Developing an AIDS prevention intervention for incarcerated male adolescents in Brazil.

The objective of this study was to investigate knowledge, attitudes, and practices regarding AIDS among incarcerated male adolescents in Brazil and to develop an AIDS prevention intervention for this population. A questionnaire administered to 275 boys in São Paulo covered demographic and social characteristics, drugs, and HIV risk perception and behavior. Subsequently, we collected qualitative data on the development and implementation of a prevention program. Ninety-eight percent of adolescents were sexually experienced, most initiating by age 13; 22% were fathers. Injection drug use was reported by 5.5%, 12% had exchanged sex for money, 35% had more than 15 partners and 8% had homosexual experience. Although 72% had used condoms, only 9% used them consistently, and only 35% used one in their last intercourse before incarceration. Predictors of condom use included carrying condoms and endorsing the statement "I would use condoms with my girlfriend." Many said their lives include other risks more important than AIDS, such as survival in the crime scene. Initial efforts at prevention based on commonly used approaches of providing information to guide future rational decisions generated limited participation. However, when we worked with them to develop interventions based on their interests and needs, using modalities such as music, hip-hop arts, graffiti, and helping them to create an AIDS prevention compact disk, they responded with enthusiasm. These incarcerated adolescents are at extremely high social risk and report high levels of risk behavior for HIV infection. Interventions for these youth were better received when developed in collaboration with them and based on their beliefs, aspirations, and culture. The intervention that resulted went beyond AIDS to include issues such as violence, drugs, sexuality and human rights.

[AIDS prevention among incarcerated teenagers, Brazil]. / Prevenção da Aids com adolescentes encarcerados em São Paulo, SP.

OBJECTIVES: To describe social and family support, drug use, and knowledge, practices and attitudes related to AIDS and its prevention among male teenagers. METHODS: Participants were 275 male teenagers interned in a youth detention center (FEBEM - State Foundation for Juvenile Well-Being) in São Paulo, Brazil. There were two segments. In segment 1, semi-structured interviews with 20 detainees took place. In segment 2, close-end self-administered questionnaires covering sociodemographic data, criminal records, sexual practices, drug use, attitudes, knowledge and AIDS-related practices were applied. RESULTS: Ninety percent of the detainees lived previously with their families. All of them had attended public schools, although 61% had already dropped out. Twelve percent had never used drugs, and 5.5% were intravenous drug users. Most (98%) were sexually active; 35% had had more than 15 sexual partners, 8% had homosexual experiences (inside or outside the center), 12% had exchanged sex for material return and 22% were fathers. Many said that getting HIV infected "that's life " and that they face greater risks in their lives, such as surviving on the streets. They think condoms are easily broken (83%) and interfere with sex (58%); 72% had used condoms but only 9% used them with all their partners. CONCLUSIONS: These teenagers have a very high risk of HIV infection. It is necessary to integrate AIDS prevention programs to their life ills and related problems such as racism, expectations for the future, criminality, drug use, basic rights including sexual and reproductive rights, and show them there are alternatives other than exposing themselves to HIV infection or dying as criminals.

[Differences in AIDS prevention among young men and women of public schools in Brazil]. / Diferenças na prevenção da Aids entre homens e mulheres jovens de escolas públicas em São Paulo, SP.

OBJECTIVES: To investigate risk sexual for HIV infection among young adult night school students (18 to 25 years old) and to assess gender differences in sexual practices and the impact of AIDS prevention program. METHODS: A longitudinal intervention study was carried out among students of four public inner-city night schools, in the city of São Paulo, Brazil, randomized into two groups: an intervention group and a control one. Three hundred and ninety-four students participated in the study; 77% completed the post-intervention questionnaire. The intervention consisted of a "Safer Sex Workshop" where the following topics were discussed: Aids symbolism, risk perception, influences of gender norms on attitudes, Aids-related knowledge, erotic and reproductive body, sexual pleasure, and condom use negotiation. Statistical analysis was performed using Pearson's Chi-square test and variance. RESULTS: The frequency of condom use was low (33%). There were significant gender differences concerning sexuality and AIDS prevention. Workshop evaluation showed a statistically significant impact on women, who improved chiefly their attitudes regarding safer sex. Changes were not significant among men. CONCLUSIONS: HIV risk infection can be lowered but more significant results can be achieved if gender differences and sexual scripts are taken into account while developing specific long-term community programs.

Family structure and adolescent sexual behavior in a poor area of São Paulo, Brazil.

PURPOSE: In Brazil, as elsewhere, behavior during adolescence can place young people at risk for serious medical and social problems, including sexually transmitted infections, unintended pregnancy, drugs, crime, and violence. Few studies internationally have examined the influence of family structure on risk behavior among low-income youths. METHODS: This cross-sectional study included 296 young people in one of the poorest areas of São Paulo who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. We examined associations between family structure and various risk behaviors. RESULTS: Ages ranged from 13-24 years (82%, 15-18); 67% were of Afro-Brazilian ancestry, and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. CONCLUSIONS: The presence of both parents is an important protective factor for Brazilian youth vulnerable to multiple risks. Prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children.

