Sexual and Relationship Therapy, Vol. 15, No. 3, 2000
Working with young
peopleÐ towards an agenda for
sexual health
PETER AGGLETON1 & CATHY CAMPBELL2
1
Institute of Education, London; 2London School of Economics, United Kingdom
In this paper we outline key elements of a human rights-based framework for sexual
health promotion that takes account of young people’s needs and interests. This framework is located
against the backdrop of a critique of the way in which negative de® nitions of `sexual health’ and of
`adolescence’, as well as restrictions on open and appropriate sex education in schools, undermine the
likelihood that young people will achieve optimal bene® t from existing services and strategies in
countries such as England and Scotland. Central to our analysis is an af® rming and positive
de® nition of sexual healthÐ that focuses on the attainment of sexual pleasure and which links
sexuality to an expression of individual and collective needs and broader human rights and
responsibilities. We point to ways in which such a framework might inform the provision of
appropriate information about positive sexual health, and of more accessible and integrated sexual
health services. We also highlight the need for measures to improve young people’ s con® dence and
aspirations, and to increase youth participation in decision making in matters relating not only to
their sexual health, but also to the wider social and community environments within which young
people’s sexuality is negotiated.
ABSTRACT
Introduction
Only 20 years ago, to talk publicly about `sexual health’ would probably have been
meaningless. In the early 1980s, when we ® rst began work in this ® eld, we can recall
colleagues looking askance when the word `sex’ was mentioned, and early UK
research on AIDS was reportedly delayed on the grounds that such enquiry could
hardly be `serious’ subject matter (Berridge, 1996). Nowadays, much has changed
and there can be relatively few health promotion workers who cannot talk
con® dently about oral, vaginal and anal sexÐ at least in the safety of their
professional environments.
Much has changed also at the level of of® cial discourse. Both England and
Scotland are currently embarked on the development of sexual health strategies
which, in perhaps different ways, will seek to integrate concern about rising rates of
Correspondence to: Peter Aggleton, Thomas Coram Research Unit, Institute of Education University of
London, 27± 28 Woburn Square, London, WC1H 0AA, UK. Email p.aggleton@ioe.ac.uk.
ISSN 1468-1994 print/ISSN 1468-1749 online/00/030283-14
Ó British Association for Sexual and Relationship Therapy
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Peter Aggleton & Cathy Campbell
sexually transmitted infection with work to limit teenage conceptions. Throughout
the corridors of power, in hospitals and health care centres, in schools and colleges,
and even on the street, there is now more talk than ever about sex, sexuality and
sexual health.
Yet paradoxically, the social changes that have made it easier to talk about sex
have made it harder to articulate a coherent vision of what `sexual health’ might
mean. Now, perhaps more than ever before, sex has become linked (in the public
health imagination at least) to infection and disease and, in the case of young people,
to unintended pregnancy. We are encouraged, therefore, to view sexual health in
largely negative termsÐ as the absence of infections such as chlamydia, gonorrhoea
and HIV, as the avoidance of pregnancy among teenagers, and as the avoidance of
sexual violence and abuse.
In this paper we want to explore the adequacy of such a conceptualization, in
particular its usefulness for countries such as England and Scotland which are in the
process of developing their ® rst ever sexual health strategies[1]. We will begin by
considering what sexual health might be. We will next want to explore a number of
barriers to its promotion among young people. Finally, we will identify elements of
the framework within which a sexual health strategy might be conceived if it is to
address young people’ s interests and needs more inclusively.
So what is sexual health?
Before the advent of HIV and AIDS, the phrase `sexual health’ was rarely if ever
used in Britain and its present familiarity is perhaps something of a re¯ ection of the
way in which we have started to think differently about sex, sexuality and sexual
relationships. Some people have been distressed by this new willingness to talk about
sexual matters, likening what they see to a new age of `permissiveness’ . Others have
welcomed the opportunity to be less hypocritical about sexual life, seeing in this new
openness the opportunity for a more honest appreciation of sexual diversity, sexual
pleasure and sexual rights.
