistically – do you think?

Have you ever been called a slag – even in joke? How did it feel? Sexy Looking And

Gorgeous…is that something that you could see yourself talking about – does it fit with ho you see yourself when someone calls you a slag? What does it do to your conf idence? w

•

•

•

If you responded to someone like this person is, what would be their response? Would tha t be good/a problem? Why? What would you be pleased with/worried about?

How are confidence and good sexual health choices related? Who is the most confident person you know about themselves – and their sexual health? What do they say and do that helps make them like that?

What’s the ideal for you?


•

Are things getting worse or better? More people getting drunk, more accidental pregnancies, more STIs. What do you think they can do about this, realistically, if you can’t stop it happening?

• Who could help you? Who would you like to help you? What sorts of promotions, events products would help keep women’s confidence in themselves high – and so impact on their good sexual health?


Wo uld this be a goo s d topic for a ‘workshop’ session or learning/training ession? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do dividually/very small groups/friends? Who would run it – young people in or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

6) Bootylicious: Female sexual imagery

•

•

•

What do you think of these images? What do you think boys think of them?

How do they relate to sex and sexual health for boys? And for girls?

Which if these wome n is making the most positive sexual health choic es? What choices is she making? What sorts of things does she do to keep sexual health on her terms?

• Show card G5: “I would never go to the pharmacy and buy c ondoms in my school uniform. I wouldn’t even go and get the morning after pill, even if I needed it. You can’t. they look at you like – you shouldn’t be doing thing, dirty little girl” this sort of

•

•

•

•

The girl who made this art was trying to say that she finds it very intimidating with all th ese pictures like this – and she doesn’t see anyone in her position trying to deal with the things she’s dealing with. How d o you feel about what she says?

What do other people think about younger people being sexually active – whether that’s just snogging or playing – or actually having sex? Why do you think older people are so against it? Why do you think a young person should feel like there’s nowhere for them?

Do you feel supported? Where do you go for your support?

How could things be improved?

How could information, products, services be improved? Probe for Ideas

Who sets a good example? Who gives good advice? Who could do a better job? What about

Mums, how much do they help? What do they help with? What are they not so g when do they actually make it harder? ood at?

•

Pro

Who else could be a role model, someone to set up good rules for girls to follo w? Why them?

What would boys think of them? be fully on any suggested Inter ventions/Initiatives or new ideas – list.

Wo s uld this be a good topic for a ‘workshop’ session or learning/training ession? Why? What would you specifically hope to get out of it? Would it


need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

7) Solidarity: exploring possible support networks and messages for sexual he alth

•

•

•

•

•

•

Which if these women is making the most positive sexual health choices? What choices is she making? What sorts of things does she do to keep sexual health on her terms?

Many women say they will not carry condoms or have anything to do with sexual health in case they are seen as desperate or big headed. Could you understand why they say this?

Would you share that feeling or reject it?

Some people have said, if all girls carried condoms, then they’d also be looking a bout for their mates? Is that true? Why? Could you buy into that? What would stop this happening? want Many boys say they won’t carry condoms because they have nowhere to put them – they girls to carry them. If you knew that, woul d you be more confident carrying them?

To make sure there was a condom in every girls pocket, all the time, where and when would condoms be available?

What other innovations and ideas are there for making condoms more visible? Less visible?

Compulsory?

Pro be fully on any suggested In terventions/Initiatives or new ideas – list.

Wo uld this be a good topic for a ‘workshop’ session or learning/training ession? Why? What would you specifically hope to get out of it? Would it s need to be a bunch of boys or girls (or both)? Or would it better to do in dividually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

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8. MONTAGE

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What did you hear about that? What stuck in your mind?

What was interesting? What shocking?

Anything you di sagree with? Which art seemed to make most sense to you – or told you something true that you haven’t thought about before?

Could you see any ways of making any of what they were talk ier? ing about into things that can be done to make sexual health choices eas

Anything you want to add? About boys and sex? About boys and sexual health?

How do you think the boys pictures will differ from the

If you had to talk to a male friend of yours today about sexual health, what would you say?

If you had to talk to a female friend about sex

girls? More of what? Less of what? ual health, what would you say?

What difference does it make hearing about these things and talking about them?


Probe fully on any suggestion Interventions/Initiatives or new ideas - list

STICKERS

− RED: which pieces are closest to their own experience

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BLUE: which pieces are most informative about sexual health an d accidental pregnancy

YE LLOW: which pieces are the most appealing, and make them want to find out more information about sexual health and accidental pregnancy

GREEN: which piece s are most influential; i.e., which would be most persuasive in making them think about the subjects of sexual health and accidental pregnancy

G LLERY NEXT

Take thro ugh artworks briefly but probe specifically on:

7)

A piece of me

: looking at the presentation of the female body as a sexual instrument.

• Who do you think did this? What’s it about? Talk me through all the images and what they are/mean?

•

•

•

•

What do you feel when you see these images? What does it make you think of? Who do you think of?

Does it make you laugh/is it funny? In what ways?

Where do these th ings not apply? To who? Why?

Why’s all this OK for boys/men? Why’s it OK for girls/women too?

• If you or yo ur mates think of an encounter in these terms is it good? Bad? Neither? Why?

• Does it make you think about sexual health in any w

Pregnancy? Are condoms relevant when you’re havi ay? Using condoms? STIs? ng this kind of sex? Why/why not?

• Do these images make you think about being more choosy about sex? H ow exactly (just choice of person or using protection)? Why?

• If you feel you’re in this kind of situation, is there anything you regret? At what po int could you have changed what was happening/made a different decision/got a different outcome?

• What does it make you think about men? In these situations, what’s happening with girls/women and condoms? What’s said? W

(to make sure a condom is used)? hat’s not? How could they be more persuasive

Probe fully on any suggested Interventions/Initiatives or new ideas – li st.

Wo uld this be a good topic for a ‘workshop’ session or learning/training es sion? Why? What would yo u specifically hope to get out of it? Would it s need to be a bunch of boys or girls (or both)? Or would it better to do in dividually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?


THEN DIARY ROOM QS

1) how do you feel about today and discussing sexual health?

2) What was most interesting of all the artworks for you and why?

3) What’s your best idea fo

4) Last question, a bit of an aside: what would you do as your ideal career or job?

Why? r what they could do to make sexual health easier?

EXIT & THANKS

Thanks and close


DISCUSSION GUIDE: SEXUAL DEPTH INTERVIEWS – BOYS

GALLERY v4

8 gallery installations

1)

2)

3)

4)

Whore or Heaven:

vocabulary

Condomania:

in more widespread locations

The Dick Doc:

testing and anonymity

Chained:

improved sexual health

5)

6)

7)

8)

exploring the possible avenues by which condoms could be accessed discreetly examining the power of unexpected fatherhood as a consequence and motivator to

The main gun:

Hammered:

A piece of me


bridging the divide between current ‘harder’ and ‘every day’ sexual

exploring the question of alcohol, social pressure, convenient sexual health

exploring fear of humiliation and ridicule in condom usage

microscoping the effect of alcohol and drugs on sexual health behaviours.

: looking at the presentation of the female body as a sexual instrument

f

exploring current roots of ‘empowerment’ in healthy sexual behaviour

Bootylicious:

Female sexual imagery

the males

Plus for specific focus when moving through the girls’ gallery:

2) behaviours

5)

6)

Slagshag:

hijacking current terminology to establish levels of sexual and social attitudes and

Introduction

•

Moderator

-

Moderator to introduce self, explain the process of market research to respondents and the format of the interview/discussion

•

Inform

-

Explain topic of discussion is around an art gallery and particular pieces of art that they will be taken around and asked some questions about. Explain the need for recording and

f

.

1)

Whore or Heaven:

bridging the divide between current ‘harder’ and ‘every day’ sexual vocabulary

To allow us to understand respondent’s verbal toolkit for discussing sexual health, normalising emotional discussion and warm up.

Leave space for spontaneous responses and mirror respondents initial comments back to them


Then ask:

•

Who drew this?

• Where were they?

