According to World Health Organization estimates, 10 million children will have been infected with human immunodeficiency virus (HIV) as a result of maternal transmission by the year 2000. The risk of maternal-child transmission ranges from 15-20% in Europe to 25-39% in Africa. The risk appears to be increased by premature delivery, recent maternal HIV infection, and breast feeding. Prevention of HIV infection in women of childbearing age through condom use remains the central strategy. Other measures currently under review include vaginal lavage with antiseptic or virucides during delivery, anti-retroviral therapy, and passive immunization. Although cesarean section decreases infection, the decrease is not substantial enough to justify the costs associated with surgical delivery. The additional risk of HIV transmission through breast feeding by women infected before pregnancy has been estimated at 14%. In areas where malnutrition and infectious diseases are rampant, the protective benefits conferred by breast feeding on the part of HIV-infected mothers outweigh this increased risk.
The existence in Kenya of 750,000 individuals infected with the human immunodeficiency virus (HIV) and 41,000 cases of acquired immunodeficiency syndrome (AIDS) has impelled state officials and nongovernmental organizations to develop a more comprehensive approach to AIDS prevention. For example, PLAN Kiambu's AIDS Education, Prevention, and Community Support Program is providing emergency assistance (food, medical care, financial support) to those with AIDS and their families, facilitating school attendance of children orphaned by AIDS, establishing AIDS support groups, conducting outreach to prostitutes and other high-risk groups, and developing educational materials for children 7-16 years of age. Traditional media, such as drama, songs, and dance, are the preferred communication channels for AIDS education. People with AIDS are recruited to serve as peer counselors. Another nongovernmental organization has targeted female children for educational campaigns aimed at raising their self-esteem and capacity to be assertive.
In 1991, 34 cases of acquired immunodeficiency syndrome (AIDS) were recorded for the province of Bam, which has a population of 4239. Since 1992, PLAN and the local Ministry of Health have been conducting an AIDS prevention program in the province. An initial baseline community survey to assess knowledge, attitude, and practices about the disease was conducted in order to tailor the program to the needs and characteristics of the target population. A questionnaire was administered to 300 randomly selected adults in 10 rural villages. The sexes were equally represented. 74% of the villagers were found to be illiterate and the major sources of health information were radio, health facilities, and friends and relatives; therefore, educational activities were carried out through non-written methods (traditional and modern) that employed these communication channels. Initially, 5 men and 5 women ("Village Communicators") were selected by their communities to be trained in information, education, and communication (IEC) techniques regarding AIDS prevention; under the supervision of their trainers, they organized and conducted 2 weekly sessions. An additional 62 women and 50 men were trained as Village Communicators to promote AIDS awareness among their own gender. A team of health personnel, artists, and a traditional music group conducted collective sessions to promote condom use and address problems relating to AIDS (polygamy, remarrying of spouses of AIDS victims, availability of testing during prenuptial visits). Although 90% of respondents had heard about AIDS, 30% did not understand the disease or its routes of transmission; so messages about the effects and the transmission of AIDS were emphasized. Because 56% of respondents admitted having had 2 or more sex partners, and a similar percentage admitted having had 2 or more sexual encounters per week, messages were disseminated on sexuality using community volunteers and the folkloric band. 42% of respondents were aware of the protective effect of condoms, but only 9% used them during their last sexual encounter; so village leaders, traditional healers, and PLAN and MOH staff promoted condom use at community sessions. Since 68% of respondents approved of the sale of condoms, a community-based system, which would be managed by village committees, for the sale and distribution of condoms was established.
PLAN Bicol in the Philippines is a community based Health Manpower Development Program (HMDP) geared toward training and mobilization of indigenous health practitioners, providing infrastructural and logistical support to individual families, and educating the community about health, nutrition, and the environment. The field officer recommends at the initiation of a project that program staff have roles that are well defined. New programs should be introduced to the community first and should involve the community in the planning stages. The HMDP program is directed to 38 villages located around national parks that have suffered from deforestation. Community health issues are malnutrition, low immunization, and lack of access to health services. HMDP established a training program for auxiliary health workers (AHWs), who make a commitment to return to their villages after training. Midwives are being trained at local schools. Village houses are being built and repaired; water systems and sanitary toilet facilities are being installed. Village health stations have been constructed and equipped with basic medicines, supplies, and equipment, and are open 5 days a week. Health education classes inform the community about nutrition and health. The problems at inception were the unwillingness of field staff to participate in the program and a high drop out rate among AHWs. Problems were worked out as the program progressed. Facilitative factors are the close coordination with the provincial health office, community acceptance, and the availability of qualified people.
The field report from PLAN field offices in Sucre and Altiplano in Bolivia, Santo Domingo in the Dominican Republic, and Amatitlan in Guatemala provides a summary of survey results pertaining to diarrheal disease control, immunizations, and nutrition. The PLAN sites are rural with the exception of the periurban slum surrounding Santo Domingo, which has better access to health services. Interviews were conducted among mothers with children aged 0-23 months in project areas, with the exception of Altiplano and Santo Domingo which included nonproject areas for comparative purposes. The results for diarrhea disease control are that an estimated 90% of episodes can be successfully treated at home. Evaluation is made of the timeliness and coverage of immunizations, the degree of management of diarrhea at home and at the health facility, and the extent of exclusive breast feeding in the first 4 months, and total breast feeding with food supplementation in the first year of life. The conclusion is that the four field offices make a significant and positive impact on children aged 0-23 months.
