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Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
International Breastfeeding Journal. 2006 Mar 9; 1(1):2.To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workershad concerns about early cessation of breastfeeding. Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions. (author's)
UN Chronicle. 2003 Dec; 40(4): p..The media, as an important agent of socialization in the modern world, either support or contest cultural conceptions, and have a significant impact on the social construction of gender. The media's effects operate at the level of gender belief systems, affecting individual "beliefs and opinions about males and females, and about the purported qualities of masculinity and femininity". The mass media have been found to play a critical role in maintaining the gender-power imbalance, "passing on dominant, patriarchal/sexist values". But such a situation is not inherent in the nature of media. They can instead be agents of development and progress if guided by clear, socially relevant policies. Their hoped-for positive contribution to women's advancement will only take place in the context of a framework that clearly defines policy objectives, maps out actions and decisions which comprise the particular policy, defines the minimum standards to be met by all participants in the process, and provides mechanisms for assessing progress towards policy objectives. (excerpt)
Testing the effectiveness of integrating community-based approaches for encouraging abandonment of female genital cutting into CARE's reproductive health programs in Ethiopia and Kenya.
Washington, D.C., Population Council, Frontiers in Reproductive Health, 2004 Dec.  p. (USAID Cooperative Agreement No. HRN-A-00-98-00012-00; USAID Cooperative Agreement No. HRN-A-00-98-00023-00)Between 2000 and 2002, CARE International, with technical support from the Frontiers in Reproductive Health Program of the Population Council, implemented an operations research (OR) project among the Afar people of Ethiopia and Somali refugees in Daadab camps in Kenya. The OR project aimed to assess the effectiveness of community-based female genital cutting (FGC) strategies in increasing the knowledge of harmful FGC effects and positive FGC related attitudes and intended behaviour among the intervention communities. Both communities are predominantly of Islamic faith and practice infibulation, the most severe form of FGC. In both Ethiopia and Kenya, CARE integrated FGC interventions into existing community-based reproductive and primary health care information and service delivery activities. The study in Ethiopia was designed to test the effectiveness of education activities using behaviour change communication (BCC) approaches and advocacy activities by religious and other key leaders in the intervention site. No interventions occurred in the control sites. In Kenya, both the intervention and comparison sites had education/BCC activities. The intervention site had advocacy activities in addition to education/BCC activities. The OR study assessed the effectiveness of BCC and advocacy activities versus no interventions in Ethiopia, while in Kenya the comparison was between BCC strategies alone and the combination of BCC and advocacy activities. (excerpt)
Development of a scale to assess maternal and child health and family planning knowledge level among rural women.
Health and Population: Perspectives and Issues. 2000; 23(1):37-52.This paper presents a tool specifically developed for assessing the knowledge of rural women in Rohtak district of Haryana regarding maternal and child health. This tool can also be used for (i) identification of high risk women groups in the community by the programme managers as well as by the researchers; (ii) quantitative analysis of the relationship between various decisions making variables and the knowledge level of women regarding MCH and FP and (iii) impact evaluation of the IEC programme on the knowledge of women regarding maternal and child health. (author's)
BMJ. British Medical Journal. 2003 Oct 11; 327:822-823.The likelihood of successful treatment of tuberculosis depends on the extent to which patients complete the prescribed treatment regimen (usually called compliance with, or adherence to, treatment). Interrupted treatment of tuberculosis results in ongoing transmission of disease. Without support throughout the full course of treatment, many patients with tuberculosis adhere to treatment until symptoms have resolved and then stop, since patients may equate disease and therefore the need to continue treatment with illness (symptoms). The consequent risks of failure of treatment, relapse, death, and drug resistance, threaten not only patients but also communities. Recognition in the 1950s of the importance of providing intensive support to patients with tuberculosis to promote adherence to treatment paved the way for later promotion of directly observed therapy (DOT) for adherence to treatment. (excerpt)
Journal of the American Water Resources Association. 2000 Aug; 36(4):799-809.Drinking of arsenic-contaminated tubewell water has become a serious health threat in Bangladesh. Arsenic contaminated tubewells are believed to be responsible for poisoning nearly two-thirds of this country's population. If proper actions are not taken immediately, many people in Bangladesh will die from arsenic poisoning in just a few years. Causes and consequences of arsenic poisoning, the extent of area affected by it, and local knowledge and beliefs about the arsenic problem - including solutions and international responses to the problem - are analyzed. Although no one knows precisely how the arsenic is released into the ground water, several contradictory theories exist to account for its release. Initial symptoms of the poisoning consist of a dryness and throat constriction, difficulty in swallowing, and acute epigastric pain. Long-term exposure leads to skin, lung, or bladder cancer. Both government and nongovernmental organizations (NGOs) in Bangladesh, foreign governments, and international agencies are now involved in mitigating the effects of the arsenic poisoning, as well as developing cost-effective remedial measures that are affordable by the rural people. (author's)
Integration of population education in APPEAL. Volume Two. Population education in universal primary education.
