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HIV/AIDS and Latin@s: The Impact, The Solutions!*
On September 20, I attended a Congressional Briefing in Washington, D.C at the U.S. Capitol Visitor’s Center. The briefing was in preparation for National Latino AIDS Awareness Day and was hosted by two groups: the Latino Commission on AIDS (represented by Guillermo Chacon and Melissa Faith Ramirez) and the National Latino AIDS Action Network (represented by Francisco Ruiz). The focus of the briefing was “HIV/AIDS and Latinos/Hispanics: Identifying and Addressing the Needs of a Growing Community in a Changing Landscape”.
Several U.S. Senators were invited to provide remarks: Senator Gillibrand (D/NY), Senator Rubio (R/FL), Congresswoman Ileana Ros-Lehtinen (R-18/FL), and Congresswoman Lucille Roybal-Allard (D-34/CA). Other guests from six separate organizations and establishments also spoke, giving brief presentations.
From the U.S. Health and Human Services, Department of HIV Services, Dr. Timothy Harrison spoke about the National HIV/AIDS Strategy and how there needs to be better coordination efforts at the local level. He emphasized the need for programs targeting women who are positive and mentioned that the Health and Human Services is looking to evaluate and support programs who’s services target this population (women who are HIV positive). 
Dr. Joseph Prejean, from the Centers for Disease Control and Prevention, shared with us some of the CDC’s recently released HIV/AIDS data. Reinforcing the impact of the HIV/AIDS epidemic on the Latino/Hispanic population was the fact that Hispanics only represent 13% of the population (in 40 states studied) but accounted for 19% of those infected. Furthermore, the age distribution of infection varies depending on the population. New infection rates for Hispanics are much younger, between the ages of 13 and 29, compared to Whites who are older when newly infected (40+). Dr. Prejean also noted that the goal is not to stabilize rates of new infection, but it is to reduce the rate of infection. There was also mention of looking at differences between foreign-born and U.S. born Latinos/Hispanics.
Teresa Chapa, the Senior Policy Advisor for Behavioral Health in the Office of Minority Health, spoke on behalf of Dr. Garth N. Graham and Jay Blackstone (Office of Minority Health). She mainly spoke about “collaborative care” and the formation of a delivery system that addresses the needs of our communities. Similar to the idea that interventions should have a “bottom-up” path, a grassroots approach so that they specifically address/take care of those issues most dear to the community being helped.
Roxana Olivas, from the Executive Office of the Mayor of Washington, D.C., continued the conversation by speaking about linguistically and culturally appropriate programs. It is great that individuals in the nation’s capitol are speaking about a type of program that Transdiaspora Network is already working with.
Catalina Sol is the Chief Program Officer at La Clínica del Pueblo, a health center in the area that has been serving the Latino community in D.C. As a federally qualified health center (since 2007), La Clínica del Pueblo receives funding to help with the provision of services and direct care to patients. Ms. Catalina Sol mentioned that the Office of Minority Health is sponsoring community-based organizations (i.e. PPFA, Andromeda, La Clínica del Pueblo) who are providing valuable services to their surrounding communities. There was also mention that testing without prevention is not sufficient! That organizations and health centers are doing a good thing by promoting testing and helping individuals access testing, but that more needs to be done: that prevention education and access to prevention (safe sex and clean needles) is also needed in order to prevent the spread of HIV/AIDS and reduce the rate of new infections.
Lastly, a young man by the name of Jose Ramirez gave his perspective of a Latino living with HIV. Diagnosed when he was 17 years old, he has become an advocate and speaker for Latino rights and educating youth about the importance of protection, prevention and being screened for HIV/AIDS. His story can be heard in the documentary “The Other City” (trailer). He emphasized that yes, it is great that we are talking to the youth about this disease/epidemic, but that we also need to talk to the families and schools.
*Written by Dominique Dupont-Dubois, MPH, TDN Community Outreach & Public Health Advocate.
Where Do Babies Come From?*
That is probably the question most parents try to avoid at all costs, and kids, once that question materializes in their heads, do not rest until they get an answer. Some of the answers involve flowers and bees, others involve a stork, and of course, we all have heard “Ask your mother.”
When I was in primary school, I had a weekly class called “I am a woman” –I went to an all-girls school. This class was about women’s reproductive system, the process of pregnancy, what happens during menstruation, and where babies come from. In second grade, I had my first class about reproduction, and the image that comes to my mind when I think about that class is a cartoon of two machines –a male and a female machine. The male machine was a mechanical device, like a large compressor, with levers, gears and belts; the female machine was an electrical device with bulbs, switches, fuses and a small screen on the front showing a big red heart. Both machines were connected by what seemed like a vacuum hose, going from the center of the male machine to the center of the female machine, below her heart. Using this analogy of the machines as humans, my teacher explained about the seed and the sperm (or “male liquid”), and how the “male liquid” travels to the female’s egg, and together created a baby.
