Dating, mating, and motherhood: identity construction among Mexican maquila workers.

PIP: The authors explore the gender identities among women factory workers in Ciudad Juarez, Mexico. Using data from 3 generations of women, they show that women's participation in the maquila work force is exposing them to new ideologies which challenge traditional images embodied in the marianismo ideal of Mexican womanhood. By focusing upon women's changing experiences of courtship and motherhood, the authors suggest that conventional discourses stressing parentally supervised mate selection and full-time motherhood are being challenged by alternative ones which allow young women to socialize freely with prospective mates in unsupervised contexts, and expand the meaning of responsible motherhood to encompass full-time employment. Women workers' identities are fluid processes in permanent negotiation. ¿^ieng

Jamaicans begin to embrace safer sex.

PIP: Over the past decade, studies in Jamaica revealed widespread acceptance of sex outside of marriage or other stable relationships and a common perception that sexually transmitted diseases (STDs) are a natural and easily curable outcome of sexual activity. However, recent surveys suggest that these attitudes and behaviors are beginning to change. Jamaican men who once readily had 5 or more sex partners per year are choosing their partners more carefully and staying in relationships longer. Men and women report having fewer sex partners, while young male adolescents are waiting until they are older to begin having sex. This attitudinal and behavioral change may be attributed to the Ministry of Health's HIV/STD control program launched in 1987. The program is comprehensive, systematic, and sometimes uses an unorthodox approach to HIV/AIDS prevention. HIV/AIDS and STDs were linked in the integrated approach.^ieng

Brazil got first condom machines when Carnival heated up.

"AIDS Awareness Is Love Awareness." It's a message Massachusetts health officials and AIDS educators hope will reach the state's Black male community, a group that is seeing its rate of HIV infection rise at alarming rates. The campaign is aimed exclusively at Black men, and health officials say it comes none too soon. Black men make up only 2.2% of the state's population, yet comprise 19% of all male cases of AIDS in Massachusetts according to the state's Department of Public Health (DPH). More than 1700 Black males in Massachusetts have been diagnosed with AIDS. Nationwide, AIDS is the leading cause of death among Black males aged 25-44. As the director of an AIDS prevention clinic, Lawrence Robinson knows how difficult it is to teach young people, especially young Black males, about the dangers of unprotected sex. Once Robinson was preaching his message to a teenager on the streets of Boston. "What he said to me was, 'What do I have to look forward to? I'm having sex, I like it, and I'm not going to let anybody take that away from me,'" Robinson said.

The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients.

GOAL OF THIS STUDY: This study examined the effectiveness of video-based patient education interventions on promoting condom use among men and women seeking services at a large public STD clinic in New York City. METHODS: Culturally sensitive video-based interventions designed to promote safer sex behaviors were evaluated in a randomized study of black and Hispanic male and female STD clinic patients. Subjects (n = 1,653) were randomly assigned to one of three groups: 1) control, 2) video viewing, and 3) video viewing followed by participation in an interactive group session led by a trained facilitator. The authors examined 1) the effectiveness of interventions in increasing STD and condom-related knowledge, positive attitudes about condoms, human immunodeficiency virus/STD risk perceptions, and self-efficacy and 2) the relationships among these variables, level of intervention, and condom acquisition, a behavioral measure of condom use. RESULTS: Compared with a control group, subjects assigned to video viewing demonstrated greater knowledge about condoms and STDs, more positive attitudes about condom use, increased human immunodeficiency virus/STD risk perceptions, greater self-efficacy, and higher rates of condom acquisition. Subjects assigned to video viewing followed by interactive sessions demonstrated still further increases in risk perceptions, self-efficacy, and condom acquisition, but not in knowledge or condom attitudes. A significant proportion of the association between the behavioral outcome of condom acquisition and level of intervention is attributable to the impact of interventions on risk perception and self-efficacy. CONCLUSIONS: Based on extensive formative research that identified barriers to safer sex behaviors, video-based interventions were developed to promote condom use among black and Hispanic men and women attending STD clinics. Designed to be integrated into clinic services, these interventions help improve knowledge, promote positive attitudes about condoms, and increase condom acquisition among individuals at high risk of acquiring and transmitting human immunodeficiency virus infection and other STDs.

