World AIDS Day: Addressing HIV in Rural Guatemala
December 1, 2011—In Guatemala, less than one percent of the adult population is estimated to be HIV positive. But with that seemingly small percentage, Guatemala is considered, nonetheless, to have a concentrated HIV epidemic, according to a USAID Guatemala Health Report.
In remote locations with widespread poverty, the risk for HIV is higher. Because of these factors, most men leave home to find work in distant cities or farms. While in transit, the men may participate in high-risk sexual behavior, increasing their chances of contracting HIV or other sexually transmitted diseases. Upon their return home, they risk passing the infection to their wives or partners.
Earlier this year, Curamericas Global, Inc., a nonprofit international health organization, addressed the risk for HIV in the rural communities of Sebastián Coatán, located in the Guatemalan highlands. Curamericas disseminated culturally appropriate health messages to men and women through trained health educators, peer educators, and traditional midwives. The pilot program, “Promoting HIV/AIDS Awareness and Prevention to Rural Guatemala,” was made possible through funding support from the United Methodist Global AIDS Fund.
“By training community members to become educators among their peers, the project ensured that health messages would be delivered in a culturally appropriate manner, and it empowered community members to take ownership of the health and well-being of their village,” says Erin Pfeiffer, program specialist for Curamericas Global.
Reaching Men with HIV Message
Curamericas primarily trains women as health educators in Guatemala, but during the HIV awareness and prevention program, they trained men as well—a huge milestone for Curamericas, as this method allowed for the delivery of gender-tailored health messages on the sensitive topic. The messages promoted abstinence, faithfulness, and HIV prevention methods.
The primary challenge of the project was reaching the men in the community, as the men traveled often to find work. Curamericas Guatemala Director Dr. Mario Valdez engaged in problem-solving discussions with community health committees and local leaders. This led to a solution: use trained health educators to train existing community facilitators and village mayors as lead-trainers. Then, educate the men at their places of work, or during late evening hours, when they returned home. This strategy allowed for men to be reached with critical HIV information and facilitated wider community ownership of the project.
By educating lead-trainers in multiple communities, HIV awareness messages were dispersed across a broader geographic area, and educational messages were tailored to the local context of the communities.
Communications methods to promote behavioral change included easily remembered axioms, role-play, and visuals aids to enhance learning and empower men and women to model healthy attitudes and behaviors among their peers.
Over the course of the yearlong project, more than 2,500 men and women learned HIV awareness and prevention. At the end of the project, there was an increase in the number of men and women who indicated an intention to use this knowledge and apply the learned prevention practices.
“At the program’s inception, it was extremely rare to find a single community member who had heard of HIV/AIDS,” stated Pfeiffer. “Yet within months of the program’s health education efforts, a widespread cultural awareness about HIV/AIDS grew among the communities.”
Pfeiffer indicated that despite the sensitive nature of the topic, men and women openly voiced their interest and their desire to learn more. After the educational meetings, they approached their health educators and asked for future refresher sessions, as well as for additional information on the prevention of HIV/AIDS.
“The unexpected eagerness of community members to learn came as a welcome surprise to Curamericas’ staff,” said Pfeiffer.
Overall, the number of men and women who could identify three ways HIV/AIDS is transmitted increased by 73 percent and 86 percent, respectively. Prior to the trainings, only 13 percent of men and 1.5 percent of women could make this determination. In addition, 67 percent of adolescent females indicated their intention to practice abstinence until they are engaged in a monogamous relationship.
The five-day training to promote HIV/AIDS awareness was centered at the Curamericas Guatemala training facility where a pre-test was administered to five participants to establish a baseline survey of HIV knowledge. The training consisted of role-play exercises, group discussions, and “Train the Trainer” materials to equip participants with the skills necessary to prepare others.
A Model for Tomorrow
Curamericas was encouraged by the success achieved by this HIV project funded by the UM Global AIDS Fund. The culturally appropriate project design, the hardworking staff of Curamericas Guatemala, and the supportive communities of San Sebastián Coatán were integral to the tremendous gains in HIV awareness and prevention skills that resulted from the project activities. The impact made by the program spurred a desire to replicate its design in other communities.
How You Can Help
Observe World AIDS Day, today and throughout the year, by supporting projects like this one that are reaching vulnerable and rural populations with the HIV/AIDS prevention message. Give to the United Methodist Global AIDS Fund, UMCOR Advance #982345. Also, you can download and share a World AIDS awareness poster here.
Erin Pfeiffer, MS, Program Specialist for Curamercas Global, contributed to this article which was based on a report to UMCOR.