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Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Pan American Health Organization August 1, 2003; Rev. 3/23/04 Approved as Consensus Document In addition to the 42 million people in the world living with HIV/AIDS in 2002, UNAIDS also estimates that there were 5 million new HIV infections and 3.1 million people died due to HIV/AIDS. They wrote, “the epidemic continues to shift into marginalized populations that lack access to the services and information they need to protect themselves against HIV/AIDS.” They label the AIDS epidemic as a global humanitarian crisis. Nurses are a significant component of the available health work force. The care provided by nursing and midwifery personnel is essential to the prevention and control of HIV infection and the care for persons living with and affected by HIV. It is important that an organized plan be developed to strengthen and mobilize nurses and midwives to contribute to the prevention and control of HIV/AIDS. This document briefly outlines five areas identified as important to strengthening nursing and midwifery services for HIV/AIDS prevention, control, and care. It is a document originally endorsed by the WHO/PAHO Nursing and Midwifery Collaborating Centers and proposes five priorities areas that will support prevention and enhance the quality of care for people living with and affected by HIV/AIDS. The Global Network of WHO Nursing Collaborating Centers subsequently endorsed this document. Individual work plans reflecting the needs in the Regions of WHO will be developed for each of these areas. 1) Understanding of the social and political context of HIV disease and the impact of disclosure on stigma and discrimination. Growing evidence has demonstrated that fear of disclosure, stigma, and discrimination are having significant impact upon people and families living with HIV/AIDS as well as their care providers. Nurses must be equipped with the knowledge and skills to understand stigma and help themselves and their patients work through these negative experiences. Stigma and discrimination impact clients ability to participate in health care, take medications, keep appointments, etc. Stigma also impacts the decision of some nurses to leave the nursing work force because of the discrimination and fear they experience. Stigma also contributes to sustaining gender discrimination. Poverty has been documented to significantly contribute to poor health and must be considered a significant factor in understanding the social context of HIV/AIDS care (Millennium Development Goals, 2003, UNDP). 2) Enhancing models of nursing care and nursing service administration for different settings including health promotion and disease prevention in outpatient, hospital, home, and palliative care including hospice care settings. Nursing has demonstrated excellence in developing a social model of HIV/AIDS care that is interdisciplinary and requires community-level support. There is significant knowledge available on Page 1 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control how to deliver effective AIDS care across different settings and for different groups of patients. The administration of care is a specific nursing function and places nursing at the center of organizing prevention and care services to meet the needs of individuals, families and communities. 3) Supporting quality of life for people living with and affected by HIV/AIDS, including symptom management, adherence to treatment modalities, and prevention for positives. HIV is now viewed as a chronic condition and requires long-term management strategies to be effective. Lifetime medication adherence is a tremendous challenge to patients and their families. Keeping appointments and following treatment modalities are extremely challenging, particularly when resources are limited. Living well with HIV includes a greater understanding of symptom management and control due to the devastating effects of physiological and psychological symptoms experienced by people due to the disease, medications, treatments, and stigma. As people with HIV feel better taking antiretroviral medications, they are challenged to develop safe sex practices to prevent themselves from re-infection, perhaps with a resistant strain, and to stop the potential spread of the virus to others. Treatment modalities include antiretrovirals, prophylaxis for opportunistic infections, prevention of vertical transmission, and counseling and testing. 4) Providing leadership training and capacity building in order to ensure that nursing expertise helps to guide the development of HIV care services and policies at the local and national levels. At a recent regional consultation on “Enhancement of Nursing and Midwifery Contribution to National HIV/AIDS, TB, and Malaria Programmes” (Bangkok, Thailand, August 10-23 2002) representatives gathered from all member states of the SEARO region of WHO. One outcome of this meeting was that no country-member of WPRO WHO could identify one nurse in any leadership or policy position related to the country-level, national AIDS Control program. This situation is not unique to the WPRO region. Strategies must be developed and implemented to ensure that nursing is represented at the highest decision-making levels related to policies on prevention and care for people living with HIV/AIDS. 5) Training of a qualified nursing and midwifery work force. An excellent example of the required knowledge base for a nursing work force qualified to work in HIV/AIDS care is presented by the Association of Nurses in AIDS Care (ANAC) core curriculum for HIV/AIDS nursing. This core curriculum outlines ten major content areas (see Table 1). This curricular outline provides a sense of the broad knowledge required for effective HIV/AIDS nursing care. In addition to the content or knowledge base required, experiential clinical training through residencies or fellowships are also required to provide the necessary skill level for enhancing clinical decision-making and the delivery of qualified nursing HIV/AIDS care. Page 2 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Table 1. ANAC’s Core Curriculum for HIV/AIDS Nursing (Kirton, 2003) 1. HIV Infection, Transmission, and Prevention 2. Clinical Management of the HIV-Infected Adolescent and Adult 3. Symptomatic Conditions in Advanced Disease AIDS Indicator Diseases 4. Symptom Management of the HIV-Infected Adolescent and Adult 5. Psychosocial Concerns of the HIV-Infected Adolescent and Adult and their Significant Others. 