Providing information. To help prepare boys and young men to become more responsible sexual partners and spouses, programs can offer relevant information about sexuality and reproductive health, including the risks of STDs and how to avoid them (159). Young men also need encouragement to delay sexual activity until they are better prepared to cope with their own and their partners' emotional and health needs. Influencing young men to delay sexual initiation requires changing social norms and how young men perceive themselves. It may also mean changing how parents, friends, teachers, and girlfriends define masculinity. Training in interpersonal communication skills can help young men talk honestly with girlfriends about reproductive health issues.

Entertainment formats and the mass media can be powerful ways to reach youth with reproductive health information (123, 159, 198). In Uganda, for example, a national music competition called "Hits for Hope" formed the centerpiece of the government's HIV/AIDS prevention effort (123). Young artists performed original songs with AIDS-prevention messages. The winners recorded their song, Ray of Hope, in a professional studio, and it aired on national radio as part of a 6-month mass media campaign in 1995 (123).

Also in Uganda, Straight Talk, a monthly insert in a daily newspaper, provides young people with information and advice about sex, sexuality, STDs, and HIV/AIDS (112). Much of the information comes in the form of answers from a sociologist and physician to readers' letters asking for advice. Straight Talk also features quizzes, contests, and readers surveys to engage its audience (112).

Young men can be a particularly challenging audience to reach. Because young men and their health needs vary considerably, programs often cannot reach them as a single, homogenous group (80). For example, young men who have dropped out of school are usually much more likely to be involved in risky sexual behavior than are students. They are also harder to reach (297).

Some youth programs have found that peer educators can reach groups of adolescents with reproductive health information (80, 97, 165). In Botswana, for example, as part of the Tsa Banana Reproductive Health Program, peer educators talked to secondary school students about pregnancy, AIDS, HIV transmission, and condoms. They demonstrated correct condom use and taught sexual negotiation skills, including how to refuse sex and how to ask a partner to use a condom (165).

Serving young men. Many reproductive health programs do not serve young men or women because of opposition from religious, political, and other institutions that condemn sexual activity outside of marriage. Thus unmarried young adults of both sexes often find it much more difficult to obtain contraceptives than do married couples (51). In some places laws prohibit or limit providing contraceptives and other services to young and unmarried people. Some family planning providers have policies against serving unmarried men and women (159). Young men may be the most neglected of all. Even programs for young adults usually pay more attention to women than to men (12, 159).

The attitudes of individual providers also can stand in young men's way. Providers' religious or cultural beliefs may deter them from serving unmarried men and women (12). Rude or judgmental staff can discourage youth from seeking care. For example, in a South African study young field workers posing as clients reported that some clinic personnel resisted their requests for condoms and often provided no instructions about how to use condoms (2).

Young men need access to contraceptives and STD services where they can feel comfortable and accepted (159). Young men often feel embarrassed at clinics and fear that their visits will not be kept confidential. Finding ways to attract young men to reproductive health services is challenging because many are reluctant to seek help.

Providing a comfortable atmosphere and offering a range of services, from general physical exams to STD testing, have proved effective in some places (12, 223, 233). The experience of clinics in the US provides an example (68, 233). In Charlotte, North Carolina, a clinic called The Male Place provides educational classes and counseling on STDs, reproductive health, contraception, and testicular self-exam. It offers its largely African-American clientele general physical exams as well as testing for sickle cell anemia and STDs (68, 230).

Also, in New York City the Young Men's Clinic was created in 1986 when staff realized that very few men were attending the Young Adult Clinic (233). To appeal to young men, the clinic positioned itself as a place where young men could "hang out," receive a physical exam, get advice and counseling, and receive reproductive health care and free condoms (10). The Young Men's Clinic has worked to build a reputation for trustworthiness among the young men in its low-income, mostly immigrant neighborhood. Many clients first go to the clinic because they need to have a general physical exam for school or work. These exams double as "teachable moments," when young men can learn about safe sexual behavior (10, 233).