Peer support groups boost use of female condom.

PIP: Preliminary research findings from Brazil and Kenya indicate that, when women are provided with female condoms and peer group support, traditional obstacles to safe sex practices can be overcome. In these countries, as well as many others, women face cultural barriers to negotiating condom use with male partners. The study, conducted by the Women's Health Initiative of Family Health International's AIDS Control and Prevention Project, involved 106 Kenyan and 103 Brazilian women. A female focus group was held at the beginning of the study, followed by two peer support group meetings, with another focus group at the end of the study. Group support was an essential element in the acceptance process. Women who were afraid or unsuccessful with initial use were encouraged by other group members to try different, non-threatening approaches to the negotiation of female condom use and given suggestions for overcoming difficulties with insertion and lubrication. Some of these strategies included laying the female condom on the bed so the male partner raises the subject of its use and telling the partner the doctor had recommended the method to avoid the negative side effects associated with the pill. When female condom use is presented as a form of pregnancy prevention, the association of condoms with infidelity is overcome.^ieng

PVO / NGO initiatives, Latin America. Grupo pela VIDDA, Brazil.

"VIDDA" is a Portuguese acronym representing enhancement, integration, and dignity of people living with HIV/AIDS (PWAs). The groups are composed of people infected with HIV, their friends, relatives, lovers, and anyone who feels that his or her everyday life has been affected by the epidemic. They hope that through solidarity they can respond to the difficult situation facing people who are HIV positive in Brazil. Grupo pela VIDDA seeks to raise the consciousness of the government and the society and force them to take responsibility for the epidemic. Their fundamental objective is to fight for PWAs to have a full range of civil rights. "This is a fight that we have in common with all the Brazilian people who are searching for democracy, the right to work, and access to good health services," states a Grupo pela VIDDA brochure. Through their network they provide accurate and current information, counseling, legal assistance, and sponsor support groups. For more information, please contact Grupo pela VIDDA, Rua General Jardim, 556 CEP 01223-010, Cx Postal 54063, CEP 01296, Sao Paulo SP, tel/fax: +55 11 258 7729; or Rua 7 de Setembro, 48 12 andar CEP 20050-000, tel: +55 21 224 1654, fax: +55 21 294 5602. There are also offices in Curitiba, Goiania, Niteroi, Recife, and Vitoria.

Group dialogue empowers Brazilian women.

PIP: In response to an alarming rise in human immunodeficiency virus (HIV) infection among Brazilian women during the early 1990s, the Sociedade Civil Bem-Estar Familiar no Brazil (BEMFAM) developed a project that integrates HIV prevention with clinical services, community-based prevention activities, and sexually transmitted disease diagnosis and treatment. Preliminary interviews with clinic clients revealed that women's fears they would be considered unfaithful were impeding their ability to suggest condom use to their sexual partners. Condom use within a relationship was considered appropriate only for pregnancy prevention. To facilitate dialogue about sexual health, BEMFAM developed a women's group intervention project. All women who attend a BEMFAM clinic are invited to participate in a one-hour group discussion before receiving medical services. Novela-style booklets with stories and characters women can relate to their own lives are used to stimulate discussion. Participants learn to use condoms correctly by putting them on a penis model and anticipate situations in which they would be able to negotiate condom use. The group setting enables women to gain confidence and practice assertiveness in a non-threatening, supportive environment. Their identification with other women's stories empowers women to take control of their health and sexual lives. Between October 1994 and July 1995, 3464 women participated in group discussions organized by BEMFAM and 40,688 condoms were distributed; 18% of these women returned to the clinic for additional condoms.^ieng

Congratulations to the mothers. Breastfeeding.

PIP: In Lima, Peru, a study was conducted that evaluated the influences on mothers' decisions regarding breastfeeding. Local views and health professional advice was ascertained. A follow-up study of a group of pregnant women was conducted to assess knowledge, attitude, and practice in regard to the early feeding of their children. The women were interviewed in their homes before delivery, as soon as possible after delivery, and twice a week until their babies were 1 month old. The experience of the mother was the key factor, but advice from relatives, neighbors, and health professionals was also important. A lack of information about exclusive breast feeding was common. Although the women knew breast feeding was good, they were unaware that exclusive breast feeding was best. Health workers knew to advise against other milks, but failed to advise mothers against the use of herbal teas and sweetened water as supplements. The women commonly believed they were unable to produce enough milk to feed their children because of their own undernourishment. Others believed exclusive breast feeding would worsen their own health, while some experienced difficulties breast feeding. This led to supplementation with other milks; herbal teas were given to cure colic and to quench infants' thirst. Based on these findings, the project focused educational efforts on providing better information to mothers. Messages stressed the thirst quenching property of breast milk and its similar benefits to herbal tea, which should be consumed by the mother, rather than the infant. Since breast feeding practices were closely linked to mothers' beliefs about their own needs, the project emphasized the value and needs of the mother and the benefits of breast feeding for her. Educational activities, which continued for 12 months, included videos shown to small groups of mothers, posters, distribution of pamphlets, and messages broadcast over loudspeakers. A significant increase in the number of children aged 0-4 months being exclusively breast fed was observed; however, the increase only occurred in the second, third, and fourth month. This seemed to be a direct result of the decrease in use of herbal teas and sweetened waters. The number of women using other milks as supplements did not decrease significantly.^ieng

Increasing FP access in Brazil.

