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Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419-7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996-15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310-4.339), experience of discrimination (OR = 3.962; CI = 1.540-10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118-6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required.

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Tubal sterilization is the most common contraceptive method used by Brazilian HIV-positive women. This cross sectional study describes the main reasons why HIV-positive women decide to be sterilized and identifies factors associated with choosing sterilization in HIV-positive women in Ceará, northeast Brazil. Data from 229 non-sterilized women, 80 women sterilized before HIV diagnosis and 48 women sterilized after diagnosis were analysed. Of the women sterilized after HIV diagnosis, 96% had the procedure done in the postpartum, during a caesarean section. No desire for more children was the most common appointed reason to be sterilized (39.6%), followed by medical recommendation because of HIV (31.3%). Seventy-nine women (28.5%) had a child after HIV diagnosis. Of those, 46 (58.2%) were sterilized in the postpartum. Factors associated with sterilization for HIV-positive women were: having a child after diagnosis (AOR: 120.9; 95%CI: 27.8-525.4) and having at least three children (AOR: 2.8; 95%CI: 1.1-7.1). It is recommended that non-coercive counselling should be provided so that HIV-positive women can make informed decisions on their reproductive options.

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Brazil has become a country known as having one of the most extreme examples of the consequences of the hospital-based medicalization of delivery care, while a model of humanization of birth was developed in the State of Ceará in the 1970s. The Government of Japan, through the Japanese International Cooperation Agency (JICA), collaborated with the Federal Ministry of Health of Brazil and the Government of the State of Ceará, in implementing the Maternal and Child Health Improvement Project in north-east Brazil (1996-2001). This project focused on 'humanization of childbirth', with training based intervention activities. Behavioral changes among health professionals who received the project's participatory type of training were described using rapid anthropological assessment procedure (RAP) survey results. Changes from 'a culture of dehumanization of childbirth' to 'childbirth as a transformative experience' were observed.

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Brazil has become a country known as having one of the most extreme examples of the consequences of the hospital-based medicalization of delivery care, while a model of humanization of birth was developed in the State of Ceará in the 1970s. The Government of Japan, through the Japanese International Cooperation Agency (JICA), collaborated with the Federal Ministry of Health of Brazil and the Government of the State of Ceará, in implementing the Maternal and Child Health Improvement Project in north-east Brazil (1996-2001). This project focused on 'humanization of childbirth', with training based intervention activities. Behavioral changes among health professionals who received the project's participatory type of training were described using rapid anthropological assessment procedure (RAP) survey results. Changes from 'a culture of dehumanization of childbirth' to 'childbirth as a transformative experience' were observed.

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Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

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This report describes the process used to develop locally appropriate educational materials and to implement the education component of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico. The process is broken into five stages: formative research, developing recommendations for behavior change, development of educational messages, development and production of educational materials, and distribution of the materials. Appropriate terminology and taxonomies for dengue were obtained from open in-depth interviews; baseline data from a knowledge, beliefs, and practices questionnaire served to confirm this information. A larval survey of house lots was carried out to identify the Ae. aegypti larval production sites found on individual house lots. This enabled the program to target the most important larval habitats. Community groups were organized to work on the development of messages and production of the educational materials to be used. The education intervention was successful in stimulating changes in both knowledge and behavior, which were measured in the evaluations of the intervention. To be successful, community-based strategies must be flexible and adapted to the local setting because of ecologic, cultural, and social differences between localities.

PIP: Aedes aegypti mosquito is a vector of yellow fever and dengue hemorrhagic fever. It was eradicated that seventeen different Latin American countries during the 1950s and 1960s, but has reappeared in almost all of these countries as a result of laxness in monitoring ports and border crossings for potential importations of eggs and adult mosquitoes. This paper describes the process used to develop locally appropriate educational materials and implement the education component of a community-based Ae. aegypti control program in Merida, Yucatan, Mexico, over the period June 1989 to December 1990. Merida is the capital of Yucatan and harbors a population of approximately 700,000. Dengue was epidemic in 1979 and 1984, and its transmission is now endemic in the city. The process consisted of the following five stages formative research, developing recommendations for behavior change, development of educational methods, development and production of educational materials, and distribution of the materials. Terminology and taxonomies for dengue were obtained from open, in-depth interviews, while baseline data were gathered via a knowledge, beliefs, and practices questionnaire. A larval study of house lots was then carried out to identify the Ae. aegypti larval production sites found on individual house lots, thus enabling the program to target the most important larval habitats. Community groups were organized to work on message development and production of educational materials to be used in the program. The education intervention proved overall to be successful in stimulating changes in knowledge and behavior measured in the evaluations of the intervention. Finally, the authors hold that community-based strategies must be flexible and adapted to varied ecological, cultural, and social differences between localities in order to be successful.