Bangkok, Thailand, UNESCO, PROAP, 1992. , 100 p. (Population Education Programme Service)As part of the goal to integrate population education into primary school curriculum and literacy programs, workshops were held in 1989 and 1991. The noteworthy teaching materials for primary education included in this document were generated from the experiences in Indonesia and Pakistan. Workshop participants completed questionnaires on various aspects of population education and then visits were made to 3 primary schools in SD Jayagiri, SD Negeri Lembang V, and SD Negeri Cibodas, Indonesia; observations were made and teachers and principals identified their needs. A similar process led to the production of materials for Pakistan after visits to a Muslim community about 4 km from Islamabad and to Saidpur, Pakistan. The materials from Indonesia focused on core messages and submessages on small family size for family welfare, delayed marriage, responsible parenthood, population planning for environmental and resource conservation and development, reorientation of beliefs, and improved status for women. Each core unit had a submessage, objective, content, method or format, target audience, and learning activity. For example, the core message on small family size for family welfare contains the message that a family needs a budget. The objective is to develop an awareness of the relationship between family needs and family income. The content is to stress the limits to expenditures within family resources and a comparison of sharing available resources in a large family. The method or format is a script for radio directed to out-of-school children and class VI. Dialogue is presented in a scene about purchasing food at a local market. The noteworthy curriculum materials from Pakistan focuses on their problems, their population, family, teachings of the Holy Prophet Muhammad, implications of population growth, living things and their environment, and Shimim's story. Each issue has a class time, subject, core message, and instructional objective. In Shimim's story, the social studies class is devoted for 45 minutes to the core message about elders as an asset to the family and society. Reading material is provided and the teacher directs questions about the material and tests students with true/false questions.
Statement from the Second Regional Conference on AIDS in Africa, Kinshasa, Zaire, 24-27 October 1988.
[Unpublished] 1989.  p. (WHO/GPA/INF/89.7)The 2nd Regional Conference on AIDS in Africa was organized by the World Health Organization (WHO) in cooperation with the Ministry of Health of the Republic of Zaire. Representatives from AIDS programs and committees from 44 WHO African Region countries were in attendance, along with representative of multilateral and non-governmental organizations. Summaries of discussion from the conference's 8 working groups are presented in the paper. Working group discussion topics include implementation and monitoring of national AIDS programs; defining and reaching target groups; counselling; involving the media in promoting AIDS prevention and control; knowledge, attitudes, beliefs, and practices (KABP); surveillance for HIV infection in national AIDS programs; and condoms. Management, internal communication, decentralization, project integration, and cooperation were recognized as important in implementing AIDS programs, while the need for epidemiological assessment in defining target groups was pointed out. Counselling's importance and the need for confidentiality were stressed, followed by discussion of the need to educate and collaborate with the media. Data on KABP are seen as central to prevention and control programs, while sentinel serosurveillance is urged especially for pregnant women presenting for antenatal care, blood donors, and STD patients. The paper concludes with discussion of barriers to widespread condom use.
