Cambios en el estilo vida de mujeres de raza negra con intervención educativa del programa "Actúa con corazón de mujer" / Changes in lifestyle of black women with educational intervention of the "Actúa con corazón de mujer"

Resumen: Introducción: a diario en Colombia mueren 60 mujeres por enfermedad cardiovascular y las mujeres de raza negra tienen mayor riesgo. Según la Organización Mundial de la Salud (OMS) estas muertes son, en su mayoría, prevenibles. El cuidado como estilo de vida es una intervención del programa "Actúa con corazón de mujer" de la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular (SCC) y la Fundación Colombiana del Corazón (FCC). Objetivo: formar líderes para promover la adopción de comportamientos saludables. Método: se seleccionaron municipios con población de raza negra y compromiso de las autoridades locales. 395 mujeres fueron elegidas. La percepción del riesgo se midió con un instrumento adaptado por la FCC. La intervención educativa se dividió en cuatro sesiones en cada municipio durante cinco meses. Las participantes fueron formadas en toma de presión arterial; se utilizó la automonitorización de presión arterial (AMPA) para confirmar hipertensión y se incluyeron mediciones antropométricas y fisiológicas para calcular el riesgo cardiovascular y de diabetes. Resultados: Los resultados consolidados de los instrumentos y mediciones aplicados demostraron significativos aportes en reducción de riesgo cardiovascular, en razón de una nueva percepción de los peligros y de la incorporación de comportamientos saludables. Conclusiones: las mujeres aprendieron del cuidado. 90% reportaron percepción "ideal" del riesgo, hicieron promesas y adoptaron comportamientos tomando acción frente a sus factores de riesgo y más del 50% evidenciaron cambios en las medidas antropométricas. Los resultados demuestran que estrategias de educación, especialmente con líderes comunitarias, pueden ser de gran relevancia para la salud pública.

Abstract: Introduction: every day in Colombia 60 women die from cardiovascular disease and black women are at higher risk. According to the World Health Organization (WHO) these deaths are preventable. Care as a lifestyle is an intervention of the "Actúa con corazón de mujer" program of the Colombian Society of Cardiology and Cardiovascular Surgery (SCC) and the Colombian Heart Foundation (FCC). Objective: Train leaders to promote the adoption of healthy behaviors. Method: Municipalities with a black population were selected with the commitment of the local authorities. 395 women were elected. Risk perception was measured with an instrument adapted by the FCC. The educational intervention was divided into four sessions in each municipality for five months. Participants were trained in blood pressure measurement, blood pressure self-monitoring (AMPA) was used to confirm hypertension, and anthropometric and physiological measurements were included to calculate cardiovascular and diabetes risk. Results: The consolidated results of the instruments and measurements applied showed significant contributions in reducing cardiovascular risk, due to a new perception of the dangers and the incorporation of healthy behaviors Conclusions: the women learned about care. 90% reported "ideal" perception of risk, made promises and adopted behaviors taking action against their risk factors and more than 50% showed changes in anthropometric measurements. The results show that education strategies, especially with community leaders, can be of great relevance for public health.

Acciones educativas para cambios de comportamientos en la práctica de relaciones sexuales entre adolescentes / Educational actions aimed at modifying the sexual behavior of adolescents

