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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



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                     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.




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          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.




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                    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. burragej@uab.edu.
   Dr Jane Castle- research in palliative and end-of-life care; castlej@uab.edu.
   Dr Pamela Fordham – developing on-line masters program in Palliative Care; leadership in
       home and hospice care; fordhamp@uab.edu.
   Dr Lynda Harrison, Fulbright Scholar working at Catholic University of Chile 2003-04, re:
       research methodologies. Fluent in Spanish; harrisonl@uab.edu.
   Dr Jill Ross – former Peace Corp volunteer. Fluent in Spanish; current research prevention
       of unwanted pregnancies and control of spread of HIV; rossj@uab.edu.
   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; woodrinb@uab.edu
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.




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                    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.
           bill.holzemer@ucsf.edu Botswana, Lesotho, Malawi, South Africa, Swaziland,
           Tanzania,
       Dr. Carmen Portillo, Adherence, Symptom Management, Hispanic women; I-TECH:
           International Training with HRSA; Mexico, Puerto Rico
           carmen.portillo@nursing.ucsf.edu
       Dr. Carol Dawson Rose, adherence, providers, PAETC: Pacific AIDS Education
           Training Center,cdawson@itsa.ucsf.edu
   UCSF Affiliates:
       Dr. Adey Nyamathi, Co-director, UCLA AIDS International Training & Research
           Program. (UCSF Center Affiliate) anyamath@sonnet.ucla.edu
       Dr. Marta Rivero, University of Puerto Rico, Health Disparities &
           HIV/AIDS.mrivero@rcm.upr.edu
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.
           jka8@columbia.edu
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
           rcarty@gmu.edu




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                     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. mcelmurr@uic.edu rciane2@uic.edu lferre2@uic.edu
      Dr. Carol Christiansen, Swaziland Rural Health HIV/AIDS initiative; Mobilization of
          nurses for HIV/AIDS response in China. carolahw@aol.com
      Dr. Beverly McElmurry, Co-director, AIDS International Training Research Program,
          Chile, Malawi, & Indonesia. mcelmurr@uic.edu
      Dr. Kathleen Norr, Mobilizing health workers for HIV prevention in Malawi.
          knorr@uic.edu
      Dr. Barbara Dancy, African-American mother/daughter HIV risk reduction
          intervention. bdancy@uic.edu
      Lucy Marion, PhD, RN, STD Prevention for At-Risk African American Women.
          lmarion@uic.edu

                      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.




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                    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




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                    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




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                    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




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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 (rawlp@mahidol.ac.th)

   Yale University School Nursing, New Haven, Connecticut, United States: Ann B
   Williams (ann.williams@yale.edu)

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).




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                     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.




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                    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. avillarr@umich.edu
          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)
              jraisler@umich.edu

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.




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                    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




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                     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)




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                     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.
          coopintl@eerp.usp.br and egir@eerp.usp.br

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.




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                      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




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                    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.


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                   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
mcelmurr@uic.edu

William L. Holzemer, RN, PhD, FAAN
Professor and Director, WHO Collaborating Center
University of California, San Francisco
Bill.holzemer@nursing.ucsf.edu

Sandra Land, RN, PhD
Regional Nursing Advisor
Health Services Department
Pan American Health Organization, WHO
landsand@paho.org




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