Sexual and Reproductive Health/HIV Awareness: Amazonas State-Brazil

First ever official Policy Document in the area of HIV/AIDS and Disability published in Brazil

The Brazilian Ministry of Health has published on 9th October 2009 the first ever official Policy Document in the area of HIV/AIDS and Disability (Disabled People: Sexual and Reproductive Rights in the Integrality of Healthcare) which, after a process of public consultation, will be the reference document for policies and governmental actions throughout Brazil to benefit millions of Brazilian disabled people to realise their sexual and reproductive rights .

In particular, the Policy Document states that the Public Health System needs to “include disabled people in all the activities of promotion, prevention and assistance in sexual and reproductive health realised by all the public health units and services” and that it is necessary to “make available, in all the public health units and services, basic and specific equipments and materials needed to attend the sexual and reproductive health needs of disabled people”.

International Service (IS) is particularly proud of this result because the Brazilian Federal Government recognised IS’ significant input in advocating the rights of disabled people and people living with HIV/AIDS in the area of HIV/AIDS and Disability (policies, actions, services), starting from the Workshop on Sexual and Reproductive Rights of Disabled People which IS organised in August 2006, the first national thematic event involving governmental and non-governmental organisations in Brazil.

Together with the National Programme of STI/AIDS, IS organised in June 2008 the First National Forum on HIV/AIDS and Disability, supported by the Big Lottery Fund through IS. The main product of the Seminar has been the "Carta de Florianopolis", a declaration from non-governmental and governmental organisations, associations, and individuals participating in the Forum directed to the Federal Government with the objective to expand and guarantee the sexual and reproductive rights of disabled people at national level.

After a year and a half, great part of this first ever Policy Document has been inspired by the "Carta de Florianopolis", which is also annexed to the Policy.

IS acknowledge the contribution and the partnership of the Big Lottery Fund, through it has been achieved this first important result for the disabled people in Brazil in their pathway for being recognised their sexual and reproductive health rights.

2009 World Aids Day in the Municipality of Lábrea Focuses on Prevention and Youth

This year, Lábrea experienced a world AIDS day campaign without precedents. Many different actors moved the strings and the result was a set of advocacy and prevention activities that promoted the participation of a large number of people due to its fun factor. The events were promoted through the radio and a “broadcasting car” and furthermore, ten community health agents visited the school going from classroom to classroom to raise awareness about discrimination and prejudices, through a game and inviting students to take part in the events of the campaign. A poster contest on prevention was organized, which ended with an exhibition and the award for the winners on the first of December. Throughout the whole campaign the syphilis and HIV testing campaign that took place the following week was promoted, pointing out the importance of early diagnose. On Sunday 29th of November, the main square of Lábrea was transformed in a colorful and varied scenario centered around prevention and eliminating prejudices. University students had organized educational games, such as “Love bowling”, “Fishing for prevention” or “Treading on prejudices”. Members of the youth group “Pro-Jovem” improvised a cinema, projecting prevention films. Simultaneously, a stage featured Capoeira, Forró, street dance and theatre; above it the red ribbon made of gas balloons was floating and raising the flag of the campaign. What could not be missing – of course – were condoms.

Cooperante do Serviço Internacional (IS) no município de Eirunepé/AM

A experiência da cooperação em outros paises enfatiza a nossa humanidade comum. A compreensão que você ganha com outros povos e culturas é profunda. É definitivamente uma forma socialmente responsável de viajar e aprender sobre a vida no exterior. Mas é também uma oportunidade de auto-reflexão, para saber como podemos agir individualmente sobre questões globais e como podemos causar um impacto positivo no mundo.

Espero revelar uma nova perspectiva de vida para vocês. A diversidade de vida por todo o mundo é realmente impressionante.

Eu nasci e cresci em Uganda. Por causa do meu amor por crianças vulneráveis, eu escolhi trabalhar, após a graduação no ano de 2000, na minha Uganda natal com o Fundo das Crianças Cristãs em Uganda. Depois, eu entrei na Organização de Apoio a AIDS. Trabalhar com eles ampliou minha perspectiva e eu vi o mundo de um ponto de vista diferente.

Trabalhar com pessoas internamente deslocadas em Uganda significa que eu vi as pessoas passarem por sofrimento como resultado de uma brutal insurgência de 20 anos pelos rebeldes do Exército de Resistência do Senhor (Lord’s Resistance Army). Milhares e milhares de cidadãos do norte de Uganda foram desalojados de suas casas para viver sob duras condições em campos de refugiados superlotados. Tenho lembranças vivas das pessoas com HIV que conheci naquele tempo.

Em 2006 fui para o “Fórum Internacional de Insegurança Alimentar e HIV" em Lusaka, no Zâmbia. Isto foi uma grande surpresa, também. Eu vi em primeira mão como a pobreza, doença e a falta de desenvolvimento social afetam os indivíduos e suas comunidades. Conscientizei-me de como os cooperantes de todos os cantos do mundo estão ajudando a aliviar a pobreza e a resolver problemas de HIV no Zâmbia e no mundo.

A conferência e a minha experiência de trabalhar com as ONGs em Uganda me fizeram decidir que passar um tempo como cooperante no exterior me capacitaria para ter conhecimentos e habilidades, fortaleceria a minha habilidade para defender os pobres e marginalizados e faria uma contribuição para os esforços de desenvolvimento em todo o mundo.

