[Masculinity and vulnerability to HIV among heterosexual men in São Paulo, Brazil]. / Masculinidade e vulnerabilidade ao HIV de homens heterossexuais, São Paulo, SP.

OBJECTIVE: To identify aspects of masculinity that could be associated with vulnerability to HIV among heterosexual men. METHODS: A qualitative survey was conducted among bus drivers and members of the Work Accident Prevention Committee of a public transportation company in São Paulo city, Brazil. Ten individual interviews and four safe sex workshops were tape-recorded and transcribed, and their contents were categorized and discussed in thematic blocks: sexuality, infidelity, condom use, and sexually transmitted diseases and Aids. RESULTS: Aspects that make heterosexual men more vulnerable to HIV are as follows: feeling strong and immune to disease; engaging in impetuous, risky behaviors; inability of refusing a woman; belief that men need sex more than women do and that their sexual desire cannot be controlled. Men's infidelity is considered a natural behavior while women's infidelity is a result of to her partner's inaptitude. It's up to men to make the decision of using or not condom and women can only ask them to use it in order to avoid pregnancy. The refusal to use condoms is related to: aesthetical and economical reasons, fear of failing erection, loss of sensibility for both men and women. Interviewees do not consider themselves vulnerable to either HIV or STDs and have little knowledge about the modes of infection. CONCLUSIONS: An aspect that favors prevention in this population men are expected to be responsible and good providers for their families. Thus condom use could be advocated as a contraceptive method and to avoid "bringing diseases home". It is important to know the different conceptions of masculinity to be able to intervene as they are related to increased vulnerability to HIV and could lead a way to better promoting prevention in this population.

[Community based intervention and reduction of women's vulnerability to STD/AIDS in Brazil]. / Intervenção comunitária e redução da vulnerabilidade de mulheres às DST/ Aids em São Paulo, SP.

OBJECTIVES: Despite the growing number of AIDS cases in women reported, community-based interventions, which are essential in this context, are scarce and rarely evaluated. The aim of this study was to carry out a community-based research intervention, to develop and evaluate a set of STD/ AIDS prevention actions targeting the vulnerability of low income women population. METHODS: The study was carried out in Monte Azul slum in the city of São Paulo, SP, Brazil, in the period 1998-1999. The following actions were put in place: training of health professionals from the local outpatient clinic, availability of prevention resources (male and female condoms), educational groups, educational materials and community radio programs. For evaluating intervention, data from four different research instruments were assessed: pre and post training testing of health professionals, monitoring of condom supply, direct observation of community activities, and record of health professionals and target population's voluntary statements during activities. RESULTS: It was observed an increase in demand for male condom and an interest in female condoms. There were relevant gender and age differences in adhering to proposed activities. Although there were good results regarding sensitization and training of health professionals, their involvement in prevention activities was limited. CONCLUSIONS: Strategies relating to codes, demands and specific interests of the local society, especially those related to gender roles, have successfully performed as preventive actions. Health professionals' overwork at the local outpatient clinic proved to be an important limitation for maintaining preventive actions.

[Limitations of multiprofessional work: a case study of STD/AIDS reference centers]. / Limites do trabalho multiprofissional: estudo de caso dos centros de referência para DST/Aids.

OBJECTIVE: To understand the possibilities and limitations of developing coordinated work among professionals of different background in order to promote work collaboration and improve the quality of care of HIV/AIDS patients. METHODS: A qualitative study on multiprofessional work was carried out in five STD/AIDS reference centers in the city of São Paulo, Brazil. Semi-structured interviews were applied to 26 professionals from different background, focusing on how they position their practices in a multiprofessional setting. RESULTS: Significant differences were observed as to the outreach of multiprofessional work collaboration and possibilities of improving health care are related to the circumstances the multiprofessional work is done. CONCLUSIONS: When the multiprofessional team has to deal with predictable circumstances and the planning of long-term care projects where demands are anticipated from situations found in their practices, this creates better working conditions for effective collaboration. This collaboration favors interventions that promote a more productive interaction between the medical treatment and other relevant dimensions of care, such as social, psychological, and emotional needs of the patients.

Intervençäo comunitária e reduçäo da vulnerabilidade de mulheres às DST/Aids em Säo Paulo, SP / Community based intervention and reduction of womenïs vulnerability to STD/AIDS in Brazil

OBJETIVOS: Com o aumento do número de casos notificados de Aids em mulheres, as intervençöes comunitárias, que säo fundamentais nesse contexto, säo poucas e raramente avaliadas. Assim, objetivou-se realizar um estudo-intervençäo de base comunitária, buscando desenvolver e avaliar um conjunto de açöes de prevençäo das DST e da Aids voltadas a atingir a vulnerabilidade da populaçäo feminina de baixa renda. MÉTODOS: O estudo foi realizado na favela Monte Azul, na cidade de Säo Paulo, SP, no período de um ano (1998-1999). Foram desenvolvidas as seguintes açöes: treinamento de profissionais de saúde do ambulatório local, disponibilidade de recursos preventivos (camisinha masculina e feminina), realizaçäo de grupos educativos, distribuiçäo de materiais educativos e realizaçäo de programas na rádio comunitária. Para avaliar a intervençäo, foram analisados dados provenientes de quatro diferentes instrumentos de investigaçäo: pré e pós-teste sobre capacitaçäo de profissionais de saúde para o trabalho preventivo, monitoramento de retirada de preservativos, observaçäo participante das atividades comunitárias e registro de depoimentos espontâneos dos profissionais de saúde e populaçäo-alvo durante as atividades. RESULTADOS: Entre os achados do estudo, destacam-se o aumento da demanda pela camisinha masculina e o interesse pela camisinha feminina; diferenças relevantes relacionadas a gênero e idade e à adesäo às atividades propostas; e bons resultados na sensibilizaçäo e capacitaçäo dos profissionais de saúde, embora com limites na manutençäo de seu envolvimento com as atividades preventivas