Introducción: En Cuba las tasas de aborto predominan en el grupo de 15-19 años de edad. En Villa Clara ocurren el 7 por ciento de los abortos en adolescentes, la provincia tributa el 25 por ciento del total en la región central. En el último quinquenio según datos de estadística municipal en Quemado de Güines se registraron cerca de 33.8 embarazos en adolescentes por cada 1000 mujeres. Objetivo: Desarrollar acciones educativas para cambios de comportamientos en la práctica de relaciones sexuales entre adolescentes con enfoques diferentes. Métodos: Estudio de intervención, en el área urbana del municipio de Quemado de Güines en el período comprendido entre septiembre 2012-2014. El universo lo constituyeron 1190 adolescentes de ambos sexos, la muestra obtenida de forma no probabilística e intencional, quedó formada por 83 adolescentes de ellos 50 femeninas y 33 masculinos entre 12 y 16 años de edad. Se diseñaron e implementaron un grupo de acciones educativas para cambios de comportamientos en la práctica de relaciones sexuales entre adolescentes con enfoques disímiles según etapa de cambio diagnosticada. Resultados: Un amplio porcentaje de adolescentes sin intención de cambio de comportamiento en la práctica de relaciones sexuales, cambiaron su conducta a corto, medio, y largo plazo. Conclusiones: Las acciones educativas desarrolladas en el grupo de adolescentes sustentadas en la Teoría de las Etapas de los Cambios, creada por James O. Prochaska con enfoques disímiles promovieron cambios de comportamientos en la práctica de las relaciones sexuales(AU)

Introduction: Abortion rates in Cuba are highest in the 15-19 age group. 7 por ciento of teenage abortions occur in Villa Clara, whereas this province contributes 25 por ciento of the total teenage abortions in the central region. According to statistical data, nearly 33.8 teenage pregnancies per 1 000 women were recorded in the municipality of Quemado de Güines in the last five-year period. Objective: Develop educational actions aimed at modifying the sexual behavior of adolescents. Methods: An intervention study was conducted in the urban area of the municipality of Quemado de Güines in the period 2012-2014. The study universe was 1 190 teenagers of both sexes. The sample consisted of 83 teenagers selected by intentional nonprobability sampling, of whom 50 were female and 33 were male aged 12-16 years. A number of educational actions were designed and implemented with the purpose of modifying the sexual behavior of adolescents, based on a variety of approaches according to the change stage diagnosed. Results: A large percentage of adolescents with no intention to modify their sexual behavior eventually did modify it in the short, medium and long terms. Conclusions: The educational actions implemented with the study group of adolescents, which were based on the model of behavior change by stages developed by James O. Prochaska, applied a variety of approaches to foster changes in the sexual behavior of teenagers(AU)

Rapidly progressive cognitive impairment with neuropsychiatric symptoms as the initial manifestation of status epilepticus.

The purpose of this article is to describe the clinical and electroencephalographic features of patients diagnosed with non-convulsive status epilepticus (NCSE) with uncommon cognitive and behavioral involvement. We present two cases with sub-acute cognitive impairment and neuropsychiatric disorders (including anxiety and transient behavioral changes) as their first manifestation of NCSE. A neuropsychological profile demonstrated executive dysfunction. In addition, the neurological examination revealed automatisms and 24-hour video EEG showed epileptiform activity. Although neuroimaging studies showed frontotemporal abnormalities, both neurophysiological and cognitive improvement after specific antiseizure drug treatment confirmed the diagnosis of non-convulsive status. Theoretical considerations between mental status changes and focal epilepsy will be reviewed. Our cases raise awareness of the importance of considering NCSE, a treatable condition, in the differential diagnosis of rapidly-progressive cognitive impairment with neuropsychiatric symptoms.

Condom use increasing.

PIP: Condom use is central to the prevention of AIDS among people at risk for contracting HIV. As such, condom use is increasing dramatically even though many men say that they do not like using them. Condom sales through social marketing campaigns have increased dramatically in some countries, where tens of millions of condoms are sold annually. For example, during the period 1991-96, annual social marketing sales increased about five-fold in Ethiopia to 21 million, and nine-fold in Brazil to 27 million. These sales reflect the success of condom social marketing campaigns in making condoms accessible and largely affordable. There is also a greater general awareness of AIDS than there used to be, and communication campaigns have shown that condoms are an effective solution. More condoms still need to be used in the ongoing struggle against HIV/AIDS. The author discusses the factors which affect the limited acceptance of condoms, condom use outside of marriage, social marketing, and family planning programs.^ieng

Reproductive health programs for men.

