The Institute Mexicano de Investigacion de Familia y Poblacion, A.C. (IMIFAP) tested the effectiveness of a training course and educational materials that were designed to increase the awareness and knowledge of pharmacy employees concerning acquired immunodeficiency syndrome (AIDS) and its prevention, and to promote condoms. 174 employees participated in workshops that included information on transmission and prevention of sexually transmitted diseases (STDs) and AIDS, and condom usage. Pre- and post-session tests were performed to ascertain the short-term retention of information; the long-term effect was assessed via incognito shopper visits and monitoring of condom sales. Short, intensive training, when reinforced by posters, pamphlets, and video, significantly increased knowledge of AIDS (symptoms, transmission, and prevention) and correct condom usage. Awareness of risk behaviors and groups at risk for AIDS improved. Printed materials alone did not have a substantial impact on knowledge or sales of condoms, and increased knowledge alone did not increase information disseminated. After 6 months there was a significantly higher rise in condom sales (16%) in the course-plus-materials group. This group also took a greater initiative in providing information to clients. In spite of these positive results, knowledge and initiative are still unsatisfactory, especially when the role of pharmacies in general health care and the suspected prevalence of sexually transmitted diseases and human immunodeficiency virus in Mexico are considered.
HIV/AIDS control policy in China focuses on high risk populations. The public security system is intricately intertwined with the Chinese government's HIV control activities. The government can justify its control of high risk activities because prostitution, related trafficking in females, drug abuse, and drug trafficking are elements of the Six Evils: social problems considered to be pre-revolutionary, influenced by decadent western morality, and incompatible with modernization. Public security campaigns involve arresting tens of thousands of people annually in the combined efforts against HIV and the social evils. Instigators of crime are given punitive prison sentences. For their victims, however, incarceration leans toward treatment. The moral-rehabilitative philosophy is the normative foundation of the Chinese criminal justice process. Confucian thought holds that teaching the disobedient person proper social conduct, not punishment, will effect endless change. So correction officials use patient persuasion and re-education with most criminals. The public security system coercively collects drug abusers for as much as three months of counseling and detoxification (methadone or clonidine). The police detain prostitutes for 6 months to 2 years for re-education, including legal indoctrination, labor, and prevention of sexually transmitted diseases. Family members and community groups participate in treatment and aftercare. All drug abusers and prostitutes undergo HIV testing. HIV-positive offenders are separated from HIV-negative offenders. Pimps, panderers, or traffickers in females or drugs are either executed or put in prison for at least 10 years. A weakness of China's approach is its exclusive focus on high-risk groups rather than on high-risk practices. This approach assumes HIV will be restricted to these groups. Police will likely increase its punitive and regressive responses to group members as its approach fails to prevent HIV transmission.
In Kenya, the church provides a 2-way channel of information on acquired immunodeficiency syndrome (AIDS) and could act as a power base in the fight against the epidemic. The views of people are accessed through the church's web of schools, clinics, and vocational training facilities; their needs are ascertained through its development projects, women's groups, and youth groups. The same web returns the moral doctrines and social views of the church leadership to the people. On December 15, 1993, the Catholic Church condemned the use of condoms and any form of birth control; Protestant churches have been less harsh, but also condemn premarital sex, birth control, and condoms. In spite of this, most schools and local clinics, including those run by various churches, are conducting human immunodeficiency virus (HIV) prevention education and condom distribution programs. In some youth groups, HIV prevention methods are being discussed with the full knowledge of the church hierarchy. Government nurses and health educators have been allowed to conduct classes on family planning, premarital sex, and birth control in Catholic schools. Condoms are distributed within this framework for the prevention of HIV. Although not publicly approved, Kenyan churches, Catholic and Protestant, are permitting HIV prevention programs to enter through their back doors.
HIV/AIDS is a health problem that is inseparable from individual and collective behavior and social forces, particularly linked with societal respect for human rights and dignity. In its second decade, the HIV/AIDS pandemic continues to thrive. Where organized communities have access to adequate information, education, and services, the incidence of infection has begun to decline. Elsewhere, HIV continues to reach new populations and new geographic areas. Lessons learned in more than a decade of prevention work point to new directions for expanding national responses, at a time when the UNAIDS program, to be launched in January 1996, offers opportunities for innovative, broad-based, coordinated, and expanded global action. Prevention activities have shown that the spread of HIV can be effectively reduced. Public health interventions, including providing information and applying prevention methods, reduce the probability of infection, the risk of transmission, and the chances of not accessing appropriate care or support once infection has set in. These are proximal interventions that yield the short-term benefits of the decline of incidence and improved quality and duration of life for those infected. Societal vulnerability translates today into the focus the pandemic has on individuals, communities, and nations that are disadvantaged, marginalized, or discriminated against for reasons of gender, age, race, sexual orientation, economic status, or cultural, religious, or political affiliation. A fully expanded response to HIV/AIDS requires a combination of risk-reduction (proximal) and contextual interventions--those directed at reducing vulnerability through social change to enable people to exert control over their own health. Contextual actions can be implemented in the short term (changing laws, policies, practices that discriminate, promoting human rights, developing the most vulnerable communities) and in the long term (cultural changes, gender equality in power, education, and employment, and bridging the poverty gap).
The number of orphans in East Africa is growing rapidly due to the combined effects of the atrocities in Rwanda and Burundi and the acquired immunodeficiency syndrome (AIDS) pandemic. To meet their needs, Ukimwi Orphans Assistance (UOA), a nonprofit nongovernmental organization (NGO), was founded by East Africans in 1990; it has built "secondary family structures" of NGOs in Tanzania, Uganda, and Kenya. Needs assessment studies showed that food producing and income generating projects had highest priority, but communities have made strides in housing, education, and health. Communal food plots, repair and building of shelters, using traditional crafts to earn money for school fees, developing remedial schools, and organizing traditional medical practitioners into clinics have all been undertaken in the effort to stop disease, restore normal living, and forestall socioeconomic collapse. UOA has found that culture-based programs succeed because they offer guarantees of sustainability and cost effectiveness. African principles of kinship and extended family are used to develop resources for providing minimum assistance and to rebuild caring and supporting communities for the children. Determined community efforts should be an incentive for increased external aid.