In the early 1990s the former Health Education Authority commissioned a
telephone survey to explore what a range of respected agencies working with young
people on sexual and reproductive health matters thought about sexual health
(Aggleton & Toft, 1992). Representatives of several of the bodies contacted,
including what was then a national organization with a brief for promoting sex
education, said that they actually found the term `sexual health’ unhelpful, since to
them it implied that there were `healthy’ and `unhealthy’ forms of sexuality. In their
view, to promote `sexual health’ ran the risk of being overly prescriptive and of
avoiding bigger questions such as who had the power to de® ne what sexual health
means.
Several other organizations advocated more implicit de® nitions in terms of,
for example: (i) being knowledgeable about reproductive health; (ii) being able to
make informed choices about parenthood and sexuality; and (iii) being comfortable
with one’s own sexuality. Only one organization out of the many contacted made
any reference to sexual pleasure. That was a London-based centre providing
Working with young peopleÐ
towards an agenda for sexual health
285
contraceptive advice, whose representative suggested that sexual health implied a
philosophy whereby people might increase their sexual enjoyment, while avoiding
sexually transmitted infections (STIs) and unwanted pregnancy.
On balance it seems important to recognize that sexual health is (or should be)
an af® rmative concept, a state of well-being imbued with positive qualities, not
merely the absence of those that are undesired. Thus sexual health is about a lot
more than the avoidance of STIs and unwanted pregnancy, although these may be
preconditions for its attainment. Second, sexual health is more than reproductive health,
being concerned with more than procreative relationships and modes of sexual
expression. Third, sexual health seems inextricably linked to the expression of
individual and collective needs as well as to broader human rights and responsibilities.
The concepts of sexual health which seem most valid are those which respect the
variety and uniqueness of sexual experiences, needs and identities. They are those,
moreover, which af® rm the right of all people to be free from sexual exploitation
oppression and abuse. Sexual health, therefore, is not simply an individual state of
being. Finally, sexual health must be concerned with the attainment and expression
of sexual pleasure, not with the repression of sexual energies and desires or their
denial.
Working with young people
Among its many provisions, the United Nations Convention on the Rights of the
Child assigns to children and young people the right to express their views, and have
them considered, in relation to many walks of life. These include the manner in
which they are treated by adults as well as society more generally, as well as the
services that are provided, and to which they have access. This view of young people
as sentient beings, meaning givers and construers of their own reality, is very much
at odds with some of the dominant tendencies in policy making today. It poses major
challenges for those who wish to listen more actively to what young people say, and
to ensure that health programmes more genuinely work for the young people whose
needs they purport to meet.
Why should such a view be at odds with the mainstream? There are
several reasons for this. First, because since the turn of the century `adolescence’
has been seen as a period of storm and stress linked to biological changes and
their behavioural correlates. According to such a view, young people can barely be
treated as rational, still less as individuals whose perspectives on events should be
taken as equal to those of older generations. As Nadarajah (1992) has succinctly put
it:
Adolescence is a period of psychosocial development in which teenagers
begin to separate from their parents by shifting emotional ties to others ¼
adolescents suffer a great deal from the physical problems associated with
puberty, e.g. `Puppy fat’, spots and physical changes ¼ [they] have rapid
mood swingsÐ they become easily upset and emotional. Con® dence and
self esteem are very fragile at this early stage in social development.
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Peter Aggleton & Cathy Campbell
Second, in much mainstream literature in health psychology and adolescent
medicine there is a tendency to vilify and pathologize young people. Adolescents are
not untypically viewed as `problems’ for adultsÐ wayward individuals whose
behaviour needs to be brought into line if they are to be ® tted for their proper role
in society. Indeed, the very use of the word adolescent is symptomatic in this
respect, carrying with it strongly biomedical and psychiatric connotations, in Europe
at least. How many young people aged between 10 and 20, for example, consider
themselves to be `adolescents’ or to have the adolescent problems so often ascribed
to them by the academic and professional literatures?
