Blaming Machismo: How the Social Imaginary is Failing Men with HIV in Santa Cruz, Bolivia

Drawing from an ethnography of HIV care in Santa Cruz, Bolivia, in this article I explore how the social imaginary surrounding gender relations shapes men's experiences of seeking care for and living with HIV. 

Popular understandings of gender relations, which draw heavily on the machismo concept, intersect with a global health master narrative that frames women as victims in the AIDS epidemic in a way that generates a strong sentiment of blaming machismo within local HIV/AIDS-related services. Statements such as, "it's because of machismo" are used to explain away epidemiological trends. Participant observation in the context of HIV care, coupled with illness narrative interviews, illuminate how blaming machismo shapes men's experiences of care and the ways that they feel excluded from various forms of support. 

Thus, the illness experiences of men with HIV problematize the machismo concept and how it is drawn upon in the context of care.

Purchase full article at:   http://goo.gl/8ZcAZq

By:  Heckert C1.

• 1 University of Texas at El Paso. 

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An Ethnographic Study of HIV/AIDS among Ayoreo Sex Workers: Cultural Factors & Risk Perception

Abstract

AIMS AND OBJECTIVES:

To describe and understand Ayoreo sex workers' perceptions of HIV/AIDS and to identify factors that may affect the prevention of risk behaviours.

BACKGROUND:

According to recent HIV/AIDS incidence reports, being female, indigenous and a sex worker means belonging to a maximum-risk group, left in the background in terms of strategies for the fight against HIV. Although there has been research into intervention models in these populations, it is important to detail the perceptions of the problem from the perspective of sex workers from the affected ethnic groups.

DESIGN:

This study used an ethnographic methodology that included participant observation and semi-structured interviews.

METHODS:

The research was conducted in two phases. First, participant observation was chosen to access and observe the behaviour of Ayoreo sex workers. The second phase was a semi-structured interview with sex workers and key informants. The interviews, together with the field notes, were transcribed and analysed, following inductive strategies to find emerging themes.

RESULTS:

Here, we present the results related to four emerging themes: the cultural acceptance of sex work as a useful economic activity; the lack of concern for sexually transmitted illnesses and the stigmatisation of people who are HIV seropositive; external factors that increase vulnerability such as difficulties in using a condom; and conflictive and unbalanced relationships between the Ayoreo people and the health system and health professionals.

CONCLUSIONS:

The health- and sexual reproduction-related culture, the knowledge and attitudes of sex workers, external factors, and relationships with the health system and health professionals continue to place Ayoreo sex workers in high-risk conditions in relation to sexually transmitted diseases and HIV/AIDS.

RELEVANCE TO CLINICAL PRACTICE:

Employing cultural care as its base, nursing could develop programmes and interventions culturally adapted for the prevention of disease and the promotion of health in these populations.

Purchase full article at:   http://goo.gl/ziaUAz

By:   López-Entrambasaguas OM¹, Granero-Molina J, Fernández-Sola C.

¹High Guadalquivir Public Hospital, Andújar, Jaén, Spain.

 

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Prevalence of Marijuana Use among University Students in Bolivia, Colombia, Ecuador, and Peru

Young adults 18 to 25 years old show the highest prevalence of marijuana use in Latin America. This study analyzes the changes in prevalence of marijuana use among university students in the Andean Community (Bolivia, Colombia, Ecuador, and Peru) from two studies carried out in 2009 and in 2012. 

Data were collected through representative two-stage samples of universities and students in the Andean Community. An online survey was administered using a standardized questionnaire. Prevalence was calculated for lifetime, past year, and past month. Marijuana was the most widely used illicit substance consumed among university students, in 2009 and in 2012. 

Past month prevalence among university students in 2009 in Colombia was 5.27%, in Peru 1.00%, in Ecuador 1.68%, and in Bolivia 0.76%. Past month prevalence in 2012 in Colombia was 7.14%, in Ecuador 3.67%, in Peru 1.62%, and in Bolivia 1.45% in 2012. Among university students in the Andean Community, past month prevalence increased among both males and females between 2009 and 2012 in most countries. 

Marijuana continues to be the most commonly used illicit drug in Latin American countries. Increases in prevalence among young adults could have important implications for national drug policy.

Below:  Past year incidence of marijuana use in Andean Countries, by country

Full article at:  http://goo.gl/C3Q4wJ

By: Hynes M1, Demarco M2, Araneda JC3, Cumsille F4.

• 1Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. mhynes@oas.org.
• 2Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. mdemarco@oas.org.
• 3Global SMART Programme (Latin America), United Nations Office on Drugs and Crime, 1889 F Street NW, Washington, DC 20006, USA. jaraneda@oas.org.
• 4Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. fcumsille@oas.org. 

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Improving Antenatal Care in Prisons

Significant progress is being made to improve the outcomes of pregnancy and childbirth in many countries. In many low- and middle-income countries, including Ethiopia, Bangladesh, Bolivia, Myanmar and Pakistan, great strides have been made in significantly reducing maternal mortality.1 However, the estimated 24 000–60 000 women who are pregnant and incarcerated worldwide often lack access to antenatal care at the same level as that available in their communities (Table 1).2 Despite clear international standards that mandate equivalent care for people in prison, pregnant women in these settings face significant barriers to adequate antenatal care.3–5 The needs of pregnant women are often overlooked in prisons designed to house men – who comprise most of the world’s prison population of over 10.1 million people.3,6 As the World Health Organization’s Member States consider the post-2015 agenda for maternal health, this vulnerable and hidden cohort of women should not be forgotten.  

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Family Planning for Strangers: An Experiment on the Validity of Reported Contraceptive Use

Below:  Scatterplot for Reported Sterilization and TFR in Urban Latin American DHS data, 42 surveys from 15 countries, including OLS Regression Prediction Line (R2 = 0.14; p = 0.015).

Sterilization levels reported in the Dominican Republic appear well above what we would normally expect given prevailing patterns in the region. We suspect that the use of strangers as interviewers—the normative approach in data collection in both developed and developing country settings—may be partly responsible for this result, and may underlie a long history of bias in family planning data. We present findings from a field experiment conducted in a Dominican town in 2010, where interviewer assignment was randomized by level of preexisting level of familiarity between interviewer and respondent. In our data, sterilization use is higher when the interviewer is an outsider, as opposed to someone known to the respondent or from the same community. In addition, high sterilization use is correlated with a propensity of respondents to present themselves in a positive light to interviewers. These results call into question the routine use of strangers and outsiders as interviewers in demographic and health surveys.

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