[People's perception of diseases: an exploratory study of popular beliefs, attitudes and practices regarding immunizable diseases]
Dhaka, Bangladesh, Worldview International Foundation, 1987 Nov.  p.Researchers interviewed 57 mothers and 27 heads of family in predominantly rural areas about 135km from the capital city of Dhaka, Bangladesh to learn about their perception of diseases. They also talked with 3 traditional healers and 8 influential people in the different locales, e.g., teachers and imams. They learned that each vaccine preventable disease has at least 1 local name rooted in popular beliefs, e.g., all local names for poliomyelitis are associated with an ominous wind. Generally, the local people believe that witches or evil spirits cause all the vaccine preventable diseases. These entities prefer attacking babies, but also are known to afflict women. A preventive measure practiced includes pregnant women never leaving the house in the evening, at noon, or at midnight since these are the times when they are most exposed to evil spirits. There exist 2 traditional healers--fakirs and kabiraj. Fakirs use mystic words with religious chants and perform various healing rituals. The kabiraj sometimes use healing rituals, but also prescribe indigenous medicines. This research provides some useful insights into WHO's Expanded Programme on Immunization in developing communication strategies which build on what people already know. For example, since the local people believe that evil spirits or witches attack the newborn immediately after birth may provide an incentive for early immunization. Since preventing illness and death in newborns is a goal of both modern and traditional medicine, it is likely that the local people are not so concerned with the real cause of illness and will accept any practice that keeps their infant healthy and that fits into their beliefs and perceptions.
Network. 2001; 21(2):13.In many settings, domestic violence is accepted by both women and men, and will only be reduced as basic human rights are recognized. Since many health care workers do not have the time, training, resources, or support to help victims of domestic violence, the WHO recommends several ways that they may be able to perform their duties at a minimum. The provider's first priority should be to evaluate the woman's safety in terms of risk of recurrence of violence, adverse reproductive health outcomes, or death through homicide or suicide. They should also keep in mind the credo "do no harm." This includes not blaming a woman for the domestic violence she has suffered. In general, a provider who wishes to take the first step of trying to identify victims of domestic violence should have a specific goal either to give better care, counseling, or refer the victim to the appropriate services. One source of guidance on integrating gender-based violence into sexual and reproductive health is the International Planned Parenthood Federation/Western Hemisphere newsletter. In the winter 2001 and summer 2000 newsletters, it describes how to create a protocol for implementing screening and services for victims of domestic violence and tells how to create a referral network and begin implementing client screening and staff training, respectively.
[Unpublished] 1990 Jan 26. vii, 169 p.In 1988, research teams from 17 countries from all regions of Africa met in Ethiopia to assess how to develop a broad, adaptable knowledge, attitudes, beliefs, and practices (KAP) survey and interview schedule for AIDS research. Subsequently, researchers from North and South America and Europe have been involved in adapting the African KAP surveys to their regions. This document presents the research documents resulting from that work. Organized into four parts, this WHO draft document has been prepared to permit researchers to follow a standardized approach to this type of research and to generate information that will be comparable between countries. Part one covers the introduction. Part two deals with the study design, including the conceptual framework, objectives, training, ethical issues, and information dissemination. The interviewers' manual is described in part three. This section includes information on locating subjects in the community, conducting interviews, fieldwork, training interviewers, and detailed notes on the individual questionnaire. Finally, part four presents models of each of the tabulation plans.
Interview schedule for Knowledge, Attitudes, Beliefs and Practices on AIDS. Phase I: African countries. A. Household form. B. Community characteristics. C. Individual questionnaire.