This problem of homogenization, whereby all young people are assumed to be
the same, regardless of social background, gender, culture, ethnicity, etc., is an
interesting one. As Herb Friedman (1989: 310) so correctly observed:
The ostensible con¯ ictual relationship with parents, so often described
in Western societies as one of turmoil resulting from the `generation
gap’ is perhaps more mythical than real since it is much more common
to ® nd young people and their parents sharing the same fundamental
values. The differences are likely to occur on much more ephemeral
subjects.
Why is it, therefore, that not only are all adolescents assumed to be the same, they
are also assumed to hold attitudes and values very different from their parents? This
strange inversionary logic perhaps reveals as much about adult desires for social
difference as it does about young people themselves.
More recently, the view has been expressed that young people as a whole
are not necessarily `bad’ or `mad’ but simply sadÐ the victims of the actions of
others (Aggleton & Warwick, 1997). We can see such a perspective most clearly
in accounts of the `innocent’ victims of HIV and AIDS, in which children and
young people most usually ® gure strongly. This view of young people as tragic
victims is as damaging in its effects as are alternative conceptions emphasizing
deviance, wantonness and irrationality. It too encourages us to understand
young people not on their own terms but on those of an essentially adult logic, in
which those who cannot be controlled through psychological, behavioural and
biomedical interventions are rendered malleable through the twin prisms of pity and
projection. It offers us a fantasy image of what young people are like that has
received more than an appropriate level of recognition among policy makers and
practitioners.
How then can we steer a course between these twin poles, the one vili® catory
and negative, the other romanticized and seemingly more positive? The answer, we
argue, lies at least in the questions we ask of ourselves and young people and in the
`theories’ we build with young people about their sometimes different but often very
similar hopes, aspirations, desires and needs (cf. Coleman & Roker, 1998). It
behoves us as workers in the ® eld, as policy makers and practitioners to take
seriously the accounts and perspectives of children and young peopleÐ on sexual
and other matters.
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287
Sex education in school
Nowhere have dominant ideologies of young people and adolescence had greater
impact than in relation to ongoing debates about the role of schools in sex
education, and in education concerning personal and social relationships. On the
one hand it has been suggested that it is the `innocence’ of young people that needs
to be protected, for fear that they run wild when provided with information about
sex and sexuality. On the other hand, there is clear evidence to suggest that many
parents themselves (who as adults should know better) feel ill-equipped to take on
this role, preferring to leave the task to others, most usually teachers. That said,
teaching about sex and sexuality is still not included in the curriculum of by far the
majority of teacher education and training courses in the UK. As a result, those
teachers who do take on the task are often ill-prepared for the work they have to do.
The situation is made more complex by ambiguities within the broader policy
context. Despite the fact that legislation has been passed in England requiring state
secondary schools to provide sex education which includes teaching on STIs and
HIV in a form which complements the school’s broader responsibility to prepare
young people for the `responsibilities, opportunities and experiences of adult life’ ,
many teachers remain profoundly anxious about teaching sex. Some are simply
unprepared for the task and ® nd it uncomfortable to talk about sex. Others cite what
they see as the confusing legal context surrounding discussions of sex, sexuality,
contraception and, of course, homosexuality.
Section 28 of the Local Government Act 1988, for example, which prohibits
local authorities from promoting homosexuality, offers a clear barrier to sex
education by making teachers worried about what they can and cannot say. This is
the case despite subsequent guidance from the former Department of Environment
stating that Section 28 should `not prevent the objective discussion of homosexuality
in the classroom, nor the counselling of pupils concerning their sexuality’ .
Given this policy environment, it is not unknown for teachers to be quite unsure
what to say to young people about sex and contraception. Many fear that it might
be illegal to teach about contraception to under 16s. Others are anxious that they
might inadvertently offend different faiths, some are worried that they do not have
enough background knowledge. Yet others are unsure of the appropriate context in
which to teach about sex and sexual relationships, and perhaps the majority are
uncertain about how to address issues relating to sex and the law.