PIP: In 1992 in New York City, 1653 Black and Hispanic men and women at the Morrisania STD Clinic in the South Bronx were randomly assigned to one of three groups [routine clinic services (control); video viewing (video titles: "Porque Si" for Hispanics and "Let's Do Something Different" for Blacks); and video viewing plus an interactive session] for a study assessing the effectiveness of video interventions in promoting condom acquisition. Condom acquisition was a proxy for condom use. STD patients in the video viewing groups increased their knowledge about condom use and STDs/AIDS (p 0.001). They had more positive attitudes about condom use (p = 0.0021), perceived themselves at a greater risk of contracting an STD or AIDS (p = 0.0314), and had higher levels of self-efficacy (p 0.0001). The video viewing plus interactive session group made further gains in measures of risk perception and self-efficacy (p 0.01) but not in knowledge or positive condom attitudes. 27.4% of the video viewing group and 22% of the routine clinic service group redeemed coupons for condoms at a neighborhood pharmacy compared to 41.4% of those in the video viewing plus interactive session group (p 0.0001). The multiple logistic regression analysis confirmed that scores in knowledge, positive attitudes, perceived risk, and self-efficacy were greater among the video viewing group than the controls (odds ratio [OR] = 1.11, 1.07, 1.10, and 1.08, respectively; p 0.01). When comparing the video viewing group and the video viewing plus interactive session group, there were positive interactions between intervention and risk perception (OR = 1.08) and self-efficacy (OR = 1.07) (p 0.01) but not between intervention and positive condom attitudes. There was a negative interaction between intervention and knowledge for the video viewing plus interactive session group (OR = 0.92; p 0.01). These findings suggest that culturally sensitive video-based interventions improve knowledge, promote positive condom attitudes, and increase condom acquisition among persons at high risk of STDs and AIDS.

Responding to the real needs of women.

PIP: INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.^ieng

BEMFAM delivers AIDS alert.

PIP: The Sociedade Civil Bem-Estar Familiar (BEMFAM) of Brazil developed a project using integrated communication strategies to alert prostitutes and their clients about the risks of contracting HIV. The project specifically promoted condom use and was conducted within the context of BEMFAM's Integrated Family Planning Program. Villa Mimoza, a prostitution zone in the Estacio neighborhood of Rio de Janeiro, was the site of the intervention. This neighborhood harbors 44 houses of prostitution where an estimated 500 female prostitutes receive clients. An agreement was reached with the Association of Prostitutes of the State of Rio de Janeiro whereby it would help mobilize local women, merchants, brothel owners, and clients. Initial needs were assessed by BEMFAM and AIDSCOM through questionnaires and focus groups. It was subsequently resolved that radio programs, counter displays of educational materials in brothels, and posters in brothel rooms would be the most effective channels through which to carry integrated, effective messages to the community. Final evaluation found a change in attitude and an awareness of the importance of measures to prevent AIDS along with a prevalent increase in condom use.^ieng

Country watch: Dominica.

PIP: A campaign conducted in the Caribbean island Dominica has diminished the secrecy and embarrassment which surround condom use. Men had been reluctant to buy condoms at pharmacies and women had regarded the purchase of condoms as unacceptable. The project was initiated before 1990 and included redesigning the package of condoms. The new display included a durable cardboard dispenser which showed the symbol and the word for condom, instead of the previous plain white carton. The word was added because focus group discussion suggested that the word would help reinforce the idea that condoms are in the box. The idea was to increase condom visibility and accessibility. Other promotional efforts involved a poster which carried the slogan, "Condoms...because you care," and the condom symbol. Buttons, key chains with a condom visible in the plastic case, posters, and pencils were distributed island-wide. Feedback on the campaign revealed that most considered the message to be that condom use was acceptable and consistent with the problems posed by AIDS. The key chains were very popular, and the problem of children having access to the chains did not materialize. Interviews and focus groups revealed that there were complaints about having only one condom brand available, and that it was considered of inferior quality. Project staff thought that the issue of quality was related to the relatively inexpensive price, which was 25% of the price of other brands. A small increase in condom distribution was shown in monitoring evaluations. In 1990, there were 34 outlets and 11,300 condoms distributed; in 1991, there were 40 outlets and 12,640 condoms distributed. By June 1992, there were 50 outlets and 12,300 condoms sold.^ieng

Learning through experience.

