There has been very little public promotion of condoms and monogamy expressly to prevent STDs other than AIDS. Conventionally, STD prevention strategies have focused on high-risk groups, and communication has taken the form of counseling, print materials such as brochures and posters in clinics, and presentations for captive audiences, such as films or lectures in military barracks and schools (38). It is now being recognized that these approaches are too limited and piecemeal. Systematic approaches, based on modern theories and experience in communication and behavior of the lessons learned come from family planning promotion and AIDS prevention (see Population Reports, Condoms—Now More than Ever, H-8, September 1990, and AIDS Education—A Beginning, L-8, September 1989).

Promoting safer sexual behavior, like any systematic promotional effort, begins with careful audience research. Surveys, focus-group discussions, interviews, and pre-testing help ensure that a promotional campaign identifies its audiences, chooses media that reach the intended audiences, and delivers persuasive messages (see Population Reports, Lights! Camera! Action! Promoting Family Planning with TV, Video, and Film, J-38, December 1989).

Audience. The intended audience for STD prevention messages is usually people who tend to have several sexual partners and do not use condoms. Preliminary research must assess who these people are, where they live and work, and why they behave as they do.

Media. Factors that influence the choice of media include:

LI>The intended audience. Audience research should assess how the intended audience gets information—from radio, television, newspapers, peers, family members, health care providers?
• Cost. Broadcast promotion can be expensive, but it may cost very little per person reached (53). Posters and brochures are often less expensive to produce, but they reach a smaller audience and often have less emotional impact.
• Media restrictions. In countries that do not allow brand-name advertising of condoms or explicit discussion of sexual behavior in the mass media, opportunities for promoting safe sex may be limited.

Messages can best change these attitudes by offering new images of condom use and monogamy. Thus promotional campaigns have implied that condoms are sexy and safe or that wholesome couples use them (343, 344). In the Philippines, for example, condoms are marketed with the brandname Sensation, which has a sexual connotation, and the slogan "Make it sure, make it safe." (343). Since poor communication between couples may prevent condom use, advertisements should portray couples talking openly about condoms (340). Monogamy can be depicted as the responsible behavior of a leading citizen, winning the approval and admiration of family, friends, and community. These positive appeals are more likely to change attitudes and influence behavior than exhortations to stop unsafe behavior or attempts to frighten people with the consequences of STDs (340, 344).

Messages must go beyond what audience members say about their own behavior and motivations, however. Behind these statements, patterns of behavior reflect peer group attitudes, beliefs about health and about the body, rumors and misperceptions, distrust or dislike of other groups including health authorities, and inequities of power between men and women in sexual relationships. Gender inequities are particularly important in communicating about condom use and monogamy. Rather than berating women to change their behavior, messages must help women find ways to protect themselves from STDs without risking their physical and financial well-being.