[Unpublished] 1989 Feb. 28 p.The household interview form has spaces in which to designate a household's location and track interviewer visits with notation of visit results. Basic information can be recorded about the people over age 10 years who usually live in the household or who slept in the household on the preceding night. Data are then taken on the community characteristics form on the type of locality, travel time to the nearest large town, and facilities available in the community. The individual questionnaire is for people aged 15-64 years who slept in the household on the preceding night and is comprised of the following sections: identification; individual characteristics; awareness of AIDS; knowledge on AIDS; sources of information; beliefs, attitudes, and behavior; knowledge of and attitudes toward condoms; sexual practices; injection practices; locus of control; IV drug use; and drinking habits.
New York, New York, Population Council, 1997. 28 p.The International Planned Parenthood Federation/Western Hemisphere Region and the Population Council hosted a workshop on February 6, 1996, on the challenges of incorporating sexuality into family planning programs. Discussion highlighted the need for family planning programs to pay greater attention to the implications of clients' social context, especially partnership relations and sex behavior, in order to ensure appropriate method choice and successful contraceptive use. The following myths which have prevented family planning and reproductive health services from dealing directly with sexuality and gender were examined and are discussed: sexuality is a personal matter which people are unwilling to discuss, sex is a voluntary activity between individuals of equal status, clients prefer family planning methods which do not interfere with coitus, family planning providers are prepared to respond to clients' questions and needs concerning sexuality, and addressing sexuality will overburden family planning programs. Poems from the Belize Family Life Association Community Workshop are also included.
AIDS ASIA. 1996 Nov-Dec; 3(6):6-7.Peter Piot, head of the Joint United Nations Program on HIV/AIDS (UNAIDS), told the World AIDS Conference in Vancouver that India had 3 million people infected with HIV. The Indian government, however, gave no estimate because it has no baseline data upon which a realistic projection can be made. The National AIDS Control Organization (NACO) officially questioned Dr. Piot on the basis of his estimates. Piot attributes his figure to World Health Organization estimates made in consultation with NACO at the end of 1994 that there were 1.75 million people living with HIV in India. Alarmist reports have appeared in the media based upon Dr. Piot's comments. Some health experts, however, believe that the figures are being inflated by the West to pressure India into accepting vaccine trials and other research on HIV-infected people. For now, neither the Indian government nor the country's general population seem concerned about the reported statistics.
Some lessons from the World Health Organization Global Programme on AIDS (WHO / GPA) sexual behavior surveys and knowledge, attitudes, beliefs, and practices (KABP) surveys.
In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 140-5.Sexual behavior surveys were conducted during 1980-94 among the general population of specific population groups in 67 countries. 15 of the sexual behavior and knowledge, attitude, behavior, and practices (KABP) surveys conducted during 1989-90 in developing countries were reviewed and summarized by the World Health Organization's Global Program on AIDS. While not all of publishable quality, the studies nonetheless shed light upon HIV/AIDS KABP. For example, while there was considerable awareness of HIV/AIDS during the late 1980s, incorrect beliefs on the modes of HIV transmission were quite prevalent. The large majority of women and 66% of men claimed to be faithful to one regular sex partner, although there was considerable variability among sites. 0-11% of men reported having five or more extramarital sex partners within the preceding 12 months, 20-50% of whom reported not feeling at risk of contracting HIV. The survey data failed to support the assumption that towns and cities are more conducive than rural areas to nonregular sexual relationships. Large variations were identified in the levels of condom awareness and use.
In: Sexual behaviour and AIDS in the developing world, edited by John Cleland and Benoit Ferry. London, England, Taylor and Francis, 1995. 124-56. (Social Aspects of AIDS)Primitive forms of the condom were used to prevent pregnancy more than 3000 years ago. The widespread use of condoms to prevent sexually transmitted diseases (STD), especially syphilis, however, over the past two centuries has made condoms highly controversial. In many countries since the beginning of the AIDS pandemic, condoms have come to connote illicit sex. Their widespread use as a contraceptive has therefore been impeded by the historical association with STD prevention. This chapter summarizes survey findings on the awareness, use, and attitudes toward condoms. It is divided into the following sections: awareness of condoms and access to supplies, condom use, and perceived attributes of the condom. The implications of survey findings are discussed.