• What do you think they are drawing about? Why are they?

• Anything in here which is relevant to you/could be in a picture you might draw?

What/why?

• What’s definitely not in your version?

Looking at the picture – the words on the left – compared to the words on the right:

• What can you see? Why are the on one side of the line or the other?

• Who could you say these words to? Who couldn’t you say them to?

• Which do you use?

• Who do you most use these words with?

• What about with a partner? Could you use these words when you are talking to them?

• What words could you use? Any words that would cause you a problem? What would happen?

Show Comments Card B1: “It’s hard to talk about sex and sexual health –

FUCK is what you mean. You mean you want to do that, but if I said

“Wanna fuck?” to my girlfriend, she’d get the hump and then you won’t get any”

• What do you think about what this person is saying about the words he can use? Is that familiar to you? Are there any of these words that your partner might be offended by if you said them? Any that you’d be offended by if someone else said them to you?

• What about if they were said by someone you knew really well – does that change what is allowed?

• What about in films, movies, magazines? Any of these words more likely? Less likely?

• Thinking about sexual health – taking care so that you have sex you don’t regret – what do you know about that in general?

• What words fit with that? What words don’t? Why not?

Show Comments Card B2: “Sexual Health – I know you are supposed to have safe sex, but how are you supposed to bring up that conversation.

Excuse me, have you got the clap? I hate talking about it. I just get on and do it.”

• STIs, condoms, pregnancy, safe sex: do you ever talk about these things? Who with? When?

What do you say?


• How do you talk about sex and sexual health with your partner? Sexual health in particular: is either set of words more sexual health than sex? Or more sex than sexual health?

• How do you discuss putting on condoms, starting to have sex, getting STI tested, asking about STIs, etc etc

• How do other people that you know discuss sex and sexual health?

• People need to talk more about sexual health and feel comfortable doing that: how do you think that could happen? How do you think we could help? What actual things could you do to help people know what words are suitable and help them feel comfortable talking?

− Probe fully on any suggested

Interventions/Initiatives or new ideas – list.

− Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

2)

Condomania:

exploring the possible avenues by which condoms can be accessed discreetly in more widespread locations?

• Looking at these scenes, what do you see? What else?

• What’s going on in this art? Why is the person making this? What are they trying to say?

• How do you feel about it? What does it make you think of?

• Does it look normal? Does it look weird? Do you like this art?

• What tone does it have? Is it funny? Bit odd? Boring? Why?

• Where have you seen condoms offered?

• Where else? Where do you get yours? Do you use them? Ever? Often? Sometimes? Depends?

Show Comments Card B3: “I don’t mind using condoms. But you never have them when you want them. It would be brilliant if you could get them in your packet of cereal – COCO POPS with added CONDOMS”

• What about the person who said that – condoms in coco pops? What do you think about that? Why? Who would like that? Who wouldn’t like that? How could you get round that?

• When do you need a condom? When else? When was the last time you used a condom?

Why? Do you like using them? How do they change the experience?

• Where would you have them? Where would it be ideal to have a condom? Where else?

Where else?


• What about people who are drunk? Where would you have condoms that they might want to use?

• When you haven’t used a condom and you think back to where having access to them would have really made you pick one up, where would that be?

• Of all these places we’ve just discussed, where is it OK to pay? How? How much? Where would it be essential that is was free?

• Condoms are free to everyone from different clinics and the doctor, there are lots of different sorts in the shops and they can be bought really cheaply online. Why are they difficult to have/get hold of then?

• How do you get yours? Why don’t you get them from any of the other places (as relevant)?

• When and how do you decide to take condoms out/carry or decide not to carry a condom?

Why?

• How would you remind people to think about their sexual health and to take advantage of the protection of a condom?

• Why is a condom more linked to sexual health than the pill? Or a Femidom?

• What makes people not use condoms or want to move on from them?

• Who uses condoms? Who doesn’t? Who else doesn’t?

• How does that connect with your sense of yourself? Are you more like one of those groups or another? What do you really think of condom wearing? Is it you? Why? Why not?

• How could they make it more you? More your friends kind of thing to do? What about the girls?



− Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

3) The Dick Doc:

exploring the question of alcohol, social pressure, convenient sexual health testing and anonymity

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•

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What’s going on in this art? What do you think about it?

Any thoughts about that as an idea – it’s something someone came up with because he said blokes can’t be bothered to go to the clinic to be tested for stuff – Any thoughts on whether it would work?

What’s good about this idea? Imagine someone didn’t want it to happen – what would you say to defend it? What about if you didn’t want it to happen – what would you say to make sure it doesn’t get permission to happen?


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What if you were at the pub and the word went out that the Dick Doc had arrived outside – would you have a quick run through the clinic and back to your pint? How would you feel?

What about standing there with other blokes in the queue? Would that be ok? Why/why not?

How would you get your results – if they had to go away to a lab for testing? By text? By post? By meeting back up again the week after? Through your GP?

How would you feel about that?

What would the girls think? Would it put people off you?

If the result was positive, how would it make you feel? Would it make you change and start using condoms, or would you not bother? Why?

How else could you make it easier for people to g et sexual health testing? Where else could it be? Here’s some other suggestions (from the INTERVENTIONS LIST – including

SEX HAVEN and PINT OF PEE, PLEASE)…which of these sounds best? Wh y?

What works for you?

What doesn’t work for you?

What do these mobile clinics r emind you of? Could they be combined with other services – mobile barbers? Dentist? Blood donating? Opticians?

Boots operate a ‘Health Bus’ to help people ‘just change one thing’ like smoking, diet, etc? could that kind of thing help? How specifically?

Would they have to be outside the pub? Anywhere better?

Where do you get big crowds of men? Where else? What abo ut in the highstreet on a

Saturday night – or outside the kebab shop? Football grounds? Marathon?

Any other ideas that you would have for making the STI testing process better – have you ever been to a clinic and know what’s inside? Which bits are best – which bits are worse?

What should they do to make the subject more sensible and less stressful for people? What else they could do that would be really funny and cool? How could they make it worse?

What about sponsorship? Any good people who would sponsor sexual health clinics? Make them more cool? More relaxed?

If pubs aren’t the place for these, what else could be done about pubs/bars? Why would that be good?

Why are any of these suggestions better than what’s on offer currently? What’s wrong with current se rvices? Why are they good/no good for men/boys? What should change?

What do you think about GPs? Would you go there for testing? Or for getting condoms?

What would need to change about the way you did this at the GP for you to go? W was mixed up in a single clinic with other issues (like smoking) – would this really make easier? How? What else should be included? hat if it it

− Probe fully on any

I

suggested nterventions/Initiatives or new ideas – list.

− Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What wou ld you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing


to say about it to entice you to take part? How would they let you know about it (channels)?

4)

Chained:

examining the power of unexpected fatherhood as a consequence and motivator to improved sexual health

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What do you see?

Who did this pictu re?

Anything you like abou t it? What are the downsides to this feeling/image?

Anything you recognise? What’s the message in this? Why did the artist use t hat image?

And that one?

How is that related to sex and sexual health?

Is this a common way of thinking about it – would lots of people understand what he’s getting at?

What is it saying about accidental pregnancy? Or STIs? How different are they from ea

? ch other? Why

Have you ever discussed this with anyone else – the fact that you can’t tell who has an STI?

Do you think you can tell? Does this remind you of any advertising or anything you’ve seen on TV or in magazines recently?

What about pregnancy and being chained – what do they mean? Is it true?

Tell me about that? Do you think model? Would you use a condom?

people take notice – would it stop you sleeping with the

What else could they do to make the message heard more – to make people stop and think about sexual health even when they are drunk?

What else? What else?

− Probe fully on any su ggested


− Would this be a good topic for a ‘workshop’ session or learning/training session? Why?

Would this be a good topic for a ‘workshop’ session or learning/tr aining session?

Why? What would you specifically hope to ge out of it? Would it need to be a bunch of boys or girls

(or both)? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to t take part? How would they let you know about it

(channels)?