6. Concerns of Special Populations 7. Clinical Management of the HIV-Infected Infant and Child 8. Nursing Management Issues a) Case Management b) Ethical and Legal Concerns 9. Prevention Transmission of HIV in Patient Care Settings 10. Home, palliative and hospice care. (Not part of ANAC) 11. Working in interdisciplinary teams (Not part of ANAC) 12. Midwifery services related to HIV/AIDS care. Page 3 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control HIV/AIDS Ongoing Work by PAHO WHO Nursing Collaborating Centers March 23, 2004 University of Alabama at Birmingham, USA WHO Collaborating Centre for International Nursing Dr Joe Burrage – research program in family & community supports for HIV patients/families and HIV related stigma. firstname.lastname@example.org. Dr Jane Castle- research in palliative and end-of-life care; email@example.com. Dr Pamela Fordham – developing on-line masters program in Palliative Care; leadership in home and hospice care; firstname.lastname@example.org. Dr Lynda Harrison, Fulbright Scholar working at Catholic University of Chile 2003-04, re: research methodologies. Fluent in Spanish; email@example.com. Dr Jill Ross – former Peace Corp volunteer. Fluent in Spanish; current research prevention of unwanted pregnancies and control of spread of HIV; firstname.lastname@example.org. Dr Barbara Smith –current research related to physical activity and interventions for lipodystrophy in persons with HIV/AIDS. Dr Barbara Woodring –Materials-development for the education of nurses and children/families affected by HIV/AIDS; email@example.com University of Alberta, CANADA PAHO/WHO Collaboration Centre for Nursing and Mental Health Title: Support for Persons with AIDS and their Family Members in Sub-Saharan Africa. Details: April 2003 March 2004, Dr Judy Mill, Co-Investigator Funding Source: CIHR Global Health Research Program Development and Planning Grants Title: The Diagnosis and Care of HIV Infection in Aboriginal Youth Details: October 2002 September 2004, Dr Judy Mill, Principal Investigator Funding Source: CIHR. Title: The Influence of Stigma on Access to Health Services by Persons with HIV Details: December 2002 November 2004, Dr. Judy Mill, Principal Investigator Funding Source: CIHR. Page 4 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control University of Alberta, CANADA (cont.) Title: Challenging Lifestyles: Aboriginal Men and Women Living with HIV Details: September 2002 August 2004, Dr. Judy Mill, Principal Investigator Funding Source: Health Canada. Title: Ghanaian Student Nurses' Knowledge and Attitudes about HIV Illness Details: February 2001 August 2002, Dr. Judy Mill, Principal Investigator University of California, San Francisco, USA WHO Collaborating Center for Research and Clinical Training in Nursing. Dr. Bill Holzemer, Adherence, Symptom Management, Stigma and HIV/AIDS. firstname.lastname@example.org Botswana, Lesotho, Malawi, South Africa, Swaziland, Tanzania, Dr. Carmen Portillo, Adherence, Symptom Management, Hispanic women; I-TECH: International Training with HRSA; Mexico, Puerto Rico email@example.com Dr. Carol Dawson Rose, adherence, providers, PAETC: Pacific AIDS Education Training Center,firstname.lastname@example.org UCSF Affiliates: Dr. Adey Nyamathi, Co-director, UCLA AIDS International Training & Research Program. (UCSF Center Affiliate) email@example.com Dr. Marta Rivero, University of Puerto Rico, Health Disparities & HIV/AIDS.firstname.lastname@example.org Columbia University, USA WHO Collaborating Center for the Development of Innovative Methodologies in the Teaching-Learning in PHC Dr. Joyce Anastasi, home-based palliative care, traditional/alternative therapy for symptom management, and monitoring community-based interventions. email@example.com George Mason University, USA WHO Collaborating Centre for Health Policy, Health Care Ethics, Health Systems Management, Nursing Administration, and Post Graduate Health Science Dr. Loretta Normile, tool kit for mental health assessment and HIV counseling. Contact: Rita M. Carty, DNSC, RN, FAAN George Mason University firstname.lastname@example.org Page 5 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control University of Illinois at Chicago, USA WHO Collaborating Centre for International Nursing Development in PHC Dr. Beverly McElmurry, Dr. Rosina Cianelli and Ms. Lillian Ferrer, HIV/AIDS prevention training in Chile. email@example.com firstname.lastname@example.org email@example.com Dr. Carol Christiansen, Swaziland Rural Health HIV/AIDS initiative; Mobilization of nurses for HIV/AIDS response in China. firstname.lastname@example.org Dr. Beverly McElmurry, Co-director, AIDS International Training Research Program, Chile, Malawi, & Indonesia. email@example.com Dr. Kathleen Norr, Mobilizing health workers for HIV prevention in Malawi. firstname.lastname@example.org Dr. Barbara Dancy, African-American mother/daughter HIV risk reduction intervention. email@example.com Lucy Marion, PhD, RN, STD Prevention for At-Risk African American Women. firstname.lastname@example.org UIC HIV/AIDS INITIATIVE DESCRIPTIONS Title: Mobilizing health workers for HIV prevention in Malawi Investigators: University of Illinois at Chicago Team: K.F. Norr, PhD; K. Crittenden, PhD.; B. Dancy, PhD RN; L. McCreary. PhD RN; J.L. Norr, PhD Kamuzu College of Nursing, U. of Malawi: C.P.N. Kaponda, PhD RN; S. Kachingwe, MS, RN; D. Jere, MS, RN; M. Mbeba MS, RN; U. Kafulafula, MS, RN. Objectives: To test a primary health care model to mobilize health workers as leaders for peer group HIV prevention intervention in rural communities in Malawi, Africa. The six- session peer group intervention for community members has been demonstrated to be effective in changing behaviors for women in Botswana (Norr, et al, 1994) and for primary school teachers in Malawi (Kaponda, et al, 2002). This intervention is being expanded to include sessions specifically for health workers regarding universal precautions and how to work with clients around issues of HIV prevention, testing, and living with HIV/AIDS. Method: This quasi-experimental research takes place in two districts (intervention and control) in Malawi, at the district hospital, 2-3 rural health clinics, and their surrounding communities. The intervention is being implemented in four phases using a train-the- trainers model: 1) the research team trains district hospital workers as HIV prevention peer group leaders; 2) district health workers train rural clinic workers and other community leaders; 3) community trained peer leaders offer the intervention for rural adults; and 4) the researchers and community adapt and offer the intervention for adolescents ages 10-17. A process evaluation documents the fidelity of the intervention. Outcomes to be evaluated at baseline, mid-intervention, and post-intervention include a) health workers’ occupational HIV prevention behaviors, use of teachable moments to promote HIV prevention, and sensitivity in interactions with persons living with HIV/AIDS; b) health workers’ personal HIV risk behaviors; and c) HIV prevention behaviors of rural adults and adolescents. Page 6 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: Mobilizing health workers for HIV prevention in Malawi (cont.) Results: (to date): Formative evaluation using interviews and focus groups has documented that health workers in Malawi urgently need HIV prevention interventions to reduce their exposure to HIV infection both from occupational risk and from personal risky behaviors. Rural adults and adolescents also engage in risky behaviors and express great interest in having an HIV prevention intervention in their own communities. Accomplishments to date include: Modification of the six-session community intervention for rural residents. Development of four new sessions especially for health workers; Completion of baseline assessments. Development of an observation form to assess health workers’ occupational behaviors. Development of an observation form for process evaluation. Completion of the training of 50 peer group leaders at the district hospital. Conclusions: (to date): This intervention takes advantage of the existing primary health care system and the leadership potential of health workers. Health workers have high potential to be effective community leaders for AIDS prevention because they have extensive community contact, and they are respected and trusted health advisors. The training is based on social-cognitive learning and builds specific skills and self-efficacy, strategies that have been shown to be effective in changing attitudes and behaviors. If this intervention is effective in mobilizing health workers to be AIDS prevention leaders in rural communities, it will be a cost-effective approach to scaling-up HIV prevention interventions to reach rural communities and a model of change for the region. Funding Source: National Institute for Nursing Research, World AIDS Foundation 10/01 to 7/06. Keywords: HIV prevention, peer group intervention, primary health care, Malawi References Cited: Kaponda, C.P.N., et al. (2002, July). Impacts of a peer group intervention on HIV attitudes, knowledge and behaviors for primary school teachers in Malawi. XIV International AIDS Conference, Abstracts. Norr, K.F., Moeti, M., Tlou, S.D., & McElmurry, B.E. (1994). Safer Sex Increases after Peer Education for Women in Botswana. X International Conference on AIDS, Abstracts. Preparing Traditional Birth Attendants for HIV Prevention in Malawi, [pilot study within: Building AIDS Research Through UIC AITRP in Malawi, NIH: National Center for Complementary and Alternative Medicine (NCCAM), ($1,343,743), C.Kaponda PI (University of Malawi)] G.B.Keeney, Primary Investigator (20%), 2004-2007 Page 7 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control UIC HIV/AIDS INITIATIVE DESCRIPTIONS (cont.) Title: Mother/Daughter HIV Risk Reduction Intervention Investigators: Barbara L. Dancy, Principal Investigator, Kathleen Crittenden, Susan Levy, Sally Freels, Marie Talashek, and Bonnie Breitmayer Background: Though HIV risk reduction interventions delivered by health experts have generally proven successful, their success has not significantly reduced the impact of the HIV/AIDS epidemic among African American adolescent girls, especially low-income girls from single mother headed homes, who are at high risk for contracting HIV. While several researchers have advocated that active parental involvement may have a more profound effect on HIV risk reduction, they also note that parents have inadequate skills to assist their adolescents. Few programs have tested the effectiveness of preparing mothers with the knowledge and skills needed to assist their daughters to develop HIV risk reduction behavior. Objectives: The specific aim is to examine systematically over a two-year period the effectiveness of the Mother/Daughter HIV Risk Reduction Intervention in increasing daughter’s self-reported HIV risk reduction behavior: delay of sexual activity and if sexually active, either refrain from sex or consistently use condoms and have fewer sex partners Methods: A split-plot repeated measures design is used to compare the treatment intervention, the Mother/Daughter HIV Risk Reduction Intervention (MDRR), with two control groups: the Health Expert HIV Risk Reduction Intervention (HERR) and the Mother/Daughter Health Promotion Intervention (MDHP). Guided by the African American Daughter HIV Risk Reduction conceptual framework that is based on social cognitive theory, theory of reasoned action, womanist theory, black feminist thought, black feminist, Africana womanism, and bioecological development theory, the research utilizes a convenience sample of low-income inner city adolescent females who range in age from 11-14: 184 mother/daughter pairs in MDRR, 184 mother/daughter pairs in MDHP, and 184 daughters in HERR. The interventions have been randomly assigned to one of three demographically similar but geographically distinct study settings. The adolescents’ mothers deliver the content in MDRR and MDHP and the research staff delivers the content in HERR. The content for MDRR and HERR focuses on HIV risk reduction skills while the content for MDHP focuses on nutrition and exercise. Mothers receive intensive group training from the research staff before they teach in a group setting the content to their daughters. Mother/daughter pairs and daughters will be assessed at pre and post intervention and biannually for 24 months. Multiple logistic regression, multiple linear regression, and proportional hazard models will be used to analyze the data. Page 8 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: Mother/Daughter HIV Risk Reduction Intervention (cont.) Results and Conclusions: We are currently collecting data and are beginning the analysis phase. Funding Source: National Institutes of Health, National Institute of Mental Health Key words: Mother/Daughter relationship, HIV risk reduction behavior, sexual behavior, female adolescents Title: STD Prevention for At-Risk African American Women Investigator: Lucy Marion, PhD, RN Funding Source: National Institute of Nursing Research Background: This is a randomized controlled trial to determine the effectiveness of a 12- month intensive, case managed intervention for preventing newly contracted sexually transmitted diseases (STDs) among low income African American women, with a history of repeated STDs. The target group lives on or near the Westside of Chicago, where women are plagued with some of the highest STD rates in the nation. Objectives: The specific aim is to determine the effects of the intervention on (a) the mediating outcomes (STD related social influences, psychological factors, and STD prevention skills and behaviors) and (b) the health status outcome (laboratory-confirmed newly contracted STDs during the course of the intervention). Methods: Low-income African American women, aged 18 years or older, who have a history of STDs, are recruited from the West Side of Chicago. After completing baseline STD testing and psychosocial measures, the women are randomized to control or intervention groups and follow study protocols. Both groups complete baseline, 2 month, 6 month, and 12 month STD testing and psychosocial measures. HIV tests are completed at baseline and 12 months. The intervention includes a 2-month intensive phase, followed by a 10-month maintenance phase. The protocol includes 1) individually tailored STD treatment, teaching, support, and case management by Advanced Practice Nurses (APNs); 2) STD prevention classes led by peer educators; and 3) counseling and referrals provided by a Social Worker. The control group receives usual STD care from community clinics and primary care providers. After completing the final study visit, women in the control group are offered a concentrated intervention, which includes an APN visit and a class led by peer educators. Page 9 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: STD Prevention for At-Risk African American Women (cont.) Benefits: Health care benefits for participants include: learning about STD prevention; free testing for HIV and other STDs; case- managed health care provided by an APN, including complete history and physical; testing, referral and education offered for male partners; and consultation and counseling with a social worker. Other benefits include: CTA fare cards, healthy snacks, male and