The image was simple, and even though it did not involve humans; it was not confusing because the teacher’s explanation was thorough. She also made clear that it was just an analogy.
I am very fond of my memory of the “love machines;” however, I do not have a particularly interesting memory of how I learned about HIV/AIDS. When I started working for Transdiaspora Network, to get more connected to its cause and to relate to the teenagers in our programs, I tried to remember my experience in learning about HIV/AIDS, and I noticed that no one ever taught me what it was about. I learned about HIV/AIDS mostly from news, TV, articles, and even from myths and beliefs such as “Don’t drink from there, you can get HIV.”
I want to share this story with you because I feel it’s a good example of how creativity and learning can work together successfully. That is what Transdiaspora Network (TDN) does: it proposes an innovative approach to talk about HIV prevention through storytelling, dance and photography, and I’m very happy to be a part of it.
Share your story with us. How did you learn where babies come from? Contact us.
*Written by Federica Rangel, TDN Communication Coordinator
As you gear up to support the causes you love this holiday season, please consider making a gift to Transdiaspora Network (TDN) and help us to continue developing our culturally-sensitive prevention programs where at risk teens are finding their voice, and using it to protect their bodies and their futures. For more information about TDN and its programs, or to make a tax-deductible donation, please visit us online at www.transdiasporanetwork.org. Support prevention. One teenager at a time!
Contexto Sociocultural del VIH en Cartagena, Colombia (3ra Parte)
Resultados
Aun cuando se han implementado diversos planes y programas de prevención para controlar la difusión del VIH, las dinámicas sociales y los factores culturales locales generan un contexto propicio para que la infección continúe vigente. Al respecto debe ser resaltado que Cartagena es la ciudad de mayor desigualdad socioeconómica en relación con su número de habitantes tanto para el país como para América latina.
Aunque efectivamente las desigualdades sociales impactan la situación de la epidemia a nivel local va permeando los procesos de salud y enfermedad, existen otro tipo de elementos propios de lo sociocultural que determinan contextos de riesgo que sostienen y dan sentido al mantenimiento y reproducción de la enfermedad. En este sentido el riesgo de adquirir la infección está inmerso en un entramado de significados en los que interactúan la organización social, las relaciones de género y las representaciones sociales del placer y la sexualidad. La vida sexual en Cartagena responde a lógicas particulares que a su vez manifiestan un orden social específico. En consecuencia, aquello que desde la salud pública es promovido como “sexo seguro” en particular frente al uso del condón, encuentra dificultades para integrarse a las prácticas y racionalidades locales de lo que es deseable frente a una relación sexual.
EL RIESGO EN LA COTIDIANIDAD: SER COSTEÑO, FAMILIA, SEXUALIDAD Y GÉNERO
Las percepciones frente al riesgo de adquirir VIH, así como de hacer uso o no del condón, están fuertemente influenciadas por el tipo de organización familiar que actualmente se evidencia en Cartagena. La familia como eje central de la organización social se consolida como un espacio necesario para comprender los roles de género y por tanto la forma como se relacionan los hombres y las mujeres en la cotidianidad.
La estructura familiar en Cartagena es una construcción social y cultural producto del encuentro durante la colonia de las culturas indígena, africana y española, que se articularon en un contexto marcado por su carácter portuario y esclavista, la estructura familiar cartagenera se inscribe dentro de lo que se denomina el complejo familiar costerofuvial, cuyas características básicas recaen en la constitución de formas de facto, con dos tipos de modalidades tipológicas: la primera de ellas siendo la monogamia marcada especialmente por la uniones libres, y la segunda la poliginia, en la que se incluye la poliginia de soltero y el concubinato o poliginia de casado. En concordancia con esta descripción, en el estudio se encontró que el inicio de la vida en pareja suele estar marcado por una relación de unión libre que con el tiempo puede presentar variaciones propias de la poliginia encubierta.
Este tipo de estructura familiar cambia permanentemente; su dinamismo exige que se entienda teniendo en cuenta una trayectoria temporal para, de esta forma, dar cuenta de cómo se estructura y reestructura en la historia de vida de los individuos. La constitución de la unidad doméstica atraviesa por diversas fases en el tiempo, y en este sentido, la primera de ellas se daría por el establecimiento de una unión libre. De esta primera unión es posible que surjan hijos, cuyo sostenimiento económico es responsabilidad del padre, mientras que las necesidades afectivas y de cuidado las debe proveer la madre. La unión puede permanecer monógama, aunque es frecuente que pase por una etapa de poliginia encubierta en la que el hombre mantiene relaciones con otras mujeres, siendo ésta una dinámica que se inserta en la unión libre de manera transitoria o permanente. Esta situación puede generar inestabilidad en la unión, llevándola a su separación y permitiendo que tanto el hombre como la mujer establezcan una nueva unión, lo que vendría a ser una tercera fase. De la segunda unión es importante resaltar que el hombre suele hacerse cargo de los hijos de la primera unión y de los propios, según sea el caso. el hombre cumple entonces la función de mantener el hogar siendo el proveedor económico, no sólo en cuanto a la alimentación y educación, sino que también opera como el proveedor de los bienes materiales que componen la casa, como la nevera, el televisor, la cocina entre otros.