5)

The main gun:

exploring fear of humiliation and ridicule in condom usage

• Who do you think did this one? Why? What else would you say they are lik e?

• What is the image? And this one? What are they trying to say?

• Why are they talking about putting condoms on with an applicator?


• Why would that be good?

Show card B5: “It’s lik to open it and then yo e, dark, and you’re saying where is it, and then you have u put the light on, it’s on the wrong way round and you end up looking like a prick. Embarrassing and it ruins the moment”

• Is it really an issue – putting the condom on? Does it really make people not wan t to use them? Is there anything else that is as embarrassing as that? Or more embarrassing?

• What could they do – seriously, an applicator? Would people just feel even more embarrassed?

• Could you see them making something like this? Really and you using it?

• Would it make you more or less likely to use it if you knew that putting it on was really really easy?

• What would help everyone make it easier to use condoms – to always get it right and putti it on be probl em free?

• How would you want to find out about this? What would be the best place to learn? Who

should pass on this info ? When? What age?

Do people talk when they are putting o n a condom? Or thinking about it?

What do they say? What’s easy/difficult about that convers it be easier? How could that happen/who could help? ng ation? How could

• Is it only condoms that make up sexual healthy choices – what el

(Probe for good oral sex protocol, outercourse, double dutch) se is sexual health about?

• Who would promote these kinds of message – any particular organisation? Any company?

Any others?

• How would you promote these choices? How do people promote other things – like cheese or gigs or credit ca rds? Could you do that? Or anything like it?


I nterventions/Initiatives or new ideas – list.

− Would this be a good topic for a ‘workshop’ session ld you or learning/training session? Why? What wou specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?


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6)

Hammered:

microscoping the effect of alcohol and drugs on sexual health behaviours.

Who do you think did this? What’s it about?

Is this something that happens often?

What do you know about this scenario? Have y ou ever been in it? Anyone you know been in it?

Drinking alcohol is never going to stop – realistically – do you think? What about having sex w ithout condoms, is that going to stop?

Is it getting worse or better? (drinking, accidental pregnancies, STIs?) nd may have sex with someone, why don’t they em? What could

If people know they are going to get drunk a just make sure they have a condom in their pocket? What’s stopping th change this?

What about drugs, is the same as alcohol or different in any way? How? Explore spontaneou sly then probe as appropriate re cocaine and ecstasy

What do you think they can do about this, realistically, if you can’t stop it happenin

Do you have any personal worries for yourself when you might get drunk and situation? Do your friends share your worries? Why? Why not? g?

get into this

Who could help you? Who would you like to help you?

Do you protect other people? Is there anyone who protects you? Wh compulsory to be tested? Have sex police??!!! Anything a

Anything else? Condoms in pubs? at could they do? Make it t all that you could think of?

What else can’t you stop people doing? How do they make the risks smaller? What cou ng for sexual health? ld you do that would be the same sort of thi

How much of a difference do these consequences make? Why? Specifically - what about getting an STI? What about pregnancy?

Who would know? What would they say? How would you feel about that?

Which STIs would you be more wo and risk of infertility – is this something they think about? Do they care ab likely is it/is it a real risk? rried about, why those? Probe if necessary on Chlamydia out this? How

− Prob

I e fully on any suggested nterventions/Initiatives or new ideas – list.

− Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What wou ld you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?


7)

A piece of me

: looking at the presentation of the female body as a sexual instrument.

• Who do you think did this? What’s it about? Talk me through all the images and what they are/mean?

• What do you feel when you see these images? What does it make you think of? Who do yo u

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• think of?

Does it make you laugh/is it funny? In what ways?

Where do t hese things not apply? To who? Why?

Why’s all this OK for boys/men? Why’s it OK for gi rls/women too?

• How does this fit with your experience?

• If you or your mates think of an encounter in these terms is it good? Ba d? Neither? Why?

• Does it make you think about sexual he alth in any way? Using condoms? STIs?

Pregnancy? Are condoms relevant when you’re having this kind of sex? Why/why not?

• Do these images make you think about being more choosy about sex? How exactly (just choice of person or using protection)? Why?

• How does it make you think about girls/women? Do they mind these things? In these situations, what’s happening with girls/women and condoms? What’s said? What’s not?

How could they be more persuasive (to make sure a condom is used)?



− Would this be a good topic for a ‘workshop’ session or learning/training session? Why? What wou ld you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

8.

Montage

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What did y ou hear about that? What stuck in your mind?

What was interesting? What shocking?

Anything you disagree with? Which art seemed to make mos t sense to you – or told you something true that you haven’t thought a bout before?

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Could you see any ways of making any of what they were talking about into things that ca n be done to make sexual health choices easier?

Anything you want to add? About boys and sex? About boys and sexual health?

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How do you think the boys pictures will differ from the girls? More of what? Less of what? you say? If you had to talk to a male friend of yours today about sexual health, what would

If you had to talk to a female friend about sexual health, what would you say?

What difference does it make hearing about these things and talking about them?

STICKERS


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RED: which pieces are closest to their own experience

BLUE: which pieces are most informative about sexual health and acciden tal pregnancy

YELLOW: which pieces are the most appealing, and m ake them want to find out more information about sexual health and accidental pregnancy

− GREEN: which pieces are most influential; i.e., which would be most persuasive in making them think about the subjects of sexual health and accidental p regnancy

G IRLS GALLERY NEXT

T ake through artworks briefly but probe specifically on:

1 )

Slagshag:

behaviours hijacking current terminology to establish levels of sexual and social attitudes and

• thought of as slagshag boy/m

• Why? Why not?

What difference would it make to you and how you think about yourself now? In the future?

When you are married or you have

• Is this like anythin g else in life? What? How important is it generally? Can it be counter-

• balanced, how? What’s the ideal, how would you prefer to be seen?

Can a boy be a slagshag boy

kids? ‘I was a slagshag when I was younger?’

? Can a boy be a ‘ slag’ ? Or a ‘ slut’ ? What wo uld you call a boy sleeps with lots of girls but won’t use condoms? Would that be negative or not


really? What about stud , is that a male slag? How positive or negative is it?

The girls we have interviewed across this project have come up with quite a few words or terms that they think apply to male ‘slags’

: G igolo? Male whore?

What do you know about this term? How would it make you feel to be called this? What about other people? someone who does sleep with a lot of girls - do you think he would care about any of these? Who might?

• W hat about cruiserboy ? Cottager ? What do you know about these terms? In what way do they/can they apply to male slags? Does it matter that gay men who are sleep with lots of other men are also called ’sluts’, cruiserboys or cottagers? In the gay community, a ry rent’ - how do you think men would react to being male slag is also someone who’s ‘ve called this? How would you feel about it? What would you least like to be called, why?

What about someone you know who does sleep around a lot, what label do you think they would be most concerned about? Why? Do you think terms like these would make you/them/others rethink some of their choices/behaviour?



− Would this be a good topic f or a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would i t better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

2)


behaviour exploring current roots of ‘empowerment’ in healthy sexual

• Who do you think did this? What’s it about?

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If a boy calls a girl a slag and she responds like this, what will the boy do/say/ why? What would you do/say/why?

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What will the girl do/say after that?

The girls who did this think boys bully girls into sex by calling them names - and lots of other girls in the group agreed with them. Is that true? Sometimes – when? at? Does it matter who the person is? In what way – How does it make you feel to know th who matters/who doesn’t? why?


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Would th o is be a good topic for a ‘workshop’ session r learning/training session? Why? What would you


specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

3)

Bootylicious:

Female Sexual Imagery

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Who do you think did this? What’s it about?

What do you think of these images? Boys often love these – tell us all the reasons why?

Wh t is it about these women that girls s hould try and follow? Why are they good role models? Is there any way in which they are not so good? What should girls do differently, if anything?

What do you think girls think of them? Why? What do you think about the way girls a re thinking? Do they present a problem for girls in any way?

How do these images relate to sex and sexual health for boys? And for girls?

