Advancing a National Dialogue

The primary purpose of this Surgeon General's Call to Action is to initiate a mature national dialogue on issues of sexuality, sexual health, and responsible sexual behavior. As stated so eloquently in the Institute of Medicine report, No Time to Lose (IOM, 2000):

"Society's reluctance to openly confront issues regarding sexuality results in a number of untoward effects. This social inhibition impedes the development and implementation of effective sexual health and HIV/STD education programs, and it stands in the way of communication between parents and children and between sex partners. It perpetuates misperceptions about individual risk and ignorance about the consequences of sexual activities and may encourage high-risk sexual practices. It also impacts the level of counseling training given to health care providers to assess sexual histories, as well as providers' comfort levels in conducting risk-behavior discussions with clients. In addition, the 'code of silence' has resulted in missed opportunities to use the mass media (e.g., television, radio, printed media, and the Internet) to encourage healthy sexual behaviors."

The strategies set out above provide a point of reference for a national dialogue. How it will be implemented will be determined by individuals and families, communities, the media, and by government and non-government agencies, institutions, and foundations. We must all share in the responsibility for initiating this dialogue, working at every level of society to promote sexual health and responsible sexual behavior.

Individuals can begin the dialogue -- adult with adult, adult with child -- by developing their own personal knowledge, attitudes, and skills with respect to sexual health and responsible sexual behavior. Adults can communicate with other adults about their views on responsible sexual behavior, what it is, and how to promote it. Parents can educate their children about sexuality and responsibility, most importantly by being healthy and positive role models.

Communities must necessarily approach a dialogue on sexual health and responsible sexual behavior in different ways, according to their diverse composition and norms. But all must participate so that all voices are heard. This dialogue can be sponsored by local governments, businesses, churches, schools, youth-serving organizations and other community-based organizations and should, at a minimum, include: emphasis on respect for diversity of perspective, opinion and values; assessment of community resources available for educating community members and delivering necessary services; attention to policies and programs that support and strengthen families; and assurance that systems are in place to promote equitable access and respect for all cultural, gender, age, and sexual orientation groups.

Media in all its forms can be engaged, by both public and private entities, in a national dialogue to promote sexual health and responsible sexual behavior. This dialogue should be a long-term effort and should treat sexuality issues responsibly, accurately, and positively. With respect to media programming, the portrayal of sexual relationships should be mature and honest, and responsible sexual behavior should be stressed. Finally, it is also important that young people, as well as adults, be educated to critically examine media messages.

Government, in partnership with foundations and other private organizations, can target support for the research, education, and services necessary to sustain a meaningful campaign to promote sexual health and responsible sexual behavior. Government should continue to develop objective and measurable indicators to monitor progress over time. It can also review policies and laws to ensure that they facilitate -- rather than impede -- the promotion of sexual health and responsible sexual behavior.

Conclusion

Based on the scientific evidence, we face a serious public health challenge regarding the sexual health of our nation. Doing nothing is unacceptable. More than anyone, it is our children who will suffer the consequences of our failure to meet these responsibilities.

Solutions are complex but we do have evidence that we can promote sexual health and responsible sexual behavior. Given the diversity of attitudes, beliefs, values and opinions, finding common ground might not be easy but it is attainable. We are more likely to find this common ground through a national dialogue with honest and respectful communication. We need to appreciate and respect the diversity of our culture and be informed by the science that is available to us.

This is a call to all of society to respond to this challenge. These efforts will not only have an impact on the current health status of our nation, but lay the groundwork for a healthier society for future generation