Todas las mujeres lo que dicen es que no hay hombre que no sea infel. Y entonces le perdonan la infidelidad porque el hombre responde en casa. Mira yo vi a un ex cuñado mío, o sea que fue esposo de mi hermana siendo infel (…). Mi papá creo que se dio cuenta, o escuchaba los rumores y mi papa decía “pero bueno él responde en la casa, le tiene la nevera llena, le paga los colegios al niño y ya, y seguramente cumple con sus deberes en la casa y ya, es un buen hombre. Y ya” (entrevista a mujer de veintiocho años, Cartagena).
Sí, mi papá me decía: “no, pues, usted tiene es que estudiar, capacitarse primero para que, después, se lleve una muchacha a vivir, para que pueda ser responsable y comprarle todas sus cosas …” (entrevista a hombre de treinta y cinco años).
Las mujeres en particular, reportaron de tres a cuatro uniones de hecho, con periodos cortos de tiempo entre ellas, de tal forma que sus hijos pasarían a cargo de la pareja momentánea, es así como se establecen dinámicas familiares en las que la figura paterna es transitiva y difusa mientras que la de la madre permanece estable. La estructura familiar cumple con un ciclo continuo, en el que con la llegada de un hombre a la unidad doméstica se pasa por un periodo de procreación, auspicio de la mujer y su descendencia, y por último abandono del hogar. El hombre, en este orden de ideas, es representado como una figura momentánea y funcional que permite el mantenimiento económico del hogar.
—Cuando el hombre se va, ¿quién se queda con las cosas de la casa?
—PS: Uno cuando se compromete con un hombre todo lo que uno tiene o lo que se compró es ganancia. Si uno tiene una casa o una plancha o un televisor, uno se gana eso como de premio (entrevista a mujer de treinta y ocho años, Cartagena).
Ahora bien, dentro de la estructura familiar cartagenera, debemos señalar dos aspectos que nos permiten contextualizar el problema del riesgo: Los estereotipos del hombre y la mujer costeños, y los roles de género que determinan las maneras de actuar y tomar decisiones frente a la sexualidad. en este sentido, la poliginia y las uniones seriadas son un factor que añade un nivel de complejidad a la idea de riesgo, su significado y su función dentro de las prácticas sexuales, ya que este tipo de familia permite entender la racionalidad de los roles y cómo el riesgo se inserta en la vida de las personas. el tipo de familia permite entender múltiples redes sociales en las cuales son los hombres quienes, por pertenecer al espacio público y por su naturaleza, tienen múltiples encuentros sexuales paralelos a su pareja estable. Por esto mismo se percibe que son ellos quienes sopesan el problema del riesgo de infección y por ende negocian el uso o no uso del condón. Por otro lado, el espacio privado, vinculado a la mujer de la casa, es un área simbólica en la que la percepción del riesgo se ve disminuida. allí se evidencia que este espacio es considerado como un lugar al que se le debe respeto, intimidad, confianza, placer y protección, y en el que el uso del condón no tiene cabida .
Considero que por lo que… por la libertad de que tenemos nosotros los hombres. Que nos facilita más la relación en la calle que a la mujer andamos de aquí para allá, de allá para acá, y se nos facilitan más las relaciones que a la mujer. (Entrevista a hombre de treinta y cinco años, Cartagena).
Yo digo que las mujeres se infectan por lo mismo. Porque habemos hombres que no… habemos muchos hombres que no nos protegemos en la calle. Si por lo menos conocemos mañana una muchacha y la muchacha es bonita y tai y tatai, y uno está bien parecido y muy bien presentado, y uno tiene una relación con ella, y ella ni por ahí se va a imaginar que uno esté enfermo. Uno tampoco se imagina que ella pueda estar enferma tampoco (entrevista a hombre de treinta y cinco años, Cartagena).
Estas maneras de pensar la sexualidad dentro de espacios públicos y privados pueden ser entendidas desde las formas como los habitantes del Caribe se autoperciben a sí como desde las formas como son estereotipados y escenificados. Así, es frecuente la diferenciación que hacen de sí mismos frente a otras poblaciones del país: “los costeños somos calientes, no como los del interior… es nuestra naturaleza… somos así” (entrevista a hombre de cuarenta años, Cartagena). En este sentido, los estereotipos sobre las personas de la costa Caribe son usados para definir la identidad costeña en la que se determinan atribuciones sociales para los roles esperados de cada género, esto resulta importante para dar cuenta de cómo los individuos dentro sus nichos sociales hacen uso del concepto de riesgo y toman, sobre esta base, decisiones sobre el uso o no del condón.