The girl who made this art was trying to say that she finds it very intimidating with all these pictures like this – and she doesn’t see anyone in her positio she’s dealing with. How do you feel about what she says? n trying to deal with the things

Who else do you know who sets a good example? What is it about them that makes it work well?

Who gives good advice? Who could do a better job? What about Mums, how much do they help? What do they help with? What are they not so good at? When do they actually make it harder?

Who else could be a role model, someone to set up good rules for boys to follow? Why them?

What would girls think of them?



− Would th is be a good topic for a ‘workshop’ session or learning/training session? Why? What would you specifically hope to get out of it? Would it need to be a bunch of boys or girls (or both)? Or would it better to do individually/very small groups/friends? Who would run it – young people or adults? What type of person would be ideal?? What would be a good thing to say about it to entice you to take part? How would they let you know about it (channels)?

THEN DIARY ROO M QS

2) how do you feel abo ut today and discussing sexual health?

3) What was most interesting of all the artworks for you and why?

4) What’s your best idea for wh at they could do to make sexual health easier?


5) Last question, a bit of an aside: what would you do as your ideal career or job? Why?

EX IT & THANKS

− Thanks and close

* * * * *


Appendix 4. Response to Gallery Artworks

4.1 Introduction and Overview

In the Conference stage of the research 60 , respondents were tasked with

generating artwork that reflected their experiences and issues. They were also asked to design ‘inventions’ that would allow them to have condoms to hand at the right time (and potentially get them in the right frame of mind to use them).

The discussion between respondents during the creation of the artwork and inventions and their presentation back to the wider research group of was a critical part of the data for this project; it highlighted the rationale behind their creations and gave powerful insights into their thinking and baseline assumptions.

A selection of original respondent artworks and inventions were chosen,

alongside new artworks and inventions that encapsulated key issues 61 , to be

taken forward into the second phase of Galleries. In this phase, a fresh sample of respondents was able to comment on the artworks/ideas and use their critique to inspire consideration of their own views.

While the artworks were presented in dedicated ‘male’ and ‘female’ galleries

(each with their own set of artworks), all respondents had the chance to see

both sets of images.

62

60

See Method and Sample p.10, and Appendix 3.4 for Conference Workshop Discussion Guide

61

But did not express with sufficient clarity in their own output from the conferences

62

It was decided that it would be useful to explore responses to some of the more contentious artworks from the opposite gender to understand whether the presentation of honest ideas from the opposite sex raised any new ideas or considerations. In all cases, the majority of the interview was based around the artwork of the respondents’ own gender, with the last stage of the interview around key pieces in the opposite gender gallery


Responses to each of the artworks put into the Gallery Phase have been detailed in the following sections.

4.2.1 Weighing it up

The speech bubbles of the hand-drawn characters include the following:

Bratz: ‘We’ve all had sex – haven’t you?

Boy: ‘You’re great!’, Girl: ‘Are you sure, I’m a bit worried ….’

Older Adult: ‘‘Disgraceful! Uh children these days! Can’t keep it in their pants!’

This was an original artwork from respondents. The messages hidden under the post–it notes read from left to right:

Left Post-It Right Post-It

My Mum will kill me if she finds contraceptives

How can I get out of having sex?

He’ll dump me!!!

Did I take my pill today?

I was pissed

Where’s the nearest clinic for advice?

Oh my God, what am I doing!

The argument for preventative sexual health weighed against the consequences of not taking precaution was a strong theme running through the Female Conferences. While the decision seems on the surface to be a simple, rational and logical one, there are numerous and sometimes


very specific factors that make it a difficult calculation in real life. These included fear of a mother’s reaction, forgetfulness, drunkenness, lack of sexual health facilities, not knowing what to say, not knowing how to say no, and so on.

The artwork started the female gallery and set the scene for the female experience as it offers a summary of a wide range of female issues in one place. It allowed the respondent to enter directly into the subject matter with a sense that their experience and fears will be understood – because they are not new. In this respect, it significantly aided rapport between researcher and respondent.

Across the females in this sample, this artwork resonated strongly with their personal experiences. The weighing up of different consequences

– emotional, physical, and sometimes social - was something they felt was intrinsic to their own choices, even if not always consciously, for example:

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Parental wrath needing to be managed or avoided: leading to a variety of strategies from trying to bring parents on board through to highly developed strategies for secrecy.

Role of alcohol in encouraging or facilitating poor choices around sexual events and sexual health choices.

My mum would kill me if she found my pills – yes, can recognise that!

Female, 24, BME, South

The message is about consequences. Yes, I think about this too. There are times when it comes up more than others, like if you miss the pill or whatever

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Responses also highlighted several other issues:

That shame and fear are high on their list of behavioural influencers.


Younger girls feel disgraced about going to the clinic…but at the end of the day you choose when you have sex, but no one should judge you for it. You shouldn’t be made to feel mad about going

Female, 16, South

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That the contraceptive pill has a specific role in helping keep the subject of sexual health as ‘unnecessary’ (‘I/you are covered for protection against pregnancy, so there is no need to think further’).

The artwork also prompted indications of misinterpretations between males and females in terms of what they are asking for and why, for example: females thinking that males are always asking for unprotected sex as this is assumed to be always preferable/more pleasing for him.

Lack of awareness of where sexual health services (clinics) are located and can be accessed was also something that many respondents also identified with.

Although created by younger respondents, the level of affiliation of older respondents with the artwork indicated that they are still struggling with many of the issues presented.


4.2.1 Slags

The responses of females in the Creative Conferences strongly followed gender lines – there was initial under-reporting of sexual behaviours and over-claim of sexual health responsibility, especially amongst the younger age groups.

The question of “slags” inevitably arises in any discussion about females and sexual behaviour. It is a much-used term of abuse from girls and boys and was usually directed at females. However, there was limited discrimination based on the responsibility a ‘slag’ might take for her own

(and others’) sexual health.

In that many of the female respondents went to great lengths to avoid being called a ‘slag’, but were also under high pressure to reject condoms as a form of STI protection, this artwork was included firstly to raise the slur so that it could be addressed overtly rather than remaining as a potential judgement. The discussion then aimed to explore whether there is any benefit in adopting or ‘hijacking’ the term in order to undermine the current trend towards glamorising “bareback” sexual activity. Specifically, the question was posed of whether there could there be a new term –

“Slagshag” (to have sex without condoms) that would make the target audience review their behaviour and parameters in a more sexually healthy

(and sex positive) way.

This artwork (a variation of one produced by respondents in the workshops) also challenged the notion that only females are ‘slags’, to explore whether males can occupy the same territory; and to understand whether raising the prospect of ‘men as slags’ has any power or value in reframing sexual health considerations and issues.


In terms of audience response, across the sample there was an immediate assertion that men cannot really be ‘slags’. For respondents, gender rules and expectations around sexual conquest were exposed immediately as being deeply entrenched.

That said, perceptions of ‘slag’ behaviour amongst females varied:

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For some, being a ‘slag’ was having frequent sexual encoun ters for physical pleasure only (i.e. without an emotional connection to the

• sexual partner)

For others, the behaviour was a step further removed from personal association: being a ‘slag’ did not even involve physical pleasure for the self, but simply involved supplying a ‘hole’ or being a receptacle for a male

F or females, there was no specific attachment of ‘slag’ behaviour to nonuse of condom: attention was focused instead on quantity and quality of sexual behaviour.

T his is understandable given the specific association of condoms with other types of sexual behaviour:

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There is recognition that usin g a condom is the ‘right’ thing to do with

• an unknown partner or a partner one is uncommitted to

In contrast, having sex with a single partner they are in a relationship with (normative and ideal behaviour) does not necessitate use of a condom and should be without. The removal of the condom is linked to the seriousness of the emotional commitment.


As a corollary, there is inbuilt (albeit unconscious) res istance to associating th e subject of condoms (the ideal) with ‘slag’ behaviour (what they wish to dissociate from).

The idea of a ‘m ale slag’ developed some resonance amongst the males w hen considered in conjunction with Six Degrees of Separation (see below). The term was easily attached to promiscuous behaviours: many conquests; and possibly the attitude of being less discriminating in the choice of sexual conquest.