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This paper describes the results of a trial to assess the efficacy in reducing the density of larval production sites of utilizing community involvement in the planning and implementation of an Aedes aegypti control programme, in a dengue-endemic city in Honduras. In addition to a substantial increase in knowledge about dengue transmission and prevention, a relative reduction in Ae. aegypti larval infestation indices was found in those city neighbourhoods where community involvement was utilized compared with their untreated counterparts. Several methods of improving the impact of this type of programme are discussed.

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This report describes the results of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico. Baseline surveys concerning knowledge, beliefs, and practices of 577 women and a larval survey of 616 house lots were carried out in October 1989. Following development of a public health communication intervention from this data, the program was implemented in six communities. Evaluation used an untreated control group design with pretest and two post-tests, one at completion and one six months later. Significant changes in knowledge and behavior were seen in the treatment group in both post-tests. Women in the intervention group were able to identify the Ae. aegypti mosquito, the larval production sites of the mosquito, and appropriate control methods. A behavior change proxy was measured by examining changes in the Breteau (number of positive containers/100 houses surveyed) and container indices. The Breteau index remained the same in the intervention group while it increased significantly in the comparison group. Changes were also seen with respect to individual containers. This project demonstrated that a community-based communication program aimed at larval production site elimination or control can be effective in changing behavior and reducing larval production sites.

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A series of open interviews and a survey were conducted in several neighbourhoods in the city of Mérida, Mexico to find out whether poor response to government dengue control programmes might be related to the explanatory models about dengue and its prevention held by community members. Dengue was grouped by informants with other mild febrile illnesses, all of which were thought to be inevitable and capable of converting into more serious illnesses. Although vector control personnel think of prevention in terms of eliminating the larval habitats of mosquito vectors, the form of prevention most commonly described involved looking after oneself once sick, so that mild fevers do not evolve into serious fevers. Due to the prevalence of this different model of prevention, it is argued that simple messages about dengue may be misinterpreted. Vector control programmes need to take into account local models of febrile illnesses and their prevention in order to be effective.

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International public health scientists have debated the distinction of selective and integrated primary health care since the development of new selective primary health care interventions such as the Expanded Programme on Immunizations and the Diarrhoeal Disease Control Programme of the World Health Organization were developed. This paper argues that the codification offered by the identification of two incompatible paradigms is not a productive one for describing the implementation of national-level primary health care programs. This paper will explore these concerns by reviewing case materials of the implementation of a diarrheal diseases control program in Honduras.

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PIP: This study involved collecting qualitative and quantitative data to investigate infant feeding practices in an urban low-income population of Central America, Tegucigalpa, Honduras. Ethnographic information, the subject of the article, was collected over a 9-month period in 1981-1982 in a longitudinal study of 75 families with infants. A subsequent census of more than 5000 households strengthened the results of the ethnographic study. Taxonomy of milk fed to infants was the most useful analysis for understanding infant feeding practices at the household level in the low-income culture of Tegucigalpa. This paper presents a taxonomy of milks fed to infants and explores infant feeding behavior in light of those beliefs. 2 prenatal visits were usually made to each mother. Each participating family was assigned to a fieldworker. Periodic visits were also made following the birth of the infant. The data derived from the 9-month study consist of detailed case histories; comments and explorations of hypotheses by the fieldworkers; infant feeding histories; texts of interviews with mothers and other family members; morbidity, mortality, and growth records; and extensive observational descriptions by the fieldworkers of mothers, infants, and their families. In urban Honduras, the majority of the women combine breastfeeding with feeding a breastmilk substitute to their infants. Over 95% of mothers initiate breastfeeding. 1/2 of all infants are completely weaned from the breast midway through their 1st year. Bottlefeeding is associated with infant morbidity, especially diarrhea. Breastfeeding is associated with reduced morbidity and improved growth.^ieng

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Diarrheal disease prevention and diarrheal disease control with oral rehydration therapy are major goals of the World Health Organization and the international health community. This paper promotes the use of ethnographic research in this endeavor. It illustrates the use of ethnography in a diarrheal disease prevention and control program in Honduras by illustrating how knowledge of local beliefs and practices partially shaped promotion efforts. It confirms the validity of the original ethnographic findings by reporting the results of a survey conducted two years after program onset.

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