Contexto Sociocultural del VIH en Cartagena, Colombia (2da Parte)
En el campo de la prevención del VIH, la categoría riesgo cobra particular importancia. Al ser una enfermedad cuya transmisión está directamente determinada por conductas particulares, dentro de las que se incluye el establecer relaciones sexuales sin condón, el riesgo se sitúa en las prácticas de los individuos y en particular en sus estilos de vida. La posibilidad de adquirir la infección se ubica en la responsabilidad individual y en la capacidad del individuo de autocontrolarse y evitar aquello que lo pone en riesgo, por esto mismo el riesgo como categoría está inmerso en el mundo de las decisiones. aunque desde el campo de la salud pública y la epidemiología se han identificado prácticas concretas que efectivamente impactan la salud de los individuos, éstas no necesariamente son percibidas como riesgosas al interior de las lógicas sociales y culturales de una población. la forma como las personas definen, delimitan y significan el riesgo influencia las trayectorias en salud de los individuos.
El término “riesgo” ha sido sujeto de múltiples interpretaciones y definiciones, sin embargo es posible establecer dos orientaciones epistemológicas que concentran la forma como este ha sido abordado: en la primera, el riesgo puede entenderse como un hecho medible, objetivo y que puede expresarse en términos de probabilidades y en la segunda, el riesgo, desde aproximaciones antropológicas y sociológicas, aparece como una construcción dependiente de lo sociocultural. En ambas perspectivas el riesgo es objetivado, convirtiéndose así en una categoría indispensable y en lengua franca para la salud pública y las ciencias sociales, por lo cual su definición y su uso son extensos.
Sin embargo, la literatura sobre el tema presenta un amplio espectro que sobrepasa la visión de estos autores y que evidencia que las dinámicas sociales subyacentes a la noción de riesgo van más allá de pensar el riesgo como un producto de la modernidad calificado negativamente. al analizar el riesgo y al pensar en prácticas asociadas a éste –que le otorgan un sentido–, es posible entenderlo bajo una perspectiva en donde, por ejemplo, las prácticas asociadas al self perceived risk y al risk taking no son, necesariamente negativas sino que al contrario, pueden ser altamente valoradas bajo ciertas condiciones sociales tal como lo muestran diferentes trabajos (adkins, 2001; mythen, 2007; reith, 2004; Wilkinson, 2001). Por otro lado, entre las perspectivas que contemplan el riesgo desde aspectos sociales, es posible encontrar una producción de literatura sobresaliente, que se preocupa por las desigualdades sociales, la vulnerabilidad y la estigmatización que inciden directamente en la transmisión de la enfermedad, centrándose particularmente en las inequidades económicas, de clase, raza o etnicidad y género.
Este artículo está inscrito en la discusión sobre el VIH y los aspectos socioculturales asociados a esta enfermedad en la ciudad de Cartagena. Al respecto se pretende plantear el riesgo como una categoría flexible y dependiente de los contextos socioculturales locales. Esta mirada, permite no sólo el reconocimiento de las formas como se establece la percepción del riesgo de adquirir la infección, sino que también permite comprender cómo el riesgo y el VIH están soportados en un red de significados que sostiene y da sentido a prácticas que, desde un punto de vista epidemiológico, posibilitan y potencializan la transmisión de la enfermedad. en este sentido, se busca argumentar cómo elementos propios del contexto sociocultural tales como los roles de género, la estructura familiar y los estereotipos sobre la sexualidad costeña, son fundamentales para entender el comportamiento de la enfermedad en Cartagena. el análisis alrededor del riesgo y el VIH por transmisión sexual, exige explorar el tema del uso o no uso del condón, lo cual aparece como un tema primordial dentro de las dinámicas sociales alrededor de la enfermedad, que además invita a la reflexión sobre el discurso del sexo seguro, tema central de la salud sexual y reproductiva contemporánea, en la que se promueve el condón masculino como la tecnología más eficiente para la reducción de la transmisión sexual del VIH y de otras enfermedades de transmisión sexual.
Contexto Sociocultural del VIH en Cartagena, Colombia (1ra Parte)
RESUMEN
Aun cuando se han implementado diversos planes y programas de prevención para controlar la difusión del VIH en Cartagena, la incidencia de la enfermedad sigue en aumento. En este sentido el objetivo de este estudio estuvo enfocado en entender de qué manera los contextos socioculturales influencian las percepciones de riesgo frente al VIH. De igual manera, considerando que el condón se ha promovido como la medida más efectiva para prevenir la enfermedad, en el artículo se discute la relevancia sociocultural de las políticas públicas alrededor del sexo seguro, los factores de riesgo y el cambio comportamental.