PIP: The Groupe de Lutte Anti-SIDA (GLAS) (Group in Struggle Against AIDS) is an HIV prevention program in Port-au-Prince, Haiti, which taught HIV prevention to almost 20,000 mainly male workers aged 15-49 years. Before ending in 1996, GLAS offered one, hour-long session introducing HIV and other sexually transmitted diseases (STDs), and how to prevent them; instruction on how to use condoms; an open-ended discussion hour in which workers who had attended the first 2 sessions could ask questions about beliefs and rumors related to HIV/AIDS and STDs; and intensive psychological support groups using the transactional analysis (TA) educational approach to personal growth and change. The TA approach focuses upon teaching adults how to abandon self-defeating strategies, typically learned during childhood, and how to develop attitudes for managing life's problems. It promotes clear, direct communication. Participation in GLAS's program helped men understand the benefits of adopting HIV/STD risk reduction behavior.^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

[Approaches to low-income groups' sexuality: a comparative study of women in three low-income contexts in Peru]. / Aproximaciones a la sexualidad popular: estudio comparativo de mujeres de tres contextos populares del Peru.

"This work...examines the cultural dimension of sexuality and fertility of women from [low-income] sectors in Peru. It intends to explain the cultural processes that fall into the intermediate variables of fertility, such as marriage rate, contraception, breastfeeding and...abortion. These dimensions of sexual and reproductive life are analyzed according to two explanatory dimensions: generation and cultural context of socialization. The general hypothesis is that a cultural process of homogenization of the values and behaviors has been taking place over sexuality, in such a way that the younger generations will show similar standard behaviors and values no matter their context of socialization; in the meantime, in the older groups there will exist contextual differences in these dimensions." (SUMMARY IN ENG)

The evolution of the AIDS illness and the polarisation of values.

This article is based on a study carried out in Sao Paolo, Brazil, from 1983 to 1986 among male homosexuals. It deals with the various practices and life-styles which constitute the homosexual world in Sao Paulo, and questions regarding AIDS. An analysis is made of the contrasting biographies of two patients suffering from the AIDS virus. The emphasis will be placed on the evolution of the illness and the changes in values that occur during this period. The ways in which the sexual life-style adopted prior to the illness influences the individual social course or mobility [i.e., trajectory] of the inflicted person will also be illustrated.

PIP: MC and KR are two young men who were living with AIDS in Sao Paulo, Brazil, during 1983-86. MC is a 25-year old son of Italian immigrants and KR is a 24-year old grandson of German immigrants. MC attained a relative degree of professional success by working as an airline steward, while KR was never really able to secure and maintain full-time, gainful employment. The author describes how being diagnosed and living with AIDS changed their lives and the way in which they perceive themselves. As a steward, MC traveled extensively to Europe and the US where he frequented the best gay clubs and saunas. He was open and proud of his homosexuality. Being diagnosed with AIDS and going through its sequelae of morbidity and lost income and productivity, however, changed this self-perception. MC began to deny his homosexuality, embraced religion, and avoided talking about his past. In so doing, he distanced himself from all that was responsible for his currently painful experiences. KR, however, had lived a very modest suburban life, having sexual relations with men in the city for money when the need and desire motivated him. KR enjoyed sex with men, but hated being homosexual. He had therefore denied his homosexuality and hid it from as many people as possible. As it did for MC, diagnosis and hospitalization with AIDS changed KR's life. KR's life, however, changed for the better. Once back at home out of the hospital, KR began telling everyone that he had AIDS. A well-known weekly doing a story on AIDS subsequently used a photo of KR for its cover and began paying KR a minimum salary. For the first time in his life, KR gained notoriety and began receiving affection from a broad segment of the community. KR had achieved some degree of success. KR explained that facing death gave him a newfound openness and the ability to stop considering all that is relative as absolute, such as sexuality, the family, sin, and friendship. Death became the only absolute. MC therefore fell from success to failure, while the opposite was true for KR. Both had been role models for their brothers. Once that role was compromised, the brothers rejected MC and KR. The author notes how individuals, once confronted with situations which fall outside the ordinary social world, are obliged to reconstruct and reinterpret their new situation, and suggests to what extent AIDS becomes a determining factor in recognizing and accepting homosexuality.

