Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements.

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

Vulnerabilidade ao HIV em favela do Rio de Janeiro: impacto de uma intervenção territorial / HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil / HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil

OBJETIVO: Analisar o impacto da implementação de um programa participativo de promoção da saúde sexual em uma comunidade empobrecida, e descrever como o uso dos espaços públicos e privados para práticas sexuais constitui-se um fator que exacerba a vulnerabilidade ao HIV/Aids. MÉTODOS: Estudo etnográfico conduzido em 2002, em favela localizada no município do Rio de Janeiro. Os 6.000 moradores viviam em condições de vida deficitárias em que se verificou a ausência de políticas públicas, postos de saúde, lazer, oportunidades de emprego e segurança, o que consolida o poder de grupos criminosos. Foram abordadas as condições referentes à saúde sexual e à implantação do programa participativo de promoção da saúde sexual pelo Núcleo Comunitário de Prevenção, criado por uma organização não-governamental. Após dois meses de observação participante, foram realizadas 35 entrevistas semi-estruturadas em profundidade com moradores com idade entre 17 e 65 anos. Foram analisadas 11 histórias de vida de líderes comunitários e agentes comunitários de prevenção e sete grupos focais formados a partir dos grupos pré-existentes na comunidade. O material foi categorizado e analisado qualitativamente. RESULTADOS: A precariedade das moradias favorecia maior exposição às práticas sexuais, acentuando o estigma de ser morador de favela vivenciado pela comunidade. Com a implantação do programa do Núcleo, crianças, jovens e adultos se familiarizaram e passaram a ter conhecimento sobre prevenção do HIV/Aids; e jovens e adultos passaram a ter acesso a preservativos. CONCLUSÕES: Os resultados decorrentes da intervenção mostraram que embora a vulnerabilidade permaneça, a prevenção pode ser inserida na cultura local. A prevenção da Aids pode ser fomentada por meio de uma abordagem territorial com base na participação dos moradores e no fortalecimento da organização coletiva.

OBJECTIVE: To analyze the impact of a participatory sexual health promotion program implemented in a poor community and describe how the use of public and private spaces for sex is a factor that exacerbates vulnerability to HIV/Aids. METHODS: This ethnographic study was conducted in a Rio de Janeiro shantytown in 2002. Six thousand people live in precarious living conditions in which the lack of public policies, health posts, recreational activities, employment opportunities, and security consolidates power in criminal groups. Issues related to sexual health were addressed in addition to a participatory sexual health program implemented by a Community HIV Prevention Center established by a non-governmental organization. After two months of participatory observation, 35 semi-structured in-depth interviews were conducted with community members between the ages of 17 and 65. Eleven life histories of community leaders and HIV prevention promoters and seven focus groups formed from pre-existent community groups were analyzed. The material was categorized and analyzed qualitatively. RESULTS: The precarious nature of living conditions contributes to increased exposure to sexual practices while also enhancing the stigma experienced by the community for living in a shantytown. Through the implementation of the program by the Community HIV Prevention Center, children, teenagers and adults have become familiar with and knowledgeable of HIV/AIDS prevention; and teenagers and adults gained access to condoms. CONCLUSIONS: Although vulnerability to HIV was not affected, research results reveal that HIV prevention can become part of the local culture. HIV/AIDS prevention can be fomented by a local approach based on community participation and strengthening collective organizing.

Vulnerabilidade ao HIV em favela do Rio de Janeiro: impacto de uma intervenção territorial / HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil

OBJETIVO: Analisar o impacto da implementação de um programa participativo de promoção da saúde sexual em uma comunidade empobrecida, e descrever como o uso dos espaços públicos e privados para práticas sexuais constitui-se um fator que exacerba a vulnerabilidade ao HIV/Aids. MÉTODOS: Estudo etnográfico conduzido em 2002, em favela localizada no município do Rio de Janeiro. Os 6.000 moradores viviam em condições de vida deficitárias em que se verificou a ausência de políticas públicas, postos de saúde, lazer, oportunidades de emprego e segurança, o que consolida o poder de grupos criminosos. Foram abordadas as condições referentes à saúde sexual e à implantação do programa participativo de promoção da saúde sexual pelo Núcleo Comunitário de Prevenção, criado por uma organização não-governamental. Após dois meses de observação participante, foram realizadas 35 entrevistas semi-estruturadas em profundidade com moradores com idade entre 17 e 65 anos. Foram analisadas 11 histórias de vida de líderes comunitários e agentes comunitários de prevenção e sete grupos focais formados a partir dos grupos pré-existentes na comunidade. O material foi categorizado e analisado qualitativamente. RESULTADOS: A precariedade das moradias favorecia maior exposição às práticas sexuais, acentuando o estigma de ser morador de favela vivenciado pela comunidade. Com a implantação do programa do Núcleo, crianças, jovens e adultos se familiarizaram e passaram a ter conhecimento sobre prevenção do HIV/Aids; e jovens e adultos passaram a ter acesso a preservativos. CONCLUSÕES: Os resultados decorrentes da intervenção mostraram que embora a vulnerabilidade permaneça, a prevenção pode ser inserida na cultura local. A prevenção da Aids pode ser fomentada por meio de uma abordagem territorial com base na participação dos moradores e no fortalecimento da organização coletiva.(AU)

Network of healthy communities of Rio de Janeiro--Brazil.

