Social and ethical determinants of sexuality: gender and health.

The aim of this paper is to expand concepts of gender and explore how behaviours associated with sexual identity affect health risks, as well as the right to sexual expression for sexual minorities and persons with disabilities, to promote safe sexual behaviour and reduce the incidence of sexually transmitted diseases, through the internationally sanctioned Sexual and Reproductive Health concept. During the XX century the multiple meanings of sexuality have been progressively recognized and its physical and psychological health dimension have become a reality, enshrined in United Nations (UN) documents. Countries have begun to adapt their legislations to this new reality and Conventions today guarantee equal sexual and reproductive rights to persons with disabilities, while the nature of variant sexual behaviours is being debated. Sexual and reproductive health is today an acknowledged goal for every individual and the right to equality for persons with variant behaviours and disabilities, as well as the coexistence of diverse meanings of sexuality an established fact. Healthy and safe sexual behaviour should become an important goal for all societies and cultures.

Qualitative needs assessment of HIV services among Dominican, Mexican and Central American immigrant populations living in the New York City area.

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PLWAs (persons living with AIDS) and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experiences and knowledge of HIV care issues. A total of 57 men and women participated, ranging in age from 19-61. Results included detailed information on cultural meanings of HIV/AIDS; experience of stigma and rejection; gendered health-seeking behaviour; testing issues; and satisfaction with services. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty, repressive governments, lack of education/literacy, ethnicity, class, colour-based stigma and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behaviour. AIDS agencies were seen to play a crucial role in connecting PLWAs to services and resources. The key elements for the provision of services to this population appear to be those that build on cultural norms and network human and institutional resources.

Understanding HIV risks of chronic drug-using men who have sex with men.

Focus groups and individual structured interviews were conducted in six cities with 98 predominantly street-recruited men who had a recent history of smoking crack or injecting drugs and who reported having had sex with other men (MSM) in the past year. Twenty-six focus groups explored the cultural and social context of participant's drug use and sexual activity and addressed outreach and HIV prevention issues pertinent to this population. Narrative summaries developed from verbatim focus group transcripts identified seven themes: (a) sexual orientation and gender identity; (b) interactions within and between MSM networks; (c) drug use, sexual activity and personal relationships; (d) HIV transmission bridges; (e) preferred HIV information sources; (f) HIV knowledge, prevention practices and risk behaviours; and (g) availability of HIV and drug-related services. Of the 98 MSM drug users, 42% identified publicly as gay or homosexual; 35% identified publicly, but only 21% privately, as heterosexual. A total of 51% had one or more female sex partners in the past year. There was a high frequency of unprotected sex in conjunction with drug use and a distinct preference for having sex when high. For most participants, drug use rather than sexual orientation formed the core of personal identity. Participants reported associating primarily with other drug users, usually MSM, and had limited contact with people who did not use drugs and the mainstream gay community. Participants' sexual and drug-injecting activities were judged to be a bridge for transmission of HIV to both people who used drugs and those who did not.

Bridgeport's Teen Outreach and Primary Services (TOPS) project: a model for raising community awareness about adolescent HIV risk.

The Greater Bridgeport Adolescent Pregnancy Program (GBAPP), based on its skills in sex education, pregnancy, and sexually transmitted disease prevention, developed the Teen Outreach and Primary Services (TOPS) project, an innovative teen-focused community outreach model to expand and ensure access to health and support services for primarily underserved minority adolescents and young adults at risk for or living with the human immunodeficiency virus (HIV). TOPS is supported by the Special Projects of National Significance Program, HIV/Acquired Immunodeficiency Syndrome (AIDS) Bureau, Health Resources and Services Administration. The target population for TOPS is inner-city minority youth (ages 15-24 years) at high risk for HIV or HIV positive. Services ranging from outreach to intensive case management were provided to 2173 youth in the project. The number of HIV-positive youth has increased from three in the first year of the project to 17 in 1997. TOPS provides outreach, case management, HIV counseling and testing, risk-reduction activities, and referrals for housing, entitlements, specialty HIV clinics, and substance abuse counseling and treatment. A group of peer educators has been recruited from among the target population and is trained and paired with the staff to provide outreach services, peer counseling, and education, and to assist with recreational opportunities.

Prostitution and HIV risk behavior.

The authors discuss prostitution as a high-risk behavior for HIV infection and transmission, using data from interviews with prostitutes in Bridgeport, Connecticut, and New York City. "The primary objective is to share some of the information gained in research interviews and street work so that it can be utilized to assist efforts at reaching such high risk behavior populations with appropriate AIDS prevention information, testing, counseling and health services." Factors considered include prostitute characteristics, the pimp, perceived roles of the prostitute, power and control, risky sexual practices, and knowledge, attitudes, and behavior relating to AIDS.

Paraguayan pharmacies and the sale of pseudo-abortifacients.

This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.

PIP: The hypothesis that a restriction of family planning services will be associated with an increased incidence of abortion was investigated in a survey carried out in Asuncion, Paraguay, in 1985. In 1979, the Government of Paraguay abruptly eliminated all support for family planning services at Ministry of Health clinics--a measure that affected at least half of all contraceptive acceptors and forced them to turn to pharmacies for contraceptive supplies. The survey, which samples 10% of the registered private pharmacies in Asuncion, used the sale of pseudo- abortifacients as a measure of induced abortion. Also interviewed were 56 contraceptive purchasers and 51 purchasers of injectables contraceptives intended for use as abortifacients who were recruited at the participating pharmacies. The results indicated that low-income women were 5 times more likely than their higher income counterparts to purchase pseudo-abortifacients. In addition, unmarried women were 3 times more likely to purchase progestogen injections to induce a missed menstrual period than married women. Almost 70% of abortifacient purchasers reported that they had attempted to self-abort on previous occasions. The pharmacists stated that up to 50 women a week requested medication for pregnancy termination and were in agreement that this practice had increased substantially following the government's withdrawal of support for contraception. The pharmacists expressed concern about the nonavailability of counseling from trained family planning personnel and indicated that some pharmacy staff knowingly exploit women by injecting them with unsafe preparations or drugs that cannot induce abortion. The administration of ineffective pseudo-abortifacients can delay the decision to seek an illegal abortion or result in life-threatening incomplete abortion.

Supervising Community health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977-1982.

The supervision of CHWs in the Mexican Rural Health Program (1977-82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

Assessment of body concepts and beliefs regarding reproductive physiology.

PIP: Instruments for depicting the way rural women experience and perceive their bodies were administered in an anthropological study in Central Mexico. Body outlines were filled in or finished by the women and concepts of reproductive physiology were shown during the drawing process which showed various degrees of knowledge or accuracy. The organs most frequently drawn were the stomach, intestines, heart, liver, uterus, and lungs. Ribs were the only bones spontaneously included. The external structures most often drawn were breasts, vagina, and umbilicus. All structures were represented as circles of varying sizes except for the intestines, which were lines, and the heart, which was a valentine. Accurate placement of internal organs was unusual. When the names used for the bodily parts were elicited, the breast had 5 different terms. Multiple names were also given to the stomach, uterus, and vagina. The heart is believed to the origin of feeling and emotion and has religious as well as physical meaning. It was often thought that from 2-10 coital incidents were needed to become pregnant since it was believed that the blood of man must mix with the blood of the woman. In this type of survey it is important that the women can identify with the basic body outline; in pretesting certain figures were rejected.^ieng