4.2.3 Six Degrees of Separa tion

Many of the female respondents talk ed about moving away from condoms o nce “you got to know the other person”. The sexual map of their encounters was rarely mentioned: it was taken almost as a threat to the nature and stability of their relationship to raise it with their partner.

Recognition of the sensitivity of the topic indicated a need to includ e this in some way in the gallery, to understand further the barriers to broaching the subject as well as to establish whether there is value in emphasising this aspect of relationship reality.

The artwork was developed by the research te am from ideas brought to on the ‘wall of risk’ by some respondents in the workshops.

The aerial view of the real territory of a se xual encounter was very resonant with respondents and became increasingly more engaging once decoded. While some hints


were necessary to help respondents’ get started in understanding what they were looking at, the picture fell quickly and easily into place.

The critical paths demonstrated in the artwork were easily understood to h ighlight a multitude of risks: ‘invisibility’, commitment, drug use, pregnancy, germs, social connections, proximity to undesired effects, wisdom of entering into the sexual community versus delaying, benefits of

‘having that conversation’ beforehand or keeping condom till trust is well established.

As such, the artwork was extremely powerful in terms of rebalancing risk a gainst the myth of safety within emotional commitment; and communicates a need to establish, rather than assume, trust. It is also powerful in helping respondents find self-connection: finding a ‘factual’ frame from which to consider their current activity.

We used a condom once [new boyfriend] and then I ju st said I’m on the pill. He didn’t have any condoms until he got one from his friends. I know his friends and so I’m sure he is ok, I know he’s slept with a few girls at uni, and he had a girlfriend before uni, maybe I should have been a bit more careful…he said he used protection but I don’t know who they are…


Furthermore, the factual and non -judgemental tone (the artwork simply m aps out ‘what is’) without making any comment around value or risk was very well received and added to its impact.


Separating sexual health and preparations out from the health and preparation of other parts of the body was touched upon in the Conference Workshops.

Specifically, within the ideas-generation part of the conferences, some respondents considered the idea of a

‘haven’ – somewhere where many different types of services could be brought together under one roof.

Different possible benefits were thought to be that accessing sexual health would be a) less noticeable, for those for whom invisibility was important, and b) more normalising, for those who wanted to reframe their behaviour and experience. As such, an artwork based on one of the respondents’ creations (but with additional images included) presented this idea for further exploration in the Female Gallery.

The idea of a mixed setting combining sexual health services with other target audience needs was widely received as a positive idea. It works specifically through keeping the current status quo, but making sexual health services easier to connect to and factor in. For example, such a service was perceived as:

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• low key, even ‘invisible’ enabling the user to pretend they are doing something else (duplicitous) more available and acceptable

As such, the key benefits are less about empowerment and more about convenience.


There were practical questions about how and where it could work.

Possible locations or outlets suggested included a gym or shop, or a dedicated bus. Beauty treatment venues were specifically difficult since visibility was too high (anonymity not possible) and such places are perceived as ‘hotbeds for gossip’. These are also out of range/not highly used by many of the core target.

Responses showed that the desired mixed service element was less about whole body health (although it was possible to build in through the essential component of professional nurse) and about a more complete

‘disguise’ through a wider offer encompassing varied female retail opportunities (lingerie, jewellery, etc). Within this, it would be important to stay very ‘hair and beauty’/consumer in tone and steer away from aspiration and role models/celebrity. (Too linked with success and money, these break self-connection.)

It was perceived to be more acceptable to ‘healthify’ (by adding health features and services to) a beauty or retail environment than to ‘retailify’

(by adding retail matter and values to) an existing sexual health clinic, dedicated or GP-based. The former is seen as making the facility more available to the masses, whilst the latter is seen as cheapening the quality and thus accuracy of the health advice given.

4.2.5 Frigid (Reclaim the words)

For many female respondents, the creative conferences were a new experience: a chance to discuss sex and sexual health in a totally open, nonjudgemental environment, and where the normal ‘status games’ and tricks of confidentiality were not being played. Indeed, several of the conference delegates asked if they could come back and do more work on the topic.


It was noticeable that as the discussion progressed through the session, and more ‘level playing fields’ were established between the respondents, there was a sense of empowerment and camaraderie.

The females started to knock back some of the insults and one-liners with which they were being targeted.

An artwork was therefore created from a mix of respondents’ own words and components of different artworks to capture this more militant mindset and enable exploration as to whether this could be capitalised on further in some way.

Responses indicated that language empowerment should be delivered as part of the self-connection and self-esteem thread of activity/intervention. While the desire to stand up to both insults and pressure (which comes from both males and females) is in mind for very many females, confidence and ability is very low. Empowerment in the same language as the target is particularly useful for assertion/resistance to feel credible.

There is also a need to help dismantle or correctly define some target language. In particular, ‘frigid’ is vaguely defined as ‘unable to have sex’.

Clearly undesirable, this accusation strongly pressurises many within the target to get rid of their virginity – to prove to themselves primarily that everything works.

Issues arising from the artwork, however, go beyond language. Experience of pressure to have early sex was very widespread and needs to be


addressed head-on, partly through a clear separation of preserved virginity and its unpleasant connections with low sexual attractiveness.

4.2.6 Bootylicious

For this target in particular, the media portrayal of females is at odds with the reality of their experience and appears specifically unhelpful in role modelling or as an information source.

Models offering themselves passively – or in the throes of untamed sexual desire – generally give no indication of when, how and why to broach the subject of condom usage, healthy sexual practice or positive sexual experience. For a sexually active schoolgirl of fifteen, there are few appropriate role models either for sexual behaviour or for sexual responsibility.

And given the cultural notion of believing females are not supposed to be sexual anyway, 63

there is little

desire to access sexual health services – or even emergency contraception – whilst wearing school uniform.

In this respect – and particularly with regard to the prevalence and easy availability of ‘softer pornographic’/men’s magazines

(both these magazines are available in WHSmiths), it was felt important to understand whether – and how – such images impact on sexual health

63

(see Section 3.2.1 “I am not supposed to be sexual”, p.31 for more detail


behaviours. Define created an artwork which combined examples of such magazine covers with suggestions for sexually healthy choices (condom use or the question of whether or not to have sex at all).

Responses demonstrated that certain components of this artwork are very powerful for the female audience. They connected to the idea very strongly

(although if taken forward in any way, images would need to reflect the audience at point of delivery, and a wide range of females

64 ). Specifically, in

principle, this kind of role modelling/messaging was felt to:

• reclaim the female semi-naked body for the female cause and to reunite her with an opinion and a voice

•

•

•

• present females as desirable (not just physically, but also in control) demonstrate both making a choice and leading in the sexual activity indicate that ‘the other’ might be ‘shy’ and that a female lead might be necessary, desirable and acceptable be emulate-able

Without the words, the covers were felt to present females very clearly ‘on a plate’. This particular view of women was considered to be from African and Caribbean men in particular, but not seen as overtly ‘black’: the imagery was felt to have transcended to women in general and be appreciated beyond the source.

That said, Black African Women in the sample reported the highest levels of male non-collaboration. Black Afro-Caribbean males also reported the highest levels of sexual exploration – both themselves and through mixed messages from their partners.

64

The examples in the artwork are specifically ‘hip hop’. Ideally, a range of other aspirational females would be included


This artwork also highlighted, as with Frigid (Reclaim the words) above, that there is a need to assist with language, and provide a credible vocabulary or help in building an accepted language for sexual health discussion, a few examples including:

•

•

‘have you got one’

‘don’t be shy…’

•

•

•

•

‘no glove, no love’

‘wrappin up’

‘getting dressed’ as well as more acceptable (cross-gender) labels for condoms: jimmy hat, jonny, rubber, etc

4.2.6 Female Solidarity (Bratz)

In the Conference Workshops, female respondents talked about the fact that they seldom – if ever – carried condoms. They were partly fearful of the consequences of older adults/males finding out, and partly worried about what their friends would think of them.

