Cuban women inform communities about HIV

Prevention of sexually transmitted infections (STIs), including HIV, the AIDS virus, has become the center of the lives of a small group of women in the province of Pinar del Río, in the west of Cuba. Coordinated by the Women's Project in the Provincial Center for Prevention of STIs and HIV/AIDS, they design educational strategies for villages and towns in the province, and advise the activists who promote responsible sexual behavior among the local population. "Our work is to explain all the problems related to AIDS and STI prevention, and also how women can become health promoters in their homes and neighborhoods," Martha Bermúdez, one of the 10 women making up the team of experts, tells IPS. "One of our main commitments is to take this message home with us. We have to talk to our children and their friends when they get together in our houses, but also to our neighbors and other community members, not just to the young people," she says. Bermúdez, 62, is also the provincial coordinator for the University for Older Adults, a government educational program that runs about 900 centers on this Caribbean island, where 16.2 percent of the population is over 60. To talk about prevention, almost any place will do: a village, tobacco factory, university or temporary detention center for sex workers. The aim is for the women "to feel comfortable in the learning environment, so we promote a family atmosphere," says psychologist Gilma Gómez, the project coordinator. The idea is not to transfer pre-packaged knowledge, but to stimulate a debate "on what women want and need to know about their situation with respect to HIV, as sexual beings and as educational agents transmitting information to other generations, using completely participative methods." "Women in our province have a high level of knowledge about the nature of HIV and AIDS, and the main STIs, but they are not aware of specific factors that make them vulnerable and put them at risk of contracting the virus, as women," Gómez says. In Pinar del Río, as in the rest of Cuba, most HIV-positive people are men, although in this province the proportion of HIV-positive people who are women, 29.2 percent, is higher than in the rest of the country, where 19 percent are women. "We are afraid that the epidemic will become increasingly feminised," she says. This concern is based on the fact that some men who have sex with men also occasionally have sex with women. In addition, traditional gender relations "magnify the psychosocial vulnerability of women," she adds. "The inequality in communication between spouses, women's low perception of risk -- having a live-in partner gives them a sense of security -- , 'machismo' which determines that the man rules over sexual relations, and women's conditioning to be submissive and obedient, are factors that put women in Pinar at a disadvantage with respect to HIV," Gómez says. As of October 2007, there were 7,739 people living with HIV in Cuba, of whom 1,855 had full-blown AIDS, according to Health Ministry statistics. The 2007 AIDS Epidemic Update published in December by the Joint United Nations Program on HIV/AIDS put the number of HIV-positive people worldwide at around 33.2 million. Of this total, 2.5 million were under 15 years of age. Of the 30.8 million infected adults, half (15.4 million) were women, a considerably higher proportion than that found in Cuba. "The proportions of women living with HIV in Latin America, Asia and Eastern Europe are slowly growing, as HIV is transmitted to the female partners of men who are likely to have been infected through injecting drug use, or during unprotected paid sex or sex with other men," the report says. "When the virus affects women, it exacts a high price," says Gómez. If AIDS is brought into a home by a man there is a great emotional cost, but it is even worse if the woman is infected, because in many cases it results in "violence, rejection by the family and even the break-up of the family." The prevention program aims, therefore, at raising women's awareness of the risk, visualizing the factors that make them vulnerable, and developing social skills that enable them to communicate better with their male partners, in order to negotiate things like condom use. "We are working for healthier women, physically and psychologically, with higher self-esteem, who recognize their valuable role not only in looking after their own health, but also in sex education for their children and relatives," says Gómez. In a predominantly rural province, where people are strongly attached to their traditions, open discussion about sexuality is often hindered by prejudice, Bermúdez acknowledges, especially "among older women, who are surprised by the use of certain terms to refer to the sex organs and the condom, for example." In spite of the hurdles, Bermúdez is happy in her work. "Whenever I leave one of my educational meetings I feel spiritually at peace, because I have contributed to education, health and social development," she says. "I think I am doing work that is very human, necessary and just," she says.