female condoms, and program key chains and pens. Results: 322 women have entered the study and 197 have either completed the study or are in progress with a 61% overall retention rate. Data analyses will include a variety of statistical methods to determine the effect of the intervention on the main outcome variable, recurring sexually transmitted diseases, as well as the mediating psychosocial variables. Title: HIV/AIDS Issues Among Chilean Women: Cultural Factors and Perception of Risk for HIV/AIDS Acquisition Investigators: R. Cianelli, CNM, MPH, PhD Objectives: The purpose of this research was to explore whether Chilean women relate HIV/AIDS to cultural factors, such as machismo, marianismo, domestic violence, and substance abuse and whether they perceive themselves to be at risk for HIV/AIDS because of these factors. A conceptual framework developed from the literature was used to define and explore these issues. Method: Combined qualitative and quantitative approaches were used with Chilean women from La Pintana County in Santiago, Chile to achieve a better understanding of their perceptions of HIV/AIDS issues. A total of 50 low-income women from 18-49 years old participated in this study. All of the women answered a 42-item questionnaire that allowed the investigator to assess demographic characteristics, HIV/AIDS knowledge, and risk perception. Also, 20 of the 50 participants were interviewed using a semi-structured interview guide that allowed the investigator to explore HIV/AIDS, machismo, marianismo, domestic violence and substance abuse. . Results: The results of this study showed that Chilean women related cultural factors (i.e., machismo, marianismo, domestic violence and substance abuse) to the possibility of acquiring HIV/AIDS. However, they were not taking preventive measures to avoid HIV/AIDS infection. Cultural factors such as machismo and marianismo were promoting behaviors that made the women more vulnerable to HIV and other infectious diseases. For example, male infidelity was mentioned repeatedly. Page 10 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control HIV/AIDS Issues Among Chilean Women: Cultural Factors and Perception of Risk for HIV/AIDS Acquisition (cont.) Results (cont.): Women perceived themselves as passive male complements, with their roles centered within the household and taking care of their children. Participants perceived machismo as a phenomenon present in their daily lives. They recognized male dominance and men having more rights and privileges than women, as a social structure that affects their ability to protect against HIV/AIDS. Domestic violence occurs frequently in the community, and is characterized as male physical, emotional, and sexual aggression toward women. Women associated domestic violence with HIV/AIDS because when they do not want to have sex with their partners, the men will have sex with other women. All participants agreed that illegal drugs are a community issue in La Pintana. They also agreed that female drug users are at risk for HIV because they engage in prostitution to buy drugs. Forty-two percent of the women studied perceived that they were at risk for HIV/AIDS. Age, religion, estimation of number of women infected with HIV, and years of education, were significant predictors of risk perception. Women who believe they are at risk to acquire HIV/AIDS are characterized by: (a) having had some personal experience with HIV/AIDS; (b) perceiving their male partners as the possible vector to become infected with HIV; (c) being aware of the lack of HIV/AIDS knowledge in the community; (d) being interested to receive more information about this disease; and (f) not protecting themselves to avoid HIV infection. Based on this research 2 grant applications were sent to the National Institute of Health. The two awards are pending: 1) “Mobilizing Health Worker for Community HIV prevention in Chile” was submitted to HIV-AIDS and Related Illnesses Research Collaboration Award (AIDS-FIRCA). The Parent Grant of this proposal is “Mobilizing Health Workers for Community HIV Prevention in Malawi” Grant NR08058. 2) “Testing And HIV/AIDS Prevention Intervention for Chilean Women” was submitted in response to RFA TW-03-006 Global Health Research Initiative Program for New Investigator (GRIP), Fogarty International Center. Conclusions: The current study provided a better understanding of the cultural context and its relation to HIV/AIDS among Chilean women. The conceptual framework and the results of this study provided the basis for developing an HIV/AIDS prevention model for Chilean women It shows the essential factors and the relationships among them that must be taken in consideration to develop HIV/AIDS culturally sensitive prevention programs targeted to Chilean women. Funding Source: Fogarty International Center, (Grant # D43 TW01419) Keywords: HIV prevention, Chilean women, cultural factors. Page 11 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control HIV/AIDS Issues Among Chilean Women: Cultural Factors and Perception of Risk for HIV/AIDS Acquisition (cont.) References Cited: Anderson, E. (2000). Self-esteem and optimism in men and women infected with HIV. Nursing Research, 49(5), 262-271. Arcos, E., Molina, I., Repossi, A., Uarac, M., Ritter, P., & Arias, L. (1999). Violencia domestica y sexualidad [Domestic violence and sexuality]. Revista Medica de Chile, 127(11), 1329-1338. CONASIDA (2000). Boletin de Epidemiologia 13[Epidemiology bulletin 13]. Ministerio de Salud de Chile. Retrieved September 20, 2001 from the World Wide Web: http://www.minsal.cl/iniciativas/Conasida/conasida.htm Diaz, X. (1994). Gender and occupational health in Chile. In P. Wijeyaratne, J. Roberts, ,J. Kitts, L. Arsenault (Eds.), Gender, health, and sustainable development: a Latin American perspective (pp. 77-84). Ottawa: International Development Research Centre. Title: Non Governmental Organizations: Communities organizing around HIV/AIDS in Santiago, Chile Investigator: Lilian Ferrer, PhD candidate (Trainee, Fogarty UIC AIDS International Research Training Program)Description: The project aims to describe the process by which HIV/AIDS related NGOs are established and become effective as the result of communities getting organized. The significance is that it will help to recognize, and understand the factors and forces that led to the creation of community-based organizations involved in HIV/AIDS in Santiago, Chile. All these issues are assessed from the perspective of individuals who are currently participating in Vivo Positivo and Corporación Nacional de Prevención de SIDA, both NGOs working in HIV/AIDS. Sample & Methods: The project was conducted in Santiago, Chile, with a data collection period of 3 months, using a mainly qualitative reflexive-dialectic approach that will help in describing, exploring and explaining the Chilean response towards the HIV/AIDS epidemic. The data collection method followed a case study and participatory research techniques and principles, and using 3 qualitative data collection strategies: in-depth interviews with 30 NGO members, ethnographic observations of NGO activities, and analysis of written organizational materials. Analysis: Qualitative data has been analyzed using a content analysis approach. Results: Pending Page 12 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: Swaziland Rural Health HIV/AIDS Initiative; Mobilization of Nurses for HIV/AIDS Response in China. Investigator(s): Carol Christiansen, PhD (Principal Investigator); Elissa Dresden, ND, RN; Linda McCreary, PhD, RN; Judy Popovich, DNSc, RN. Background: Swaziland has the second highest HIV prevalence rate in the world. UNAIDS estimates that approximately 38% of the population is now HIV positive. Swaziland also has one of the highest prevalence rates of tuberculosis in all of Africa. Like many other countries in Africa, however, Swaziland lacks the financial and material resources to effectively combat the HIV/AIDS epidemic. As a result, the nation's fragile health infrastructure cannot support the care of the growing numbers of those with chronic and terminal illnesses. Objectives: To provide HIV/AIDS risk reduction information and to assist families and communities in strengthening their capacity to provide home-based care for the increasing number of people afflicted with chronic diseases including HIV/AIDS. Methods: The Swaziland Rural Health Initiative will mobilize the nation's 3,000 community health workers or Rural Health Motivators (RHMs) to educate and assist families in the care of the sick and dying. This three-year program provided two weeks of specialized training in the essentials of home-based care and HIV/AIDS risk reduction to the RHMs., who have been an essential part of Swaziland's health care system since 1976. Presently, the RHMs work under the supervision of public health nurses in every region of the country. Each RHM is responsible for seven to eight families living in scattered homesteads in rural areas. Results and Conclusions: To date, curriculum materials have been developed, 25 nurse trainers have received one week of training in curriculum delivery, and 1,938 community health workers have received ten days of training in community home based care and HIV/AIDS risk reduction. A qualitative process evaluation has been conducted to assess implementation strategies and initial outcomes of the SRHI and to determine progress toward the achievement of the program objectives. This was accomplished by focus groups and interviews with all levels of participants including key community informants, RHMs, nurses and family members. When completed, the results of this assessment will be utilized to improve, modify and inform expansion of the program. Funding Source: Bristol-Myers Squibb, Cabrini Mission Foundation, Swaziland Ministry of Health, UIC College of Nursing Page 13 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: AIDS International Training Research Program, Chile, Malawi, & Indonesia. Investigators: Judith Levy, PhD (Program Director); Beverly McElmurry, EdD, FAAN (Co- Director) Background: The AIDS International Research Training Program (AITRP) is designed to build long-term scientific capacities that help to address the AIDS epidemic in Chile, Indonesia, Malawi, and China. The proposed UIC-AITRP involves collaboration between the UIC School of Public Health and the UIC College of Nursing, The Great Lakes Centers for AIDS Research (CFAR), and key institutional participants in the three countries. The collaborating partners overseas are The University of Chile, The University of Malawi, The Center for Health Research at The University of Indonesia (CHR-UI), and Peiking University in China. We have chosen to focus on the countries of Indonesia, Malawi, China, and Chile as training sites because of the gravity of the AIDS epidemic in each area, the need for clinical and behavioral science research to meet this increasing need and the presence of existing collaborative relationships with the proposed partners that will help to build a sustained research infrastructure in each country. Objectives/Methods: To provide bio-medical and behavioral science training in HIV/AIDS and TB prevention at the MS, Ph.D. and post-doctoral levels at UIC in the School of Public Health and/or the College of Nursing for students and practicing professionals from Chile, Indonesia, China, and Malawi. To strengthen the capacity for HIV/AIDS research and training at the three collaborating universities and surrounding region by helping to build a critical core of university faculty in their region with expertise in HIV/AIDS research theory and methods. To provide new and minority scholars with short-term, "hands-on" training experience in planning and conducting HIV international research. To foster multi-disciplinary HIV/AIDS prevention research in Chile, Indonesia, China, and Malawi by initiating and facilitating the establishment of long-term cooperative scientific relationships between the Program’s collaborating partners in these countries, and UIC. Funding Source: National Institute of Health, Fogarty International Center Page 14 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Mahidol University, Bangkok, THAILAND WHO Collaborating Centre for Nursing & Midwifery Title: Home care of persons with HIV/AIDS in Thailand: a train-the-trainers program for nurses and family caregivers of persons with AIDS Investigators: Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand: Wantana Maneesriwongul, Suntharee Panutat, Punwadee Putwatana, Yupapin Srirapongam, Somboon Jaiyavat, Ladawan Ounprasertpong, Somthong Churaitatsanee, Sookfong Wongsathapornpat, Sermsri Santati, Somporn Chottivitayatarakorn (email@example.com) Yale University School Nursing, New Haven, Connecticut, United States: Ann B Williams (firstname.lastname@example.org) Background: As the AIDS epidemic has overwhelmed the hospital system in Thailand, persons with AIDS (PWAs) receive more and more care at home by their main caregivers such as parents and spouses. In response to the increasing demand for home care of PWAs and the lack of opportunity for family caregiver training, a three-phase training program was conducted for nurses and family caregivers. Objectives: This program is in collaboration between Ramathibodi School of Nursing and Yale University School of Nursing, and sponsored by the World AIDS Foundation: 1) to improve nurses self-efficacy to offer family caregiver training and 2) to develop a package of training manuals for nurses and family caregivers. Methods: Two training workshops were conducted emphasizing the development of teaching and training skills along with specific information related to care for PWAs in the home, based on the needs of family caregivers and nurses caring for PWAs. There were 45 nurses from 23 hospitals around Thailand participated in this program. Participants received needed knowledge including training skills, and conducted training sessions for family care-givers at their home institutions. They received additional knowledge and shared lessons learned to each other during the follow-up workshop. Program effectiveness was evaluated using qualitative and quantitative techniques. Prior to program implementation, four focus groups among nurses and individuals currently caring for a family member with HIV/AIDS at home were conducted before the curricula were finalized to ensure that the curriculum is responsive to the Thai context and local situation. Along with the training, a draft of training manuals was reviewed and refined. The training package includes: a training / teaching manual for nurses; an AIDS care-giving