Being desperate for sex, expecting sex, or being ‘big-headed’ enough to think someone would fancy you, were all behaviours and attitudes to avoid being accused of. Females felt almost duty-bound to stay firmly in the crowd, endorsing this ‘norm’ message and low-status overall.

To this extent, the concept of solidarity and moral obligation to carry is inverted. One respondent group generated an artwork around the potential for switching the solidarity back to a more positive choice. (As the original artwork was unclear, however, it was reformulated to be easy to understand in the Gallery).


The artwork was well received by females, primarily as a positive improvement to current mentality.

The improvement included embracing the self as a sexual being but within some parameters (choice and control) and with explicit personal value. A positive idea and well-received – a sense of female solidarity and connection is key to maintaining carriage and validating choice

Respondents were also inspired to think how solidarity might be facilitated, with suggestions such as ‘National Condom Day’.

Certain aspects of the artwork (from the written comments) were specifically helpful as reasons to believe and buy into this attitude shift. For example: ‘boy I like’, which signalled sex with emotional commitment

(versus any sex); and ‘because we’re worth it’ reminding to consider role and contribution (self-esteem) within the sexual encounter itself.

There was some low-level respondent connection with a more decorative packaging as depicted in the artwork – condoms covered in ‘smileys’ and colourful stickers. However, interest was less than had been expected following the Phase 1 research. In this, respondents suggested condom repackaging might be the key to solving some of the non-carriage issues. In a wider context, however, this appears not to bear weight. In this example alone, the key differences between ‘inventions’ (that appear to encapsulate solutions) versus ‘interventions’ (that must tap into and reveal the deeper insights) is exemplified.


Respondents in the male groups found a common vocabulary that was, in a sense, fairly strong. This was used in a fairly relaxed manner when talking to other men. However, they struggled to translate concepts into femalefriendly words. Language issues raise two considerations and found it difficult to approach the question of how to discuss sexual health (important for the research process) without a suitable, shared lexicon and how to discuss sexual health with the opposite sex

(important in life).

This artwork was developed from respondent words and phrases already written and spoken during the conferences to show the separation between the two hemispheres of the male challenge – struggling to make sense of sexual health in two different ‘worlds’.

Although this is a potentially difficult topic – moving immediately into sex and body parts – it was specifically placed at the beginning of the gallery in order to set the tone and to establish ground rules. Respondents could understand clearly that any word they might choose to use would be acceptable in that it has already been used by others like themselves. They were given implicit permission to be themselves, and were relieved of the responsibility of ‘impression managing’ a social encounter with the researcher.


The artwork served its purpose in setting the scene and establishing language and rapport. Nor was any offence taken by respondents to the words within the artwork. Most were familiar and none was experienced as

‘too extreme’.

Overall, there was a low emotional connection amongst males with a language ‘problem’ - it was recognised but not clearly not dominant in their considerations.

“If you try to use the words on the right you won’t get through to the younger crowd” .


‘Double edged sword - if you use the words on the left older people will become offended, can’t use the words in a professional sense. ’


There was a higher level of personal connection for females who found this a useful start point from which to discuss ‘the other’, connecting with their awareness of the challenge and sensitivities (again, both confidence and language issues).

Ideas for initiatives and interventions within the conferences were extensive. However, in some cases, a perfectly rational suggestion was undermined by a comment to the effect that ‘but of course, you couldn’t do that, could you?’.

One underlying insight is that condoms need to be available in a variety of locations – such that accessing them will not avoid leaving the (potentially sexual) situation or seeming too obvious. However, the tendency to halt


ideas also suggests that highly-internalised social rules may be ruling out other more inventive ideas and suggestions.

It was decided to explore both issues further by presenting a potential future where condoms are accessible in many different locations; to explore where would be most useful and helpful, and why, specifically, this would be important. The artwork showed a wrapped condom in a variety of different visible locations throughout the city (e.g. in taxis, at bus-stops, in tube stations, with your drink at bars, given free in malls, in Coke vending machines and so on). The snapshots were taken by Define, but locations were chosen from suggestions from respondents in the conferences.

There were some unexpected interpretations of the photographs, indicating the powerful nuances of sexual signalling. The importance

(for the vast majority, but for specific segments in particular) of making a clear declaration of heterosexuality was heard clearly. A naked male torso plus condom, for example, was interpreted firmly as a homosexual invitation – and equally firmly rejected.

In terms of responses, the artwork proved excellent in raising and jogging memories of a sexual health context for males (who overall were not very connected to the problem).


Discussion also clearly illustrated the prevalence of ‘islands of consideration’ for sexual health planning

65 . Pre-planning is not currently

easily considered – only when in a certain mood or shop, or closer to the point of use.

For many within the sample, discussion around the ideal distribution highlighted the importance of face-saving when purchasing/accessing condoms. Presentation of the condom can also be key to acceptance (i.e. packaged or presented in a way that is not overtly sexual). The idea of condoms delivered with pizza, or accessible through McDonalds, encapsulated core needs:

•

Food is not a key component but the food environment is an example

• were delivery/access can be anonymous (face-saving) and easy (highly convenient as something I do/place I go already and for highly acceptable purpose)

Mentality when in these outlets is not sex-based but easy-going and

•

• relaxed (the tone of the ideal experience)

Similarly, as the location is not ‘lewd or sexual’ and will not have any intense/traditional sex imagery it is less stressful

For the same reasons, the emotional ‘space’ described is one that is more easily occupied by females too

This type of intervention also works with existing inertia rather than requiring a step change on the part of the audience.

Three aspects of the Creative Conference discussion and output generated this artwork – which was suggested by a respondent as a possible intervention

65

See Section x, p.xx for more detail


Some male respondents in the group were fairly relaxed about admitting having had a sexually transmitted infection – or a test for one.

Some of the harder target were reportedly more reluctant to attend clinics because they had no current symptoms (rather than because they were fearful of the experience). These males found it difficult to engage with the subject of condom usage and sexual health as long as they had no symptoms.

They were aware of their role as transmitter of STIs but were unconcerned.

The role of alcohol was acknowledged as having a very strong impact on the choices and sexual health decisions made.

The idea was to have a mobile

“dick doctor” – a sexual health clinic in a bus - waiting outside pubs and clubs which would target men at a time and a place when attendance was easy and would have an impact on thinking.

The artwork – a development of the respondents’ original – generated a positive response from the majority.

Again, this idea works with the current inertia. Rather like alcohol reduces inhibition to sex, it was also felt likely to help with reducing inhibition to getting tested.

However, alcohol was not the central benefit or facilitator, the concept of a male-oriented service was in itself is motivating. ‘The Dick Doc’


specifically was felt to raise consideration of the topic in a ‘male friendly’ way (particularly accessing male interest via a more male language, in contrast with ‘The Family Planning Clinic’ which is specifically viewed as

‘female’ or at least ‘married couples where the husband is interested enough to plan a family’). It also implied all men – not ‘just me’ singled out and vulnerable/in danger of ridicule.

It was felt that a similar idea could wrap up male whole body health – and be delivered, for example at a gym, cinema, shopping malls, etc and quite feasibly through a mobile unit. There were some practical questions about how long results would take and how these would be communicated.

Consideration of testing and public venues did raise some specific issues and barriers for some ethnic minority respondents in the sample. Ghanaian males were particularly resistant to the idea of ‘blood testing’. This was connected in their minds with HIV, dirtiness or contamination, and thus strongly roused in them associations with their religious communities – for whom pre-marital sex is sinful, dirty, contaminating and punishable.

4.3.4 Chained

In the Conference Workshops, the negative consequences of not engaging with sexual health were discussed in terms of STIs, but also very fleetingly in terms of being “chained by the ‘dog’”. The fleeting attention, however, appeared to rest mainly in the acknowledgement that the consequence is

‘politically’ sensitive.

However, this misogynistic term caught the attention of several respondents. Furthermore, there was also widespread acknowledgement that whilst they might be able to take control of STIs, pregnancy was largely out of their hands.


Since, most of the males in the sample had had experiences of negative relationships with females, they could imagine the nature of the impact they might be letting themselves in for, should pregnancy arise and be followed through with.