Introducción
El VIH es una de las enfermedades que en los últimos tiempos ha logrado concentrar gran parte de la atención de las agendas públicas en salud a nivel global. La rapidez con la que se ha propagado la enfermedad en el mundo la ha consolidado como objeto de estudio de las ciencias básicas y sociales. A pesar de las diversas estrategias y planes de control y prevención que se han establecido desde el campo de la salud pública, la incidencia de la enfermedad continúa evidenciando dificultades para lograr el control de la epidemia especialmente en los países que se han denominado por diversos organismos como de mediano y bajo ingreso.
Un estimado de la epidemia de VIH durante el 2008 indica que 39.5 millones de personas fueron directamente afectadas por la enfermedad. Las cifras epidemiológicas ubican a África con la más alta prevalencia, con 25.1 millones de personas infectadas, seguido de Asia con 8.5 millones, Europa oriental y Sur América, cada una con 1.7 millones de personas afectadas (onusida, 2009). en los últimos diez años, Latinoamérica y el Caribe tuvieron el crecimiento más alto de la incidencia, hecho que según varios autores tiene relación con cambios estructurales en los sistemas de seguridad social, la disminución de políticas sanitarias, el incremento en el número de personas viviendo bajo condiciones de pobreza absoluta.
Aunque se han identificado como grupos de riesgo importantes los hombres que tienen sexo con hombres y las trabajadoras sexuales, el rápido crecimiento del contagio en mujeres representa una de las características más importantes del comportamiento de la epidemia actualmente. Es decir que, aunque en un principio los hombres eran los principalmente afectados, la proporción de mujeres que actualmente conviven con el virus ha aumentado dramáticamente. En Colombia, por ejemplo, la relación entre el número de casos de hombres infectados con respecto al de las mujeres ha pasado de 10:1 a 2:1 en veinte años.
Para el caso colombiano, la feminización de la epidemia se ha venido manifestando gradualmente, en particular se resalta la situación de la costa Caribe, región que en los últimos años ha evidenciado un aumento importante en la incidencia de la enfermedad particularmente en el grupo de mujeres jóvenes entre los veinticinco y treinta y cuatro años, seguido del grupo entre los quince y veinticuatro años.
Con el objetivo de prevenir la propagación de la epidemia, en el país se han diseñado campañas de comunicación y educación a nivel nacional cuyo enfoque es primordialmente comportamental e informativo. Bajo esta perspectiva, es frecuente que se asuma que la divulgación de información o de conocimiento en las comunidades va a generar necesariamente un cambio en su comportamiento, de tal manera que los individuos lleven a cabo prácticas saludables. Las campañas de prevención basadas en este enfoque parten del concepto implícito de que los individuos tienen control sobre su salud una vez obtienen determinados conocimientos y que pueden dejar de lado las influencias del contexto social que los rodea. Aunque cada vez más crece la necesidad de comprender y abordar el fenómeno del VIH sobrepasando las teorías comportamentales, sigue siendo limitado el peso que se le da en el campo de la prevención a los contextos socioculturales de la enfermedad.
In Africa, HIV/AIDS Awareness Through Performance*
Using traditional arts to in raise awareness about HIV/AIDS is more than a local phenomenon. The following article centers around a festival held in 2003 in a village in Guinea, West Africa, yet it deals broadly with the benefits as well as the potential risks of disseminating health information through the arts. Here organizers and health experts in Guinea reveal that while performance can be a vital tool for conveying messages, it can also be a liability if artists aren’t well informed.
A village in Guinea may seem worlds away. However, given that Africa is home to 60% of the global population living with HIV/AIDS, any larger perspective on the disease must inevitably look to the continent. And since Transdiaspora Network’s interventions employ Afro-Caribbean traditions such as storytelling and dance, this article’s sojourn could also be conceived as a return.
Friguiagbe, Guinea, September 2003:
Under a florescent floodlight, some 2,000 people—mostly residents of this town in Guinea’s coastal region—gather until the wee hours of morning for a festival of music, theater and dance. While the traditional melodies performed here are centuries old, their lyrics are decidedly modern.
“Use a condom!” chants one ensemble. “Or else stay celibate!”
The Ballet Wassasso from the capital city of Conakry sings the message in French and Susu, the local language, before regaling the audience with a dance of flailing limbs, an explosion of drums, and a shower of prophylactics.
As the number of Africans living with HIV/AIDS approaches 30 million, this event, the Festival of African and Guinean Folklore (FESTAFOLG), has joined an Africa-wide trend integrating AIDS education and traditional culture. The Festival’s theme: “Stigmatization and discrimination associated with HIV/AIDS, the cultural context.”