The 1992 Earth Summit: background and prospects.

PIP: In 1989, the UN General Assembly agreed to sponsor a conference on environment and development and that the Heads of State would attend this 1st ever Earth Summit in June 1992. The planned agenda included making concrete changes to the basis of our economic life, relations between and among nations, and the outlook for the future. This would result in restructuring world priorities. Despite the 1972 Stockholm Conference on the human Environment acknowledging the basic link between environment and development, the environment has deteriorated even further, especially ozone depletion. Yet some governments did set up environmental agencies or ministries, like the US Environmental Protection Agency, but they were not allowed to influence economic policy or the policies and/or practices of major sectoral agencies. These environmental organizations relied too heavily on regulation. The 1992 conference needs to result in a political commitment to place reduction of poverty worldwide as the 1st priority since poverty and underdevelopment are strongly related to destruction of the environment. It is particularly important that developing countries improve their strengths by developing their human resources and institutional capacities (science, technology, management and professional skills) and reduce their vulnerabilities, such as dependence on foreign experts. This can best be achieved if they have access to technology. Moreover they must reduce population growth and reach population stability quickly. The 1992 conference in Brazil should also result in a global partnership based on common interest, mutual need, and shared responsibility. The world ecoindustrial revolution has already begun in some countries, such as Japan which has reduced energy use 40% since 1975. In fact, Japan has proven that environmental improvement can be accomplished with high rates of economic growth.^ieng

Behaviour change -- measured by the community, for the community. Community counselling.

PIP: Community counseling is a process that supports the community to act assertively and confidently in its own interests to provide support for those affected by HIV/AIDS and to reduce the spread of HIV. Hope is fundamental in initiating this process and should begin by rendering care and support to individuals affected by HIV/AIDS. Care and support helps generate a sense of self worth and confidence which in turn motivates the recipients to take personal responsibility in preventing further spread of HIV. Moreover, care stimulates awareness and illustrates a commitment to non-discrimination against those infected, or at high risk. Another key aspect of community counseling is a commitment to monitoring changes in high-risk behavior. This process involves identifying high-risk behaviors, choosing strategies for prevention, and recognizing and recording ways of showing that these risk behaviors are changing. In conclusion, community counseling is facilitated by the skills and training from outside the community, and the community decides the content. This process allows monitoring of behavioral change and is a way of sustaining it.^ieng

USAID steps up anti-AIDS program.

PIP: This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.^ieng

Planning and pre-testing: the key to effective AIDS education materials.

PIP: The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process.^ieng

[After ten years of AIDS, a vision emanating from feminism]. / A diez anos del SIDA: una vision desde el feminismo.