PIP: A 1979 survey of women aged 15-45 years from Sao Paulo, Brazil, concerning their contraception use demonstrates the impact of family planning, even without an official family planning program. 23% of the women were using the pill and 16% were sterilized. Very few used diaphragms, condoms, or IUDs. Although there is now an official family planning program in Brazil, only middle and upper class women have access to sophisticated means of birth control. Poor women are limited to tubal ligation which is often disguised as a cesarean section (the rate at some hospitals for this operation is 90%). Since the Integrated Project was introduced in 2 pilot areas in 1983, 12 branches, where community representatives run monthly discussion meetings and classes are held on family planning methods, have been established in the city. Nurses coordinate volunteer efforts. The program began in slum areas by utilizing the nurses and nurseries already in place to care for children of working women. New expansion will require integrating the family planning program into other established, nongovernmental organizations and working with municipal and state governments.^ieng

[A problem-posing educational methodology for the prevention of HIV / AIDS]. / Una pedagogia de concientizacion para la prevencion del VIH / SIDA.

PIP: The problem-posing methodology of Brazilian educator Paulo Freire, using the reading circle approach previously deployed in successful literacy campaigns in developing countries, is introduced for application in AIDS information programs. The basis of this educational process is the dialogue where those to be educated resolve their problems by evaluating information critically, capturing concepts by codification and decodification, and transmitting information by creating relevant educational materials. Health circles are organized with women as educators to impart knowledge about AIDS and HIV: definitions, epidemiological components (sex, age, and risk behavior), means of transmission, stages of the progression of AIDS, prevention of HIV infection, and tests for detecting HIV antibodies. The dialogue explores knowledge and feelings about AIDS and how it affects life in the community reveals personal experiences and accounts of knowing someone who was HIV-positive, and develops action plans to minimize AIDS cases in the community. The Latin population of California, mainly of Mexican origin, with low levels of education, income, and acculturation and a high incidence of AIDS, is an appropriate target of such intervention. In 1980, there were 12.3 million people of Hispanic origin in the US. In August 1990, there were 143,280 persons diagnoses with AIDS according to the Centers for Disease Control. 78,878 of these (55%) were Anglos, and 21,752 (15%) were Hispanics. Among the Anglos, the incidence was 300/million inhabitants, while among Hispanics, it was 1059/million, a 3-field higher rate.^ieng

Help for breastfeeding mothers. Support groups.

PIP: Many people including some health workers and physicians believe bottle feeding is just as good as breast feeding, even though bottle feeding poses some dangers to infants. Further, health workers in hospital often are too busy to counsel new mothers in breast feeding or are simply not trained to do so. Moreover, young women often live in areas away from their family and friends thus not living close to women with whom they are familiar and who could guide them in mastering breast feeding skills. So new mothers who want to breast feed have no support, lack confidence, and/or feel they cannot do so because they work or have other responsibilities. Support groups for new breast feeding mothers can provide them with the needed confidence to breast feed by allowing them to discuss concerns with other new mothers and an experienced leader and to learn the advantages of breast feeding, e.g., a breast fed infant is never constipated. A confident experienced woman in breast feeding is best suited to start a support group in a community. She needs to promote the group by talking to health workers and physicians and advertising at maternity hospitals, women's organizations, and health centers. Once the support group has become successful, several mothers can undergo training to start and lead new support groups. If no national breast feeding promotion organization exists to offer advice on starting a support group, the article provides addresses of international organizations. At support group meetings, mothers learn how to breast feed, how to express and store breast milk, breast feed inconspicuously in public, how their bodies work, and about child growth and development. Support group members from the Philippines, Belize, Trinidad and Tobago, Australia, and singapore share their experiences.^ieng

Use of ethnographic research for instrument development in a case-control study of immunization use in Haiti.