Poor communities in Rio de Janeiro, which are known as favelas, suffer from various problems related to poor housing, poverty, unemployment, violence and organized crime, and lack of access to basic services, such as health care and education. In order to tackle these determinants, and inspired by WHO's international Healthy Communities/Cities movement, the etwork of Healthy Communities of Rio de Janeiro was formed in 2004. The Network is coordinated by the Center for Health Promotion (CEDAPS) and now includes more than 100 community groups and organizations in the state of Rio de Janeiro. Their aim is to promote health, community development and equity through community empowerment, participation, capacity building and advocacy. The paper describes the work that has been done since the Network's inception and the challenges which they face to reach their goals in the context of a country like Brazil. The Network represents an important landmark of how poor populations can organize themselves in a collective, participatory and constructive way to influence public policy and strive for better conditions of life in disadvantaged settings, like the favelas.

Theory and practice in the context of health promotion program evaluation.

Evaluation of health promotion (HP) actions is a major challenge, generating inquiries and reflections that can contribute on the effectiveness of the actions themselves. With the aim on fostering exchange on monitoring and evaluation experiences related to the implementation of healthy settings, the 1 st Brazilian Seminar on Health Promotion Effectiveness was launched in 2005. The program included round table and workshops known as Working Groups (WG) in Brazil. The criteria used to constitute the workshops focused settings as spaces of circulation and living as an intrinsic connection to lifestyles and conditions, as well as to social and/or environmental risk factors associated with groups living in these settings day after day. Focusing on evaluation as an activity that generates knowledge, this article highlights and stimulates the discussion about some major issues arising from the theoretical-methodological approach and the discussions developed in the workshops. The debates carried out during the Seminar illustrated the different perceptions and views of the social players involved in implementation and evaluation of H P practices, disclosing a multiplicity of meanings. It became clear that procedures are needed to document a future maturation of concepts and methods, in combination with further in-depth theoretical discussion.

The prevention and control of HIV/AIDS, TB and Vector-borne diseases in informal settlements: challenges, opportunities and insights.

Today's urban settings are redefining the field of public health. The complex dynamics of cities, with their concentration of the poorest and most vulnerable (even within the developed world) pose an urgent challenge to the health community. While retaining fidelity to the core principles of disease prevention and control, major adjustments are needed in the systems and approaches to effectively reach those with the greatest health risks (and the least resilience) within today's urban environment. This is particularly relevant to infectious disease prevention and control. Controlling and preventing HIV/AIDS, tuberculosis and vector-borne diseases like malaria are among the key global health priorities, particularly in poor urban settings. The challenge in slums and informal settlements is not in identifying which interventions work, but rather in ensuring that informal settlers: (1) are captured in health statistics that define disease epidemiology and (2) are provided opportunities equal to the rest of the population to access proven interventions. Growing international attention to the plight of slum dwellers and informal settlers, embodied by Goal 7 Target 11 of the Millennium Development Goals, and the considerable resources being mobilized by the Global Fund to fight AIDS, TB and malaria, among others, provide an unprecedented potential opportunity for countries to seriously address the structural and intermediate determinants of poor health in these settings. Viewed within the framework of the "social determinants of disease" model, preventing and controlling HIV/AIDS, TB and vector-borne diseases requires broad and integrated interventions that address the underlying causes of inequity that result in poorer health and worse health outcomes for the urban poor. We examine insights into effective approaches to disease control and prevention within poor urban settings under a comprehensive social development agenda.

[HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil]. / Vulnerabilidade ao HIV em favela do Rio de Janeiro: impacto de uma intervenção territorial.