“Folkloric culture is an important platform for relaying messages,” said Alfred Houlemou, a Guinean television journalist and the Festival’s principal organizer. Houlemou explained that the West African singer/historian, the griot, traditionally plays a social role not only as a traveling artist but also as a conveyor of practical information from village to village.
“Will you say to the people of Friguiabe, ‘Hey, I’m going to send you an e-mail with information on preventing AIDS?’ No—the medium is wrong,” said Papa Fadiara Cissokho, who organizes a festival each year in Louga, Senegal. Even drumming, which he says replicates spoken language in many traditional African cultures, is being used to further AIDS awareness. “Rhythm is the best vector of communication in Africa,” he said.
The Paris-based International Council of Organizations of Festivals and Folklore says FESTAFOLG is one of many African festivals that have used folk culture as a platform for addressing societal concerns, ranging from ethnic conflict to sustainable development. Africa Alive!, a network of media-savvy youth organizations that have become one of the continent’s largest AIDS prevention groups, also uses music festivals to relay educational messages in eight countries. And in Cameroon, the John Hopkins University School of Public Health has collaborated with Cameroonian folk artist Paul Kengmo to produce cultural events about AIDS in rural villages known as Project Ah Ta-Ah.
In Guinea, the government’s Department of Culture provided most of the $50,000 needed to produce FESTAFOLG, which featured two-dozen ensembles from Guinea, Ivory Coast and Benin. Meanwhile, a group called PRISM sponsors 10 traveling theater troupes in Upper Guinea as part of its HIV/AIDS education program. On the day of a performance, the group organizes a Mamaya—a dance for members of a particular age group—or commissions a konden—a masked dancer—to parade around the village with drummers to attract villagers to watch interactive theater performances about HIV/AIDS.
The idea of integrating traditional West African arts and HIV/AIDS education dates to at least 1993, when Antonio Francesco, a U.S. Peace Corps volunteer in Diourbel, Senegal, assembled a troupe to bring health education with support from doctors to rural villages. The group toured for several months, performing with permission of village leaders and holding seminars after each show. Two months later, a health team was sent to conduct random interviews in each village, and found that villagers both remembered and understood the message.
PRISM has seen similar results. A survey conducted a year into its program found that compared to the population of Beyla—a control province in Guinea’s forest region which received no HIV/AIDS intervention—Upper Guinean men were twice as likely to use a condom.
But some HIV/AIDS workers warn that purveying health facts through the arts can be risky. “Theater and music and traditional ballets are good for attracting big audiences and presenting basic information,” said Kimberly Ross, HIV/AIDS adviser in Guinea for the U.S. Agency for International Development. “But they haven’t been effective in addressing myths and misconceptions.”
At the Friguiagbe festival, a group called Ballet Saamato performed a scene in which a comb and razor used by an unhygienic barber were said to be contaminated with the HIV virus. Such an infection “is possible,” said Mackenzie Dabo, former coordinator for the Peace Corps’ HIV/AIDS programs in Guinea, “but the chances are slim.”
Many of the festival’s scenes portraying death from AIDS included a sexually promiscuous female character, usually a prostitute. Such depictions are common in educational theater “because they’re funny and easy to represent, but they reinforce the stereotype that only prostitutes and promiscuous people can get AIDS,” Ross said.
Without consultation from knowledgeable AIDS workers, cultural performances may even reinforce misconceptions and add to the societal stigma suffered by many AIDS victims, Ross said. However, most health workers add that simply by addressing the topic of sex openly, folk performances can break through the fundamental taboo about discussing sexuality that is one of the biggest barriers to AIDS education in Guinea and elsewhere in Africa. They say traditional culture is a powerful awareness-raising tool when coupled with accurate information, thoughtful production, and discussions following each performance.
*Written by Joshua Cohen, a PhD student at Columbia University’s Art History Department, who aims to change western framings of African arts.
Fighting HIV/AIDS in French*
I travelled to France a few weeks ago for a family reunion, and as I walked the streets of Paris where spring was just starting to bud, I noticed large flyers posted all around town, sporting bright red ribbons and big letters that read “SIDACTION 2009.” My curiosity was peaked and I had to find out more about this Sidaction, or “AIDSaction” in English.
Sidaction was founded in 1994 as a fundraising mechanism to collect funds for research and to support organizations engaged in the fight against HIV/AIDS, especially those located in the French oversees departments (i.e. Martinique and Guadeloupe) and territories where the need was greatest. During that first fundraising drive, Sidaction raised 45.7 million Euros (or about 61 million USD, in today’s dollars) from 1.4 million donors! This was a stellar accomplishment, which unfortunately was never repeated, perhaps a sign of changing times and changing priorities. In 1996, Sidaction launched its second fundraising drive, raising a bit less than 10 million Euros. In 2006, it raised 5.1 million Euros and in 2007 5.9 million Euros.