Diferenças na prevençäo da Aids entre homens e mulheres jovens de escolas públicas em Säo Paulo, SP / Differences in AIDS prevention among young men and women of public schools in Brazil

OBJETIVOS: Estudar as práticas sexuais de risco para a infecçäo pelo HIV de estudantes adultos jovens (18 a 25 anos) de escolas públicas noturnas e avaliar as diferenças de gênero e o impacto de um programa de prevençäo de Aids. MÉTODOS: Estudo longitudinal de intervençäo, em quatro escolas da regiäo central do Município de Säo Paulo, SP, divididas aleatoriamente em dois grupos: intervençäo e controle. Uma amostra de 394 estudantes participou do estudo, e 77 por cento completaram o questionário pós-intervençäo. Realizaram-se "Oficinas de Sexo Mais Seguro" para discutir simbolismo da Aids, percepçäo de risco, influências das normas de gênero nas atitudes, informaçöes sobre Aids, corpo erótico e reprodutivo, prazer sexual e negociaçäo do uso do preservativo. Para a análise estatística, foram empregados os testes qui-quadrado de Pearson e a análise de co-variância. RESULTADOS: A freqüência do uso consistente de preservativo foi baixa (33 por cento), e existiam diferenças significativas entre homens e mulheres com referência à sexualidade e à prevençäo de Aids. Ao avaliar os efeitos das oficinas, as mudanças foram estatisticamente significativas entre as mulheres, que relataram maior proporçäo de sexo protegido entre outros aspectos relacionados à prevençäo da Aids. As mudanças näo foram significativas entre os homens. CONCLUSOES: O risco para a infecçäo pelo HIV pode ser diminuído, mas resultados mais expressivos podem ser encontrados se forem consideradas as diferenças de gênero e de papéis sexuais por meio de programas comunitários específicos de longa duraçäo. Gênero

Prevençäo da Aids com adolescentes encarcerados em Säo Paulo, SP / AIDS prevention among incarcerated teenagers, Brazil

OBJETIVOS: Descrever o perfil de adolescentes quanto ao apoio social e familiar, ao uso de drogas e os conhecimentos, as práticas e atitudes relacionadas à Aids e sua prevençäo. MÉTODOS: Foram estudados 275 jovens internos, do sexo masculino, de um centro de internaçäo da Fundaçäo Estadual do Bem Estar do Menor (Febem), em Säo Paulo, SP. A pesquisa foi feita em duas fases: a primeira por meio de entrevistas semi-estruturadas com 20 internos; a segunda, com questionários para auto-respostas aplicados aos 275 internos, com perguntas fechadas referentes a características sociodemográficas, criminalidade, práticas sexuais, uso de drogas, conhecimento, atitudes e práticas relativas à Aids. RESULTADOS: Do total estudado, 90 por cento dos jovens internos residiam com suas famílias antes da internaçäo; todos haviam estudado em escolas públicas, ainda que 61 por cento já houvessem abandonado os estudos; 12 por cento já haviam usado drogas; e 5,5 por cento eram usuários de drogas intravenosas. A maioria (98 por cento) era sexualmente ativa; 35 por cento haviam tido mais de 15 parceiras(os) sexuais ao longo da vida; 8 por cento haviam tido experiências homossexuais (dentro ou fora da Febem); 12 por cento já haviam trocado sexo por benefícios materiais; e 22 por cento já eram pais. Muitos dos adolescentes afirmaram que adquirir o HIV "é parte da vida" e que suas vidas apresentam riscos piores, como sobreviver na criminalidade. Acreditam que o preservativo é frágil (83 por cento) e atrapalha a relaçäo sexual (58 por cento); 72 por cento já haviam utilizado preservativo, mas apenas 9 por cento o utilizavam sempre. CONCLUSOES: Os adolescentes apresentaram um elevado risco de aquisiçäo do HIV. Assim, torna-se necessário integrar a prevençäo da Aids em sua problemática de vida e em temas como racismo, esperança pelo futuro, criminalidade, uso de drogas, direitos fundamentais, incluídos nestes os referentes ao sexo e à reproduçäo, mostrando existir alternativas a adquirir o HIV ou morrer na criminalidade

Fala Educadora! Fala Educador! / Speak Women Educator! Speak Educator!

Este material é dirigido a todos/as que participam do processo de construçäo do conhecimento e das açöes educativas em cidadania, nas áreas de adolescência, sexualidade, prevençäo das doenças sexualmente transmissíveis (DST) e AIDS. Estamos aqui iniciando uma conversa sobre o processo de implantaçäo e implementaçäo de projetos de Orientaçäo Sexual em escolas. Você, que é educador/a e trabalha em outras Instituiçöes (Posto de Saúde, Centro Cultural, Centros de Juventude e outros) pode estar aproveitando idéias e experiências, descritas aqui, e adaptar o Projeto no contexto do seu trabalho com os adolescentes. Este caderno é um complemento à cartilha Fala Garota & Fala Garoto. Mas desta vez queremos estar com você, educador e educadora. Contribuir para o desafio que é a educaçäo para cidadania