In: Sexual behaviour and AIDS in the developing world, edited by John Cleland and Benoit Ferry. London, England, Taylor and Francis, 1995. 43-74. (Social Aspects of AIDS)Data derived from surveys conducted in 1989 and 1990 on the levels of awareness of HIV and AIDS, the accuracy of specific areas of knowledge regarding transmission routes, the perceived severity of the condition, views on the appropriate ways in which to care for people who are HIV-seropositive, and attitudes toward testing are presented. There was some variation between study populations with regard to the proportions of people who had heard of AIDS, with a trend toward lower figures in francophone central and west Africa. Within populations, the groups less likely to have heard of AIDS were women, those with lower levels of education, those in rural areas, and those with lower media exposure. Generally, levels of accuracy concerning actual routes of HIV transmission were high. Accuracy levels regarding transmission through casual routes, however, tended to be very poor. The implications of these findings are discussed.
AIDS SURVEILLANCE REPORT. 1995 Jan; (4):3, 5-6.More than forty studies were reviewed in 1995 on the knowledge, attitudes, beliefs, and practices of individuals with respect to HIV/AIDS in American Samoa, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong, Japan, Lao People's Democratic Republic, Malaysia, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu, and Vietnam. In all but one of the twenty studies which inquired, more than 80% of respondents had heard of AIDS. In a number of countries, correct knowledge about the sexual transmission of HIV/AIDS was found to be at least 80%. A similar level of knowledge was found about needle transmission of HIV/AIDS, although comparatively lower levels of knowledge about HIV transmission via sexual intercourse, needle use/reuse, and maternal-child exchange was, however, identified in Cambodia, Fiji, Malaysia, Solomon Islands, and the high-risk populations of Vietnam and French Polynesia. Relatively high levels of incorrect answers were observed for the incorrect modes of HIV transmission. Moreover, 20% of respondents in each of the eight studies are in favor of exiling or isolating HIV-infected persons; in two countries, support for isolation or exile was 60% or greater. Overall, risk behaviors appear to exist at levels which will support an HIV epidemic in the countries studied. Levels of other sexually transmitted diseases and reported levels of extramarital and premarital sex, especially among males, support this conclusion. Commercial sex appears to occur at a substantial level in most of the societies studied, while condom use in casual and commercial sexual encounters seems to be the exception rather than the rule.
Dietary management of young children with acute diarrhoea: a manual for managers of health programmes. 2nd ed.
Geneva, Switzerland, World Health Organization, 1991. iii, 29 p.This WHO manual is appropriate for use by managers of health programs in controlling the dietary intake of young children with acute diarrhea. diarrhea is a major cause of malnutrition because of the low food intake during the illness, reduced nutrient absorption, and increased nutrient needs from the infection. Those most at risk are young infants 4-6 months old, who are not breastfed, and older infants and children (4-6 months to 2 years old). The introduction presents the causes of diarrhea, causes of malnutrition, and recent findings on nutrition in young children and mothers and on the digestion and absorption of nutrients during diarrhea. The selection of foods to be given during and after diarrhea is discussed in terms of the following variables which affect the choice of foods: age of the child, availability of foods, resources needed for food preparation, nutritional value of food, stage of illness, consistency of food, and frequency of feeding. The role that traditional beliefs and practices play in treatment is also mentioned as is the nature of the beliefs. Foods are classified as food and nonfood, appropriate and inappropriate foods, cultural superfood, special occasion foods, and foods related to ideas concerning physiology. Common treatments for diarrhea are starving the child for a short time; partial food restriction; continuation or restriction of breastfeeding; the feeding of certain foods, at certain times, and in specified amounts; the administration of herbal drinks and plant infusions; and the use of purgatives, emetics, or magical potions. It is important to collect information from several sources in communities and to gather data from discussions, written records, and observation. Methods to prevent diarrhea include following good feeding practices, washing hands after defecation, and keeping the children clean. Monitoring children on a growth chart to diagnose specific nutrient deficiencies, particularly of vitamin A and iron, helps in determining malnutrition. The multimix principle in introducing weaning foods is given, and a table provides a list of important nutrients as well as a list of foods rich in these nutrients. It is of particular importance during diarrhea to consume potassium-rich foods, carotene-rich foods, and milk and to avoid sweetened drinks.