Minha decisão de me tornar cooperante no Brasil veio poucos dias depois de aprender sobre uma organização chamada Serviço Internacional (IS). Eu a achei ao navegar na Internet uma manhã ao procurar notícias e artigos. Após a leitura através do site, vi um anúncio para ser cooperante exatamente na minha área de trabalho: "DST / HIV / AIDS entre Crianças e Adolescentes '. Mandei meu formulário de inscrição na última hora possível, e menos de um dia mais tarde, recebi uma resposta. Ao receber um convite para participar de uma reunião de seleção de voluntários, eu sabia no meu coração que eu estava, de fato, indo para o Brasil.

Após a entrevista, recebi a boa notícia que eu tinha sido aceito pela organização parceira no Brasil.

Tornou-se rapidamente evidente que eu teria muito trabalho a fazer para tornar este sonho uma realidade. Eu comecei o processo demorado de obtenção de um visto da embaixada brasileira em Nairóbi, no Quênia. Além disso, eu precisava preparar minha família para estar em uma posição financeira sólida. E eu tinha que pedir demissão de meu emprego, TASO, que tinha feito uma grande contribuição para a minha carreira. Fazer as minhas malas para 24 meses de viagens internacionais criou uma espécie de caos controlado dentro do meu ser.

No dia 8 de março de 2008, com abraços marejados de minha esposa, eu sai de Johanesburgo, fiz uma conexão em São Paulo e desembarquei em Recife em 9 de março de 2008. Felizmente, desde o início dos preparativos para ir ao Brasil, eu tinha o amor incondicional e apoio genuíno da minha família e de grandes amigos.

Fui recebido por George, meu gerente, e levado para o hotel onde fiquei para o processo de uma semana de ‘orientação’ no país. Outros 3 voluntários da Inglaterra chegaram na noite seguinte. Conheci eles durante as reuniões de seleção em York e fiquei muito feliz por me juntar com eles novamente.

Durante a orientação no país, em Recife, a equipe de campo do Serviço Internacional explicou sobre o plano estratégico, a situação política no Brasil, quem as organizações parceiras eram, e os parceiros com quem eu estaria trabalhando.

Após a orientação, partimos para Manaus - a capital do Amazonas. Fomos levados para as famílias de acolhimento individual, onde me comprometi com a minha preparação com a organização parceira (o Programa Estadual de DST/AIDS do Estado de Amazonas), e eu também comecei a ter aulas de Português. Minha família me acolheu e me abraçou como um filho. Gostei muito de minha permanência com a família em Manaus, amei e fui amado.

Indo além da Esperança e do Medo

Esperança é o que nos impulsiona a agir. Me ensinaram a sonhar com um mundo melhor, assim como a dar o primeiro passo necessário para criarmos um. Nós criamos uma clara visão para o futuro que queremos, para depois definirmos uma estratégia, fazer planos, e começarmos a trabalhar.
Quero compartilhar com você meu coração, minhas experiências desde quando vim aqui para o Amazonas – as minhas convicções, pensamentos e sentimentos, agora que tive a oportunidade de ver a realidade do Amazonas. Após quase dois meses em Eirunepé, era hora de descobrir a realidade das condições de vida das comunidades ribeirinhas.

Sábado, 27 de junho de 2008: já fora do barco com cinco profissionais de saúde e um cozinheiro. Preparamos nossas malas com vacinas, medicamentos, água potável, gás, blocos de gelo e suprimentos de alimentos, o bastante para durar sete dias, quando os profissionais estarão prestando serviços médicos para as comunidades rurais no Rio Eirú. A unidade com a comunidade ribeirinha foi excepcionalmente linda, tão tropical, tão exuberante e verde. Eu realmente não sabia como o Amazonas parecia quando cheguei aqui até vê-lo com meus próprios olhos.

Em Eirunepé existem 166 comunidades ribeirinhas com base ao longo dos seguintes rios: Baixo Juruá, Alto Juruá, Rio Gregório, Rio Tarauacá, Rio Itucuma, Igarapé Preto e Rio Eirú. Os profissionais de saúde costumam viajar para a comunidade ribeirinha duas ou três vezes por ano para oferecer tratamento médico e vacinas. É comum ver as canoas se apressando com pessoas doentes para os centros de saúde ou hospitais– algumas têm casos de malária. Isso me lembra da situação na África.

Levamos 6 horas para chegar à primeira comunidade de Santo Antonio. Oh meu deus, linda! Estas famílias vivem em barracos muito básicos de madeira, com a área da cozinha em uma armação coberta de palha, onde o fogareiro está localizado. Quando cheguei com uma das famílias, eles me saudaram calorosamente. Após conversar por alguns minutos, ofereceram-me um copo de vinho de ‘açaí’. Não pude deixar de perder a oportunidade de participar de experiências culturais, eu simplesmente concordei. Uma experiência cultural que ganhei!

É realmente incrível ver o empenho e o amor que estes profissionais de saúde têm por toda a comunidade e lares que eles visitam! Eles nunca deixam passar uma família, e em algumas casas tiveram que dar longas palestras sobre o valor das vacinas antes dos pais permitirem que seus filhos fossem vacinados.

Nossas atividades diárias foram planejadas para que terminássemos cada dia numa comunidade estabelecida e que encontrássemos um lugar para atar nossas redes. Nós passamos nossa primeira noite em Santo Antonio numa sala de aula, a segunda noite em uma igreja. A terceira noite foi num barco e foi provado ser de pouco sucesso... entre violentos trovões, relâmpagos intermitentes, a chuva caindo sobre mim pelo lado do barco, e um buraco no mosquiteiro da minha rede que eu, acidentalmente causei ao esticar minhas pernas... Essa noite senti-me como um favo de mel para as abelhas. Os mosquitos me atacaram tão intensamente que me senti traumatizado. Impressionante!

