Pleasure and desire for intimacy are good forces and play a major role in people’s lives. However, constraints of time and mutated cultures can leave people de-prioritizing the role of sexual dialogue and consciousness. Sexual health education is mostly driven by prevention of disease and moral order, thus unwittingly linking sex with fear. A growing commercial industry focuses on gratification, gender stereotype and consumerism. This is the Great Divide in sexual health promotion. The first case of AIDS in Nepal was reported in 1988. By the middle of 2008, about 1750 cases of AIDS and over 11,000 cases of HIV infections were officially reported. The National Centre for AIDS and STD Control estimates the HIV population increased to 69,790 by the end of 2007 with 92 % infections occurring among 15-49 age group. No reliable data exists in Nepal for sexually transmitted infections (STI) other than the most-at-risk population. Accepting global trends, can we presume STI must be on the rise in Nepal?

For answers to these trends, researches look to Nepal’s poverty, political instability and gender inequality, combined with low levels of education, denial, stigma and discrimination. What is the missing link? Could it also be the absence of the erotic form, sensible pleasures and emotional safety in relationships with oneself and others? Training programmes provide authoritative knowledge but do they make us “feel safer”?

Sex that is exciting can still be safe. Safer sex brings relaxation that can allow better enjoyment. Knowing how to have and talk about good sex allows more opportunities to have safer sex. Because protected sex is rarely perceived as fun and fun sex can be rarely safe, programmes in sexual and reproductive health have become a means for damage control rather than aids to practical solutions for modern times.

The decade-long discussions brought by HIV/AIDS has paved the way for sex to be discussed in areas where it was previously impossible. This allows sexuality-positive messages to be sensitively inserted into even the most reticent of cultures. Given the status of sexual health, the world needs a broader definition of safer sex. Could Nepal blaze a trail? Communicating risks in sexual health should be re-evaluated to give greater authority to the power of pleasure in the practice of safer sex.

Promoting safer sex through the original motivations, such as passion, can make safer sex and sex necessary partners for a healthy life rather than uneasy bedfellows. Responses to the HIV epidemic reproductive health have had limited success when negative messages have been used to motivate safer sex. On the other hand experiences in social marketing has demonstrated that positive messaging results in more people adopting the desired behaviour. There is evidence from public health programmes, bold and brave enough to include pleasure as a motivating factor in their educational campaigns to increase the prevalence of safer sex practices.

During 2005-2007, a global mapping exercise conducted by the Pleasure Project (UK) showed that a number of commercial health promotion agencies linked enhancement of sexual pleasure as a result of using lubricated condoms. Sales quadrupled following the advertisement using the pleasure principle.

The Society for Women and AIDS in Senegal promoted the female condom as an erotic accessory to great programmatic success. A recent public-private initiative in India uses texts of Kama Sutra to enable sex workers to make the clients happy without penetrative sex. Christian organizations in Southern Africa have offered sex positive

marriage counselling to reduce infidelity. These examples illustrate that in matters of sex no society is any less intelligent; that public reality does not uphold the institutional fear of discourse on sex and sexuality. Parents, educators and young people can and do balance their personal beliefs with the testimony of reason. The communication of risk, as much as it may be a matter of life and death, is about education and learning. The responsibility for scaling up and integrating good sex values into sexual health education programme lies first and foremost with the public sector.

It is now time for a “bespoke” sexuality education that puts the individual first, providing a mentored and gradual learning in and out of schools. Everyone is not comfortable with the self-centeredness of commercial sex industry where all things sensual are reduced to performance, caricature and profit. Building bridges between public and private sectors can reduce sexual risk.Communicating risk at present needs to take heed of the risks that lie ahead if the ideals of policy, education and consumerism refrain from engaging with each other. However, fun is critical to learning. The truth about sex lies somewhere between protection and play.

Dr Thapa takes interest in sexual and reproductive health and AIDS issues