Social Science and Medicine. 1993 Jul; 37(1):97-103.Dehydration from diarrheal disease is the leading cause of infant and child mortality in many developing countries. World Health Organization (WHO) policy recommends oral rehydration solution (ORS) for its treatment and prevention. In concordance with this recommendation, many community-based oral rehydration therapy programs have been implemented since the late 1960s, making ORS widely available and affordable. The solution, however, has not been incorporated universally where needed into people's health-seeking practices. A study was conducted on the household management of childhood diarrhea in a poor, urban neighborhood of Managua, Nicaragua, over the period February 1987 - April, 1988. Results are based upon data collected from interviews with 8 key informants and 109 mothers, and 44 reported cases of diarrhea. Despite the provision of ORS by state health facilities, pharmacies, and informal drug vendors, and health education efforts to change mothers' beliefs and practices, the appropriate use of ORS was not common in the household management of diarrhea. Mothers knew about dehydration and diarrhea, but their explanatory models and actual practice reflected heavy reliance upon self-prescribed pharmaceuticals and home remedies; ORS use was associated with clinic attendance. These findings underscore the existing obstacles to changing people's explanatory models for illness and illness management. To best effect positive, healthy change, the context in which treatment options are assessed and used must be understood.
Epidemiological studies on measles in Karachi, Pakistan -- mothers' knowledge, attitude and beliefs about measles and measles vaccine.
ACTA PAEDIATRICA JAPONICA. 1992 Jun; 34(3):290-4.In Pakistan, the Accelerated Health Program has greatly improved the immunization coverage rates, and local area monitoring revealed a marked decrease of measles between 1974 and 1984. In October 1988, 287 randomly selected mothers living in Karachi who took their children to the Civil Hospital or to the Abbasi Shahid Civil Hospital were interviewed by means of a questionnaire about their knowledge of the clinical manifestations of measles, their own children's history of morbidity and mortality, and any history of immunizations, and attitude and beliefs about measles and measles vaccine. In 1989 and 1990, in a community-based survey visits were conducted in Neelam Colony, Karachi, with a population of about 3000, and infantile mortality rate of 153/1000 births, and an immunization acceptance rate up to 1 year of age of about 35%. More than half of the women mentioned serious complications of measles, including diarrhea and malnutrition. Of 1076 children whose parents gave usable answers, only a few had repeated episodes of measles. The age of contraction of measles varied widely from 4 months to 12 years with high prevalence: 89% of them contracted it before 6 years of age, primarily between 9 and 18 months of age. The vaccine efficacy rate was 72%. The severity of the illness and complications were well known and immunizations were appreciated. In traditional families, grandparents had made the decision about immunization, but many mothers were starting to assume that responsibility. The vaccine acceptance rate had increased sharply in recent years, as a result of local health educators' activities in clinics providing regular health checks and especially owing to TV programs. The importance of promotion of primary heath care by collaboration of motivated mothers and community health workers is emphasized.