PIP: AIDS and the economic crisis in Mexico are threatening the epidemiologic transition in which infectious diseases ceased to be the only major cause of death and chronic degenerative diseases began to account for a growing proportion of deaths. Many factors combined to produce the sexual, gay, and women's liberation movements beginning in the 1970s. At the beginning of the feminist movement, women proposed different kinds of interpersonal relations both between women and with men. Women together realized their rights to control their own bodies, to sexual enjoyment, to abortion, and to free themselves of feelings of shame and guilt. The weight of moral pressures was lessened and the personal desires of the woman assumed a greater role in selection of sexual partners. Conservative forces grew stronger in the 1980s, and the proliferation of sexually transmitted diseases began to imperil the sexual revolution. But these setbacks were minor compared to AIDS. Now, 10 years after its appearance, it is clear that AIDS is not limited to homosexual men. The number of cases in Mexico increased from none 10 years ago to some 10,000 estimated cases reported and unreported today. 1/6 of the cases are in women. Many women and heterosexuals felt immune from AIDS in the beginning, and some still do, but many more have become aware of the danger. Women now fear contracting AIDS, but they also fear confronting their partners to suggest that they use condoms. Denial may play a role, but deeply rooted cultural factors that women may recognize but fee powerless to change may also be at play. Many women over 30 have difficulty taking the initiative in sexual matters. They are embarrassed to buy condoms and even more embarrassed to propose their use. They imagine that men will consider them "loose" if they carry condoms. Mexican women are poorly prepared to tell their men explicitly what they want sexually, and Mexican men are also poorly equipped to ask what women want, accustomed as they are to exercising sexuality exclusively to satisfy their own needs. The entire problem of condom use is related to ethical-moral and ideological factors and to broader attitudes toward knowledge. Those with more rational orientations see AIDS as a disease rather than a divine punishment and can more easily accept condom use as a preventive.^ieng

Health damage caused by the smoking habit in Chile.

The authors review available literature on tobacco use in Chile, devoting particular attention to smoking prevalences, smoking-related health problems, risk factors that tend to encourage smoking, and appropriate control measures. Overall, the available data indicate that roughly 40% of Chile's adult population smokes, that smoking among women is on the rise, that some 11% of both infant and general mortality can be linked to tobacco use, that smoking during pregnancy poses serious health risks, and that the attitudes of physicians and other health workers can have a crucial impact upon the smoking behavior of their patients.

Solidarity and AIDS: introduction.

Perhaps more than any other disease in recent history, AIDS has taught a cruel and crucial lesson: the constraints on our response to this epidemic are as deep as our denial, as entrenched as the inequities that permeate our society, as circumscribed as our knowledge, and as unlimited as our compassion and our commitment to human rights. Elaborating on these themes, the final three articles in this Special Section on AIDS consider three widely divergent yet intimately connected topics: AIDS in Cuba, AIDS in Brazil, and global AIDS prevention in the 1990s. Together, they caution that if we persist in treating AIDS as a problem only of "others," no country will be spared the social and economic devastation that promises to be the cost of our contempt and our folly. Solidarity is not an option; it is a necessity. Without conscious recognition of the worldwide relationship between health, human rights, and social inequalities, our attempts to abate the spread of AIDS--and to ease the suffering that follows in its wake--most surely will fall short of our goals. Finally, as we mourn our dead, we must take to heart the words of Mother Jones, and "fight like hell for living." This is the politics of survival.

PIP: This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.

"Sing and the world sings with you".

PIP: Mass media techniques that combine entertainment with health education are particularly effective in producing behavioral changes. The Enter-educate approach is based on the assumption that the power of mainstream popular culture is great enough to generate models for overall social behavior. Enter-education incorporate 5 factors; projects are personal, popular, pervasive, persuasive, and profitable. The importance of personal identification with characters in a film or radio serial is demonstrated by a Filipino television drama that dealt with teenage pregnancy. 27% of the target audience of 17-24-year-old females watched this show, and 98% found it believable and informative. A campaign in Nigeria to support responsible parenthood was boosted by the participation of a popular rock star. 88% of residents in Lagos reported hearing the 2 songs and seeing the music video that featured this star. A project in Mexico and 10 other countries in Latin America recognized the importance of pervasiveness in its combination of music recordings, radio, and television to reach young people with messages about responsible sexuality. The persuasive effect of television was confirmed in a Turkish television campaign that showed a series of portraits of a family as children were added over time and ended with a portrait containing an empty chair for the mother. The health risks to women of too many closely spaced pregnancies could not have been as dramatically portrayed in print. Finally, enter-education campaigns have the potential to attract commercial support. A campaign in the Philippines against adolescent pregnancy received generous support from corporations in the form of purchase of air time, subsidization of printed materials, and provision of hotline counselors.^ieng

[Women pioneers of reproductive change in Mexico]. / Mujeres pioneras del cambio reproductivo en Mexico.

