Lisette Irarrázabal

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.

Observed Use of Standard Precautions in Chilean Community Clinics

OBJECTIVES In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described. SAMPLE A total of 52 structured observations with potential contamination with body fluids were done. RESULTS HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP. CONCLUSIONS It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.

Effectiveness of an educational program about the Chilean AIDS law in primary care health workers

BACKGROUND In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. AIM To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice among primary healthcare workers in southeastern Santiago. MATERIAL AND METHODS Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. RESULTS The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). CONCLUSIONS The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

Exploring the Masculine Identity in the Context of HIV Prevention in Chile

PURPOSE This study aims to describe human immunodeficiency virus (HIV)-related knowledge and beliefs, as well as understanding attitudes towards masculinity in the context of HIV prevention, held among Chilean men. DESIGN This study reports the qualitative findings of a sequential qualitative-quantitative mixed methodology study: Bringing men into HIV Prevention in Chile, NIH R01 TW007674-03. METHODS Twenty in-depth interviews using a qualitative, descriptive approach to elicit information for the study were conducted among men residing in two communities of low socio-economic status in Santiago, Chile. FINDINGS Content analysis of interviews revealed three main themes regarding machismo and how it relates to HIV: sexuality and machismo, the changing nature of machismo, and violence against women. CONCLUSIONS Addressing HIV and intimate partner violence through developing education programs tailored to meet the needs of Chilean men are needed to include men in HIV prevention efforts. CLINICAL RELEVANCE Specifically, incorporating ideas of what men consider healthy masculinity and working to destigmatize men who have sex with men are important steps in addressing the negative aspects of machismo.

Mujeres que consumen sustancias y su vulnerabilidad frente al VIH en santiago de Chile

Introduction: Women represent 15% of the people living with HIV in Chile. Risk behaviors for HIV are: multiple partners, unsafe sex, and exchange of sex for drugs/money. Methodology: A correlational design was used. A sample of 203 women who were sexually active and consumed substances within the last 3-months were selected for this study. Results: The average age of the participants was 32.4 years (SD = 9.2) and 68.1% were housewives. The substance most commonly used was alcohol (95.1%) and marijuana (49.8%); 23.7% of the women were drunk or drugged before having sex; 74.4% had multiple sexual partners and 95.6% had unprotected sex. There is a significant correlation (p < 0.05) between substance abuse and HIV risk behaviors. Conclusion: It is necessary to develop more research to understand in depth the relationship between substance use and HIV risk among Chilean women. It is important to consider the use of substances to develop and implement HIV prevention programs in the Chilean community.The Government of Malawi recognizes that the health of young people is a component of public health which is of concern in this country. However lives of most young people continue to be threatened by a number of factors such as sexually transmitted infections including HIV and AIDS teenage pregnancies unsafe abortion complications nutrition inadequacies alcohol and drug abuse and mental health problems. This contributes significantly to the high mortality and morbidity rates in Malawi. The Ministry of Health through the Directorate of Reproductive Health and partners initiated the program evaluation of youth-friendly health services to assess the extent to which young people access the health services they need at various levels of care. The findings and recommendations from the evaluation stressed the need to have a robust adolescent and youth sexual and reproductive health strategy. This strategy therefore aims at giving direction and guidance to the implementation of SRH services for all young people country wide so as to achieve the highest possible level of quality integrated services.

Mujeres que Consumen Sustancias y su Vulnerabilidad frente al VIH en Santiago de Chile (Women Who Consume Substances and Their Vulnerability to HIV in Santiago of Chile)

Introduction: Women represent 15% of the people living with HIV in Chile. Risk behaviors for HIV are: multiple partners, unsafe sex, and exchange of sex for drugs/money. Methodology: A correlational design was used. A sample of 203 women who were sexually active and consumed substances within the last 3-months were selected for this study. Results: The average age of the participants was 32.4 years (SD = 9.2) and 68.1% were housewives. The substance most commonly used was alcohol (95.1%) and marijuana (49.8%); 23.7% of the women were drunk or drugged before having sex; 74.4% had multiple sexual partners and 95.6% had unprotected sex. There is a significant correlation (p < 0.05) between substance abuse and HIV risk behaviors. Conclusion: It is necessary to develop more research to understand in depth the relationship between substance use and HIV risk among Chilean women. It is important to consider the use of substances to develop and implement HIV prevention programs in the Chilean community.The Government of Malawi recognizes that the health of young people is a component of public health which is of concern in this country. However lives of most young people continue to be threatened by a number of factors such as sexually transmitted infections including HIV and AIDS teenage pregnancies unsafe abortion complications nutrition inadequacies alcohol and drug abuse and mental health problems. This contributes significantly to the high mortality and morbidity rates in Malawi. The Ministry of Health through the Directorate of Reproductive Health and partners initiated the program evaluation of youth-friendly health services to assess the extent to which young people access the health services they need at various levels of care. The findings and recommendations from the evaluation stressed the need to have a robust adolescent and youth sexual and reproductive health strategy. This strategy therefore aims at giving direction and guidance to the implementation of SRH services for all young people country wide so as to achieve the highest possible level of quality integrated services.

Mano a Mano for Health Professions Students in Chile: A Pilot HIV Prevention Program

Lilian Ferrer, RN, MS, PhD, is the Director of International Affairs, School of Nursing, Pontificia Universidad Catolica de Chile, Santiago, Chile. (*Correspondence to: lferrerl@uc.cl.) Margarita Bernales, MA, PhD, is an Assistant Professor, School of Nursing, Universidad del Desarrollo, Santiago, Chile. Rosina Cianelli, RN, MPH, PhD, FAAN, is a Professor, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA. B altica Cabieses, RN, ME, PhD, is an Assistant Professor, School of Nursing, Universidad del Desarrollo, Santiago, Chile. Ximena Trivi~no, MD, MHPE, is an Associate Professor, School of Medicine, Pontificia Universidad Cat olica de Chile, Santiago, Chile. Reiley Reed, MPH, is a Research Assistant, School of Nursing, Pontificia Universidad Cat olica de Chile, Santiago, Chile. Lisette Irarr azabal, RN, MSN, PhD, is an Assistant Professor, School of Nursing, Pontificia Universidad Cat olica de Chile, Santiago, Chile. Nilda Peragallo, RN, MS, DrPH, FAAN, is the Dean and Professor, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA. Kathleen Norr, MA, PhD, is a Professor, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA. HIV is cause for major concern all over the globe. By the end of 2009, there were 33.3 million reported cases of people living with HIV (PLWH) worldwide, with 2.6 million new infections and 1.8 million HIV-related deaths (Joint United Nations Program on HIV/AIDS [UNAIDS], 2010). Specifically in Latin America, the incidence of HIV has increased from 1.1 million adults and children living with HIV in 2001 to 1.4 million adults and children living with HIV in 2009 (UNAIDS, 2010). Additionally, the rate of new infections has grown, as there were 150,000 reported cases of new infections in 2001 and this number increased to 170,000 reported cases of new infections in 2008. While in other regions of the world the rate of new infections has declined, Latin America has yet to experience this reduction in new infection rates (UNAIDS, 2009). Although, in comparison to other Latin American countries, Chile has a lower incidence of PLWH, HIV is still a serious public health concern. By 2010, 23,997 cases of HIV and AIDS were recorded; however, it has been estimated that only 63.2% of PLWH are included in this number (Ministerio de Salud,