Underpinning many of these anxieties are two further mythsÐ the myth that
parents object to their children being taught about sexual matters, and the myth that
to teach children about sex is to encourage them to have it. Fortunately, objective
and reliable research has been carried out on both these topics. It is now known that,
in England, 94% of parents do approve of sex education taking place at school, and
consultation between teachers and parents can enable a better appreciation of the
concerns and anxieties that some parents have (NFER/HEA, 1994). Moreover,
recent reviews by the NHS Centre for Reviews and Dissemination (1997) and by the
Joint United Nations Programme on AIDS (UNAIDS) (Grunseit 1997) show
unequivocally that well designed and properly planned programmes of sex education
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do not encourage promiscuity or heighten sexual activity. As the former of these two
reviews concludes:
School based sex education can be effective in reducing teenage pregnancy
especially when linked to access to contraceptive services. The most
reliable evidence shows that it does not increase sexual activity or
pregnancy rates. (p. 1)
Were it not for the fact that many teachers feel ill-prepared to teach about sexual
matters, and were it not the case that personal, social and health education remains
underdeveloped in most school curricula, a major upgrading of sex education might
occur (cf. Sex Education Forum, 1999). As it is, progress must needs be slower, as
hearts and minds are won for a new vision of how best to help young people learn
about sexual mattersÐ one which is hopefully attuned to the ways in which
increasing numbers of young people organize and live their lives.
Effective work with young people
So far, we have described what sexual health might be, and discussed some of the
barriers to undertaking this kind of work with young people, in schools at least. We
will now turn to what has been learned about some of the most effective styles of
promoting sexual and reproductive health before identifying in our ® nal section
some of the issues which a national policy framework for sexual health ought
properly to take on board.
Ask perhaps the majority of people what they consider crucial to the success of
education for sexual health and they will say knowledge about sex, sexuality and
human reproduction. This commonsense view has dominated mainstream thinking
and continues to hold sway among those who believe that health education is about
providing the facts for people to act upon. Beyond knowledge, however, people need
the skills to negotiate for safer sex, and they need to have the attitudes which make
the adoption of certain behaviours seem worthwhile (Aggleton, 1997).
Developing the skills that can be used to assert one’s sexual needs, particularly
if one is a woman or a younger person, requires practice. Sadly, even in rich and
reasonably liberal countries, there are few formal environments in which skills such
as these can be acquired, particularly by young people. This may be one of the
reasons why there is much current interest across Europe in a life skills approach to
education about sex and personal relationships in schools.
Attitudes are of course notoriously dif® cult to change. If only there were a quick
formula that could be applied, our work would be so much easier. Policy makers
could be instantly persuaded to make the right decisions, and communities and
individuals would have the motivation to act wisely. Successful approaches to
attitude change include approaches which have aimed to shift perceived social
norms, around safer sex for example, and, in poorer countries anyway, social
marketing campaigns which have aimed to increase the desirability of prevention
technologies such as condoms (Aggleton, 1997; Rivers & Aggleton 2000).
Work on knowledge, skills and attitudes alone is quite insuf® cient to
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promote sexual health. It is now well documented that societal factors such as power
relationships and social inequalities render some groups more systematically
vulnerable to STIs than others. For example, Young people who are denied access
to the information and services they need to prevent pregnancy and STIs (including
HIV) stand a far higher chance of becoming pregnant or acquiring an infection than
those for whom services are more readily available (Kane & Wellings, 1998).
Perhaps as a result considerable investment is being made in the development of
`youth friendly’ sexual health services in a form which young people ® nd accessible,
acceptable and appropriate to their needs.
Young people without family support or who are marginalized for other
reasons, such as poverty or ethnicity, are also vulnerable to sexual health problems
(Milburn, 1996; CASPE Research, 1999). Interviews with homeless young people,
those in care or excluded from school, show that they frequently feel isolated, have
dif® culties in forming and maintaining relationships, and lack a sense of hope for the
future (Lilley, 2000). Sex, sometimes seen as a means of instant grati® cation,
without meaning or value, is often opportunistic, with little forward planning, and
the use of contraceptives or condoms is less likely in such circumstances.
