Prevention of STDs -- the challenge of changing behaviors.

PIP: STD prevention efforts in Latin America, particularly in the Dominican Republic, have begun to stress the need for behavioral changes. Traditionally, the professional public health community has focused on secondary prevention of STDs -- detection and treatment of the disease in order to prevent complications from developing. But in light of the AIDS epidemic, greater attention has been paid to primary prevention. Hoping to prevent the disease from occurring, primary prevention efforts target high risk groups (prostitutes and their clients and young people) with health education and promotion of behavioral change. Such changes include using condoms, seeking medical care for STDs, and decreasing the number of sex partners. An example of primary prevention programs is the Avancemos Project in the Dominican Republic. Launched in 1989 by the country's Ministry of Health and Family Health International's AIDSTECH Division, the project targets sex workers with several intervention measures. Initially, the Avancemos Project trained 16 sex workers to serve as peer educators to distribute condoms and educational materials. These 16 volunteers have in turn trained more than 300 other peer educators. Among the educational materials distributed by the peer educators are 2 comic books entitled "Martiza's Advice" and "The Triumphs of Maritza." A handsome, well dressed, and street-wise sex worker, the title character in these comic books instructs on a range of issues, including how to negotiate with clients how to use a condom. As those involved with the project attest, the comic books have become extremely popular among the target group, tapping into the women's buried feelings of self-worth.^ieng