In: Issues in reproductive technology I: an anthology, edited by Helen Bequaert Holmes. New York, New York, Garland Publishing, 1992. 11-30. (Garland Reference Library of Social Science Vol. 729)The progestin, levonorgestrel, suppresses ovulation and thickens the cervical mucus. The 1-year pregnancy rate is 0.2/100 users and the 5-year rate is 3.9/100 users. Contraindications of Norplant include abnormal bleeding, cardiovascular conditions, liver tumors, and breast cancer. The most frequent side effect is changes in bleeding patterns. A main concern of women's health advocates is that women are dependent on the medical establishment for insertion and removal of Norplant which affects the provider-client relationship. Family planning programs that do not recognize a woman's right to free choice of existing contraceptives and her right to have Norplant removed at any time may abuse Norplant. Health workers still do not know the long term effects of Norplant and Norplant's effect on the fetus in case of method failure or insertion while pregnant. Most acceptability studies occurred at university-based health clinics or at clinics in urban areas. The clinic environment may affect women's answers. These studies should occur in the community and home of users and nonusers. Another bias of these studies was clinic staff chose women who would tend to continue using Norplant. Thus subjects were not representative of the population. Researchers did not attempt to understand the women's perception of reproduction physiology and mode of action, the women's cost benefit analysis used to determine what method to use, or the consequences of menstruation changes. They also did not report on the information women received about contraceptive choices. The issue of abuse has arisen in Kansas where a state legislator proposed paying any mother on welfare US$500 if she uses Norplant. In California, a judge ordered a woman convicted of child abuse to use Norplant after release from jail and throughout her probation period.
INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.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.
POPULATION EDUCATION IN ASIA AND THE PACIFIC NEWSLETTER AND FORUM. 1991; (34):17-20.In May 1991, UNESCO and the Ministry of Education of Pakistan sponsored a Regional Workshop for the Integration of Population Education in Asia-Pacific Programme of Education for All in Islamabad, Pakistan. Prior to the workshop, resource persons and experts met to develop guidelines for participants that were geared towards curriculum and material needs and core population education messages. 1 workshop group addressed integration of population education messages into primary education and the other into literacy programs. All participants observed and analyzed the problems and needs of a Muslim community and Saidpur village. The 1st group visited primary schools and spoke to teachers. The participants agreed that population education messages should be integrated into social studies, science, languages, and religion subjects at grade levels 3-5. The messages should include population related beliefs and values, problems of population growth, small family size, responsible parenthood, sex preference, population and development, the role of elders, and improving the status of women. They tested 4 of 11 developed lesson plans. Both teachers and students were generally pleased, but believed that posters and illustrations would better the plans. The other group conducted a needs assessment survey among 27 Muslim families. Participants found >100 population related issues that needed to be addressed in literacy programs. These issues fit into 6 categories and the group focused on social and cultural values and beliefs. Participants developed materials that highlighted several topics, such as early marriage and preference for males. They used puppet shows, puzzle games, posters and discussions, and story telling with pictures to communicate the messages. Puppet shows were the most popular method among housewives.
SCIENCE. 1991 Oct 25; 254:511-2.The 1st Director of the World Health Organization's (WHO) Global Program on AIDS (GPA) abruptly resigned March, 1990. Jonathan Mann led the GPA in an innovative, aggressive, and comparatively non-bureaucratic style since its inception in 1986, building a staff of nearly 200 under an eventual 1990 budget of $90 million. Mann's non-conformist style and ever-growing budget, however, ran counter to the bureaucratic forces in WHO, causing him to leave for a position at Harvard University. A 12-year WHO veteran, Michael H. Merson succeeded Mann, and has since managed the GPA in a more conventional, bureaucratic manner. Senior staff have resigned, and the budget will drop to only $75 million for 1992. Staff replacements are used to the bureaucratic structure and demands of WHO, but lack experience in the field of AIDS. This paper discusses the markedly different management styles and approaches of Merson and Mann, with concern voiced over the future of the GPA. Critics are uncertain of GPA's present direction, and whether or not it is a necessary, positive change in the fight against the AIDS pandemic. As AIDS appears with less frequency and centrality i the world's media, the GPA is needed now even more than just a few years ago to inform the world of the dangers of AIDS. Merson is expected to promote relatively simple treatment options for AIDS, with some emphasis upon technological fixes like the condom. With cuts to the behavioral research budget, however, it is almost certain that inadequate steps will be taken to effect behavioral change for the prevention and control of HIV infection.