Designing Safer Sex

Creating responsive solutions inspired by teens' real lives.

I work at the intersection of design and adolescent sexual reproductive health, which takes a bit to wrap your head around. Even for me. Essentially, I spend a lot of my time talking with teenagers—and the people in their lives—about sex. And, together with the team, our partners, and the communities we work with, I build, test, and refine solutions that aim to make that sex safer and pregnancy free–if that’s the intention.

I was in Kenya a few months ago checking in on a new program that we’re piloting to reframe the conversation around contraception. During the first couple of days I met up with a group of teen ambassadors who are responsible for helping to spread awareness and spark interest in the program amongst their peers. My colleague and I met up with a group, all around 18 or 19 years old, to hear about an event they had run the week before and better understand what was working and what wasn’t working with the program. After chit chatting for awhile the conversation shifted to the topic of condoms. One teen ambassador, I’ll call him George, let it slip that he had stopped using them altogether.

I’m going to press pause here because George’s entire role—bullet point number one in his job description—is to act as a role model and advocate to his peers for the safe-sex behavior we’re promoting through the program. Not using condoms is a big deal.

I’ll admit, my first reaction was frustration, not empathy. George had been part of the pilot for a number of months. We’d developed all the things you might in a service model—trainings, tools, support and appreciation structures. We’d considered his experience and designed for touch points along his journey. Over the past months he’d participated in numerous activities all aimed to build his confidence in, and an understanding of, contraception and the positive role it can play.

I took a deep breath. “George, tell me more.” He went on to explain that every time he went to put on a condom, he would lose his erection. My instinctive reply was to quip that this was totally normal and pretty much every guy on the planet has complained about condoms.

He looked at me with a mildly alarmed expression: if this is totally normal, then why isn’t this bullet point number one?!

You and me both.

Then came my internal groan: my team and I had focused so much on championing the benefits of safe sex that we’d overlooked addressing a critical one: barriers to pleasure—the reason we’re all having sex in the first place.

So we spent some time talking about condoms and the causes of retreating erections like becoming distracted. Suggested prototypes: keep condoms near your bed or try having your partner put them on. George seemed open.

I’ve been back in San Francisco now for a few months since that visit, but I keep finding myself thinking about George’s erection (and apparently writing about it as well).

As our partner Marie Stopes Kenya scales this program across the country there could soon be 100 teen ambassadors, then 1000. So yes, there will be other George’s and other concerns we didn’t anticipate or design for. In this case, it means designing for George—for his behaviors, mindsets, for the training and support he’ll need, the tools he’ll use, for what will keep him motivated, and ensuring that everything entailed is also feasible for our partner to run and deliver. 

But it also means we need to build a system that has the ability to be responsive, to be able to adapt as we learn and discover new things we may not have anticipated.

At we’ve shifted from a shorter project-based model where engagements might run for a handful of months, to a program model where we’re working with our partners over a much longer period, sometimes even years. Thanks to this brand of long-term engagement, we're able to continue to measure, learn, and refine our solutions with our partners well after they’ve gone to market. Plus, working this way means that we get more chances to design for the full system, to design for George.

For us, design is all about impact. And we believe that a big part of getting there is staying in the game for the long haul. Our program model has allowed us to be more responsive to how our designs hold up when they’re out in the real world. But if nothing else, this evolved approach has allowed us to do something we weren’t positioned to do before—to be there when condoms threaten to kill erections.

Adapted from the speech Health XO Program Director, Jessa Blades, gave at Design Museum SF’s Story Hour during SF Design Week 2016.

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