manual for nurses; and care- giving manuals for caregivers (pull-out booklets). Page 15 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Home care of persons with HIV/AIDS in Thailand: A train-the-trainers program for nurses and family caregivers of persons with AIDS (cont.) Results: The program found significant improvement of nurses' self-efficacy in establishing teaching contents, selecting teaching methods, and teaching patients/family caregivers (p < 0.01). The final packages of the training manuals are helpful for nurses in training of family caregivers to care for PWAs were distributed nationwide after the completion of this program. Additionally, applications of these materials were found to be useful in caring of other chronically ill patients who must be cared for at home. Funding Source: The World AIDS Foundation Key words: HIV, AIDS, PWAs, training, caregivers Universidad Nacional Autonoma de Mexico Escuela Nacional de Enfermeria y Obstetricia, MEXICO WHO Collaborating Centre for the Development of Innovative Methodologies in the Teaching-Learning of Primary Health Care Investigators: Teresa Ayala Quintero, Isabel Gomez Miranda, Gullermina Galvan, Thorny Veronica Meneses, Frank Magdalena, Thorny Veronica; Research in Development: Security for the palliative worker providing home care, Children with HIV/AIDS. Working in conjunction with the National Institute of Pediatrics and the Infantile Hospital of Mexico. Title: Social and Personal System of the Nurse in the Care of the Child with HIV/AIDS Investigator(s): Magdalena Franco Orozco Objective: To identify societal factors and nurses’ attitudes in the care of children with HIV/AIDS Methods: A cross sectional, descriptive design. Convenience sample of 369 subjects completed questionnaire that sought to gauge attitudes towards AIDS. Results and Conclusions: Positive and significant association exists between indexes of fear and attitude of nurses caring for children with HIV/AIDS. Page 16 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control University of Michigan, USA WHO Collaborating Center for Research and Clinical Training in Health Promotion Nursing Dr. Antonia Villareal, HIV/AIDS prevention with adolescents and their families in Mexico. email@example.com Dr. Jeanne Raisler, Prevention of mother to child transmission of HIV, mother and child health, HIVAIDS training for nurses and midwives, HIV/AIDS curriculum for schools of nursing and midwifery. Fluent in Portuguese. Nursing consultant to HRSA HIV-AIDS Bureau, President’s Initiative (PEPFAR) firstname.lastname@example.org Title: Reducing HIV Risk Among Mexican Youth Investigators: Principal Investigator: Antonia M. Villarruel, PhD, RN, FAAN. Co-Investigators: Carol Loveland-Cherry, PhD, Esther C. Gallegos, PhD, Maria Refugio Duran Lopez, MS, RN Background: AIDS is a global epidemic. For both Mexican and Latino adolescents, unprotected sexual activity is the major mode of HIV transmission (Centers for Disease Control [CDC], 2002; UNAIDS/WHO, 2000). This is a growing and significant problem in Mexico, which currently ranks third in the Americas in the total number of AIDS cases reported (CONASIDA, 2002). Objective: The objective of this project is to test a theoretically based HIV prevention intervention, which includes both adolescent and parent components, to reduce the risk of sexually transmitted HIV infection among Mexican youth. Page 17 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: Reducing HIV Risk Among Mexican Youth (cont.) Method: In this randomized controlled trial, 936 adolescents, ages 14 to 17 and one of their parents, will be recruited from school and community settings and randomly assigned to an HIV risk-reduction intervention or a control intervention consisting of general health promotion material. Both programs will be presented in a small-group format with adolescent and parent intervention presented separately. Adolescents assigned to the HIV risk reduction program will receive an intervention developed for US Latino adolescents and tailored for Mexican youth. Parents assigned to this group will receive similar content regarding HIV prevention as well as content to support general and HIV-specific parent- adolescent communication. Adolescents and parents assigned to the control intervention will receive information regarding other behavior-linked diseases such as cancer, heart disease, and diabetes. Data from adolescents and parents will be collected at pre- and immediately post-intervention, as well as at 3, 6, and 12-month follow-up intervals. Outcome: Outcome measures for adolescents will include self-reported HIV risk-associated sexual behavior and hypothesized mediators of behavior such as attitudes, beliefs, subjective norms, self-efficacy, and behavioral intentions. Parental outcome measures include comfort of the content and frequency of parent-adolescent communication. Four specific aims will examine whether: 1) compared to the control condition, the HIV risk- reduction intervention will reduce self-reported risk-associated sexual behavior in adolescents, 2) the effects of the intervention are moderated by individual (sexual experience, gender, age, relationship status), microsystem (parent-adolescent communication), and macrosystem (cultural) variables, 3) the theory-based mediators explain the intervention’s effects on self-reported behavior, and 4) the parental component of the HIV risk-reduction program increases the amount and comfort with parent- adolescent communication when compared to the control intervention. Conclusion: This study builds upon prior research interventions for US Latino and African- American adolescents and is an important contribution in curbing the increasing threat of HIV among Mexico’s youth. Funding: National Institutes of Health, National Institute of Nursing Research Key Words: Adolescents, HIV, Mexican Title: An HIV/AIDS Training for Nursing and Midwifery Faculty in Tanzania Principal Investigator: Jeanne Raisler, DrPH, CNM, FACNM. Co-Investigators: Helen Lugina, MSN, PhD, Fred Mhalu, MD, PhD Page 18 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control An HIV/AIDS Training for Nursing and Midwifery Faculty in Tanzania (cont.) Background: Preparing nurses and midwives to confront the HIV/AIDS epidemic is an urgent challenge in Tanzania where an estimated 2,229,700 persons (11% of the population) is living with HIV/AIDS, and the rate of infection is still rising. As the primary care providers for much of the population, Tanzania’s ~ 20,000 nurses and midwives can and must play a leading role in HIV/AIDS prevention, care and treatment. But nurses and midwives have not received sufficient training, resources and support to carry out this vital work, and HIV/AIDS is not yet well integrated into their professional education. Indeed, funding for training for health workers about AIDS has until now been focused almost exclusively on in-service training, while pre-service education, curriculum development, and faculty development have been largely ignored. Objectives: This collaborative project of the University of Michigan and Muhimbili University School of Nursing will create a two-week HIV/AIDS training course for nursing and midwifery faculty in Tanzania, which will take place in June, 2004. The course will use a “training of trainers” format