Tarde da noite, nós fomos acordados por um dos grupos gritando bem alto. Devido à forte chuva e vento, o barco tinha saído da margem e chegado até o meio do rio... Sim, estes e outros eventos me mantiveram alerta e sem dormir na primeira noite neste meu barco-casa.

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Morar no rio era como um sonho se tornar realidade, ter a chance de ver as complexidades das condições em que os profissionais de saúde prestam serviços de saúde para a comunidade ribeirinha, e como é difícil para as pessoas viajarem para os centros da saúde nas cidades para conseguir serviços médicos – viajar numa canoa sob o sol escaldante, com medo de cobras e crocodilos, ser mordido por uma colônia de mosquitos.

Uma reunião com os anciãos e anciãs se revelou cheia de estórias interessantes. Raimundo não sai de sua comunidade há mais de 30 anos. Ele diz que ‘sua comunidade é enriquecida com todos os suprimentos, peixes, animais selvagens, variedades de frutas incluindo o delicioso “açaí”, mas é desprovida de serviços de educação e de saúde. ’ A razão para ele não visitar a cidade é que ele não tem uma casa ou um parente na cidade. Se ele tiver que viajar para a cidade, seja para ter serviços médicos ou por outras razões, então ele tem que dormir no barco por toda a duração da viagem até a cidade. Existem centenas de pessoas na mesma situação de Raimundo por causa das dificuldades, as pessoas da comunidade ribeirinha raramente terminam seus tratamentos – incluindo o tratamento de DST – já que não podem esperar por causa das condições estressantes de permanência na cidade.

Todos os dias, algo novo

Em uma das comunidades que visitamos vimos um barco se aproximando, e as pessoas do lugar disseram: ‘Ah, é o Frank. ’ Frank é um pastor e sua esposa Cristina é uma médica que trabalha na COMINS, uma organização Cristã Alemã que têm fornecido serviços de saúde e água potável para a comunidade indígena pelos últimos 15 anos. Quando me apresentei a ele e disse que eu era um cooperante no Serviço Internacional, ele disse que havia se lembrado de viajar por várias comunidades ribeirinhas com um dos cooperantes do Serviço Internacional alguns anos atrás. Ele estava trabalhando no controle da hanseníase. Gostei muito das conexões que fiz naquele dia e percebi que há muitas pessoas apaixonadas e dedicadas da mesma maneira que sou.

Uma marca indestrutível...

É uma alegria ver meus esforços serem reconhecidos pelo público. Eu fui realmente encorajado na reunião de Conselho Municipal de Saúde quando a nova secretária de Saúde disse: ‘Eu reconheço a presença do nosso cooperante. Espero que com a nova equipe, ele continue com o seu zeloso apoio. ’

Márcio é um enfermeiro que entrou no hospital em julho de 2009, e durante sua primeira semana nos tornamos amigos instantaneamente. Ele me disse recentemente, ‘eu estive em alguns municípios do Amazonas, mas nunca vi uma atividade de DST/HIV acontecer. Fiquei surpreso em ver tantas atividades acontecendo aqui em Eirunepé. Acho que é por causa da presença do cooperante.’ Então ele me disse, ‘you are a good guy’. Você é um cara bacana.

Lições de vida aprendidas...

Minha estadia aqui no Amazonas, Brasil – com o objetivo de obter uma compreensão mais profunda sobre a expressão cultural, a diversidade e a personalidade - é experimentar coisas que eu jamais poderia sequer conceber.

Ser cooperante abriu meus olhos para o que eu poderia oferecer, como eu poderia ser um homem genuíno. Descobri algo em mim que eu não percebia que eu era. A experiência superou todas as minhas expectativas. Sinto que eu entendo mais sobre como a outra metade do mundo sobrevive.

Desde o primeiro dia eu instantaneamente senti-me confortável com a minha organização parceira, e embora o meu português deixar muito a desejar, de alguma forma me comunico com todos e eles ganharam um brilho instantâneo em mim. Eles realmente valorizam os cooperantes, nós somos uma parte da equipe desde o primeiro dia.

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Comunidade de Mourão: o cooperante Lincoln Ópio é

A flexibilidade me colocou no caminho do sucesso. Cheguei na minha organização parceira com as expectativas do papel que eu tinha que fazer, mas quando chegou a hora de começar a fazer as coisas eu descobri que a descrição do trabalho era amplamente irrelevante. Não havia plano e nem objetivos. Eu percebi que eu estava aqui para ajudar a organizar o grupo e a estrutura que eles precisavam. Nenhum cooperante sabe exatamente o que será pedido dele ou dela no local de trabalho, mas, ser um bom cooperante é fazer o que é necessário. Ser flexível envolve adaptar-se ao que está ao seu redor, mesmo que seja radicalmente diferente do que você está acostumado. Eu tive a oportunidade de fazer as coisas que jamais teria feito em casa: fazer-me de bobo dançando em público, presenciar um festival folclórico. Eu agarrei a chance.

A paciência paga. Os cooperantes internacionais devem aprender a ser pacientes e ir devagar. Ao chegar ao local de seleção eu percebi que o passo da vida é mais devagar do que no meu país natal onde eu costumava projetar o trabalho com um prazo em conformidade. Eu passei a perceber que eu deveria centrar-me mais no processo do que no sucesso, e não tentar fazer muito.

Os cooperantes devem perceber que a parceria significativa é um longo e vagaroso processo. Evite forçar a agenda deles e deixe as coisas acontecerem no tempo deles.

