Audiovisual production and embodied pedagogy as health promotion: The experience of a university extension project in partnership with the Casa Nem LGBTQIA+ shelter in Brazil.

The project "Audiovisual production and vital strategies" interwove art, life, academic research, and activism with decolonial feminist perspectives. It was carried out as part of an audiovisual laboratory with students from the Federal State University of Rio de Janeiro and Casa Nem, a squatters' settlement, cultural and educational project in Rio de Janeiro led by transgender people in situations of high social vulnerability. The audiovisual Lab was facilitated by a group of artists and educators, and the majority of project participants were Black people who identified as trans* or LGBTQIA+. We worked with critical and emancipatory pedagogies that allowed the impacts of each participants racialized and gendered life experiences to guide the entire creative processes. The project's creative processes were inspired by bodywork dynamics from the field of performance art, and focused on uncovering profound dialogues and depths in each participant's life narratives. In this essay, we reflect critically on aesthetic choices and modes of creation. Through our discussion of the images and processes as a whole, we discuss how reimagining the encounter between pedagogy and audiovisual production established new modes of mediating relationships inside and outside of the university, and connect these processes to broader questions of health promotion.

Findings from Encontros: a multilevel STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil.

BACKGROUND: Sexually transmitted infection (STI)/HIV prevention programs, which do not modify social structural contexts that contribute to risk of STI/HIV may fail to bring about improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multilevel intervention with sex workers, including improved clinical care and community-mobilizing strategies to modify social structural factors that shape sexual behavior, to improve condom use and reduce incident STI. METHODS: We followed 420 sex workers participating in the Encontros intervention in Corumbá, Brazil, between 2003 and 2005. We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities (exposed) with those who were less engaged (unexposed). We also determined the association of participation on reported social cohesion and participation in networks. RESULTS: Exposed participants had significantly higher odds of reporting consistent condom use with regular clients (odds ratio [OR]: 1.9, 95% confidence interval:1.1-3.3) and nonsignificantly increased odds with both new clients (OR: 1.6, 0.9-2.8) and nonpaying partners (OR: 1.5, 0.9-1.5). The odds of an incident STI were nonsignificantly reduced for exposed participants compared with unexposed (OR: 0.46, 0.2-1.3). Participation was significantly associated with increased perceived cohesion and participation in networks. CONCLUSION: This prospective study provides evidence that multilevel interventions with mobilizing strategies to modify aspects of the social environment can improve condom use, reduce STIs, and increase social cohesion and participation in networks among sex workers.

'She's a professional like anyone else': social identity among Brazilian sex workers.

Community mobilisation among sex workers is recognised as an important HIV/STI prevention strategy. However, factors such as poverty and stigma often negatively influence participation in activities that attempt to mobilise around a common identity of 'sex workers'. A qualitative study was conducted to explore the relationship between social identity and participation among 24 sex workers enrolled in an HIV/STI prevention intervention research project with a community mobilisation component. The relationship between social identity and participation was found to be a dynamic process in which participation in project clinic and community-based activities was motivated by three overlapping strategies: participation for psycho-social and health benefits; participation to improve individual status; and participation to change group status. Rather than mobilising around a 'sex worker identity', we conclude that projects with a community mobilisation approach may be more effective if they facilitate space for critical self-reflection and opportunities for collective action with an emphasis on acceptance and solidarity.

Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil.

OBJECTIVES: We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts. METHODS: Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data. RESULTS: Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR] = 0.80; P < .01), and there was a marginal association among men (adjusted IRR = 0.41; P = .08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR = 0.83; P = .04), as was men's access to and management of social and material resources (IRR = 0.15; P = .01). Social-environmental factors were not associated with STIs. CONCLUSIONS: The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.

Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil / Evaluation of the organizational structure of HIV/AIDS outpatient care in Brazil

OBJETIVO: No contexto de acesso universal à terapia antiretroviral, os resultados do Programa de Aids dependem da qualidade do cuidado prestado. O objetivo do estudo foi avaliar a qualidade do cuidado dos serviços ambulatoriais que assistem pacientes de Aids. MÉTODOS: Estudo realizado em sete Estados brasileiros, em 2001 e 2002. Foi avaliada a qualidade do atendimento a pacientes com Aids quanto à disponibilidade de recursos e a organização do trabalho de assistência. Um questionário com 112 questões estruturadas abordando esses aspectos, foi enviado a 336 serviços. RESULTADOS: A taxa de resposta foi de 95,8 por cento (322). Os indicadores de disponibilidade de recursos mostram uma adequação maior do que os indicadores de organização do trabalho. Não faltam antiretrovirais em 95,5 por cento dos serviços, os exames de CD4 e Carga Viral estão disponíveis em quantidade adequada em 59 e 41 por cento dos serviços, respectivamente. Em 90,4 por cento dos serviços há pelo menos um profissional não médico (psicólogo, enfermeiro ou assistente social). Quanto à organização, 80 por cento não agendavam consulta médica com hora marcada; 40,4 por cento agendavam mais que 10 consultas médicas por período; 17 por cento não possuíam gerentes exclusivos na assistência e 68,6 por cento não realizavam reuniões sistemáticas de trabalho com a equipe. CONCLUSÕES: Os resultados apontam que além de garantir a distribuição mais homogênea de recursos, o programa precisa investir no treinamento e disseminação do manejo do cuidado, conforme evidenciado nos resultados da organização de trabalho.

[Evaluation of the organizational structure of HIV/AIDS outpatient care in Brazil]. / Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil.

OBJECTIVE: In the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. METHODS: The present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of the care provided to AIDS patients from the standpoint of resource availability and care process organization. A questionnaire comprising 112 structured questions addressing these aspects was sent to 336 services. RESULTS: Response rate was 95.8% (322). Greater adequacy is seen for indicators of resource availability than for those of work organization. The supply of antiretroviral medication is sufficient in 95.5% of services. CD4 and viral load tests are available at adequate amounts in 59 and 41% of services, respectively. In 90.4% of services there is at least one non-medical professional (psychologist, nurse, or social worker). As to work organization, 80% scheduled the date but not the time of medical appointments; 40.4% scheduled more than 10 appointments per period; 17% did not have exclusive managers; and 68.6% did not hold systematic staff meetings. CONCLUSIONS: The results indicate that, in addition to ensuring the more homogeneous distribution of resources, the program must invest in the training and dissemination of care management skills, as confirmed by the results of care process organization.

Acompanhamento terapêutico e transtornos alimentares / Continued Therapeutic Assistance and Eating Disorders

O presente artigo relata a experiência da Equipe Contatos de Acompanhamento Terapêutico no projeto de atendimento de grupos de usuárias do Hospital-Dia do Ambulatório de Bulimia e Transtornos Alimentares do Instituto de Psiquiatria do Hospital das Clínicas em saídas semanais pela cidade. Tem por objetivo relatar e analisar as experiências dos encontros, de forma a pontuar a aproximação dos sintomas com o modo pelo qual as usuárias se relacionam com o ambiente social e salientar o que o acompanhamento terapêutico tem a oferecer como dispositivo clínico no tratamento destes casos.