Beverly J. McElmurry

HIV prevention and low‐income Chilean women: machismo, marianismo and HIV misconceptions

Socio‐cultural factors and HIV‐related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low‐income Chilean women regarding HIV and relevant socio‐cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed‐methods study, fifty low‐income Chilean women participated in a survey and twenty were selected to participate in prevention, in‐depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV.

Impact of peer group education on HIV prevention among women in Botswana.

A peer group HIV prevention intervention based on social–cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.

CULTURAL AND GENDER ISSUES RELATED TO HIV/AIDS PREVENTION IN RURAL SWAZILAND: A FOCUS GROUP ANALYSIS

HIV/AIDS is a serious public health problem in Swaziland, a small land-locked Southern African country. The epidemic affects all subpopulations, but women are increasingly at risk for contracting the disease. Focus groups were conducted in a rural area to obtain qualitative information on the rural dimensions of HIV/AIDS, vulnerability to HIV/AIDS, and sociocultural factors influencing the spread of AIDS. Five themes were identified from analyses of the focus groups that are relevant in developing an AIDS prevention program for this population in Swaziland. Implications for future research and health care practice focus on gender-sensitive cultural research (e.g., women and mens roles and responsibilities in rural Swaziland society) and how social, economic, and cultural factors impact the spread of AIDS. Recommendations include reorienting and allocating resources for health, education, and social services to address the relative neglect of rural areas and strengthening policies and programs to achieve the equal participation of all women in all aspects of societys decisions. Specifically, policies related to economic and food security should result in programs to improve local access by women to all resources.

Primary and preferred sources for HIV/AIDS and sexual risk behavior information among adolescents in Swaziland, Southern Africa

The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescents preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.

Couple decision making and use of cultural scripts in Malawi.

PURPOSE To examine the decision-making processes of husband and wife dyads in matrilineal and patrilineal marriage traditions of Malawi in the areas of money, food, pregnancy, contraception, and sexual relations. METHODS Qualitative grounded theory using simultaneous interviews of 60 husbands and wives (30 couples). Data were analyzed according to the guidelines of simultaneous data collection and analysis. The analysis resulted in development of core categories and categories of decision-making process. Data matrixes were used to identify similarities and differences within couples and across cases. FINDINGS Most couples reported using a mix of final decision-making approaches: husband-dominated, wife-dominated, and shared. Gender based and nongender based cultural scripts provided rationales for their approaches to decision making. Gender based cultural scripts (husband-dominant and wife-dominant) were used to justify decision-making approaches. Non-gender based cultural scripts (communicating openly, maintaining harmony, and childrens welfare) supported shared decision making. Gender based cultural scripts were used in decision making more often among couples from the district with a patrilineal marriage tradition and where the husband had less than secondary school education and was not formally employed. CONCLUSIONS Nongender based cultural scripts to encourage shared decision making can be used in designing culturally tailored reproductive health interventions for couples. CLINICAL RELEVANCE Nurses who work with women and families should be aware of the variations that occur in actual couple decision-making approaches. Shared decision making can be used to encourage the involvement of men in reproductive health programs.

Lessons Learned in Using TAKE 10! With Hispanic Children:

Physical inactivity and lack of nutritious diets increase children’s risk of obesity, especially children from low-income and ethnic minority groups. To address this risk, the school-based TAKE 10! program was implemented to increase the physical activity and improve the nutrition of K-6th grade students in one public urban school serving a predominantly low-income, Hispanic population. In this study the researchers (a) evaluated the program outcomes using the physical activity and nutrition questionnaires provided with the TAKE 10! curriculum material, teacher surveys, observations, and interview data; (b) evaluated the questionnaires provided with the TAKE 10! curriculum material and provided suggestions for modification; and (c) described the experience of a positive partnership among school, university, and community agencies implementing the TAKE 10! curriculum. Based on the findings, recommendations are offered for successful physical activity and nutrition health promotion programs for these children.

Active Living Logan Square: Joining Together to Create Opportunities for Physical Activity

BACKGROUND The Active Living Logan Square target audience is the community of the southwest corner of Logan Square, an urban Chicago community of 84,466 residents, mostly Latinos. Through the Active Living by Design (ALbD) initiative, the Logan Square Neighborhood Association leveraged its 48 years of existence in the neighborhood to create opportunities and build partnerships. INTERVENTION Activities addressed three primary goals: (1) enhance school environments and practices to support physical activity before, during, and after the school day; (2) encourage individuals and families to enjoy outdoor activities in their own communities; and (3) create safe, inviting places for activity that connect to surrounding communities. The partnerships participatory approach involved a variety of community stakeholders in developing and implementing affordable, accessible, culturally acceptable, and sustainable physical activities for children and their families. RESULTS The partnership successfully piloted Open Streets (temporary street closures) and advocated for development of the Bloomingdale Trail, an elevated rails-to-trails project. In schools, the partnership changed the culture at McAuliffe Elementary to support healthy behaviors through new policies, physical projects, and programs. LESSONS LEARNED Vital components of the projects success included a full-time coordinator with strong community ties; time to build healthy relationships within the partnership and community; the use of culturally relevant strategies; and flexibility to welcome complementary opportunities. CONCLUSIONS The partnership intentionally did not produce a single community-recognized campaign; instead, it chose to use limited resources to promote tangible programs and projects that led to sustainable and replicable changes that promote physical activity.

Mano a Mano-Mujer: An Effective HIV Prevention Intervention for Chilean Women

The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.

Women and HIV/AIDS in China: Gender and Vulnerability

A comprehensive literature review was conducted to determine if there was a research gap between womens vulnerability to HIV and research addressing that vulnerability in China. Türmens article Gender and HIV/AIDS served as a framework for examining the eight determinants placing women and adolescent girls at greater risk of HIV infection than men. Eighty-eight research reports were retrieved and categorized by general characteristics and the eight determinants. Women were found to be more vulnerable than men to HIV infection in China and worldwide. While researchers reported a considerable amount of research regarding womens HIV/AIDS-related issues in China, there is insufficient attention to some risk determinants. Investigators are encouraged to take advantage of political commitment and policy changes in China to conduct more research focusing on female vulnerability and to address the effects of violence, laws, stigma, and discrimination in female HIV prevention.

Becoming bicultural: Chinese American women and their development.

Ethnic and racial diversity in the United States has led to increasing interest in research on biculturalism, yet the meaning and underlying processes of biculturalism in the context of development in young adults are not well understood. Fifteen interviews were conducted with second-generation Chinese American women to explore how being bicultural fit into their lives. Data analysis yielded a developmental map that reflected their experiences throughout life as minority women. Findings suggest that biculturalism is more than being functionally competent in two cultures, it is both a behavioral and psychological orientation in life. From the findings of this study, we have increased our knowledge of Asian American womens development and provided a foundation for nursing research with minority women.