Aqui em Eirunepé, a eletricidade é através de uma estação de geração termal com constantes racionamentos de energia. Quando a energia acaba, tudo para – incluindo a única conexão de telefone. Todas estas coisas podem atrasar um projeto, e a paciência é necessária.
Respeito e tolerância são essenciais. Você vai estar em situações em que você não vai entender imediatamente. Tenha cuidado para não julgar muito rapidamente. Esteja disposto a ver as coisas através dos olhos dos outros.

Ser cooperante ensinou-me a humildade e me deu uma oportunidade única de descobrir o quão pouco eu sei. Aprender a nova língua o mais rápido que puder, as regras são novas, a cultura é diferente. Percebi que, enquanto eu sou um profissional realizado e um líder comunitário em minha terra natal, nesse novo ambiente eu sou um novato. Eu fiz um monte de perguntas e cuidadosamente observei o que me cercava, a fim de realizar mesmo as tarefas mais básicas. Se eu tivesse que lutar com meus ocasionais sentimentos de impotência de teimosia e orgulho, isso teria levado à frustração e ao conflito.

Eu olhei para as pessoas com quem eu estou trabalhando e fiz uma simples auto-avaliação, perguntando-me algumas questões: o conhecimento e as habilidades que eles possuem que eu não tenho; experiências de vida que eles têm que são diferentes das minhas, os obstáculos que têm para vencer na vida, os desafios que enfrentamos diariamente que não tenho, alguns dos seus pontos fortes pessoais e profissionais; o que eu posso aprender com eles? Ser cooperante é uma capacitação de duas vias, aprender e ser transformado pelas pessoas que você pretende ajudar. Nada é previsível durante um trabalho como este.

Eu descobri que a comunicação entre diferentes culturas requer um grande senso de humor. Em vez de apontar o que a equipe não está fazendo de certo ou o que eles precisam fazer, eu sempre digo 'eu estou tendo um problema e não sei como resolvê-lo.’ Isso me mostrou que eu posso esperar bons resultados, porque as pessoas tendem a serem mais receptivas à informação quando ouvimos como um pedido e não uma exigência. Eu sempre afirmo que eles são parte da equipe. Eu deixo as pessoas saberem que elas são necessárias, e acredito na sua capacidade de conseguir resultados.

Ter tempo para ser cooperante no exterior mudou a forma de como vejo o mundo. Gostaria de convidar a todos para passar o tempo que poderem como cooperantes. As recompensas se multiplicam a cada semana, e você faz relacionamentos duradouros. A cooperação certamente lhe permite penetrar em baixo da superfície, e realmente faz você achar que tem um propósito. Não tenha medo da originalidade, do novo pensamento. Madre Teresa disse: "Nós não podemos fazer grandes coisas, mas podemos fazer pequenas coisas com grande amor."

Estou vivo e bem, aprendendo muito, crescendo bastantes e continuo sendo humilde diariamente. Estou muito feliz de poder informar a vocês que as coisas estão bem. A cada minuto do dia, eu penso que sou feliz. Esta foi uma grande oportunidade para mim, ver o coração do Amazonas, a vida no coração da selva, os ricos espíritos da população rural, a vida em outra realidade.

Lincoln Opio

Biografia do Autor:

Lincoln Opio é um cooperante do Serviço Internacional onde está atualmente trabalhando no Estado do Amazonas. Ele trabalha no Programa Estadual de DST/AIDS de Amazonas no município de Eirunepé, onde está se dedicando ao planejamento e desenvolvimento de atividades ligadas à educação de saúde preventiva para crianças, jovens e adolescentes.

Antes disso, ele trabalhou no Fundo Cristão para Crianças em Uganda, trabalhando em questões que envolvem os direitos das crianças, pessoas deslocadas internamente, intervenção de subsistência, captação e gestão de projetos.

Ele é especialista em treinamento e prevenção contra HIV/AIDS e ganhou experiência no monitoramento e avaliação do tratamento de terapia anti-retroviral e programas de prevenção de HIV na Organização de Apoio contra a AIDS (TASO), uma das mais amplamente reconhecidas ONGs de serviço contra o HIV.

Case Study: The Realities in the Interior of the State of Amazonas by development worker Mirriah Vitale

Maria do Socorro dos Santos (name changed for privacy reasons) is 22 years of age, married, and a mother of a two-year-old daughter. She lives in the municipality of Itapiranga and become pregnant with her second child in October 2007. She started prenatal care at the local health post by her house. She continued her prenatal care visits, but did not ask for an HIV test due to the lack of materials and the lack of trained health professionals in her municipality. When she was in her 8th month of pregnancy, her husband and she moved to the nearby municipality of Itacoatiara because Maria’s mother lives there. When her water broke in July 2008, she went to the hospital in the municipality of Itacoatiara for the delivery. This hospital has the Project Nascer which is a public service to prevent, diagnosis, and treat the mother-to-child transmission of HIV and syphilis. It is the hospital’s routine to offer the rapid HIV testing exam to all pregnant women who have are in labour that have not had two previous HIV tests during prenatal care visits. However, as it was not possible to offer her the test during at the time of birth of her son, she asked for a test for her son afterwards the birth. The test came back positive. She received counselling on HIV and how to avoid the possible transmission of the HIV. Her son started to take AZT for newborn babies that may have been exposed to HIV. It should be noted that newborn babies may test positive for HIV, but they may be the HIV antibodies of the mother. At the 18th month, a baby will have developed its own immune system and further testing will determine if the child has HIV or if they were the mother’s HIV antibodies.