Overall, if there is one key message that we should take from work so far it is
that both individual persuasion and societal enablement are necessary if we wish to
have a serious impact on young people’s sexual health (O’ Reilly & Piot, 1996; Tawil
et al., 1995; Sweat & Denison, 1995). Developing programmes and interventions
which pay attention to one but not the other is simply not enough.
Priorities for action
Ultimately, in this ® eld as many others, the key challenge for policy is how to
promote environments that enable health-enhancing behaviour. In particular, it is
important to address the quality of information that young people receive and the
factors that in¯ uence their ability to act on this information.
Information and misinformation
Research in a number of high-income countries now suggests that, despite exposure
to a range of sources of information about sexual and reproductive health, many
young people have misconceptions or limited knowledge about how to prevent
pregnancy and sexually transmitted infection, and how to use condoms and other
contraception (Hughes, 1999; Mitchell & Wellings, 1998). Others may be confused
by the mixed messages they receive (Health Education Authority, 1999), with media
images about sex as a glamorous and desirable activity being at odds with adult
refusal to discuss sexual matters with young people, or to acknowledge adolescent
sexuality.
Young people commonly describe the sex education they receive as `too little,
and too late’ , with an overemphasis on the mechanics of sexual intercourse and
reproduction at the expense of issues such as con® dence, self-esteem, non-sexual
ways of showing affection, and the pleasurable, emotional and complex aspects of
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sexuality (Hughes et al., 1999). In practice, too many young people receive their ® rst
exposure to sex education after they have become sexually active, and the timely
provision of information, ideally before individual s have their ® rst sexual experience,
must be given higher priority (Milburn, 1996; Rivers & Aggleton, 1999a).
Comparisons of levels of sexual health in high-income countries suggests that
open communication with parents, and an open approach to sex in the broader
community, is an important determinant of the relatively good sexual health
experienced by young people in countries such as the Netherlands and Sweden,
compared with the USA, the UK or Canada (Cheesebrough et al., 1999). The
Netherlands has the lowest reported rates of teenage sexual activity, and the oldest
average age for ® rst sexual intercourse (despite the fact that the legal age for
intercourse is 12); among Dutch teenagers both boys and girls are signi® cantly more
likely to cite `love and commitment’ as their primary motivation for engaging in their
® rst sexual experience, rather than `physical attraction’, `peer pressure’ and
`opportunity’. The latter tend to be the primary reasons cited by young people in the
UK, particularly by young men (Health Education Authority, 1999; Social
Exclusion Unit, 1999).
Providing young people with easy access to frank and consistent sex education,
and more effective preparation for sex and relationships, requires partnerships
between a range of sectors (Gillies, 1998). Such sectors include the media, schools,
youth opinion formers, welfare agencies, health services and representatives of
parents and young people. Every effort should be made to identify a wide range of
representative young people from more mainstream youth groups, faith groups and
so on, as well as groups representing youth who are marginalized or excluded from
the social mainstream (Department of Health, 1993; Egan, 1998).
Accessible, youth-friendly, integrated services
In keeping with the emphasis on enablement described earlier, health education
must be backed up by more youth-friendly services. Young people’ s perceptions of
sexual health services have an important role to play in in¯ uencing whether or not
they decide to use them (Hughes et al., 1999). Young people often avoid
mainstream servicesÐ particularly family doctorsÐ because of concerns about
con® dentiality, inconvenient locations and opening hours, and perceptions of
homophobic and disapproving health provider attitudes (Allen, 1991; Aggleton et
al., 1996).
Staff providing sexual health services not infrequently require training to
improve their skills in communicating with teenagers and to develop more positive
and supportive attitudes to young people’s sexuality. Providing services in
non-traditional settingsÐ such as detention centres, homeless drop-in centres,
shelters, schools, parks and car parksÐ to reach out to young people who are
reluctant to use more traditional services must also be given greater attention
(DeLisle & Wasserheit, 1999).