PIP: After the first AIDS patients were diagnosed in 1983 in Trinidad and Tobago, every nurse attended a large group lecture on HIV/AIDS which lasted 1 or 2 days. Even though the information acquired helped them greatly in infection control, the lectures did not prepare them adequately for caring for AIDS patients. The nurses did not want to treat AIDS patients and would not make home visits. They feared infection with HIV and stigmatization through their contact with AIDS patients. They often believed God was punishing AIDS patients. They were intolerant of homosexual men and were more willing to care for HIV/AIDS patients who were children or infected by a blood transfusion. In 1990, these attitudes and beliefs prompted a modification of the design of the training program. The program now involves all participants and uses role playing to simulate reality. Each training course has only 10-15 people and is informal and relaxed. It is held 1 day a week for 8 weeks. The subject matter depends on participants' needs identified through a questionnaire they complete before the course. Group discussions often include HIV positive people, family members, and experienced nurses. The nurses leave the course with a better understanding of the feelings and needs of people with AIDS, human sexuality, and the diversity of sexual behaviors. They are also better able to separate illness from sexual practice, recognize the value of each patient, communicate with and encourage families to accept the patient, support the patient, spread the word about prevention of HIV and sexually transmitted diseases, and understand issues of HIV-positive homosexual and bisexual men. The primary health care system in Trinidad and Tobago serves HIV/AIDS patients. The nurses visit them in their homes and make sure they receive the care they need at hospitals and outpatient clinics.^ieng

Lessons learned from pilot projects on school-based AIDS education.

PIP: The World Health Organization and UNESCO have collaborated to establish and evaluate 7 pilot projects for school-based AIDS education in Ethiopia, Mauritius, Sierra Leone, Tanzania, Jamaica, Venezuela, and the Pacific. By training teachers and developing appropriate teaching and learning materials, they hope to add AIDS education into school curricula. Thus far, 4 projects have been completed. Review indicates that given parental support, school-based AIDS education may work in developing countries at both primary and secondary levels; initial assessment studies are valuable in program design; these programs help to increase family and community awareness; students gain knowledge and may also tend to discriminate less against those infected with HIV; prevention skills are the most difficult to teach and are rarely of primary focus; information in curricula on condom value and use is acceptable to education authorities; teaching and learning material prototypes are useful to educational planners and trainers; and teacher training should include small-group discussions on personal attitudes toward sexuality.^ieng

The International Conference on Population: Asia and the Pacific go to Mexico.

PIP: This article presents 1 view of the 1984 International Conference on Population, held in Mexico City. Individual human rights, national sovereignty, and the diversity of population situations around the world, were guiding principles and recurrent themes throughout the Conference. The US was involved in most of the controversial political issues of the Conference, 4 of which--abortion, free enterprise, disarmament and occuped territories--are mentioned here. Of greatest concern to many countries and nongovernmental organizatons was the potential loss of US funding for family planning programs that involve abortion. Many delegates were unhappy that so much time and energy were devoted to the issues and thought that more attention should have been paid to matters clearly related to the subject of population. Fortunately, most of the recommendations are more to the point. Their substance is discussed here, following the outline of the document approved in Mexico City. The recommendation document is composed of 11 preample paragraphs, the disarmament paragraph, and 88 recommendations, interspersed with 25 introductory paragraphs. The preamble reviews progress since 1974 in population and development and specifically mentions facts and trends regarding the components of demographic change, the status of women, and urbanization, among other topics. The recommendations discussed here deal with socioeconomic development and population, role and status of women, the development of population polices, and population goals. The promotion of knowledge and policy through data collection and analysis, research, management, training and IEC, as well as recommendations for implementation are reviewed. Overall, the most significant change from Bucharest was the role reversal of some of the developed and developing countries, such as China and the US. Nevertheless, the World Population Plan of Action was reaffirmed in Mexico City, despite the changes in positions and in emphases.^ieng