Maria and her husband were directed to the local Voluntary Testing and Counseling Centre in Itacoatiara where they both were offered and realised HIV testing. Both of them tested positive. The three of them were informed about the specialized services for HIV management at the Tropical Medicine Hospital of Amazonas in the nearby city of Manaus.

This case study highlights very well the realities in the interior of the State of Amazonas and the impacts of having Voluntary Testing and Counselling Services to test for HIV and to counselling services.

Carnival in Brazil is a time for celebration and fun. It is also a time of excesses and increased risky sexual behavior. The Brazilian National STI/Aids Programme theme for 2009 year’s carnival campaign was “Sex does not have any Age, nor does Prevention” targeting men and women above 50 years of age. However, since the population of Eirunepé has more adolescents and young people than older people, the theme was applied without being age specific and to include all age groups.

The STI/Aids Municipal Programme of Eirunepé campaign included the distribution of informational materials and condoms by 26 health professionals and workers including community health agents. The campaign reached almost 10,000 people – a third of the Municipal population – and distributed 10,200 condoms and over 510 information folders.

During the five days celebration, the Carnival STI/HIV/Aids prevention team work for a minimum of six hours per night to reach a wide range of the population, including motor taxi riders, married couples, men who have sex with men, and seasonal sex professionals during Carnival.

“We made a big, big impact on celebrants – people were looking out for us, and asking for us during the event. What was very striking was the number of individuals that returned night after night asking if ‘the people with the condom folders came yet’. Some individuals even asked for the condoms to take for partners. A surprising phenomenon was the number of people showing interest for the feminine condoms (FEMIDOMS),” commented the Municipal STI/HIV/Aids Coordinator of Eirunepé.

Case Study from Lábrea: “First steps on a Long Road” by development worker Elisabeth Wilhelm

Participants applaud – the teachers, Lucanira and Neofran, have just finished their interpretation of how they would act if a 13-year-old girl told them if she thought she was pregnant. The case is quite realistic – since this is approximate age of sexual initiation in Lábrea, in town as well as in the rural area. The teachers, who display their acting skills at this training course on sexual and reproductive health, work in riverside community. They spend eight months away from town teaching in rural schools.

For a visitor to the state of Amazonas, the small town of Lábrea seems distant – three hours flight or five days by boat from the state capital Manaus. On top of this, the municipality of Lábrea consists of 68.223 km² and more than a third of inhabitants, 14.966 people, live in riverside communities, some of them several days by boat from the town of Lábrea. These distances may lead us to believe that STIs are an equally distant problem for the population. However, even if the deficient epidemiological surveillance does not provide reliable data, STIs such as condiloma are frequently referred by doctors and nurses who travel to the rural area of Lábrea, and even one of the cases of AIDS reported in Manaus, states “Lábrea – rural area” instead of an address. Particularly high in the rural area is the incidence of hepatitis B and the additional infection by the hepatitis D virus, both of them mainly sexually transmitted. This form of virulent hepatitis is so endemic in the region that it has been called “Black Fever of Lábrea”.

For 2009, the municipal STI/HIV/Aids coordination has set itself the difficult task of initiating a more systematic preventative action programme in the rural area. Up to now, we took advantage of the hospital boat´s trips to provide condoms and information to this distant population, aware though that the frequency of the trips is insufficient and does not reach the whole population. A part from the distance, other obstacles to sexual and reproductive health education, such as taboos linked to traditional beliefs and gender issues, are also more profound in the rural area.

This participatory course provided its participants, a part from the theoretical knowledge about prevention of STIs and undesired pregnancy, practical tools to work with students, parents and other members of the community and offered a space to discuss their particular difficulties concerning this task. The opportunity was received enthusiastically by the 27 participants, because their job involves much more than teaching children how to read and write and some general culture. The teachers take medicines to their communities, help the families and advise the riverside population on their small and big problems. Coming from town they represent the wider world and can gain the trust of people precisely for this reason due to their relative independence from community life. Youth may feel more at ease to talk about their intimate concerns than with their family and neighbors. For this reason, as well as for the lack of access to information of rural youth, all of the participants confirmed the importance of this type of training for their work. As the teachers left for their new work places, the STI/HIV/AIDS coordination sent, through the municipal secretariat of education 2.300 comic books on STD/HIV/AIDS to the rural schools and 11 flip books on this topic to the coordinators of rural education. These materials were financed by the Big Lottery Fund and will help the teachers transmit what they have learned to their students.

The next step in our task was to train 37 rural community health agents of the rural area in sexual and reproductive health and to organize a system of condom distribution through them. This way we hope to provide the means for prevention to this low-income population, and provide support to the teachers in their task of promoting preventative behavior, integrating the intervention of the health care and education sectors.

Materials for prevention are still far from sufficient, and to change people’s behavior, the professionals have a long way to go. However, the success of these first initiatives has raised our optimism that prevention is beginning to penetrate the depths of the Amazonian rain forest.

Alex Dolzan Joins the State STI/Aids Programme and the Municipality of Benjamin Constant

In March 2009, Alex Dolzan started to work with the State STI/Aids Programme of the State of Amazonas in the municipality of Benjamin Constant.

Alex will work with the State STI/Aids programme and the municipality of Benjamin Constant to strengthen its technical and programmatic capacities in the implementation of Brazilian public policies on STI/HIV/Aids.

Alex is from the city of Ibirama that is located in the southern Brazilian state of Santa Catarina.

In 2007, Alex worked in African country of Malawi with the Institute for International Cooperation and Development that is based in the USA where he worked in the area of HIV/Aids. He trained peer educators, assisted to organise prevention and awareness-raising campaigns, contributed to the production of informational materials, and facilitated trainings of local health professionals and workers.