There is considerable scope to improve the involvement of young people in
decisions about the planning and delivery of services (Higgins, 1999). This could
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291
increase the likelihood that services are delivered in a way that meets young people’s
needs and contribute to the development of an environment where young people
feel they have the opportunity for meaningful participation in affairs that affect their
lives (Morrow, 1999a).
There is clear evidence now from a number of countries that sexual health
services are more likely to be effective if they are integrated and complement the
efforts of other agencies. In France, Switzerland and the Netherlands, efforts to
prevent STIS and unintended teenage conceptions were more successful when they
were integrated, and recent improvements in sexual health in Norway, Greece and
the Netherlands have been attributed to the combined effects of improvements in
contraceptive provision, sex education and facilitating law reform (Kane & Wellings,
1999).
Improving young people’s con® dence and aspirations
As already highlighted, young people who are disadvantage d by factors such as their
socioeconomic status, ethnicity and low educational attainment, and who have low
expectations for the future, are at particular risk of poor sexual health. They are less
likely to have protected sex, making themselves vulnerable to STIs including HIV in
the process (CASPE Research, 1999). Throughout the developed world,
unintended teenage conceptions are most common among those who have been
disadvantage d in childhood, and who have poor job prospects (Social Exclusion
Unit, 1999).
Tackling the root causes of low ambition and poor self-esteem in girls, starting
at a very young age, can make a signi® cant difference. Programmes that include life
skills education and involve young people in community work can increase
self-esteem and con® dence about job prospects. Programmes aimed at pre-school
and primary school girls have resulted in lower rates of teenage pregnancy and better
sexual health later on in their lives (Aggleton et al., 1998; CASPE Research, 1999;
Social Exclusion Unit, 1999).
Boys are frequently overlooked. There is an urgent need to provide similar
programmes for young men, to increase their self-esteem and con® dence as well as
to increase their understanding of the way dominant ideologies of masculinity (those
which link manliness to risk taking, being `tough’ and not showing your feelings)
increase their sexual health risks, as well as those of their sexual partners (Rivers &
Aggleton, 1999b; Forrest, 2000).
Family environment
Young people whose parents feel easy communicating about sex are more likely to
use condoms and contraception (Cheesebrough et al., 1999). Poor parental
communication, linked to lack of parental con® dence and parenting skills, is
strongly associated with poor sexual health among teenagers. Socioeconomic status
affects both ease of communication around sex and teenage sexual health. On
average, better-off parents are more likely to feel easy discussing sex with their
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Peter Aggleton & Cathy Campbell
children, and daughters of educated mothers are less likely to become teenage
mothers (Cheesebrough et al., 1999).
Parental attitudes are also important. Research in the USA suggests that young
people brought up in families with egalitarian attitudes to gender roles are more
likely to use condoms when they become sexually active. Among American
adolescents, safe sexual behaviour is predicted more by teenagers’ perceptions of
how much their parents care for them, than by the frequency of health warnings or
social class (Mechanic, 1990). It has also been suggested that young people who do
not feel supported by their parents are more likely to seek compensatory intimacy in
early relationships (Feldman & Brown, 1993).
Given the potentially protective role of open communication with parents and
parental support for young people’s sexual health, and the dif® culties that many
parents experience in talking about sex, there is an urgent need for advice and
support to help parents to communicate more effectively with their children about
sensitive topics. In circumstances where parents themselves are unavailable to offer
guidance and support, mentoring may provide a useful alternative (Klaw & Rhodes,
1995; Zippay, 1995).
Community environment
It is increasingly recognized that health is in¯ uenced by social support, at the
individual level and at the community level, and the link between social support and
safe sex may be one of the reasons why socially isolated young people experience
particularly poor sexual health.
