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WORLDAIDS. 1992 Jan; (19):10.White, U.S. homosexual males were primarily affected in the early stages of the AIDS pandemic. Some Western researchers argued, however, that the syndrome originated in Africa. Strong political and social response to this notion resulted in only an anemic response to the growing AIDS epidemic in Nigeria. Nonetheless, the Stop AIDS Organization finally launched the Motor Park AIDS Education Program (MPAEP) in 1988, for health and education outreach to populations at risk of STDs and HIV infection. Specifically targeted are long-distance truck drivers, their young male assistants known as motor boys, and the barmaids, prostitutes, and homeless juveniles who frequent motor parks where these drivers rest while on the road. Many of these long-haul drivers have unprotected casual and commercial sex, both homosexual and heterosexual, take drugs, and suffer high rates of STDs. Marginalized, 75% illiterate, and speaking a variety of languages, these populations tend to be largely ignorant of the incurable nature of AIDS. Over 45% of motor park populations are estimated to be infected with an STD, or to have a future re-infection. These drivers are optimal vectors for the spread of HIV both internationally and within Nigeria. MPAEP workers work 6 days/week in the larger interstate motor parks to reach out to their predominantly male customers. They meet a host of primary health needs, and refer STD clients for testing and treatment. Drug use and homosexuality are 2 topics of discussion especially taboo in African society which have nonetheless been vigorously researched by MPAEP. Many drivers are unacknowledged bisexuals who have sex with their motor boys. Workers therefore explain the need to use condoms in same-sex activity without specifically mentioning homosexuality. Many Nigerians deny the existence of HIV and AIDS, are reluctant to speak about sex, and consider MPAEP workers to be intruders. Despite opposition in Muslim- dominated Northern Nigeria, however, program efforts continue.
Social Science and Medicine. 1992 Jan; 34(1):63-73.Data from eastern and central sub-Saharan Africa suggest that women in countries of the region are increasingly at risk for HIV infection. Poverty, malnutrition, uncontrolled fertility, complications of childbirth, and sex behavior associated with male/female rural-urban migration are contributory factors. While much may go into preventing the transmission of HIV, the cooperative participation of both sex partners is certainly required. Further, while campaigns may educate both men and women of the need to limit the number and choice of sex partners, and use condoms during intercourse, they may fail to recognize the highly unfeasible nature of these behavioral changes for the majority of sub-Saharan African women. Marginally included in the development process, and poorly empowered to make decisions regarding male or female sexuality, women are largely subject to the sexual demands and economic rewards of their male sex partners. Husbands and/or other sex partners may strongly resist or refuse to employ condoms during sexual intercourse. Social expectations and/or economic necessity, however, often dictate a woman's compliance with the man's choice despite her desire to use a condom. HIV transmission and the risk to women and children, national development and the status of women, accommodation to economic scarcity, altering high-risk behavior, symbolic approaches to behavior change, and methodological issues in the study of these issues are discussed. Research is then proposed on understanding the meaning of AIDS, the context and norms of decision making, the norms of sexual behavior, the gatekeepers of sexual behavior change, the economic determinants of sexual risk, womens perceptions of control, and gender-sensitive strategies for reducing the risk of AIDS. Such research will provide a better understanding of how women perceive and respond to AIDS prevention interventions, and will constitute a necessary 1st step toward increasing male participation in protecting themselves and their families.
AIDS ACTION. 1991 Sep; (15):4.Bombay has a teeming and mobile, yet comparatively invisible, population of approximately 600 male prostitutes who ply their trade on and from Chowpatty beach. These men, aged 12-50 years, masturbate and/or perform fellatio for male clients in exchange for financial reward ranging from US$0.75 - $2. Unprotected penetrative anal sex also takes place, though it is generally not acknowledged by the prostitutes. These men and their clients are therefore in great need of information and access to condoms for the practice of safer sex. Both self- and social denial of the practice of anal sex must, however, be overcome. To this end, Bombay Dost, the 1st openly gay organization in India, distributes condoms and information to gay men on railway platforms, and in public toilets and parks. These efforts are unfortunately not welcomed by the prostitutes of Chowpatty beach for fear that acceptance of the intervention would imply their practice of anal sex and a more substantial degree of homosexuality within their subpopulation. Recruiting and training men as health educators from their ranks may be a viable, effective promotion approach. Any interventions must also understand the friendly and supportive, yet competitive, relationships within this community.
AIDS and sexually transmitted diseases in Jamaica: highlights of a nationwide survey and focus group series assessing current knowledge, attitudes, and practices.
