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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.
TEC NETWORKS. 1991 Sep; (30):1, 8-9.The author expresses concern over the lack of legislative interest in and support for reducing and rate and incidence of pregnancy and childbearing in the adolescent and teenage population. While experts and professionals have some of the answers needed to reduce these rates, often misinformed, ill-advised, and ignorant policymakers provide neither cooperation nor support for effective changes. Policymakers who have pledged to address the needs and social conditions of this age group, yet have failed to deliver once elected, should be removed from office. Those few who do support the interests of youths need help in the form of citizen advocacy and leadership. The reader is called upon to remain informed and abreast of local, state, and federal legislation regarding the needs of at-risk, pregnant, and parenting adolescents. Policymakers must, in turn, be educated about social factors directly contributing to the continued prevalence and incidence of teen pregnancy and childbearing. Systemic change, institutions, laws, and policies are required to better meet the needs of youths. Reasons for the decreased incidence of teen childbearing over the period 1970-88 include a decrease in the size of the adolescent population since 1988, increased use of contraception, and more abortions. In closing the Title X family planning program recently approved by the House Energy and Commerce Committee is discussed. In view of Title X's crucial and unique role in providing services to low-income women and adolescents, the reader is urged to rally in support of its reauthorization.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
Social Science and Medicine. 1989; 29(4):545-53.This article addresses the high incidence of AIDS in Puerto Rico (PR). Reasons include the high incidence of homosexuality and drug usage on the island, and the high rates of return migration and tourism between New York and PR. Since there is very little material on AIDS in PR, much of the data on the public's knowledge and awareness of the disease has been taken from the daily press. All copies of the 5 major daily newspapers were reviewed from January 1981 to the present. 1981 was the 1st year that AIDS was accepted as a disease, the year the 1st medical articles appeared describing it, and the year it was named. Nearly all information regarding the AIDS epidemic in PR has been turned into major controversies: the incidence of the disease (actual cases), testing for it, funding of AIDS research and patient care, methods of preventing the disease (education), the use of condoms, methods of contacting the disease and how infection can be avoided, and protection of prisoners. The victims of AIDS: the homosexuals, drug addicts, and hemophiliacs were left out of the controversies as participants. The controversies were nonmedical and nonscientific, suggesting that the public perceived insufficient interest on the part of medical and political leaders and was expropriating the problem. AIDS was seen as more of a political question than a medical one, with politicians turning the controversies into debates. It can be concluded that unless a strong apolitical socially organized assault is mounted on AIDS by the people, a society such as PR will have difficulty surviving the epidemic.