When Alex was asked why he decided to take the post of work in Benjamin Constant, he replied with the following statement. “After receiving my degree in publicity, I decided that I wanted to explore the world and fight to make the world better. Thus, I embarked on a trip of no return as I entered the world of humanitarian work. At first, I had difficulties to identify with this type of work, until I participated in a training programme in the United States. Afterwards, I placed my feet in Africa to know that this is what I was looking for. My time and work in Africa was challenging, but at the same time very exciting and rewarding. Now in Brazil, I am working once again to fight for the marginalized and vulnerable populations in the city of Benjamin Constant that is located in the interior of the State of Amazonas. Even though I am a Brazilian, the city of Benjamin Constant is extremely different then where I am from in the south of Brazil and from what I knew about my country. It is a beautiful place that stimulates me to fight for a better world.”

International Service Participates in the 17th International AIDS Conference and the Third Technical Meeting of Experts

Last year (August 2008) marked the first time that the International AIDS Society held its biannual International AIDS Conference in the Latin American region that coincided with the Third Technical Meeting from the Latin American and Caribbean region on the Integration of Disability and HIV/AIDS.

International Service project manager, George Truckenbrod who is based in the city of Manaus, Brazil, participated in both events to share lessons learned and best practices from Brazil and Latin America, learn about new approaches and critical themes, and to build up contacts with key actors in the region.

Approximately 23,000 people working in different areas and aspects of HIV/AIDS met in Mexico City in August 2008 to discuss, share, analyse, and to strengthen the responses to this global pandemic at all levels.

Emerging themes included the critical importance of monitoring and evaluation strategies by governmental and civil society to ensure that STI/HIV/AIDS services are reaching vulnerable populations, that the policy makers are fulfilling both national and international commitments, and that good governance practices and accessibility to this information are prioritised.

Another key issue is the debate around strengthening health systems in general especially at the basic or local levels and a focus to strengthen health systems that are more disease specific i.e. STI/AIDS (sexually transmitted infections and AIDS). George Truckenbrod was able to share his experiences from an International Service project based in the State of Amazonas that is working with state and municipal STI/AIDS programmes to strengthen the responses to STI/HIV/AIDS and sexual and reproductive heath in the interior of this vast state that covers part of the Amazon rainforest. The project is working to mainstream STI/HIV/AIDS into other municipal programmes that are administered by the municipal education, health and social services departments and to advocate for the inclusion and the participation of civil society groups in all processes. Thus, International Service and its partner organisations are working to strengthen both to strengthen the response to STI/HIV/AIDS and to strengthen the primary level health and other governmental health services.

The third issue that is of particular interest to International Service is the inclusion of disabled people into STI/HIV/AIDS programmes and projects. The World Health Organisation estimates that approximately 10% of the world’s population live with one type of disability or impairment; however, disabled people are often excluded, they do not know their sexual and reproductive rights and have difficulties to access and use sexual and reproductive and STI/HIV/AIDS services. Through the participation in 3 sessions focused on disability and STI/HIV/AIDS, information was shared and contacts were established with people and organisations that are working in this critical area. International Service Brazil and its partners can integrate the knowledge into its activities on disability and STI/HIV/AIDS that have included the First Forum on Disability and STI/AIDS that was facilitated during the STI/AIDS Prevention Congress in Florianopolis, various meetings, and the development of strategies by International Service and its partners on how to mainstream disability and include disabled people in public STI/AIDS policies.

Previous to the World AIDS Conference, George participated in a two-day meeting to share, discuss, and to strengthen public STI/HIV/AIDS policies through the inclusion of disabled people and disabled people organisations. During the first day, experiences were shared including the First Forum on Disability and STI/AIDS in Brazil. During the second day, various people presented their work including George, who presented International Service Brazil’s approach and methodology to mainstream disabled people into rights-based development and inclusive projects and programmes. The results of this meeting included the following:

•    The development and dissemination of informational, educational and communication materials on STI/HIV/AIDS and sexual and reproductive health that are accessible by disabled people;
•    The development of monitoring and evaluation strategies and tools to monitor public STI/AIDS policies in relation to disabled people; and
•    Greater networking and knowledge sharing to key stakeholders.

The participants of this meeting participated in the First International March and Rally for Inclusion that preceded the opening of the World AIDS Conference.

For more information, please visit our websites at www.aidsamazonas.org.br, www.isbrasil.org.br, and www.internationalservice.org.uk

Leonardo Scalcione Starts to Work with the State of Amazonas STI/HIV/AIDS Programme

Leonardo Scalcione started to work with the State of Amazonas STI/HIV/AIDS Programme in the month of April and will work in the areas to strengthen the state programme’s planning, monitoring, and evaluation capacities and systems.

Leo Scalcione is an Italian Australian professional social worker with over 14 years post qualifying experience in social work practice, having worked in Statutory (Social Services), Health, Education and Voluntary sectors and across most service user groups, including vulnerable children and families in need and at risk of abuse, adolescents with mental health difficulties, Leaving Care, drug use, non school attendance difficulties and adults living with mental distress/ill health and physical disabilities.

He has predominantly worked in London, but also Romania and Australia. In Romania, Leo worked for a Non Government Organisation (NGO), assisting with developing a Drop In Support Project for homeless teenagers leaving the orphanage system and in developing professional capacity building for the workers, including introducing a case management and review system.

Since 2003, Leo has engaged in social work lecturing and tutoring work and in senior social work practice, including consultation and project development work (e.g. in developing and improving services for parents with Learning Difficulties; developing work protocols and procedures in assessing and supporting destitute people with No Recourse to Public Funds).