Social support at the community level is related to the amount of social capital
available as health-enhancing resources for all members of a particular community
(Campbell et al., 1999). High levels of social capitalÐ community trust, reciprocal
help and support, a positive local identity, and high levels of civic engagement in a
dense network of community associationsÐ are positively associated with the health
and well-being of both adults (Kawachi et al., 1997; Lomas, 1998) and children
(Runyan et al., 1998). The most important dimension of health-enhancing social
capital is `perceived citizen power’, a characteristic of communities where people feel
that their needs and views are respected and valued, and where they have channels
to participate in making decisions in the context of the family, school and
neighbourhood (Campbell et al., 1999).
Most efforts to date have focused on promoting youth participation in specialist
or targeted health promotional activities. Few have tried to promote young people’s
participation in wider community and social contexts as a health promotion strategy.
To do this will require a better understanding of how young people feel about their
current levels of participation in their communities. Recent research in England has
found that young people felt excluded and devalued, were sceptical about ineffective
school councils and tokenistic representation on other community bodies. Negative
media images about young people, especially young men, also contribute to negative
community attitudes and undermine opportunities for meaningful participation by
children and young people (Morrow, 1999a, 1999b).
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An appropriate policy context
The UK, along with all but two nations in the world, is signatory to the UN
Convention on the Rights of the Child. Among its many provisions, this Convention
emphasizes the need for adults and organizations to give primacy to what is best for
children and young people when making decisions about them, their right to
privacy, con® dentiality and access to information, and their right to be consulted
and have their views taken into account in decision making.
Sadly, few countries to date have sought seriously to develop their approaches
to sex and relationship education within a rights framework, which raises a number
of important questions concerning the extent to which the interests and rights of
young people have been taken on board in existing provision. Among the few
agencies that have sought to operationalize such an approach internationally, the
Joint United Nations Programme on HIV/AIDS (UNAIDS) emphasizes the
fundamental right of children and young people to information and other resources
to protect themselves (and others) against infection (UNAIDS, 1997). These
include (i) access to accurate and appropriate forms of education about sex,
sexuality, drugs and relationships that include a menu of risk reduction options; (ii)
access to the physical means to protect against infection including, condoms, clean
needles and clean syringes; and (iii) access to youth-friendly services provided by
trained personnel.
International consensus-building meetings have also led to the development of
a number of normative statements describing principles of effective work in the ® eld
of health promotion. The Ottawa Charter for Health Promotion, the Adelaide
Declaration and the Jakarta Principles all emphasize the importance of good public
policy to promote health and well-being; the value of community consultation,
involvement and participation; and the need to reorient health services to meet the
needs of users rather than the demands of bureaucracy, the convenience of health
professionals, and the cries of vociferous minorities.
In our view, these are the principles that need to be operationalized more
systematically in future health promotion efforts with young peopleÐ and this
includes work to promote sexual and reproductive health. The challenge therefore
lies in articulating a rights-based approach to sexual and reproductive health
alongside the provision of services more genuinely attuned to young people’s needs.
We should not, however, underestimate the challenges to achieving such a goal. It
took a global epidemic of the most disastrous kind to make possible the kind of
discussion of sex and sexuality in which many engage today. It will take more than
good intentions to realize the kind of pragmatic, non-discriminatory and inclusive
sexual health strategy that young people deserve.
Acknowledgements
Earlier versions of elements of this paper were presented at the International Policy
Dialogue on AIDS, hosted by Health Canada and UNAIDS in Montebello, Quebec
in November 1999, and as a Keynote Address at a Children in Scotland seminar on
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the theme `Developing a Sexual Health Strategy for Scotland’ held in Edinburgh in
April 2000.
Note
[1] It should be noted that the UK is unique among the countries of the world in never having had a
National AIDS Strategy, still less a coherently articulated policy vision of what sexual and
reproductive health promotion might involve. At least part of the problem here derives from
differences of culture, practice and commitment within the medical specialities linked to family
planning and genitourinary medicine. See Kane and Wellings (1999) for a discussion of some of
these issues.
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Contributors
PETER AGGLETON , PhD, Director, Thomas Coram Research Unit, Institute of Education,
University of London
CATHY CAMPBELL, PhD, Associate Director, Gender Institute and Lecturer in Social
Psychology, London School of Economics