[Unpublished] 1989 Jan. ii, 19 p.A nationwide baseline survey of 1,200 men and women aged 15-60 years was conducted to find information on Jamaicans' knowledge, attitude, and practices (KAP) regarding AIDS, STDs, and family planning. 25 focus group session were also held to gain more indepth knowledge and understanding of KAP. Results on KAP regarding AIDS and STDs are summarized and presented in comparison with similar data from a 35-country Gallup International study. Virtually all respondents were highly aware of AIDS and other STDs, and realize both its deadly nature and sexual transmissibility. There is, however, only low unprompted awareness of how one may protect against infection and the spread of HIV. General objection to adopting safer sex and using condoms was voiced. Over 1/2 of survey respondents perceived themselves at risk of infection. Both studies, however, show approximately 5% of the population to feel at risk. Those felling at greatest risk are aged 20-49, and especially urban males aged 20-39. Behavioral change was reported among 48% of survey respondents, especially in men, person of lower socioeconomic status, and those who perceived themselves at greater risk of infection. More concern was voiced over AIDS than for all other diseases including cancer, herpes, diabetes, gonorrhea, malnutrition, high blood pressure, and diarrhea. Further, almost 90% believe at least one important myth about a mode of transmission, and 20% think that people with AIDS (PWA) are readily recognized at sight. 5% of the population knew a PWA. Fear followed by compassion dominates public opinion toward them. Specific recommendations for AIDS media communications are presented.
Impact of the 1988-89 national AIDS communications campaign on AIDS-related attitudes and behaviors in Jamaica.
[Unpublished] 1990 Jun. iii, 61,  p. (USAID Contract No. DPE-3051-Z-00-8043-00)1,124 questionnaires were completed in order to assess the impact of a national AIDS communications campaign upon knowledge, attitudes, and practices (KAP) related to the prevention of HIV transmission and AIDS in Jamaica. Awareness of AIDS was high at baseline, and remains so after the campaign. Significantly more persons understand that AIDS is preventable, yet many still think that changes in personal behavioral will do little to protect them from infection. A high degree of negative public sentiment exists against those with AIDS, with none of the popular AIDS myths having been completed eradicated. As for condoms, they enjoy a positive image, and are widely known of in the country. Their use is comparatively high in Jamaica, slightly up from baseline levels, and chosen especially among youth and singles. Occasional condom use is high largely with primary partners, while regular use is high with secondary partners. Overall, more effective behavioral change has taken place since the baseline survey. An increased number of persons have sexual relations with only 1 faithful partner. The campaign was widely seen and memorable, albeit with retention of key preventive measures low to moderate among the campaign audience. Quantitatively, these measures seem to have gotten through to a larger audience than that reached in an earlier round of the campaign. Efforts should be made to further dispel popular myths, stress the importance and effect of behavioral changes, promote the consistent practice of correct behaviors, develop revised motivational messages, and consider the role of interpersonal communication in campaigns all with a fresh, new approach.
The cultural meaning of AIDS and condoms for stable heterosexual relations in Africa: recent evidence from the local print media.
[Unpublished] 1989 Mar. Paper presented at the Seminar on Population Policy in Subsaharan Africa: Drawing on International Experience, sponsored by the International Union for the Scientific Study of Population (IUSSP), Committee on Population and Policy, with the collaboration of Departement de Demographie de l'Universite de Kinshasa, Commission Nationale de la Population du Zaire (CONAPO), Secretariat au Plan du Zaire, held at the Hotel Okapi, Kinshasa, Zaire, 27 February to 2 March 1989. 27 p.This paper draws on the authors previous research experience in Liberia and Sierra Leone, and articles in local newspapers and journals from Central, Eastern and Western Africa. To research the AIDS epidemic in terms of: 1) problems for fertility that condoms pose 2) the association of condoms with promiscuity 3) economic pressures that induce women to contract lovers and men to enter polygamous relationships 4) the importance of fertility and 5) the association of AIDS with promiscuity. There is great concern for the uninfected children of parents who die of AIDS. Women are generally being blamed for spreading the HIV virus to their partners and being promiscuous making all her children suspicious as products of illicit unions. The father and his kin often repudiate these offspring. Questions are raised as to where these children will go and, what is the economic and social effect of their geographical mobility? Young women, school girls in particular, now comprise one of the groups at high risk for contracting the HIV virus because private schools expose girls to older, wealthier, married men. Parents may begin growing reluctant to send their daughters to school to avoid the AIDS virus, while encouraging them to marry early, leading to higher fertility rates and low interest in contraception. Yet secondary schools are the best arenas to introduce condoms and AIDS education because the girls are highly motivated. The use of condoms in Africa is controversial because they prevent fertility and suggest promiscuity. 2 major philosophies are common among health manpower: 1) minimizing the demographic impact of AIDS in light of continued high fertility rates, or 2) emphasizing the crisis brought on by death and destruction. Government efforts to publicize the AIDS epidemic and the utility of condoms as a prophylactic are doing the greatest service to women and society by providing them with credible elements of ambiguity and deniability.