Lincoln Opio Starts to Work with the State of Amazonas STI/HIV/AIDS Programme and in the municipality of Eirunepé

Lincoln Opio will work with the State of Amazonas STI/HIV/AIDS Programme and with the municipal government of Eirunepé to strengthen the technical and programmatic capacities of the municipal team in the implementation of Brazilian public policies on STI/HIV/AIDS.

Lincoln Opio is from Uganda and has extensive experience in working with community-based and participatory projects in Uganda focused on sexual and reproductive health and STI/HIV/AIDS.

From 2005 to 2008, he worked as a Field Officer with the AIDS Support Organisation (TASO) Uganda-Gulu Centre in northern Uganda. He worked in the implementation of STI/HIV/AIDS Prevention and Tuberculosis Prevention and Treatment Programmes with a focus on home-based/community model of ARV treatment programmes. This programme included components in home-based rapid HIV testing, counselling, delivery of ARVs at home, monitoring adherence of people living with HIV or AIDS, forming and training peer education groups, a Positive Prevention project, and strengthening community mobilization for co-infection on TB and HIV.

TASO was started in 1987 and is the large indigenous NGO providing HIV/AIDS services in Uganda and Africa.

Before working with the AIDS Support Organisation (TASO) Uganda-Gulu Centre, Lincoln worked with a project in the Masindi District of Uganda called the Bedmot Child and Family Project with a Ugandan NGO for 5 years. Lincoln worked in the areas of project management and administration, fund-raising and resource mobilization, in the training and formation of peer educator groups, implementation of STI/HIV/AIDS prevention activities in the schools, networked with local health and development institutions, and in mainstreaming gender and HIV/AIDS within the organisation.

On the 3rd of April 2008, International Service Brasil and the State of Amazonas STI/HIV/AIDS Programme facilitated a workshop to explore strategies for the inclusion of disabled people into public policies on STI/HIV/AIDS in the State of Amazonas. Approximately 65 people from various institutions including municipal governments in the state of Amazonas, public hospitals in Manaus, disabled people organisations, and civil society organisations that are working in the area of STI/HIV/AIDS and sexual and reproductive health and rights.

The meeting’s aim was to bring together various governmental and civil society actors working in the area of STI/HIV/AIDS and with disabled people to increase the social inclusion of disabled people, to develop contacts and networks amongst the participants, and to explore issues and strategies to integrate disabled people into STI/HIV/AIDS and sexual and reproductive health activities and projects in the State of Amazonas.

Presentations from International Service Brazil on its programmes in the State of Amazonas, the State of Amazonas STI/HIV/AIDS Programme and its activities, FENEIS-Amazonas on “Communication and Access for the Deaf Community”, International Service Brazil on “The Inclusion of Disabled People in Public Policies and Actions in Development”, and from the CVI-Amazonas on the roles and the social inclusion of disabled people.

On a much smaller scale than the world’s famous Carnival in Rio – and with much more limited resources – Carnival in this small town in the State of Amazonas is organized by neighborhood clubs, called “blocos”. In each part of the town, these clubs prepare their costumes and choreographies for the parade during the days preceding the festival. The municipal STI/HIV/AIDS team took advantage of this preparation time to get in touch with the clubs and to facilitate STI/HIV/AIDS prevention talks.

Most of the participants of the carnival “blocos” were teenagers and youth. Being new in town, Elisabeth expressed her concern, entering the first club “Do you think it’s all right, if the children assist the talk?” The local nurse replied: “About half of them did their check-ups during pregnancy with me.” One must remember that sexual initiation is extremely early and there’s a high incidence of teenage pregnancy. The talks were very well received by both the youth and the older members of the clubs and stimulated further contact with youth groups from different neighborhoods.

The day of the parade, the team was busy distributing condoms and informative pamphlets with basic information about prevention of HIV/AIDS, STIs, correct condom use and information, condom distribution and testing points in town. Again it was teenagers who picked up most condoms and pamphlets. The carnival clubs themselves also took part in spreading the message during the campaign. Some girls disguised as nurses and distributed condoms and pamphlets and there was a special act by “Little Red Riding Hood”, also distributing condoms. Not quite what one sees on television about Brazilian Carnival, but certainly fun to be part of?

The municipal STI/HIV/AIDS programme of Labrea and the State of Amazonas STI/HIV/AIDS Programme working in partnership with International Service have integrated the development worker, Elisabeth Wilhelm, as a member of the municipal and state STI/HIV/AIDS programmes.

Elisabeth Wilhelm graduated with a degree in social work from Valencia, Spain. She has a specialisation in addictions issues. She has over five years of experience in HIV prevention in Spain as a health educator for the NGO Comité Anti-SIDA de Valencia. The focus of her work included working in a harm reduction project with intravenous drug users, assisting with HIV/AIDS prevention work in schools, and supporting people living with HIV. She gained valuable experience in project planning, monitoring and evaluation, and research during this experience.

Elisabeth also worked as a volunteer with Medicos del Mundo Valencia with condom distribution programmes, counselling, sexual and reproductive health workshops with immigrant sex professionals, outreach work with intravenous drug users, campaigns, and volunteer management.

She spent a year in Kazakhstan as a volunteer social work advisor. Elisabeth worked in the areas of staff training on social and preventative approaches and in the orientation of primary health care; in the training youth peer educators in sexual and reproductive health; and in drug abuse prevention.

On the 6th of March 2008, a Youth Congress took place in Lábrea, promoted by the State Secretary of Youth, Education and Leisure Affairs. Around 400 young people from the city’s different youth groups, schools, churches and other institutions were given the opportunity to be heard.