OBJECTIVE: To analyze the impact of a participatory sexual health promotion program implemented in a poor community and describe how the use of public and private spaces for sex is a factor that exacerbates vulnerability to HIV/Aids. METHODS: This ethnographic study was conducted in a Rio de Janeiro shantytown in 2002. Six thousand people live in precarious living conditions in which the lack of public policies, health posts, recreational activities, employment opportunities, and security consolidates power in criminal groups. Issues related to sexual health were addressed in addition to a participatory sexual health program implemented by a Community HIV Prevention Center established by a non-governmental organization. After two months of participatory observation, 35 semi-structured in-depth interviews were conducted with community members between the ages of 17 and 65. Eleven life histories of community leaders and HIV prevention promoters and seven focus groups formed from pre-existent community groups were analyzed. The material was categorized and analyzed qualitatively. RESULTS: The precarious nature of living conditions contributes to increased exposure to sexual practices while also enhancing the stigma experienced by the community for living in a shantytown. Through the implementation of the program by the Community HIV Prevention Center, children, teenagers and adults have become familiar with and knowledgeable of HIV/AIDS prevention; and teenagers and adults gained access to condoms. CONCLUSIONS: Although vulnerability to HIV was not affected, research results reveal that HIV prevention can become part of the local culture. HIV/AIDS prevention can be fomented by a local approach based on community participation and strengthening collective organizing.

Theory and practice in the context of health promotion program evaluation

La evaluación de las acciones de promoción de la salud es un desafío de primer orden, que suscita interrogantes y reflexiones cuyo contenido puede contribuir a la efectividad de las propias acciones. Con el fin de promover el intercambio de experiencias de seguimiento y evaluación en relación con la implementación de entornos saludables, se organizó el Primer Seminario Brasileño sobre efectividad de la Promoción de la Salud em 2005. El programa incluía mesas redondas y talleres denominados grupos de trabajo en Brasil. Los criterios utilizados para organizar los talleres se concentraron en los entornos, entanto que espacios de tránsito y de vida intrinsicamente vinculados a los estilos y condiciones de vida, así como en los factores de riesgo sociales y medioambientales asociados a los grupos que viven en dichos entornos día tras dia. Este artículo trata sobre la evaluación en tanto que actividad que genera conocimientos, y subraya y estimula el debate en torno a algunas de las principales cuestiones que surgen del enfoque teórico-metodológico y de las discusiones que tuvieron lugar en los talleres. Todo lo que se habló en el transcurso del Seminario ilustró las diversas percepciones y puntos de vista de los actores sociales implicados en la aplicación y en la evaluación de las prácticas de la promoción de la salud, que desvelaron la multiplicidad de significados que encierran. Quedó claro que se precisan procedimientos para documentar la maduración de conceptos y métodos, sin olvidar la necesidad de profundizar en el debate teórico.(AU)

Network of communities in the fight against AIDS: local actions to address health inequities and promote health in Rio de Janeiro, Brazil.

When combined with major social inequities, the AIDS epidemic in Brazil becomes much more complex and requires effective and participatory community-based interventions. This article describes the experience of a civil society organisation, the Centre for Health Promotion (CEDAPS), in the slum communities (favelas) of Rio de Janeiro, Brazil. Using a community-based participatory approach, 55 community organisations were mobilised to develop local actions to address the increasing social vulnerability to HIV/AIDS of people living in squatter communities. This was done through on-going prevention initiatives based on the local culture and developed by a Network of Communities. The community movement has created a sense of "ownership" of social actions. The fight against AIDS has been a mobilising factor in engaging and organising communities and has contributed to raising awareness of health rights. Local actions included targeting the determinants of local vulnerability, as suggested by health promotion workers.

An innovative geographical approach: health promotion and empowerment in a context of extreme urban poverty.

This article describes and analyses a territorial intervention, the Vila Paciencia Initiative--a local development/health promotion programme implemented in a context of extreme poverty in the western district of Rio de Janeiro. The main goal of the programme was to empower individuals and communities. We emphasise the lessons learned and the potential for integrating them into local and regional health services, which could strengthen community participation and capacity-building and improve the effectiveness and community orientation of primary health care and other public policies directed to geographical development.

Empowerment e avaliação participativa em um programa de desenvolvimento local e promoção da saúde / Empowerment and participatory evaluation: lessons from a territorial health promotion program

Este artigo discute o conceito de empowerment em Promoção da Saúde e a importância dos processos de avaliação neste contexto, através da análise de uma intervenção territorial - a Iniciativa de Vila Paciência, realizada na Zona Oeste do Rio de Janeiro. Partindo de uma breve revisão da literatura sobre empowerment e das propostas mais recentes para sua operacionalização e avaliação, descrevem-se as múltiplas estratégias utilizadas para promover a participação da comunidade na construção de um programa de Desenvolvimento Local e Promoção da Saúde. Enfatiza-se o processo avaliativo, estruturado em três níveis complementares: o Diagnóstico Comunitário, seus resultados e implicações; o estudo das intervenções realizadas pelos próprios moradores, capacitados por uma metodologia participativa de planejamento e solução de problemas (Problem Solving for Better Health); e a sistematização de depoimentos e relatos dos participantes sobre as experiências vivenciadas no programa. São discutidos os desafios, limites e perspectivas deste processo, buscando-se contribuir para a melhor compreensão da importância da avaliação para o desenvolvimento pessoal dos moradores e para a mobilização coletiva da comunidade em direção ao empowerment.