Women in Thailand are increasingly finding themselves responsible for caring for the physical and mental health of HIV-infected men. The author gained such experience caring for her husband, while her suffering since youth of a series of chronic illnesses helped her to understand that life is full of surprises. Moreover, meditation also helps her to squarely confront problems as they arise, such as when she learned that she contracted HIV from her husband 5 years ago. The author then learned about AIDS and attended, together with her husband, conferences on HIV/AIDS to learn how to care for them both. She also enrolled in a Red Cross program on in-home care. In 1994, the husband returned home from the hospital in poor health, with little time left to live. However, surrounded by the warmth and affection of home, friends, and family, the man¿s health status improved to the extent that his opportunistic diseases disappeared. Since that experience, the author visits other households where people are living with AIDS in an attempt to bring them moral support, to teach about in-home care, and to coordinate hospital care when needed. The author now knows that HIV-seropositive people can contribute considerably to help the lives of both others living with AIDS and the general community. She is determined to show that families working together can reduce the level of suffering experienced by HIV-infected individuals and that such people will survive longer through families¿ efforts.
HIV/STD prevention programs can stimulate debate over behavior change at the community level. In 1993, Yayasan Haumeni, a local nongovernmental organization (NGO) in Timor, southeastern Asia, launched an HIV/STD prevention program when voluntary health agents announced an increased level of STDs in the community. The NGO first conducted a study in 12 villages to identify the main modes of HIV transmission. Data were collected through in-depth interviews and group discussions with traditional healers, religious leaders, and youth. A ritual linked to puberty was found to be a practice potentially fostering the transmission of HIV/STDs in the community. Once circumcised by traditional practitioners, pubescent boys in the community are expected to have sexual relations with 2-4 different women. Study participants also discussed the subjects of multiple sex partners, abortion, adolescent pregnancy, family planning, and the exodus of young people. Study results were presented to district decision-makers, who decided to implement an education program on HIV and STDs designed to foment debate upon the circumcision ritual, the sex roles of men and women, and perceptions of male sexual power. Even though it remains too early to assess sexual behavior changes in the community, some young people and their families have begun to question the traditional circumcision practice and its associated rituals.
The diagnosis of scabies depends on finding a burrow or one stage of the parasite. The search is prompted by clinical suspicion and informed by knowledge of the natural history and habits of the human Acarus scabiei. The best source of this information is the monograph by K. Mellanby.1 Scabies should be considered in every patient who complains of persistent itch. In typical cases the diagnosis is easy, but when the visible changes are unusual or slight scabies may not be suspected. It is important to think of the itching patient in relation to his environment, and if another member of the household is itching too there is a prima facie case for suspect ing an infestation.
In Brazil, NEPAIDS developed an AIDS workshop for 5000 adolescents and young adults attending a night school in a poor urban neighborhood. The found that youth were hoping to thoroughly examine feelings of fear, prejudice, and powerlessness associated with AIDS; sexual pleasure as well as responsibility without linking sex to sickness and death; sexuality, including pregnancy, contraception, and sexually transmitted diseases (STDs); inequalities between men and women; and homosexual intercourse. The workshop uses participatory methods such as role playing. The workshop consists of 5 meetings of 3 hours each over several weeks. The first 4 meetings have males and females separated so they can talk freely and think about questions linked to gender. The 2 groups come together during the last meeting. The first meeting focuses on identifying and confronting fears and stereotypes. This allows the youth to realize that they could be exposed to HIV risks and to accept different life styles. The second meeting focuses on sexuality, contraception, and reproduction, since most youth know little about these issues even though many of them are sexually active. During this meeting, participants produce models of body parts associated with sex and reproduction so they can discuss how HIV is transmitted. Sexual practices that reduce the HIV risk and condom use comprise the third meeting. Participants use cucumbers to practice putting on condoms correctly. Communication is the theme of the fourth meeting. Participants practice negotiating skills to refuse unwanted sexual relations, to propose sex without penetration, or to use a condom. Both the young men and young women discuss their different experiences during the other meetings and how they are going to pursue this work without the intervention of adult facilitators.
In two regions of Tanzania, school teachers and health workers developed an education program on HIV called Ngao, which means shield, symbolizing the fact that youth must be prepared to protect themselves against HIV infection. The program targets 14-year-old students. School health workers and teachers underwent 3 days of training on AIDS. After the training, the teachers organized about 20 training meetings where they used flipcharts, black boards, posters, brochures, and manuals for students. They learned about using participative teaching methods and how to organize students to direct class discussions. Students made their own posters; enlivened discussions with 6-7 peers; directed and performed skits in which they together tried to conquer HIV risks or acquire negotiation skills; and wrote songs, plays, and poems about ways youth can protect themselves or ways to address AIDS in their community. The plays, skits, poems, and songs were performed in front of younger children to also inform them about AIDS. Students wore special T-shirts with the logo of the Ngao program, which stimulated discussion on the program. Information on condom use was introduced as an option. Dignitaries, religious leaders, and parents participated in discussions on the program and on AIDS control strategies for the community to adopt. Initially, the program was implemented in 6 schools in urban and rural areas. The students had more knowledge and more positive attitudes towards persons with AIDS than those in comparison schools. They were also less likely to become sexually active in the near future. Teachers and health workers enjoyed teaching the program's curriculum. They felt that the program better equipped and prepared the students to protect themselves against HIV infection. After the pilot project, the program was revised to make it a permanent part of the curriculum in primary schools. An expanded version will be integrated into the health program of secondary schools.