A rapid ethnographic assessment of barriers to health service utilization was conducted to identify maternal factors predicting use of child immunizations in Haiti. Methods included four focus group interviews, four natural group interviews, individual interviews with 14 health care providers and participant observation at vaccination posts. Analysis of qualitative data identified five categories of maternal factors associated with immunization use: competing priorities, low motivation, socioeconomic constraints, perceived accessibility of services, fears about health or social consequences and knowledge and folk beliefs related to vaccines. Selected variables among these factors were incorporated into a survey instrument designed to compare mothers of completely vaccinated children (cases) with mothers of incompletely vaccinated children (controls). The questionnaire was administered to 299 randomly selected mothers (217 cases, 82 controls). Bivariate and multivariate analyses found that of the factors identified through ethnographic research, only vaccine-related knowledge was significantly associated with immunization status. The utility and constraints of using ethnographic research for instrument development in epidemiological studies are discussed.

PIP: A rapid ethnographic assessment consisting of 4 focus groups, 4 natural group interviews, 14 provider interviews and participant observation rally posts was combined into a questionnaire which was tested by chi square for use in predicting which Haitian mothers utilize immunization services. The study population were mothers of 1800 children 12-23 months old in the Mirebalais Area Community Health program in the central highlands of Haiti. The program uses the rally post system, with teams visiting villages at 6-week intervals. Audio tapes and written notes were reduced to lists of all possible barriers to maternal utilization, and then regrouped into 16 categories, under 5 topics: competing priorities, lack of motivation, socioeconomic constraints, perceived accessibility of posts, fears of health consequences and knowledge of folk beliefs about vaccines. 22 questionnaire items were then developed, which were edited by the overall project director without input from the ethnographer. The questions were administered to 299 mothers, 82 with incompletely immunized, and 217 with completely immunized children. The questions which significantly predicted complete vaccination by bivariate analysis were knowledge of the name of 1 or more vaccines or illnesses, the recommended number of doses, and the correct age to begin vaccinations. It was likely that time demands from subsistence farming and income generating activities also affected service utilization, but the women probably interpreted the question on employment incorrectly.

Teaching sexual education: the experience of a group of housewives in a poor neighborhood of Bogota.

PIP: This article relates the experiences of a group of housewives who organized a women's health education project in Usme, a poor neighborhood of Bogota, Colombia. The group consists of 6 volunteer health workers from poor and marginal areas of the city. They met at a workshop on sex education and training for family life. The workshop covered such topics as physiology, anatomy, stages of sexuality and family planning. Their experiences reportedly had direct impact on their lives--improving communication with and understanding of their spouses and children. The workshop was considered fulfilling and enlightening. Consequently, following the conclusion of the workshop they formed a new group to continue to educate themselves and to teach their own communities what they had learned. They developed methods and materials to facilitate learning. Masks, puppets and murals were used as aides to impart information of nutrition, general health, family planning, sex education and family communication. They also developed special crossword puzzles and games to test knowledge of vocabulary and to evaluate learning. The group has been well received in their communities, and they were recently invited to assist in a workshop given by the Colombian Institute of Family Welfare.^ieng

Family planning in the workplace in Jamaica.

PIP: The Jamaica Family Planning Association started holding presentations and discussions in the workplace in January 1986, now reaching 8000 people in 32 companies. The firms are primarily manufacturers (21) and hotels(7), but also include publishing, construction, printing and supermarket businessess. In these companies as well as many of the 480 members of the Jamaica Chamber of Commerce, employees are usually women of reproductive age who cannot afford to take time off to attend a clinic. There is a great demand for information and discussion on sexually transmitted diseases and clarification of the contraindications of various contraceptive methods. At the end of the discussions, educators offer pills, condoms and neo-sampoon, and may refer people for clinical services. Almost new acceptors have been recruited. The success of the project depends heavily on cooperation of management, supervisors and union representatives. In some cases union representives or company nurses act as distributors of contraceptives. This project has been so successful that some companies expressed an interest in participating in the Associations's resource development program.^ieng

[Travelling together: an experience in sex education in the area surrounding Sao Paulo]. / Caminhando juntas: uma experiencia em educacao sexual na perifera de Sao Paulo.

PIP: This study describes group discussions of female sexuality held in a Sao Paulo Mothers' Club for the purpose of educating participants and producing educational pamphlets for publication. The participant research methodology is an attempt to integrate feminism with academic practice; the research is to be used to improve the condition of the research subjects and the research process itself is seen as educational. Participants were 8-15 low-income housewives 25-33 years old, with low level reading skills. In a series of discussion meetings, topics of interest identified included the physiology of the human body, sex education of children, and methods of contraception. Drafts of pamphlets and illustrations were presented for the immediate feedback of the group. Additional topics included the role of women in the family and society, women's rights, traditional class beliefs and myths about sexuality, medical care and examinations, and self-examination. 5 pamphlets and an accompanying manual for their use were produced for distribution to women's groups throughout Brazil. These include: Understanding Our Body; Do I want to be a Mother?; When Children Ask Certain Things; A gynecological Exam; and Much Pleasure.^ieng