The young people were divided into groups of interest, such as: education, drug abuse, environment and other issues. Two members of the municipal STI/HIV/AIDS team co-facilitated the group discussion on sexuality.

First of all, youth defined the current problems, such as insufficient sexual education, lack of dialogue in the families, lack of participation by youth and child abuse. Secondly, they proposed and transformed these ideas into concrete proposals. Some of their proposals were:

* to include sexual education in the school curricula as a subject, rather than mainstreaming it;
* to intensify informational campaigns in schools and extend them to youth clubs, to train parents on sexuality and on how to talk to their children about it and to create and distribute appropriate educational material for youth on sexuality and related issues.

The meeting was a good example of bottom-up democratic processes and of giving young people a say in decisions that affect them.

On the 6th and 7th of March 2008, Lábrea celebrated 122 years since rubber planters and adventurers founded the town. There were shows of local artists, the election of “Miss Lábrea,” and popular groups from Recife and Manaus were invited.

Festivals are always moments when the population becomes more vulnerable to risk behavior, and they also provide a good opportunity to reach a broad public and spread the message for STI/HIV/AIDS prevention. The municipal STI/HIV/AIDS team hired a local artist to prepare three banners on HIV testing and condom use, the right to sexual diversity, and the final one reminding people of The International Day of Women – the 8th of March. The star of our campaign, though, was a 2-meter-high cartoon Styrofoam condom that greeted people approaching our stand.

Equally successful was the participation of a local dance group – six young people performing to rap music with a preventative message and wearing the campaign’s T-shirts.

1.940 condoms were distributed during the campaign. “Only one?” – “Yes, sorry, but your partner can pick up one too”. Women are still rather shy when it comes to fetching condoms with the greatest demand being among male adolescents. 191 people participated in demonstrations of correct condom use, most of them adolescents and women. They also showed great interest in a female condom exhibited at our stand, which most people had never seen before. Not only youth benefited from the campaign. One middle-aged man thanked the team “My wife didn’t know how to put on a condom – until you showed her.”

The municipal STI/HIV/AIDS programme of Itacoatiara working with the support of International Service’s development worker Mirriah Vitale recently launched a series of activities on STI/HIV/AIDS awareness for World AIDS Day.

A week before World AIDS Day, the municipal team began their campaigning activities in local health posts, the hospital and schools with distribution of condoms and informative materials, and prevention workshops.

On World AIDS Day, the activities included the first Parade on Sexual Diversity in Itacoatiara, sporting events for adolescents, including a 5K run and football, handball and volleyball tournaments, and distribution of condoms and informational pamphlets on STI/HIV/AIDS and voluntary testing and counselling services in Itacoatiara.

Manaus-based Programa Expressão, an extreme sports filming company, filmed Itacoatiara’s World AIDS Day events for advertising on a local television station. The focus of these activities was pregnant mothers, young men and women, and members of the Gay, Lesbian, Bisexual and Trans Community.

Mirriah Vitale has been working with the municipal STI/HIV/AIDS programme of Itacoatiara and the State of Amazonas STI/HIV/AIDS programme since early 2006.

“I (Mirriah Vitale) have been working in Itacoatiara for a little over a year, in partnership with the municipal STI/HIV/AIDS programme. We are a team of five, and together we are responsible for all prevention, diagnostics, and treatment of STIs and AIDS in the municipality. Itacoatiara is one of the largest municipalities in Amazonas, with a population between 85,000 and 100,000 residents. Although the majority are city or village dwellers, others reside in small communities along the river. Some travel four or five hours to access health services, complicating consistent condom use and antenatal examinations for pregnant women.”

It is common in most of the state of Amazonas for health professionals to oversee more than one programme or position, and this is true within the municipal STI/HIV/AIDS programme, where all team members are only available part time to concentrate on programme activities. Every afternoon, the Voluntary Testing and Counselling Centre (VTC) is open to the public for HIV rapid testing.

About 15 patients are tested daily, 85% of them are pregnant women. Recently, two of the ‘polo’ municipalities began sending blood samples to Itacoatiara for HIV testing, which increased monthly tests to about 300. Decentralization of rapid testing kits to the two larger villages in the municipality is in the plans for early 2008.

“My role as a development worker has been in a bit of everything. Because we are such a small team, with a large population to target, each member takes on as many roles as possible. I’ve focused the majority of my work in the area of organizational development; working on the details that are often left behind in the daily rush. Be it compiling data, planning campaigns, sending out monitoring sheets, or writing reports, these little things have made a world of difference here and opened our eyes to our limitations and possibilities.”

Before arriving in Brazil, Mirriah Vitale spent 10 months as a reproductive health coordinator for a grassroots organization in rural Ghana. The Ghana Health and Education Initiative was in its beginning stages when I arrived, focusing its objectives on developing sustainable, culturally appropriate programmes on STIs, HIV/AIDS, and teenage pregnancy.

I worked with a local programme manager to develop and implement adult and adolescent peer education programs. We used local media to communicate HIV prevention messages to villagers and youth peer educators traveled from school to school giving talks on teenage pregnancy and disease prevention. This was my first experience in putting my formal education into practice, and through it I learned how much I love working on community development projects.

From rural Ghana Mirriah Vitale was transported straight into the World Health Organization (WHO) in Geneva, where she volunteered with the family planning department for a few months. Although it was a true culture shock, the opportunity to see the WHO from the inside was remarkable. Mirriah participated in various international conferences on family planning issues and saw how the public health system works from the top down. It was an excellent opportunity for her to compare her experiences in Ghana to the international strategies put forth by the WHO.