The level of connection with this respondent-generated data suggested that it should be included in the

Gallery for further exploration. The artwork itself is redrawn from respondents’ original but retains all key elements.

Overall, this artwork was very motivating to a wide range of male respondents: reflecting a situation they wished to avoid and prompting reconsideration of behaviour.

It was clear that this dilemma was relatively well-considered. Respondents were aware of significant negative consequences to themselves from lifestyle constraints (time and responsibility for babysitting) to financial burden (CSA) to being locked into an emotional relationship they did not want in some way, simply from being an unwitting biological parent.

Respondents also immediately drew upon a range of ‘evidence’ to establish the truth of the risk, consistently citing the following ‘facts’:

•

•

•

The numbers of teen mums are increasing

Some girls want babies

It only takes one of yours (i.e. sperm)


This was the only artwork with negative male imagery, but this was given much more interest and attention - in terms of more effort to find out what is going on – than the other artworks.

Responses also clearly indicated a hierarchy of importance of different risks for males: with not getting trapped by a sexual partner at the top.

In the Conference Workshops, several male respondents discussed their discomfort with condoms – not only wearing them, but putting them on the wrong way round and at the wrong time.

In terms of ‘mood breaker’, this was a potentially very high risk situation for the males. Even if they had condoms on them and were aware enough to suggest them, this last hurdle (whether the condom would go on or not) was too sensitive to be discussed for long.

A condom applicator was suggested as one way of getting round this

66 .

66

Such an applicator has been designed – and patented worldwide – in South Africa


It was suggested that putting this invention in front of respondents could help to establish how much of an impact simple product design might have on sexual behaviour with different target audiences.

The idea of a condom applicator did resonate with the audience but offered only mild motivation to action. As condom applicators are not currently a British reality, they were deemed hard to judge; increased cost was considered likely to be part of the problem (especially true as condoms are only a minor feature of sexual repertoires currently).

However, the artwork prompted discussion around the current routes to learning and developing condom familiarity – as well as the extent to which these are under-utilised as a means of encouraging early experimentation and familiarity with condoms before the occasion arises:

•

•

“posh wank” use of the model penis in SRE classes

The artwork also worked well to remind females of the vulnerability of the opposite sex. Considering vulnerability help females to self-define and find both a role and control.

Overall, it was felt that there would be some value in addressing this issue in workshops or education, in terms of compulsory engagement plus seeded ‘advice’ about how and why it is important to practice.

4.3.6 Hammered

Many of the Conference artworks were based on a theme of the night before (with several steps to the story) and events thereafter. As such, it was decided to include an example which follows such as story as it


unfolds – getting drunk, sleeping with someone, going to the clinic, and waiting for rest results.

The artwork was useful in terms of offering respondents an aerial perspective on the timeline of events and an opportunity to establish and assess points of risk.

Responses made it clear that this journey is generally not considered beforehand (especially if drunk) but only in hindsight (through playback of ‘what I did’).

It was not clear at what stage it would be possible to intervene, given that pre-planning is not advanced. However, ‘looking backwards from ahead’ was felt to be a potentially useful reminder to have on the back of toilet doors. In line with expectations and positive hopes for the evening, there would be little rejection of the message because it does not involve interruption to plans only the addition of an extra step. Needless to say, the availability of a working condom machine would be important to enable considerations to be followed up.

4.3.7 Mag or Bag?

Comments by some respondents in the Conference Workshops highlighted the gender stereotype of females as passive recipients of male sexual labelling. This artwork was included, as an expression of a respondent description, to present this idea of women as sexual objects to males and understand whether this prompted reassessment in any way (at some levels a male version of Bootylicious – see 4.2.6, p. xx). This was also


a potentially important artwork for the girls through illustrating, at some level, their worst suspicions.

The artwork did not prompt a strong response around sexual health from either gender.

However, it was a useful platform for approaching polysexuality/sexual experimentation and other sexual behaviours. For the first time in the research, respondents moved beyond consideration of ‘missionary position’ sex and started to consider both other options and risks.

As part of this, discussion highlighted:

•

Low awareness about sexual health risks attached to oral sex

•

That anal sex is considered as a contraceptive option without being attached to other sexual health risks and protocol needs re-emphasis

Yeah, well anal sex – you don’t get pregnant so I suppose it’s good for that.”

Male, 16-19, Mids

•

That the female who does not start dialogue about safe sex lacks positive identity (drawn from ‘faceless’ women); indicating that this needs emphasising to girls


•

That masturbation/mutual masturbation and play is currently not recognised as ‘sex’, as seduction and non-penetrative pleasure are not considered real or valid

* * * * *


Appendix 5. Pen Portraits of the Attitudinal Segments

Vulnerable – Unguided

Female – 13 – C2DE suburbs

Shania Taylor

Shania’s just turned 13. She looks a lot older when she goes out. She can get into pubs and clubs if she’s with the older girls from her street.

Her boyfriend is sixteen. She’s been going out with him for three weeks. He lives in the same area and they all hang out in a gang in the precinct.

They slept together a week ago, in one of the older friend’s houses. She told her mum she was staying at Chelsea’s. Chelsea told her mum they were staying at her cousin Jayden’s house. None of the mums check these kinds of thing.

Shania’s boyfriend has got a couple of other girls that he ‘links’ with. They’re all a bit older than her. But he likes her best at the moment. He says she’s cute. His mobile that she texts on – he always answers straight back. Sometimes his other phones go and he doesn’t answer at all.

Shania isn’t on the pill. She’s too scared to go to the doctor’s. She doesn’t know if they will tell her mum. Or the police. Her boyfriend’s told her to go on the pill because he doesn’t want to use condoms. He doesn’t like going to get them from the clinic. And it doesn’t feel as good as bareback.

She doesn’t want to get pregnant, but she’d never go get the morning after pill if she was in school uniform. They’d just look down at her. Her boyfriend would probably stay with her if she did fall pregnant….


Disinterested – Disconnected

Male – 14 – DE, Leeds

Lee Blaseby

It’s Tuesday lunchtime. Lee’s excluded from school again. F***ing morons. Mr

Pittock is a Pillock.

Stevie’s meeting him down the park. They might go round Jason’s when he gets home and play Grand Theft Auto. Lee wants to get drunk again, but they’ve got no money. He asks his mum who’s watching telly. She says she’s got none either, but it’s hard to know – she always says that. he checks her purse – but it’s empty.

He pinches six of his dad’s tinnies and shoves them under his jacket. The pigs nick it if they catch you. Tossers.

Lee watches out as he goes down the road. There’s the pigs but there’s also the gangs of Asians. There’s lots of fights between the postcodes in this area. He keeps a penknife in his trackies – his dad gave it him and it could make the difference in a fight. You never know. The estate’s already had one stabbing.

The park’s almost empty. Brooke’s there with her blond mate, who Stevie’s already copping off with. Lee dumps the cans. Brooke’s off her phone and they’re drinking. They chuck stones at the climbing frame – first to hit a metal pole…there’s no prize.

On the floor round the bench there are loads of needles – the druggies use it at night. Stevie skins up and they pass it round. They wait till it’s time to call at

Jason’s but his mum says he’s having tea and is busy. So they got to the woods.

Brooke wants to light a fire. They break branches off the trees. The pigs will move them on if they see them. Stevie and the blond one are snogging again, so Lee and

Brooke walk off. They carve words in the trunk of a tree with the penknife. Then they end up shagging. Bit weird cos nothing’s ever said like, but that’s what it’s always like with her.

They go back to the fire and the girls are giggling and whispering and texting their mates – they say they’ve got to go. Stevie and Lee walk back to the flats. Lee’s mum’s eating tea when he gets back in. He watches telly till late…don’t have to get up tomorrow.

Condoms?? Ain’t got none. She’s on the pill. She ain’t got ‘owt. I don’t know.


