HIV/AIDS prevention among female sexual partners of injection drug users in Ciudad Juarez, Mexico

Abstract

A participatory community project in the US-Mexico border town of Ciudad Juarez, aimed at helping women who are sex partners of male injection drug users to reduce behaviours which increase their risk for HIV infection, is described and evaluated. The design and implementation of the project were influenced by Paulo Freire's pedagogy in the Latin American tradition of 'popular' education, by Bandura's self-efficacy concepts, and by David Warner's 'barefoot doctor' community health care methodology. Using these approaches the participants were directly involved in the development of teaching materials, and curriculum content and implementation of the project. The programme was evaluated quantitatively using NIDA's AIDS Intake and Follow-up Assessment (AIA/AFA) questionnaires, and qualitatively using open ended interviews. While the AIA/AFA questionnaires detected small changes in the frequency of condom use among the participants, ethnographic interviews detected significant changes in the nature of the behaviours which were placing the women at risk. The changes seem to stem from an increase in the degree of self-esteem, self-efficacy and awareness of the social, economic, and political constraints of their lives. These results demonstrate the need for qualitative measures to be incorporated in the evaluation of community based health education programmes. A series of recommendations is presented to facilitate further development and replication of the programme in similar populations.