It would be easy to see sexual health as a shallow romantic vision: a state of mental, social and physical wellbeing in which sexual and gender interaction can take place positively, and without worry of unwanted pregnancy, disease or the unwanted use of power. In such a state of wellbeing, of course, concerns about the transmission of HIV/STDs disappear into insignificance and we can all love one another. Jolly good. The trouble is that life, sex and we ourselves are just not like that. Inequalities, perceived societal norms, diversity, personality, circumstance, power, love, desire, jealousy and wealth all conspire to make our interactions in general, and sexual interactions in particular, very difficult to manage  let alone ensure that all is sweetness and light. They are also the very things that make life exciting and unpredictable. And far from being a subject about which we keep quiet, sex is politicized, sensationalized, fantasized, described in anatomical detail, pored over in agony columns, or joked or gossiped about worldwide.

People who are confident of themselves and their relationships will probably be able to take better care of themselves and will have a greater interest in doing so than others. Such people will be able to act on information, be more likely to use services about which they feel confident and trust, and will be more likely to share their concerns with others.

Many people lack such confidence. They are found more frequently among the poor, the marginalized, many women, the young. However, many have made the mistake of trying to address this problem through simplistic notions of "empowerment"  focusing on the rights of individuals to stand up for themselves against the oppressor (men, adults, leaders, whoever). Many counselling and education systems focus on this aspect, missing the understanding that individuals live within a culture (which can be defined even within a street). This culture sets for them the norms for tolerance, excitement, aspirations, social hierarchies, use of power, what is accepted and what is not.

People who are in ostensible power (e.g., in public office) belong to a particular culture. When they go home at night, they are as subject as anyone else to its influence and have as many problems with handling sexual or human relationships. It is therefore not just a question of selfconfidence. It is the conditions set by a culture that make it more difficult for some people to maintain a belief in their own power to achieve things as human beings.

The argument concerning the links between sexual health, HIV/STD transmission and young people is therefore simple. Many young people are in situations in which they find it difficult to cope, to achieve what they would like. They are made vulnerable by patronizing attitudes of older people, by the exploitation of their position in society as people without power, by their relative lack of knowledge and experience in relationships, and by the barriers put in their way by adults and peers who are frightened of acknowledging their sexuality. These are facets of their culture.

Since many problems faced by youth are created by older people, such work also must be done with the older people in their particular local culture  who themselves may also have many difficulties to resolve, norms to change and understandings to achieve (just as do those who hope to facilitate the work). This approach of course includes "empowerment" but moves beyond individually-focused notions. It also moves us beyond the "romantic vision" of sexual and reproductive health outlined at the major international conferences in Cairo and Beijing.

Experience with this more comprehensive approach in many cultures worldwide, with men and women, young and old, shows that with acknowledgement of the forces of the culture they have created, people can find better ways to interact and improve the safety of their sex. Their newfound selfconfidence as players in society also acts as a powerful starting point for social, political, cultural and personal development.

We won't get rid of all inequalities, diversity, personality, circumstance, power, love, desire or jealousy, and we don't want to. But people will cope much better. In former President of Tanzania Julius Nyerere's terms, development is simply the enhancement of human dignity. People's concerns in sexual health have proved a powerful starting point for such development.