Thoughtless – Single Focus Sober

Male – 15 – C1C2, London

Adam Stephens

Adam lives with his mum, younger sister and brother in a flat in N22. Mum works in Customer Care in M&S. She leaves the house at 730am and Adam walks the kids to school. After school, they go to the club, and Adam hangs round with his mates.

He’s good looking – and he knows it. He’s been a natural charmer since Sunday

School and all the old ladies love him. All the young ladies love him too – he knows how to flirt. Even the female teachers let him get away with murder.

Since he was nine, the girls have chased him – he lost his virginity at 12 to a fourteen year old. He’s got a rep as a bit of a bad boy, which works in his favour.

His mates are the same – although some of them go with some real dogs. The most Adam’s ever slept with in one day was four. On the school trip to France he had two of the French girls, one girl Jumeila in his year, and one girl from the sixth form.

Adams mum always goes on about using condoms. She knows some of the girls in the area are just interested in having kids, and she doesn’t want that kind of girl in her family.

Adam hangs out on Saturdays at Wood Green Shopping Mall. He and his friends go to the KFC, or McDonald’s or Sub, or the Odeon. That’s a good place to shag.

But there’s never condoms in the loo. When he remembers, he carries one, but it’s not that easy…

The usual scenario…her mum’s out at work, she’s getting all hot, he tries to take off her jumper, then she goes ‘OOOOOh no! Don’t start that!’ She pulls it back together again. They’ve only got an hour so he feels a bit frustrated, but he’s got to play. So sometimes she wants him to wait and look sad, sometimes she wants him to get undressed and start charming her…be seductive, kissing, telling her she’s beautiful (blah blah blah). By the end of it, she’s still saying ‘ooooh no!’ but she’s wanking him off at the same time. If he can slip it in at that point, and if she’s on the pill, what’s the problem? She ain’t a virgin. And she wants it. They all do.


He wants a ‘crib’ and a car, nice shoes, nice clothes, nice phone, no stress. One of his mates shagged this slag in the park…she’s pregnant now and won’t have an abortion. That’s slack. You have to make them take the morning after pill – you have to be mean. Otherwise, they won’t do it. His mate didn’t take care of business and now he’s finished.

STI – what’s that? Chlamydia? Girls get it…and they get infertile – which is good!

HIV you’ve got to be worried about. Yeah. If they said condoms or no sex, then you’d wear a condom. Why don’t they just give you one? Save you looking.

Vulnerable – Denials

Female – BCI – Coventry 17

Juliet Collins

Mum works as a doctor’s receptionist. Dad is an Audi salesman. They live in a nice street, semi-detached and Juliet goes to the girls school. It has boys in 6 th form.

Juliet’s best mate is Kerstin. Kerstin’s mum’s a teacher. The girls have known each other since they were seven. They went to the same ballet class – but different schools.

Juliet’s been invited to Daniel’s birthday party. Kerstin’s going and her dad’s picking them up at ten. Juliet really fancies Dan but he’s interested in Leila; she reckons. She goes really dressed up anyway – jeans, new top, ballet pumps, lip gloss.

Kerstin’s talking to Daniel – Juliet’s really upset. She goes to the garden. She’s had a couple of vodkas – (doesn’t smell or taste if you mix it with cranberry juice).

This boy comes to talk. He’s in the year above. They talk for most of the night.

He’s really sweet.

She sees Dan and Kerstin snogging in the garden and Edwin suggests they go inside. So she does. They go upstairs to a bedroom. He’s leading her but he’s holding her hand so she doesn’t mind seeing other people on the stairs. She feels quite cool and quite special going past them. One of the bedrooms is being used, so Edwin finds the parent’s room.

It’s like her parent’s room. Different colour curtains- but same sort of furniture.

And it’s like being a married couple. But she doesn’t really know what she supposed to do. He’s pushing her hand onto his flies but she doesn’t want to be


undressing him – that’s just a bit weird. So she kisses him and he gets his kit off, then hers. She thinks it’s going a bit far, but she’s also quite curious as to what will happen. Just how much does he like her? She feels quite sexy and grownup. And a bit worried. What if someone comes in. But then Ed’s having sex with her and it’s too later to say no.

She lies in the bed while he gets up and dresses. She dresses under the covers when he’s gone and goes into the bathroom. Her hair’s a mess. Kerstin texts her.

She’s waiting outside – her Dad’s here. Juliet’s quite on the way home. She gets out of the car, thanks Mr. Evans for the lift and goes inside.

Condoms? It wasn’t like that. I know you should always use a condom because you can catch Chlamydia and become infertile. Boys can get it too, I think. And other horrible things. But it wasn’t like that. He hasn’t got anything – thought you can’t always tell…

What will he say to me when he sees me on Monday? Shall I tell Kerstin? Will anyone find out?

Thoughtless – Single Focus Drunk

Female – 16 – C2DE - Birmingham

Jodie Robinson

Jodie started doing Graphics but it’s hard so she’s changing to Beauty. Her mum wants her to run her own business.

Jodie and her mates are out on Friday night in the town centre. Saturday they go to Cinderella’s. It’s a laugh. They love seeing who’s out. They go round in the gang together – safety in numbers. Get ready at Carly’s house, have a couple of

WKDs before they go – it’s cheaper than buying out. Mind you. Not that they have to pay. What you look like makes a difference!

Jodie’s borrowed Katie’s top – and she pulls it down a bit lower. The Pervys buy the drinks as long as they can cop an eyeful. That’s what she and her friends call the older men who hang round the bar. They’re disgusting. But useful.

One bloke in the corner is looking over at the girls – he works in the garage and he’s quite sexy. He buys Jodie a couple of Bacardi Breezers. He tells Jodie early on that he’s in a relationship, but the way he says it, she knows he’s not happy. It sort


of comes out that his girlfriend’s a bit controlling – well very controlling – and really miserable, and no fun. But he’d never do anything to hurt her. He’s not like that.

His mates drift off with a wink wink nudge nudge…but he rolls his eyes – and apologises about them. They’re so childish.

He and Jodie are having a real laugh – she’s so funny. He asks her about her boyfriends – she’s so pretty. He makes a move – she’s so sexy. But then he stops himself. He’s got a girlfriend and he would have to sort that out….first.

So Jodie makes the next move. She’s drunk and he’s drunk. She’s told him she’s

17, and he looks younger than 26. He says he knows somewhere private so she follows him…under the bridge by the Rec. She’s a bit scared cos there’s no-one around, but he’s really nice and she’d look stupid saying something. He’s really sweet. And her head’s spinning. And they hold hands and kiss afterwards. He gives her his phone number.

Condoms? Er, gross! Anyway, he didn’t say anything about them and she couldn’t exactly bring that up. She didn’t even know what was going to happen till afterwards. If she’d said something and he’d not been thinking like that, she’d have looked like a right slapper. She’ll get the morning after pill again. It’s fine.

And then make an appointment for the pill, so there’s no problem next time.

Vulnerable – Disempowered

Female – South London – 18 – C1C2

Tinu Bori

Tinu’s in college doing hair and beauty. She and her sister Busi are 2 nd generation

Ghanaian. They have lived in the UK all of their lives but have gone back to visit once. They didn’t like it – it’s so hot and dusty in Ghana.

Tinu’s been sleeping with her boyfriend for about six months. They’re might get married when they are older- but her dad would kill her if he knew they were having sex. Her boyfriend’s Ghanaian as well. They know all the same people.

They don’t go the same church, but everyone knows everyone – and most of them work in the health service where her dad works. So when she went on the


pill, she had to go out of her area – and it was a lot of hassle – she stopped taking the pill because of that.

Now she’s trying to use condoms. It’s not very easy. Her boyfriend doesn’t like them and it makes her feel very cheap. She’s really not sure what’s worse.

He’s started taking the condoms off in the middle. The first time it happened he said it was an accident. Now she thinks he does it on purpose, because he doesn’t like the feel.

She just can’t get pregnant – it really mustn’t happen! But she can’t tell him what to do, and she can’t break up with him in case it gets out what’s happened.

She’s doing other sexual stuff so that there’s less risk of pregnancy, but it’s not really making her feel great in the relationship.

* * * * *