to encourage participants to return to their Schools and integrate HIV/AIDS into the curriculum. The course planners are working closely with the Department of Nursing and the Ministry of Health to ensure that the course is integrated in to the national training plan for health professionals, and that it incorporates MOH protocols and guidelines. Methods: A two-week HIV Nursing Course and follow-up activities are being developed, based on national treatment guidelines. Participants will be 45 nursing educators and clinical coordinators from Regions severely affected by HIV/AIDS. The course will provide an overview of HIV/AIDS in Tanzania, including pathogenesis, epidemiology, natural history, transmission, prevention, counseling and testing, and diagnosis and treatment, including treatment of opportunistic infections and the use of antiretroviral therapy. A major focus will be maternal and infant health, including sexual rights; antenatal, family planning, and gynecologic care for the HIV positive woman; PMTCT, infant follow-up, and infant feeding issues. Ample time will be allotted for planning how to integrate HIV/AIDS content into the curriculum. A strong focus will be placed on developing strategies and activities to protect health science students from HIV, STIs and pregnancy. After the training, follow-up visits will be made by program faculty and MOH, to monitor and support integration of course material into the nursing school’s curriculum. Results: To be reported at the end of the project, October 2004. Conclusions: This is one of the first courses designed to prepare nursing and midwifery faculty to integrate HIV/AIDS content into the basic nursing curriculum, and to offer student nurses and midwives a firm foundation in HIV/AIDS care and treatment. If it is integrated into MOH activities and followed up with more training and support, it should make a profound and sustainable contribution to the fight against HIV/AIDS in Tanzania. Funding Source: World AIDS Foundation Page 19 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control An HIV/AIDS Training for Nursing and Midwifery Faculty in Tanzania (cont.) Key Words: HIV/AIDS, nursing education, midwifery education, capacity development, HIV risk reduction behavior, Tanzania. University of Pennsylvania School of Nursing, USA PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership Title: Hampton-Penn Center to Reduce Health Disparities Investigator(s): Jemmott, Loretta Sweet Objective: This proposal seeks to narrow the gap in health disparities that currently exist between American citizens of different ethnic and racial origins by capitalizing on and extending an existing partnership between the Hampton University School of Nursing and the University of Pennsylvania School of Nursing. The proposed Hampton Penn Center for Reducing Health Disparities will 1) foster development of nursing partnerships between researchers, faculty, and students at Hampton University and the University of Pennsylvania and will further health disparity research at both institutions; 2) further the development and dissemination of culturally competent research and interventions related to health disparities among racial/ethnic minorities, marginalized and underserved populations, and 3) enhance the recruitment, retention and training of nurses into research careers who are themselves members of racial/ethnic minorities, marginalized and underserved populations who will be able to build the science that will reduce health disparities. Funding source: National Institute of Nursing Research Key Words: health disparities; culturally competent research and interventions; marginalized and underserved populations; racial/ethnic minorities Title: South African Adolescent Health Promotion Project Investigator(s): Jemmott, John. B. III & Jemmott, Loretta Sweet Objective: The major goal of this project is to identify effective sustainable interventions to dissuade South African adolescents from engaging in behaviors that increase their risk for sexually transmitted diseases(STDs), including HIV. Funding source: National Institute of Health (MH) Key Words: South African adolescents; high risk behaviors; sexually transmitted diseases (STDs), HIV Page 20 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: HIV/STD Risk Reduction for African American Couples Investigator(s): Jemmott, John. B. III & Jemmott, Loretta Sweet Objective: This project seeks to test the effectiveness of an HIV sexual risk reduction intervention for African American serodiscordant heterosexual couples. Outcomes include biologically confirmed STDs, self-reported sexual behavior, and theoretical mediators. Funding Source: NIH/NIMH Key Words: sexual risk reduction intervention; African American serodiscordant heterosexual couples Title: Reducing HIV Sexual Risk Among Black Women Who Use Drugs Investigator(s): Jemmott, Loretta Sweet & Hutchinson, M. Katherine Objective: This randomized controlled trial tests the efficacy of a behavioral intervention to reduce the risk of sexually transmitted HIV infection among inner-city Black women who abuse drugs. Outcomes include biologically confirmed STDs and self-reported sexual behavior and theoretical mediator variables measured via ACASI. Funding Source: NIH/NIMH Key Words: sexual risk reduction; behavioral intervention; sexually transmitted HIV; inner- city Black women; drug abuse Title: Church & Family Health Promotion HIV Prevention Project Investigator(s): Jemmott, Loretta Sweet & Hutchinson, M. Katherine Objective:This project seeks to test the effectiveness of an abstinence-based intervention with parents and children in reducing the HIV-related sexual risk behaviors of inner-city African American adolescents. Funding Source: NIH/NIMH Key Words: abstinence-based intervention; HIV-related sexual risk behaviors; inner-city African American adolescents. Title: Empowering Women Drug Users to Reduce HIV Risk Page 21 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Investigator(s): Gollub, E. & Jemmott, Loretta Sweet Objective: This project seeks to test the effectiveness of an intervention for drug using women to reduce sexually transmitted STD/HIV infections. Funding: NIH/NIDA Key Words: drug using women; sexually transmitted STD/HIV infections Title: Helping Families Reduce HIV in African American Youth Investigator(s): Icard, L., Jemmott, Loretta Sweet, Hutchinson, M. Katherine Objective: This project seeks to design, implement, and evaluate the effectiveness of family- based interventions to reduce the HIV-related sexual risk behaviors of inner-city African American adolescents and youth. Funding: NIH/NIMH Key Words: family-based interventions; HIV-related sexual risk; inner city African American adolescents and youth Title: The Generalizability of HIV Risk Reduction Strategies Investigator(s): Jemmott, John. B. III & Jemmott, Loretta Sweet Objective: This project seeks to test the generalizability of the abstinence and safer sex interventions across several dimensions, including ethnicity of participants (African American vs. Latino), ethnicity of facilitator (African American vs. Latino), ethnic specificity of intervention (African American vs. Latino), and type of outcome measure (self-reported behavior vs. clinically documented sexually transmitted diseases). Funding: NIH/NICHD/NIMH