Autonomy and susceptibility to HIV/AIDS among young women living in a slum in Belo Horizonte, Brazil.

In Brazil in the last decade there has been an increase in the susceptibility of young women to HIV. This study explored the link between autonomy, or control over major domains of economic, social and sexual life, and susceptibility to HIV infection among poor young women living in an urban slum area of Brazil. A cross-sectional survey was carried out on a random sample of 356 young women between 15 and 24 years old. The study found that indicators of autonomy that relate to sexuality, mobility and freedom from threat by partners were significantly correlated with practices linked to HIV prevention and with access to health services promoting prevention, especially among adolescents. Young women who talked to their partner about condom use before first intercourse and co-decided with them on condom use were more likely to use condoms. In contrast, those who had ever been victim of physical violence by a partner or whose partners restricted their mobility were less likely to use condoms. The study found that young women were more likely to have accessed health services for gynaecological examinations, family planning services and HIV testing if they had ever been pregnant. The findings indicate that structural gender inequalities translate into unequal relationships and reduced autonomy, increasing young women's susceptibility to HIV. A bias in HIV testing and reproductive health services towards pregnant women leaves many susceptible youth without early access. The study suggests the development of a reproductive health policy that ensures that young women access services before they get pregnant and that also reaches young males.

Traditional birth attendants and their practices in the State of Pernambuco rural area, Brazil, 1996.

OBJECTIVE: To obtain socioeconomic information about TBAs in the State of Pernambuco and information concerning their practices. METHOD: Statistical analysis of the answers to structured questionnaires applied to 127 TBAs. RESULTS: The results of a survey with 127 TBAs conducted in the rural area of the State of Pernambuco (Brazil) is presented in this paper. TBAs in rural Pernambuco are a group of basically old and very poor and uneducated women. Most of them learned to attend births by themselves or by helping another TBA. Thirty percent learned midwifery in hospital delivery rooms, helping doctors and nurses. How the TBAs learned to help births seemed to be the most influential factor on the kind of practices they use. TBAs who learned from other TBAs from the community seem to have the least interventionist approach, followed by the TBAs who learned by themselves. They are more likely to perform more home births and avoid practices such as shaving the pubic hair, vaginal exams, artificial rupture of the membranes, episiotomy and early cord clamping. CONCLUSION: The way women learned midwifery is the most important determinant of their practice.