This year, on March 20, 21 and 22, eleven television channels and 5 radio stations joined forces and mobilized their teams for Sidaction 2009, to celebrate its 15th anniversary. For three days, journalists, news anchors and television personalities took turns to call on the public to support the cause. Across the entire country, more than 350 cultural, sporting and educational events were organized with the goal of raising awareness about HIV/ AIDS, as well as funds. In three days, Sidaction raised 6 450 000 Euros in pledges, representing an increase of 500 000 Euros over the previous year – a good sign! 50% of the funds raised will go to support prevention programs and those already sick with HIV-AIDS, and 50% will go to funding research. Sidaction has pledged to make these funds available this year, without delay, to ensure that the researchers and organizations recipient of the funds can dedicate themselves fully to fighting HIV/AIDS as opposed to spending valuable time looking for financing.
In the fight against HIV/AIDS, mobilizing and engaging the public is crucial to preventing the spread of the virus. Raising funds to finance this prevention, from the community to the international level is also key. For those interested in getting involved, you don’t have to travel to France or anywhere else. Take the first step right here in New York City by participating in AIDS Walk New York, on May 17th. Click here to get more information about how you can sign up and walk with the TDN team! And watch the video.
*Written by Sophie Cardona, TDN Treasurer, from Paris, France.
On the Verge: The Local Other (II Part)*
“Is this the medical clinic?” asks one man, to which a middle-aged woman responds, “I think so,” pointing to a picture of an AIDS ribbon visible through an open first floor window.
The building, as well as the entire city block, is occupied by Via Libre, a non-governmental organization founded in 1990, which, at the time of its creation, operated out of a cramped office and existed only through the volunteer efforts of a small group of healthcare professionals. Since its inception, Via Libre has provided counseling and mental health services to the HIV-positive population of Lima. Over the past 19 years, Via Libre has grown exponentially to provide free comprehensive medical services to persons living with HIV/AIDS, create a drug bank for those who cannot afford expensive antiretroviral medication, and engage in creative educational campaigns aimed at preventing the spread of HIV among Lima´s youth and other high-risk populations. In recent years, Via Libre has created a laboratory dedicated to the development of an HIV vaccine.
When Via Libre was founded, there were no useful statistics about the number of Peruvians living with HIV, and worse, thousands were unaware that they had been infected. As recently as September 2007, a number of population-based surveys, including surveys by the Peruvian Ministry of Health and the United States Agency for International Development (USAID), reported that there were over 50,000 known cases of HIV or AIDS in Peru, with the capital region accounting for approximately 72% of these. Significantly, the United Nations Joint Programme on HIV/AIDS (UNAIDS) estimates that approximately 35,000 additional Peruvians are HIV positive but unaware of their status. According to the USAID, sexual transmission accounts for 97% of HIV/AIDS cases in Peru.
In the 1990s, the AIDS epidemic quickly became a burden on Lima´s then-collapsing healthcare system, and private citizens met the challenge of raising awareness about HIV/AIDS.
“Civil society is most responsible for HIV prevention in this country,” says Marcela Coronado, a director at Via Libre. Ms. Coronado, a psychologist who works closely with at-risk youth ages 14-18, believes that there is no organized education in Peruvian schools concerning HIV/AIDS but there is a “growing recognition that [HIV/AIDS] is major public health crisis.”
Coronado explains that Via Libre has gained inroads into at-risk populations by working with community groups, sports clubs, discotecas, and other public spaces frequented by young Peruvians.
“When we work with youth, it is imperative to work with their parents and communities, otherwise parents rightfully will be suspicious of our activities,” said Coronado.
In Coronado´s view, a major challenge is “gaining the respect and friendship of the various communities we work with…our approach differs with each target community.” While Via Libre uses its mobile unit to disseminate information to large groups of people at street fairs, it utilizes a more personal approach when working with teens. “We play games with the youth and get them to loosen up,” said Coronado.
One such game involves asking teens to write anonymously on a small piece of paper the first words that come to mind when they hear certain words, such as “sexuality,” then taping their notes onto a giant ball. The facilitator then passes around the ball, and each teen reads aloud one comment for the group to discuss. “There is a lot of laughing, but the kids are really put at ease and feel comfortable talking about serious issues.” recalls Coronado with a broad smile across her face.
Via Libre´s vision and many innovative approaches to HIV prevention have gained the organization national and international attention, including much-needed funding from the European Union and other international sources.
Many of Via Libre´s youth participants have already gone on to become peer educators and form an integral part of Peru´s fight against HIV/AIDS. As part of Via Libre´s “Communidad Saludable” (Healthy Community) campaign, which is in its second year, some youth participants now work with community leaders and health professionals to organize prevention activities in and around Lima. Ms. Coronado reports that youth have helped organize HIV awareness fairs, created HIV-prevention brochures, and are presently working with medical clinics around Lima to create spaces where the general public can obtain HIV-prevention materials and find support groups. Ultimately, Coronado explains, “Via Libre wants to create a culture of prevention. We want to start a dialogue that will continue even after our work in a particular community is complete.”