PIP: The authors attempt to characterize the women who have played a pioneering role in changing reproductive patterns in Mexico. They investigate groups of women having high and low fertility, the importance of generational groups, and variations in the impact of age at first union. The effect of selected socioeconomic and geographical characteristics on reproductive behavior is explored.^ieng

[The preoccupation with goals]. / La preocupacion por las metas

PIP: Contraception has become the principle factor in Mexico's fertility drop during the past 15 years. Between 1976-82, 47.7% of married women in the population used contraception. The national policy established a growth rate of 1.9% for 1988 implying a global fertility rate of 3.1, with a 58% utilization rate; results of the 1987 Demographic and Health Survey demonstrated that Mexico achieved a fertility rate of 3.8 and a 52.7% utilization rate. In Mexico fertility is perceived as the key variable that can change the demographic profile of the country with family planning as the means of changing people's value systems and controlling the growth of the population. In Mexico, regional characteristics determine the number of children couples decide to have. There are 4 groups of behavior: 1) the Northeast (63%) and Northwest (70%) which have accurate statistical data, share borders with the US and are economically developed; 2) the North Zone of the Isthmus of Tehuantepec and the 3 regions on the coast (Gulf 54%; South Center 51%; and Center 55%); 3) the North Center (46%); and 4) the Southeastern region (32%) with the lowest prevalence rates in the country. There is a need to modify the demographic rationale of determining targets towards a more social/historical perspective that acknowledges regional differences in a country and allows new interest in understanding the reproductive behavior of women and couples.^ieng

Facing AIDS in Costa Rica.

PIP: The 1st AIDS case was diagnosed in Costa Rica in 1985. By January 1988, 47 cases were recorded. Most cases are in hemophiliacs and homosexuals; one is in the heterosexual partner of a hemophiliac. 55% of hemophiliacs in Costa Rica are infected with HIV -- one of the highest levels in the world. 10 women, including 2 prostitutes, are known to be HIV-positive. The number of new cases is expected to nearly double every year, and deaths from AIDS may come to exceed deaths from diarrhea and all other infectious diseases. Since 1985, all donated blood has been screened. A national education campaign began in 1985, using television, talks, workshops, and pamphlets, and coordinated by the National AIDS Commission. AIDS education is included in secondary and high school curricula, and condoms have been distributed in gay discotheques and other public places since 1987. Failure to recognize the problem early enough resulted in fear of and discrimination against AIDS patients by health workers as well as failure to provide enough funds for AIDS prevention and control.^ieng

The selection and training of primary health care workers in Ecuador: issues and alternatives for public policy.

This article employs quantitative analysis to evaluate the effectiveness of the community health worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study first assesses CHW knowledge in the areas of prevention, maternal-child health, first aid, and treatment of common illnesses. The analysis reveals that CHWs retained less than 50 percent of what they learned one year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The second phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. These results yield some important implications for public health policy in Ecuador.

PIP: Quantitative analysis was used to evaluate the effectiveness of the health care worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study 1st assesses CHW knowledge in the areas of prevention, maternal-child health, 1st aid, and treatment of common illnesses. CHWs retained 50% of what they learned 1 year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The 2nd phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. With regard to the adoption of health behaviors, it is clear that the primary health care (PHC) program has had only limited success in convincing villagers to adopt these practices. The mean index of adoption of these practices by the 7 families interviewed in each village was 15.61 of a total of 56 possible behavior changes. Clearly, if the CHW's performance is not a major determinant of this phenomenon, then other factors must be responsible. In some cases economic factors may intercede. For example, in areas where wood is scarce, peasants are unlikely to use it to build fires for boiling drinking water. Cultural or demograhic factors cannot be ignored when searching for the causes of the low level of adoption of these behaviors.