Providers can counsel well by being aware of men's concerns. When men visit clinics, at first they may want to talk about something other than the real reason for the visit (14, 93). Thus sensitive counselors lead the conversation to reproductive health topics and ask questions that draw out men's reproductive health questions and concerns. Men sometimes ask difficult questions about such issues as sexual pleasure, sex drive, and sexual anatomy. Such questions are best answered with accurate information offered in a relaxed, nonjudgmental, and helpful manner. To encourage men's participation, providers can go beyond answering men's questions about contraceptive methods and also help them consider their reproductive goals, those of their partners, and the choices they face together (132).

Some men, especially young men, do not want to reveal their ignorance about sex and reproduction. Thus they may not ask questions, may be quiet in groups, and may act differently if their wife or girlfriend is present. Nevertheless, by being sensitive to men's concerns, educators and counselors can determine what information they need and convey it without causing embarrassment (99).

In Colombia Profamilia has learned the importance of good counseling through more than 10 years of operating men's clinics. In the Bogota men's clinic a counselor meets briefly with each man before his medical visit to give him a chance to ask confidential questions. Before such counseling was provided, male clients often received and paid for medical services they did not need (14).

Since few programs have experience working with men, training clinic staff to assure high-quality care is especially important. Clinic staff may hold prejudices against men and may even discourage them from seeking family planning information and services. In Kenya, for example, a mystery client study found that the quality of counseling for men was inconsistent. Male clients employed by the researchers visited family planning clinics and pretended to want a vasectomy. Some of the men received courteous treatment and knowledgeable counseling. Most of the men, however, reported a mixed experience with the staff. In 4 of 14 visits counselors did not explain the vasectomy procedure correctly. During eight visits female counselors asked the male mystery clients why their wives were not having tubal ligation. A few counselors even tried to persuade the men not to have vasectomies (282).

In 1993 the Jamaica Family Planning Association (FAMPLAN) began comprehensive staff training as part of its efforts to serve men and couples better. The training was part of an effort to integrate STD prevention with family planning services. First, a baseline survey of counselors, nurses, and other staff assessed their knowledge of STDs, including HIV. Then a training curriculum was developed for the entire staff, including the bus drivers and receptionists. Training focused first on STD prevention, including correct condom use, and on counseling. Training later also covered sexual health, sexuality, and advanced counseling skills. Reflecting the program's efforts, condom distribution increased by 350%, from 60,000 condoms in 1992 to 213,000 condoms in 1994 (222).