On the Verge: The Local Other*
“Can you get HIV from living with someone who has HIV?” “Will you get HIV from a mosquito bite?” “How about from kissing?” Sandesh Mahadik, an HIV counselor by day and aspiring actor by night, asked these questions to a crowd at Mumbai’s Juhu Beach on a balmy December evening. They had gathered around Mr. Mahadik as he and his fellow volunteers put on a street theater performance. Earlier in the evening, informational health literature and condoms had been disseminated among beach-goers by members of Sanmitra Trust, a non-profit organization founded in 1999 that runs several projects for HIV prevention and for the care, support and empowerment of people living with HIV/AIDS.
Mr. Mahadik, who has a bachelors degree in counseling and works at an AIDS hospital by day, believes that Indians are “dangerously” uninformed about HIV/AIDS and lack access to accurate information about prevention and treatment. “In a country that is struggling to educate its youth and to achieve 100% literacy, HIV prevention is not viewed as a top priority. But it must be.” Mr. Mahadik explains that the desire to inform fellow Indians has driven him to volunteer with the Sanmitra Trust, which, among other things, sponsors street theater relating to HIV/AIDS issues. “We try to break down stereotypes and societal stigma associated with HIV/AIDS,” says Mr. Mahadik.
One of Sanmitra Trust’s street theater pieces tells the story of a carefree Indian youth who finds out that he has contracted HIV. Faced with this news, he is confronted by his brother who tells the young man that he should leave their family’s home and live on his own. “I’m not sharing a toilet with you,” exclaims the brother. When their father gets wind of these developments, he is understanding; he sits the boys down and explains that HIV cannot be spread this way. “Does anyone know how HIV is spread?” the father asks the growing crowd.
Mahadik explains that the public has been receptive to Sanmitra Trust’s street theater performances, although noting that in Mumbai, the center of India’s film industry, “everyone’s a critic.” He believes that there is still a great deal of denial in India about HIV/AIDS; however, people are beginning to recognize that the virus “is killing millions of our countrymen.” Mr. Mahadik is hopeful that through the work of Sanmitra Trust and other local grassroots organizations and charities, India will be able to overcome the greatest public health crisis in its history. (View Pictures)
*Written by Ameet Kabrawala, TDN Board Chairman, from Mumbai, India
Let’s Build Something Together
In early June, The Archives of Internal Medicine published an article concluding that our health care system fails minority patients because of what the study’s author, Dr. Thomas D. Sequist, an assistant professor of health care policy at Harvard Medical School, called “a systemic failure to tailor treatments to patients’ cultural norms.” According to Dr. Sequist, “it isn’t that providers are doing different things for different patients. It’s that we’re doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren’t being met.” To address these gaps, Sequist suggested that health care providers learn more about minority communities so they might better understand cultural barriers to treatment compliance.
As many of you know, Transdiaspora Network recently conducted a health survey in the Crown Heights community. After analyzing the survey results with Gretchen Maneval, Lorna Mason*, and Naomi Braine at the Center for the Study of Brooklyn at Brooklyn College, we found that knowledge and impact of HIV/AIDS varied widely among survey participants, a diverse group ranging in ethnicity, age, and gender.
More than 60% of those surveyed reported that they had not participated in HIV prevention education, and 67% reported that they discussed ways to protect themselves only once per year or even less frequently.
Not surprisingly, an overwhelming majority of those surveyed (79%) reported that their HIV prevention education had not incorporated cultural elements at all.
But most interestingly, we found that 50% of those whose education had incorporated cultural heritage described their knowledge of HIV prevention as “excellent” compared to 27.7% of those whose education did not incorporate cultural heritage at all.
So what does this all mean? Sequist is right, but he is also quite wrong. While his study sheds light on the shocking lack of cultural sensitivity among most health care providers, an even more ambitious approach is needed. We must go beyond simple cultural sensitivity or even competency and demand cultural proficiency. Cultural differences need not be a limiting factor merely to be accommodated or referenced, as Sequist’s study suggests. Let’s not just consider culture. Let’s use it. Our rich cultural heritage can provide many of the tools we need to address our most intractable health challenges such as effective HIV prevention. Setting the bar higher – aiming for cultural proficiency – will allow organizations to develop more sustainable prevention programs within a community that improve the capability of its own residents. Let’s take a closer look at everything that our own community has to offer. Harnessing the full potential of our own very powerful cultural resources may well provide the more lasting, more comprehensive, and ultimately more sustainable approach to HIV prevention that we urgently need.
*TDN would like to give a special thank you to Lorna Mason for creating the beautiful graphs you see here.