Key Words: abstinence and safer sex interventions; ethnicity; African American vs. Latino) Page 22 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Title: HIV Prevention Trial Unit Investigator(s): Metzger, D. & Jemmott, Loretta Sweet Objective: The research agenda is an extension of current research activities at the University of Pennsylvania. The work supported focuses sharply on the highest risk domestic populations in order to inform prevention sciences internationally and support expanded prevention trials in other countries. Funding: NIH/NIAID Key Words: HIV prevention Title: HIV/STD Prevention Interventions for Black Adolescents Investigator(s): Jemmott, John. B. III & Jemmott, Loretta Sweet Objective: The major goal of this project is to test abstinence-only and safer sex interventions for inner city African American 6th and 7th grade adolescents and to evaluate strategies for extending the longevity of intervention effects. Funding: NIH/NIMH Key Words: abstinence-only interventions; safer sex interventions; inner-city African American 6th and 7th grade adolescents University of Sao Paulo, Brazil WHO Collaborating Centre for Nursing Research Development Dr. Elucir Gir, worker safety, quality of life for persons with HIV infection and exposure, maternal-child transmission, and adherence to treatment. email@example.com and firstname.lastname@example.org Title: Prevention of occupational accidents with biological material in the nursing team Investigators: Main investigator: Dr. Elucir Gir, PhD, RN – University of São Paulo at Ribeirão Preto College of Nursing. Co-investigators: Dr. Dulce Aparecida Barbosa, PhD – Federal University of São Paulo; Silvia Rita Marin da Silva Canini – University of São Paulo at Ribeirão Preto College of Nursing. Objectives: This study aims to identify risk factors for the occurrence of occupational accidents with biological material in the nursing team, as well as to evaluate under- notification rates and implement an educational program aimed at prevention. Page 23 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Prevention of occupational accidents with biological material in the nursing team (cont.) Methods: In order to achieve the first objective, we are realizing a case-control study (150 cases and 150 controls) involving multivariate analysis of socio-demographic and institutional variables. For the second objective, data are collected by means of semi- structured interviews, in order to evaluate accident under-notification rates and reasons, as well as the factors determining the accident. We will also elaborate an in-service educational program on the basis of the data obtained from the previous steps, focusing on the personal and organizational aspects of work. Stage: This research is currently being carried out. Funding: CNPq –National Council for Scientific and Technological Development Keywords: HIV Occupational health, nursing care, biosafety. Title: Evaluation of quality of life among HIV seropositive pregnant women Investigators: Main investigator: Dr. Elucir Gir, PhD, RN – University of São Paulo at Ribeirão Preto College of Nursing. Co-investigators: Dr. Dulce Aparecida Barbosa, PhD – Federal University of São Paulo; Silvia Rita Marin da Silva Canini – University of São Paulo at Ribeirão Preto College of Nursing. Objectives: In spite of the increased incidence of HIV/AIDS cases among women, little is known about the quality of life of this clientele during pregnancy. This study aims to compare the quality of life among HIV seropositive and HIV seronegative pregnant women. Methods: In order to measure quality of life, we will use the Medical Outcomes Study Short- Form Health Service (SF-36), which will be administered among HIV seropositive and seronegative pregnant women. The SF-36 will be applied at 4 moments. The First moment is the first appointment after the HIV/AIDS infection diagnosis, the Second will be the beginning of the HAART therapy, the Third during the last term of pregnancy and the Fourth 30 days after delivery. This is a prospective descriptive study, which will be carried out at a large Brazilian public hospital. Stage: This research is in its initial stage. Keywords: Vertical transmission, quality of life, HIV women Page 24 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Corporación Universitaria De Ciencias, Aplicadas Y Ambientales, Facultad De Ciencias De La Salud Carrera De Enfermeria Facultad Miembro De Acofaen Bogota –Colombia Titulo: Conductas de riesgo sexual y reproductivo relacionadas con la infeccion de vih/sida en estudiantes de primer semestre de las carreras de la u.d.c.a. en el segundo periodo académico del año 2003 Objetivo General: Determinar las conductas de riesgo sexual y reproductivo relacionados con la infección de VIH/SIDA a los que han estado expuestos y a los que se exponen los estudiantes que ingresaron a primer semestre de diferentes carreras de la U.D.C.A. en el segundo periodo académico de año 2003 con el propósito de implementar una estrategia educativa y una red de apoyo para los estudiantes . Objetivos Especificos Establecer en los estudiantes las conductas de riesgo sexual y reproductivo relacionados con el VIH/SIDA a las que se verán expuestos después de su ingreso a la U.D.C.A., mediante la aplicación de un instrumento Determinar el nivel de conocimiento que poseen los estudiantes a cerca de la salud y riesgos sexuales y reproductivos. Determinar la edad y el genero en la que los estudiantes adoptan conductas de riesgo sexual y reproductivo, estableciendo cuales son las más frecuentes y si se relacionan con el aumento del riesgo del VIH/SIDA. Establecer una red de apoyo social, familiar, laboral y afectiva para los estudiantes, con la participación del departamento de bienestar social universitario de la U.D.C.A traves de la implementación de asesorias educativas y preventivas utilizando los sistemas que ofrecen un fácil acceso a la información Implementar en los currículos de las carreras de Medicina y Enfermería de la U.D.C.A. la estrategia educativa sobre riesgo sexual y reproductivo con énfasis en VIH/SIDA con el apoyo de ONUSIDA. Ajustados a los resultados en la investigación Duracion: 2 años Fecha De Inicio: Febrero de 2003 y finalizara febrero de 2005, La investigación esta en desarrollo . Investigadoras: Blanca Piratoba Hernández, Enfermera- Docente; Andrea Agudelo Hernández, Enfermera –Docente; Adriana Perdomo Herrán, Enfermera- Docente. Financiacion Del Proyecto: Apoyado Por La Corporación Universitaria De Ciencias Aplicadas Y Ambientales U.D.C.A. El Proyecto No Cuenta Con Cofinanciacion: PALABRAS CLAVES Conducta, Riesgo; Conocimientos . Salud Sexual y Reproductiva, VIH/SIDA, Acceso a la información , Estrategia educativa. Adolescencia. Page 25 Strengthening Nursing and Midwifery Services for HIV/AIDS Prevention and Control Coordinators: Beverly J. McElmurry, EdD, RN, FAAN Professor and Director, WHO Collaborating Center University of Illinois-Chicago email@example.com William L. Holzemer, RN, PhD, FAAN Professor and Director, WHO Collaborating Center University of California, San Francisco Bill.firstname.lastname@example.org Sandra Land, RN, PhD Regional Nursing Advisor Health Services Department Pan American Health Organization, WHO email@example.com Page 26
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